CA
California Senate Bill SB743

California 2017-2018 Regular Session

California Senate Bill SB743 Compare Versions

OldNewDifferences
1-Senate Bill No. 743 CHAPTER 572 An act to add Section 14132.07 to the Welfare and Institutions Code, relating to Medi-Cal. [ Approved by Governor October 07, 2017. Filed with Secretary of State October 07, 2017. ] LEGISLATIVE COUNSEL'S DIGESTSB 743, Hernandez. Medi-Cal: family planning providers.Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services through fee-for-service or managed care delivery systems. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Existing law provides that family planning services are a covered Medi-Cal benefit, subject to utilization controls, as specified.This bill would prohibit a Medi-Cal managed care plan, as defined, from restricting the choice of the qualified provider, as defined, from whom a Medi-Cal beneficiary enrolled in the plan may receive family planning services. The bill would require a Medi-Cal managed care plan to reimburse an out-of-plan or out-of-network qualified provider at the applicable fee-for-service rate. If federal approval is required to implement these provisions, the bill would be implemented only to the extent that federal approval is obtained. The bill would make related legislative findings and declarations.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: NO Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. This act shall be known, and may be cited as, the Protection of Choice for Family Planning Act.SEC. 2. The Legislature hereby finds and declares all of the following:(a) California has a long history of, and commitment to, expanding access to services that aim to reduce the risk of unintended pregnancies, improve reproductive and sexual health outcomes, and reduce state costs.(b) According to the Guttmacher Institute, one-half of all pregnancies in the United States each year are unintended. By 45 years of age, more than one-half of all women in the United States will have experienced an unintended pregnancy, and 3 in 10 will have had an abortion.(c) Recognizing the importance of timely, confidential access to reproductive health care, the current federal freedom of choice provision passed in 1986 allows Medicaid managed care beneficiaries to access reproductive health care from any willing provider that serves patients covered by Medicaid, even if the provider is out of the managed care plans network.(d) The federal Balanced Budget Act of 1997 further cemented the ability of Medicaid managed care beneficiaries to go out of network to have direct access to family planning providers.(e) California has implemented the federal freedom of choice provision for decades, but it is not codified in California law.(f) To ensure that Californians enrolled in Medi-Cal managed care plans do not lose the existing ability to go out of network if the freedom of choice provision is repealed on the federal level, the provision must be established in California statute.SEC. 3. Section 14132.07 is added to the Welfare and Institutions Code, to read:14132.07. (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.
1+Enrolled September 19, 2017 Passed IN Senate September 14, 2017 Passed IN Assembly September 13, 2017 Amended IN Assembly September 05, 2017 Amended IN Senate March 23, 2017 CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION Senate Bill No. 743Introduced by Senators Hernandez and Leyva(Coauthor: Senator Skinner)February 17, 2017 An act to add Section 14132.07 to the Welfare and Institutions Code, relating to Medi-Cal. LEGISLATIVE COUNSEL'S DIGESTSB 743, Hernandez. Medi-Cal: family planning providers.Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services through fee-for-service or managed care delivery systems. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Existing law provides that family planning services are a covered Medi-Cal benefit, subject to utilization controls, as specified.This bill would prohibit a Medi-Cal managed care plan, as defined, from restricting the choice of the qualified provider, as defined, from whom a Medi-Cal beneficiary enrolled in the plan may receive family planning services. The bill would require a Medi-Cal managed care plan to reimburse an out-of-plan or out-of-network qualified provider at the applicable fee-for-service rate. If federal approval is required to implement these provisions, the bill would be implemented only to the extent that federal approval is obtained. The bill would make related legislative findings and declarations.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: NO Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. This act shall be known, and may be cited as, the Protection of Choice for Family Planning Act.SEC. 2. The Legislature hereby finds and declares all of the following:(a) California has a long history of, and commitment to, expanding access to services that aim to reduce the risk of unintended pregnancies, improve reproductive and sexual health outcomes, and reduce state costs.(b) According to the Guttmacher Institute, one-half of all pregnancies in the United States each year are unintended. By 45 years of age, more than one-half of all women in the United States will have experienced an unintended pregnancy, and 3 in 10 will have had an abortion.(c) Recognizing the importance of timely, confidential access to reproductive health care, the current federal freedom of choice provision passed in 1986 allows Medicaid managed care beneficiaries to access reproductive health care from any willing provider that serves patients covered by Medicaid, even if the provider is out of the managed care plans network.(d) The federal Balanced Budget Act of 1997 further cemented the ability of Medicaid managed care beneficiaries to go out of network to have direct access to family planning providers.(e) California has implemented the federal freedom of choice provision for decades, but it is not codified in California law.(f) To ensure that Californians enrolled in Medi-Cal managed care plans do not lose the existing ability to go out of network if the freedom of choice provision is repealed on the federal level, the provision must be established in California statute.SEC. 3. Section 14132.07 is added to the Welfare and Institutions Code, to read:14132.07. (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.
