28 CA ADC § 1300.67.8


      28 CCR s 1300.67.8

      Cal. Admin. Code tit. 28, s 1300.67.8


      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 1300.67.8. Contracts with Providers.

      Written contracts must be executed between the plan and each provider of 
      health care services which regularly furnishes services under the plan. 
      All contracts with providers shall be subject to the following 
      requirements:

      (a) A written contract shall be prepared or arranged in a manner which 
      permits confidential treatment by the Director of payment rendered or to 
      be rendered to the provider without concealment or misunderstanding of 
      other terms and provisions of the contract.

      (b) The contract shall require that the provider maintain such records and 
      provide such information to the plan or to the Director as may be 
      necessary for compliance by the plan with the provisions of the Act and 
      the rules thereunder, that such records will be retained by the provider 
      for at least two years, and that such obligation is not terminated upon a 
      termination of the agreement, whether by rescission or otherwise. (See 
      Section 1300.75.1)

      (c) That the plan shall have access at reasonable times upon demand to the 
      books, records and papers of the provider relating to the health care 
      services provided to subscribers and enrollees, to the cost thereof, to 
      payments received by the provider from subscribers and enrollees of the 
      plan (or from others on their behalf), and, unless the provider is 
      compensated on a fee-for-service basis, to the financial condition of the 
      provider.

      (d) The contract shall prohibit surcharges for covered services and shall 
      provide that whenever the plan receives notice of any such surcharge it 
      shall take appropriate action.

      (e) The contract shall contain provisions complying with Section 1379 of 
      the Act and requiring that, upon termination of the contract of the 
      provider for any cause, such provider shall comply with the provisions of 
      subdivision (a)(10) of Section 1300.67.4.

      (f) The contract shall require providers to display in a prominent place 
      in each reception and waiting area a notice informing subscribers and 
      enrollees how to contact their plan, file a complaint with their plan, 
      obtain assistance from the Department, and seek an independent medical 
      review. For the purposes of this regulation, a reception and waiting area 
      shall be defined as a room used for the purpose of subscribers and 
      enrollees waiting to receive services from a provider.

      (1) The notice shall be displayed in English and in any individually 
      identifiable language that is spoken in the home by ten percent (10%) or 
      more of the households in the U.S. Postal Service ZIP code in which the 
      reception or waiting area is located, according to the US Census Bureau's 
      Census 2000 Summary File 3, Quick Table - P16 for the appropriate ZIP 
      code, which is incorporated by reference.

      (2) The notice shall be in a form prescribed, provided and translated by 
      the Department for posting.

      (3) The notice and translations can be found at www.dmhc.ca.gov and are 
      available for downloading and printing. In the alternative, hard copies of 
      the notice and translations may be obtained by submitting a written 
      request to the Department of Managed Health Care, Attn: Waiting Room 
      Notices, 980 - 9th Street, Suite 500, Sacramento, CA 95814.

      (4) Display of a notice provided by the Office of the Patient Advocate 
      containing the information required by this subsection and in the 
      appropriate language(s) will be considered compliance with these 
      regulations.

      Upon the effective date of these regulations, plans shall require 
      providers to post said notice. The provision requiring the notice shall be 
      added to all contracts executed subsequent to the effective date of these 
      regulations.

      (5) A provider who demonstrates to the satisfaction of the Department that 
      the provider's actual patient population is made up of less than five 
      percent (5%) of patients speaking any of the languages for which 
      translations are required under subsection (f)(1) above, may be exempt 
      from displaying a translation in the particular language for which a 
      satisfactory demonstration has been made.


      


      Note: Authority cited: Section 1344, Health and Safety Code. Reference: 
      Sections 1367, 1381 and 1385, Health and Safety Code. 


       HISTORY 
         
      1. Amendment filed 6-2-78; effective thirtieth day thereafter (Register 
      78, 
      No. 22).

      2. Amendment of subsection (b) filed 1-12-83; effective thirtieth day
      thereafter (Register 83, No. 3).

      3. Change without regulatory effect amending subsections (a)-(b) filed 
      7-18-
      2000 pursuant to section 100, title 1, California Code of Regulations 
      (Register 2000, No. 29).

      4. New subsections (f)-(f)(5) filed 10-20-2003; operative 11-19-2003 
      (Register
      2003, No. 43).
      28 CA ADC s 1300.67.8

      END OF DOCUMENT

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