Cal. Welf. & Inst. Code § 14079
Physicians Costs
Redline — January 1, 2011 → current.View current text →
Current — January 1, 2019
As of January 1, 2011
The director annually shall review the reimbursement levels for physician and dental services under Medi-Cal, and shall revise periodically the rates of reimbursement to physicians and dentists to ensure the reasonable access of Medi-Cal beneficiaries to physician and dental services.
(a) The director shall periodically review the reimbursement levels for physician and dental services in the Medi-Cal fee-for-service delivery system, and shall periodically revise the rates of reimbursement to physicians and dentists to the extent the director deems necessary to comply with applicable federal Medicaid program requirements, including provisions on reasonable access to physician and dental services for Medi-Cal beneficiaries.
This annual review, as it relates to rates for physician services, shall take into account at least the following factors:
(a) Annual cost increases for physicians as reflected by the Consumer Price Index.
(b) Physician reimbursement levels of medicare, Blue Shield, and other third-party payors.
(c) Prevailing customary physician charges within the state and in various geographical areas.
(d) Procedures reflected by the current Relative Value Studies (RVS).
(e) Characteristics of the current population of Medi-Cal beneficiaries and the medical services needed.
(b) To the extent consistent with the department’s federally approved access monitoring plan, or any successor methodology for monitoring reasonable access to Medi-Cal covered services, as described in Section 1396a(a)(30)(A) of Title 42 of the United States Code, this periodic review, as it relates to rates for physician services, shall take into account at least the following factors:
(1) Annual cost increases for physicians as reflected by the Consumer Price Index.
(2) Physician reimbursement levels under the Medicare Program.
(3) Prevailing customary physician charges within the state and in various geographical areas.
(4) Characteristics of the current population of Medi-Cal beneficiaries and the medical services needed.
Official source: California Legislative Information. Reproduced from public-domain California statutes; confirm against the official source for the current text. Not legal advice.