22
3- Senate Bill No. 743 CHAPTER 572 An act to add Section 14132.07 to the Welfare and Institutions Code, relating to Medi-Cal. [ Approved by Governor October 07, 2017. Filed with Secretary of State October 07, 2017. ] LEGISLATIVE COUNSEL'S DIGESTSB 743, Hernandez. Medi-Cal: family planning providers.Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services through fee-for-service or managed care delivery systems. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Existing law provides that family planning services are a covered Medi-Cal benefit, subject to utilization controls, as specified.This bill would prohibit a Medi-Cal managed care plan, as defined, from restricting the choice of the qualified provider, as defined, from whom a Medi-Cal beneficiary enrolled in the plan may receive family planning services. The bill would require a Medi-Cal managed care plan to reimburse an out-of-plan or out-of-network qualified provider at the applicable fee-for-service rate. If federal approval is required to implement these provisions, the bill would be implemented only to the extent that federal approval is obtained. The bill would make related legislative findings and declarations.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: NO Local Program: NO
3+ Enrolled September 19, 2017 Passed IN Senate September 14, 2017 Passed IN Assembly September 13, 2017 Amended IN Assembly September 05, 2017 Amended IN Senate March 23, 2017 CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION Senate Bill No. 743Introduced by Senators Hernandez and Leyva(Coauthor: Senator Skinner)February 17, 2017 An act to add Section 14132.07 to the Welfare and Institutions Code, relating to Medi-Cal. LEGISLATIVE COUNSEL'S DIGESTSB 743, Hernandez. Medi-Cal: family planning providers.Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services through fee-for-service or managed care delivery systems. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Existing law provides that family planning services are a covered Medi-Cal benefit, subject to utilization controls, as specified.This bill would prohibit a Medi-Cal managed care plan, as defined, from restricting the choice of the qualified provider, as defined, from whom a Medi-Cal beneficiary enrolled in the plan may receive family planning services. The bill would require a Medi-Cal managed care plan to reimburse an out-of-plan or out-of-network qualified provider at the applicable fee-for-service rate. If federal approval is required to implement these provisions, the bill would be implemented only to the extent that federal approval is obtained. The bill would make related legislative findings and declarations.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: NO Local Program: NO
4+
5+ Enrolled September 19, 2017 Passed IN Senate September 14, 2017 Passed IN Assembly September 13, 2017 Amended IN Assembly September 05, 2017 Amended IN Senate March 23, 2017
6+
7+Enrolled September 19, 2017
8+Passed IN Senate September 14, 2017
9+Passed IN Assembly September 13, 2017
10+Amended IN Assembly September 05, 2017
11+Amended IN Senate March 23, 2017
12+
13+ CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION
414
515 Senate Bill No. 743
6-CHAPTER 572
16+
17+Introduced by Senators Hernandez and Leyva(Coauthor: Senator Skinner)February 17, 2017
18+
19+Introduced by Senators Hernandez and Leyva(Coauthor: Senator Skinner)
