Cal. Code Regs. tit. 22 § 56210

Current through Register 2024 Notice Reg. No. 45, November 8, 2024

Section 56210 - Scope of Services

(a) Each PCCM plan shall provide or arrange for the provision of the full scope of Medi-Cal services set forth in Chapter 3, Article 4, beginning with section 51301, and in Chapter 11, beginning with section 59998, unless services are specifically excluded under the terms of the PCCM contract.

(b) A PCCM plan may elect to provide services which are not included in section 14053, Welfare and Institutions Code at no cost to members.

(c) A PCCM plan shall obtain the prior written approval of the Department if any services are to be provided at a cost to members. Departmental approval shall be based on compliance with State and federal law and regulation and the terms of the PCCM contract. Each member shall be notified of the scope of any non-Medi-Cal covered services offered by the PCCM plan and a full disclosure of any charges:

(1) Prior to the signing of any membership designation form.

(2) Any time the scope of services is changed, and

(3) Immediately prior to rendering services at a cost to members.

(d) Each PCCM plan shall meet the requirements of sections 51163 and 51305.1 through 51305.7 of this subdivision, in providing needed human reproductive sterilization services.

(e) Each PCCM plan shall provide Child Health and Disability Prevention Program Services to members under the age of 21 in accordance with the provisions of sections 6800 through 6874, Title 17, California Code of Regulations.

Cal. Code Regs. Tit. 22, § 56210

1. New section filed 3-9-90 as an emergency; operative 3-9-90 (Register 90, No. 12). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 7-9-90.
2. New section refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90, No. 35). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed by operation of law on 11-6-90.
3. Request to readopt section on an emergency basis pursuant to Government Code section 11346.1 granted and filed 11-6-90 as an emergency; operative 11-6-90 (Register 91, No. 6). A Certificate of Compliance must be transmitted to OAL by 3-6-91 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 11-6-90 order transmitted to OAL 2-22-91; disapproved by OAL on 3-25-91 (Register 91, No. 18).
5. New section filed 3-25-91 as an emergency; operative 3-25-91 (Register 91, No. 18). A Certificate of Compliance must be transmitted to OAL by 7-23-91 or emergency language will be repealed by operation of law on the following day.
6. Certificate of Compliance as to 3-25-91 order including amendment of section transmitted to OAL 7-19-91 and filed 8-19-91 (Register 92, No. 1).

Note: Authority cited: Sections 14105 and 14124.5, Welfare and Institutions Code. Reference: Sections 14088, 14088.13 and 14088.2, Welfare and Institutions Code.