 |
California Law (Last Updated: March 4, 2014) |
 |
Welfare and Institutions Code - WIC |
|
Division 9. PUBLIC SOCIAL SERVICES |
|
Part 3. AID AND MEDICAL ASSISTANCE |
|
Chapter 7. Basic Health Care |
|
ARTICLE 4. The Medi-Cal Benefits Program |
Section 14132.277.
-
(a) For purposes of this section, the following definitions shall apply:
(1) "Coordinated Care Initiative county" means the Counties of Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara, and any other county identified in Appendix 3 of the memorandum of understanding between the state and the Centers for Medicare and Medicaid Services Regarding A Federal-State Partnership to Test a Capitated Financial Alignment Model for Medicare-Medicaid Enrollees, inclusive of all amendments, as authorized by Section 14132.275.
(2) "D-SNP plan" means a Medicare Advantage Special Needs Plan.
(3) "D-SNP contract" means a federal Medicare Improvements for Patients and Provider Act of 2008 (Public Law 110-275) compliant contract between the department and a D-SNP plan.
(b) For calendar year 2014, the department shall offer D-SNP contracts to existing D-SNP plans to continue to provide benefits to their enrollees in their service areas as approved on January 1, 2013. The director may include in any D-SNP contract provisions requiring that the D-SNP plan do the following:
(1) Submit to the department a complete and accurate copy of the bid submitted by the plan to the Centers for Medicare and Medicaid Services for its D-SNP contract.
(2) Submit to the department copies of all utilization and quality management reports submitted to the Centers for Medicare and Medicaid Services.
(c) In Coordinated Care Initiative counties, Medicare Advantage plans and D-SNP plans may continue to enroll beneficiaries in 2014. In the 2014 calendar year, beneficiaries enrolled in a Medicare Advantage or D-SNP plan operating in a Coordinated Care Initiative county shall be exempt from the enrollment provisions of subparagraph (A) of paragraph (1) of subdivision (l) of Section 14132.275. Those beneficiaries may at any time voluntarily choose to disenroll from their Medicare Advantage or D-SNP plan and enroll in a demonstration site operating pursuant to subdivision (g) of Section 14132.275. If a beneficiary chooses to do so, that beneficiary may subsequently disenroll from the demonstration site and return to fee-for-service Medicare or to a D-SNP plan or Medicare Advantage plan.