§ 14132.07
207 words·~1 min read·
/ca/welfare-and-institutions-code/14132-07A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(a)A Medi-Cal managed care plan shall not restrict the choice of the qualified provider from whom a beneficiary enrolled in the managed care plan may receive family planning services covered by the Medi-Cal program pursuant to subdivision
(n)of Section 14132.
(b)The following definitions shall apply for purposes of this section:
(1)“Medi-Cal managed care plan” means an applicable organization or entity that contracts with the department to provide services to enrolled Medi-Cal beneficiaries pursuant to any of the following:
(A)Article 2.7 (commencing with Section 14087.3).
(B)Article 2.8 (commencing with Section 14087.5).
(C)Article 2.81 (commencing with Section 14087.96).
(D)Article 2.82 (commencing with Section 14087.98).
(E)Article 2.91 (commencing with Section 14089).
(F)Chapter 8 (commencing with Section 14200).
(2)“Qualified provider” means a provider that is licensed to furnish family planning services, is an enrolled Medi-Cal provider, and is willing to furnish family planning services to an enrollee. A qualified provider may be an out-of-plan or out-of-network provider.
(c)A Medi-Cal managed care plan shall reimburse an out-of-plan or out-of-network qualified provider at the applicable fee-for-service rate.
(d)If federal approval is required to implement this section, the section shall be implemented only to the extent that federal approval is obtained.