20+February 17, 2017
721
822 An act to add Section 14132.07 to the Welfare and Institutions Code, relating to Medi-Cal.
9-
10- [ Approved by Governor October 07, 2017. Filed with Secretary of State October 07, 2017. ]
1123
1224 LEGISLATIVE COUNSEL'S DIGEST
1325
1426 ## LEGISLATIVE COUNSEL'S DIGEST
1527
1628 SB 743, Hernandez. Medi-Cal: family planning providers.
1729
1830 Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services through fee-for-service or managed care delivery systems. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Existing law provides that family planning services are a covered Medi-Cal benefit, subject to utilization controls, as specified.This bill would prohibit a Medi-Cal managed care plan, as defined, from restricting the choice of the qualified provider, as defined, from whom a Medi-Cal beneficiary enrolled in the plan may receive family planning services. The bill would require a Medi-Cal managed care plan to reimburse an out-of-plan or out-of-network qualified provider at the applicable fee-for-service rate. If federal approval is required to implement these provisions, the bill would be implemented only to the extent that federal approval is obtained. The bill would make related legislative findings and declarations.
1931
2032 Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services through fee-for-service or managed care delivery systems. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Existing law provides that family planning services are a covered Medi-Cal benefit, subject to utilization controls, as specified.
2133
2234 This bill would prohibit a Medi-Cal managed care plan, as defined, from restricting the choice of the qualified provider, as defined, from whom a Medi-Cal beneficiary enrolled in the plan may receive family planning services. The bill would require a Medi-Cal managed care plan to reimburse an out-of-plan or out-of-network qualified provider at the applicable fee-for-service rate. If federal approval is required to implement these provisions, the bill would be implemented only to the extent that federal approval is obtained. The bill would make related legislative findings and declarations.
2335
2436 ## Digest Key
2537
2638 ## Bill Text
2739
2840 The people of the State of California do enact as follows:SECTION 1. This act shall be known, and may be cited as, the Protection of Choice for Family Planning Act.SEC. 2. The Legislature hereby finds and declares all of the following:(a) California has a long history of, and commitment to, expanding access to services that aim to reduce the risk of unintended pregnancies, improve reproductive and sexual health outcomes, and reduce state costs.(b) According to the Guttmacher Institute, one-half of all pregnancies in the United States each year are unintended. By 45 years of age, more than one-half of all women in the United States will have experienced an unintended pregnancy, and 3 in 10 will have had an abortion.(c) Recognizing the importance of timely, confidential access to reproductive health care, the current federal freedom of choice provision passed in 1986 allows Medicaid managed care beneficiaries to access reproductive health care from any willing provider that serves patients covered by Medicaid, even if the provider is out of the managed care plans network.(d) The federal Balanced Budget Act of 1997 further cemented the ability of Medicaid managed care beneficiaries to go out of network to have direct access to family planning providers.(e) California has implemented the federal freedom of choice provision for decades, but it is not codified in California law.(f) To ensure that Californians enrolled in Medi-Cal managed care plans do not lose the existing ability to go out of network if the freedom of choice provision is repealed on the federal level, the provision must be established in California statute.SEC. 3. Section 14132.07 is added to the Welfare and Institutions Code, to read:14132.07. (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.
2941
3042 The people of the State of California do enact as follows:
3143
3244 ## The people of the State of California do enact as follows:
3345
3446 SECTION 1. This act shall be known, and may be cited as, the Protection of Choice for Family Planning Act.
3547
3648 SECTION 1. This act shall be known, and may be cited as, the Protection of Choice for Family Planning Act.
3749
3850 SECTION 1. This act shall be known, and may be cited as, the Protection of Choice for Family Planning Act.
3951
4052 ### SECTION 1.
4153
4254 SEC. 2. The Legislature hereby finds and declares all of the following:(a) California has a long history of, and commitment to, expanding access to services that aim to reduce the risk of unintended pregnancies, improve reproductive and sexual health outcomes, and reduce state costs.(b) According to the Guttmacher Institute, one-half of all pregnancies in the United States each year are unintended. By 45 years of age, more than one-half of all women in the United States will have experienced an unintended pregnancy, and 3 in 10 will have had an abortion.(c) Recognizing the importance of timely, confidential access to reproductive health care, the current federal freedom of choice provision passed in 1986 allows Medicaid managed care beneficiaries to access reproductive health care from any willing provider that serves patients covered by Medicaid, even if the provider is out of the managed care plans network.(d) The federal Balanced Budget Act of 1997 further cemented the ability of Medicaid managed care beneficiaries to go out of network to have direct access to family planning providers.(e) California has implemented the federal freedom of choice provision for decades, but it is not codified in California law.(f) To ensure that Californians enrolled in Medi-Cal managed care plans do not lose the existing ability to go out of network if the freedom of choice provision is repealed on the federal level, the provision must be established in California statute.
