28 CA ADC § 1300.67.60
28 CCR s 1300.67.60
Cal. Admin. Code tit. 28, s 1300.67.60
CALIFORNIA CODE OF REGULATIONS
TITLE 28. MANAGED HEALTH CARE
DIVISION 1. THE DEPARTMENT OF MANAGED HEALTH CARE
CHAPTER 2. HEALTH CARE SERVICE PLANS
ARTICLE 7. STANDARDS
This database is current through 06/09/06, Register 2006, No. 23.
s 1300.67.60. Standing Referral to HIV/AIDS Specialist.
(a) The definitions and requirements of this section are applicable only
to standing referrals made pursuant to Section 1374.16 of the Act. Nothing
in this section requires an enrollee to transfer to a different primary
care provider or limits referral authorizations that are not subject to
Section 1374.16 of the Act.
(b) For the purposes of this section "AIDS" means Acquired
Immunodeficiency Syndrome.
(c) For the purposes of this section "category 1 continuing medical
education" means:
(1) For physicians, continuing medical education courses recognized as
qualifying for category 1 credit by the Medical Board of California;
(2) For nurse practitioners, continuing education contact hours recognized
by the California Board of Registered Nursing;
(3) For physician assistants, continuing education units approved by the
American Association of Physician Assistants or those described in either
subsection (c)(1) or (c)(2), above.
(d) For the purposes of this section "HIV" means the Human
Immunodeficiency Virus.
(e) For the purposes of this section an "HIV/AIDS specialist" means a
physician who holds a valid, unrevoked and unsuspended certificate to
practice medicine in the state of California who meets any one of the
following four criteria:
(1) Is credentialed as an "HIV Specialist" by the American Academy of HIV
Medicine; or
(2) Is board certified, or has earned a Certificate of Added
Qualification, in the field of HIV medicine granted by a member board of
the American Board of Medical Specialties, should a member board of that
organization establish board certification, or a Certificate of Added
Qualification, in the field of HIV medicine; or
(3) Is board certified in the field of infectious diseases by a member
board of the American Board of Medical Specialties and meets the following
qualifications:
(A) In the immediately preceding 12 months has clinically managed medical
care to a minimum of 25 patients who are infected with HIV; and
(B) In the immediately preceding 12 months has successfully completed a
minimum of 15 hours of category 1 continuing medical education in the
prevention of HIV infection, combined with diagnosis, treatment, or both,
of HIV-infected patients, including a minimum of 5 hours related to
antiretroviral therapy per year; or
(4) Meets the following qualifications:
(A) In the immediately preceding 24 months has clinically managed medical
care to a minimum of 20 patients who are infected with HIV; and
(B) Has completed any of the following:
1. In the immediately preceding 12 months has obtained board certification
or recertification in the field of infectious diseases from a member board
of the American Board of Medical Specialties; or
2. In the immediately preceding 12 months has successfully completed a
minimum of 30 hours of category 1 continuing medical education in the
prevention of HIV infection, combined with diagnosis, treatment, or both,
of HIV-infected patients; or
3. In the immediately preceding 12 months has successfully completed a
minimum of 15 hours of category 1 continuing medical education in the
prevention of HIV infection, combined with diagnosis, treatment, or both,
of HIV-infected patients and has successfully completed the HIV Medicine
Competency Maintenance Examination administered by the American Academy of
HIV medicine.
(f) When authorizing a standing referral to a specialist pursuant to
Section 1374.16(a) of the Act for the purpose of the diagnosis or
treatment of a condition requiring care by a physician with a specialized
knowledge of HIV medicine, a health care service plan must refer the
enrollee to an HIV/AIDS specialist. When authorizing a standing referral
to a specialist for purposes of having that specialist coordinate the
enrollee's health care pursuant to Section 1374.16(b) of the Act for an
enrollee who is infected with HIV, a health care service plan must refer
the enrollee to an HIV/AIDS specialist. The HIV/AIDS specialist may
utilize the services of a nurse practitioner or physician assistant if:
(1) The nurse practitioner or physician assistant is under the supervision
of an HIV/AIDS specialist; and
(2) The nurse practitioner or physician assistant meets the qualifications
specified in subsection (e)(4); and
(3) The nurse practitioner or physician assistant and that provider's
supervising HIV/AIDS specialist have the capacity to see an additional
patient.
(g) Subsection (f) does not require a health care service plan to refer an
enrollee to any provider who is not employed by or under contract with the
health care service plan to provide health care services to its enrollees,
unless there is no HIV/AIDS specialist, or appropriately qualified nurse
practitioner or physician assistant under the supervision of an HIV/AIDS
specialist, within the plan's network appropriate to provide care to the
enrollee, as determined by the primary care physician in consultation with
the plan medical director.
(h) The Department will hold an annual public hearing to review the
implementation of this section and to consider the need to revise this
section.
(i) This section will be effective on January 16, 2003.
Note: Authority cited: Section 1344, Health and Safety Code. Reference:
Sections 1344 and 1374.16, Health and Safety Code.
HISTORY
1. New section filed 12-17-2002; operative 1-16-2003 (Register 2002, No.
51).
28 CA ADC s 1300.67.60
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