Added by Stats. 1994, Ch. 917, Sec. 2. Effective September 28, 1994.
(a)The director shall investigate and to the extent feasible require any managed care contractor serving children with conditions eligible under the CCS program, to maintain and follow standards of care established by the program, including use of paneled providers and CCS approved special care centers and to follow treatment plans approved by the program, including specified services and providers of services. If there are insufficient paneled providers willing to enter into contracts with the managed care contractor, the program shall
seek to establish new paneled providers willing to contract. If a paneled provider cannot be found, the managed care contractor shall seek program approval to use a specific nonpaneled provider with appropriate qualifications.
(b)The director shall investigate and to the extent feasible require any managed care contractor serving children with conditions eligible under the CCS program, to report expenditures and savings separately for CCS covered services and CCS eligible children.
(c)(1) If the managed care contractor is paid according to a capitated or risk-based payment methodology, there shall be a separate actuarially sound rate for CCS eligible children.
(2)Notwithstanding paragraph (1), a managed care pilot project may, if approval is obtained from the state CCS program director,
utilize an alternative rate structure for CCS eligible children.
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Other sections in Article 2.98 - California Children’s Services Program and Medi-Cal Managed Care Contracts