California Code of Regulations
Title 9 - Rehabilitative and Developmental Services
Division 3 - Department of Rehabilitation
Chapter 8 - Standards for Facilities and Providers of Service
Article 2 - Health Care Providers
Section 7295.5 - Medical Panel

Universal Citation: 9 CA Code of Regs 7295.5

Current through Register 2024 Notice Reg. No. 38, September 20, 2024

(a) Each District Office of the Department shall establish and maintain a list of all health care providers, other than hospitals, utilized in the service area of the district and its branch offices.

(b) Applicants in need of examinations and clients whose IWRP requires the receipt of health care services, other than hospitalization, shall be referred only to Medical Panel members unless the applicant or client specifically requests a provider of his/her choice and the conditions specified in Section 7295(b)(1) and (3) are met.

(c) Each District Office shall maintain an organized system of rotating the service utilization of individual Medical Panel members within each provider group. The rotation system may incorporate the client/provider geographical proximity and other modifications.

(d) To obtain membership on the Medical Panel a provider shall provide the District Office with all of the following:

(1) Written evidence to document the possession of the minimum qualifications specified in this chapter, including proof of enrollment as a Medi-Cal provider or a signed statement certifying that the provider has not been denied, or disqualified from, or currently is not suspended from, participation in the Medi-Cal program.

(2) A brief curriculum vitae. In lieu of a curriculum vitae, the District Office may verify the professional's status, board verification, professional competence and other necessary information. Such information shall be recorded and maintained as a curriculum vitae.

(3) Oral or written agreement to comply with all of the following:
(A) Directly render services to applicants and clients.

(B) Accept the Department's and/or similar benefit sources' fees as full and complete remuneration.

(C) Render services and submit reports that meet the needs of the District Office.

(e) The District Office shall:

(1) Review all requests for Medical Panel membership to determine whether both of the following conditions exist:
(A) The provider's qualifications meet the minimum standards set forth in this chapter.

(B) The provider's background and experience will meet the District's needs.

(2) For providers submitting the signed statement pursuant to (d)(1), verify that the provider has not been denied, or disqualified from, or currently is not suspended from, participation in the Medi-Cal program.

(f) The District Office shall inform each provider in writing of its decision to approve or deny membership on the Medical Panel. The decision and written notification shall be completed within 60 days of receipt of the request for Panel membership. If the request is:

(1) Approved, the District Office shall furnish the new member with the information regarding the fees and method of authorization and payment of services.

(2) Denied, the District Office shall inform the provider in writing of the reason for the denial.

(g) The District Office's Medical Consultant shall review the medical reports and practices of the members of the Medical Panel for quality control. When it is determined that a provider's practices and/or medical reports are insufficient to meet the District's needs, the provider shall be contacted by the District Office's Medical Consultant to resolve the insufficiencies. If the practices and/or reports continue to be insufficient, the provider shall be removed from the Medical Panel. The District Office shall notify the provider in writing of the effective date of the removal, which shall be the date the notice is mailed, and of the reasons for the removal. The information shall be included on a single notice. A copy of the notice shall be sent to the Department's Chief Medical Consultant.

(h) A provider may withdraw from the Medical Panel at anytime.

(i) If a provider wishes to become a member of the Medical Panel in several Districts, the District Offices shall coordinate information of approval, denial or withdrawal. However each District shall maintain its independence to make decisions concerning the provider's membership on its Medical Panel.

1. New section filed 10-9-91; operative 11-8-91 (Register 92, No. 3).

Note: Authority cited: Sections 19006 and 19016, Welfare and Institutions Code. Reference: Section 19150, Welfare and Institutions Code; 34 CFR 361.45.

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