California Code of Regulations
Title 9 - Rehabilitative and Developmental Services
Division 1 - Department of Mental Health
Chapter 11 - Medi-Cal Specialty Mental Health Services
Subchapter 5 - Problem Resolution Processes
Article 5 - Resolution of Disputes Between MHPs and Medi-Cal Managed Care Plans
Section 1850.530 - Financial Liability
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) When the resolution of a dispute under this Article includes a determination that the unsuccessful party in the dispute has a financial liability to the other party for services rendered by the successful party, financial liability and the liquidation of that liability shall follow the criteria of Subsections (b)-(d).
(b) Unless determined otherwise as provided in Subsection (c), financial liability shall not exceed the lower of the following rates, in effect at the time the services were rendered:
(c) The rate of payment included in the request pursuant to Section 1850.505(d)(1) shall be presumed correct, and the successful party shall be entitled to the full rate requested in its request should it prevail, unless the other party disputed the rate of payment in its response under Section 1850.505(e), which places the rates in issue.
(d) A plan determined to be financially liable shall within 30 calendar days of the effective date of the decision:
1. New section
filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20).
2. Change
without regulatory effect amending subsection (d)(2) and NOTE filed 8-24-2015
pursuant to section
100, title 1, California Code of
Regulations (Register 2015, No. 35).
Note: Authority cited: Sections 10725, 14680 and 14700, Welfare and Institutions Code. Reference: Sections 14681, 14683, 14684, 14718 and 14721, Welfare and Institutions Code.
