California Welfare and Institutions Code 14043.51 – (a) For purposes of this section, the following definitions …
(a) For purposes of this section, the following definitions apply:
(1) “Department” means the State Department of Health Care Services.
Terms Used In California Welfare and Institutions Code 14043.51
- Contract: A legal written agreement that becomes binding when signed.
- department: means the State Department of Health Services. See California Welfare and Institutions Code 14062
- director: means the State Director of Health Services. See California Welfare and Institutions Code 14061
- Medi-Cal: means the California Medical Assistance Program. See California Welfare and Institutions Code 14063
- Provider: means an individual, partnership, group, association, corporation, institution, or entity, and the officers, directors, owners, managing employees, or agents of a partnership, group association, corporation, institution, or entity, that provides services, goods, supplies, or merchandise, directly or indirectly, including all ordering, referring, and prescribing, to a Medi-Cal beneficiary and that has been enrolled in the Medi-Cal program. See California Welfare and Institutions Code 14043.1
(2) “Electronic visit verification system” has the same meaning as that term is defined in subsection (l) of Section 1396b of Title 42 of the United States Code.
(3) “Partners” means governmental entities, including, but not limited to, the State Department of Social Services, the State Department of Developmental Services, the State Department of Public Health, the California Department of Aging, and the Office of Technology and Solutions Integration.
(4) “Provider” means a provider who is enrolled in the Medi-Cal program, as specified in subdivision (h) of Section 14043.1.
(b) The department, as the single state agency for the Medicaid program in California, may undertake action, as determined by the director to be appropriate, to implement an electronic visit verification system for purposes of obtaining and maintaining federal approval or ensuring federal financial participation is available or not otherwise jeopardized.
(c) The department may collaborate and contract with other governmental entities, including its partners, to comply with federal requirements relating to electronic visit verification.
(d) (1) If a provider renders Medi-Cal services that are subject to electronic visit verification, they shall comply with requirements, as established by the department and its partners, relating to electronic verification of those services.
(2) Except as provided in paragraph (3), if the department determines a provider has failed to comply with the established requirements, the department and its partners, as may be appropriate under the circumstances, may take any of the following action to address the noncompliance of the provider:
(A) Provide technical assistance on compliance.
(B) Require an approved corrective action plan.
(C) Recover associated overpayments.
(D) Impose enrollment or monetary sanctions.
(E) Take any other remedial action, as deemed appropriate.
(3) Individual providers of in-home supportive services, and individual providers of waiver personal care services, who are not employed by an agency, are not subject to the actions described in paragraph (2) for purposes of noncompliance with requirements established pursuant to paragraph (1), and are instead subject to the electronic visit verification system development and implementation principles set forth in Section 10836 and the provisions of Sections 12305.82 and 12305.83.
(e) (1) The department and its partners may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis to implement this section and an electronic visit verification system.
(2) In developing and implementing electronic visit verification, the department and its partners may continue to utilize services performed under existing contracts if those services involve planning, developing, or establishing an electronic visit verification protocol or system.
(f) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department and its partners may implement, interpret, or make specific this section, in whole or in part, by means of provider bulletins, plan letters, or other similar instructions, without taking any further regulatory action.
(Amended by Stats. 2023, Ch. 43, Sec. 68. (AB 120) Effective July 10, 2023.)