4355
4456 SEC. 2. The Legislature hereby finds and declares all of the following:(a) California has a long history of, and commitment to, expanding access to services that aim to reduce the risk of unintended pregnancies, improve reproductive and sexual health outcomes, and reduce state costs.(b) According to the Guttmacher Institute, one-half of all pregnancies in the United States each year are unintended. By 45 years of age, more than one-half of all women in the United States will have experienced an unintended pregnancy, and 3 in 10 will have had an abortion.(c) Recognizing the importance of timely, confidential access to reproductive health care, the current federal freedom of choice provision passed in 1986 allows Medicaid managed care beneficiaries to access reproductive health care from any willing provider that serves patients covered by Medicaid, even if the provider is out of the managed care plans network.(d) The federal Balanced Budget Act of 1997 further cemented the ability of Medicaid managed care beneficiaries to go out of network to have direct access to family planning providers.(e) California has implemented the federal freedom of choice provision for decades, but it is not codified in California law.(f) To ensure that Californians enrolled in Medi-Cal managed care plans do not lose the existing ability to go out of network if the freedom of choice provision is repealed on the federal level, the provision must be established in California statute.
4557
4658 SEC. 2. The Legislature hereby finds and declares all of the following:
4759
4860 ### SEC. 2.
4961
5062 (a) California has a long history of, and commitment to, expanding access to services that aim to reduce the risk of unintended pregnancies, improve reproductive and sexual health outcomes, and reduce state costs.
5163
5264 (b) According to the Guttmacher Institute, one-half of all pregnancies in the United States each year are unintended. By 45 years of age, more than one-half of all women in the United States will have experienced an unintended pregnancy, and 3 in 10 will have had an abortion.
5365
5466 (c) Recognizing the importance of timely, confidential access to reproductive health care, the current federal freedom of choice provision passed in 1986 allows Medicaid managed care beneficiaries to access reproductive health care from any willing provider that serves patients covered by Medicaid, even if the provider is out of the managed care plans network.
5567
5668 (d) The federal Balanced Budget Act of 1997 further cemented the ability of Medicaid managed care beneficiaries to go out of network to have direct access to family planning providers.
5769
5870 (e) California has implemented the federal freedom of choice provision for decades, but it is not codified in California law.
5971
6072 (f) To ensure that Californians enrolled in Medi-Cal managed care plans do not lose the existing ability to go out of network if the freedom of choice provision is repealed on the federal level, the provision must be established in California statute.
6173
6274 SEC. 3. Section 14132.07 is added to the Welfare and Institutions Code, to read:14132.07. (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.
6375
6476 SEC. 3. Section 14132.07 is added to the Welfare and Institutions Code, to read:
6577
6678 ### SEC. 3.
6779
6880 14132.07. (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.
6981
7082 14132.07. (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.
7183
7284 14132.07. (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.
7385
7486
7587
7688 14132.07. (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.
7789
7890 (b) The following definitions shall apply for purposes of this section:
7991
8092 (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:
8193
8294 (A) Article 2.7 (commencing with Section 14087.3).
8395
8496 (B) Article 2.8 (commencing with Section 14087.5).
8597
8698 (C) Article 2.81 (commencing with Section 14087.96).
8799
88100 (D) Article 2.82 (commencing with Section 14087.98).
89101
90102 (E) Article 2.91 (commencing with Section 14089).
91103
92104 (F) Chapter 8 (commencing with Section 14200).
93105
94106 (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.
95107
96108 (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.
97109
98110 (d) If federal approval is required to implement this section, the section shall be implemented only to the extent that federal approval is obtained.