California Welfare and Institutions Code

§ 14197.2

WIC § 14197.2 Effective Sep 29, 2022Div. 9 · Part 3 · Ch. 7 · Art. 6.3

Statute text

(a)This section implements the state option in subsection (j) of Section 438.8 of Title 42 of the Code of Federal Regulations.

(b)Commencing July 1, 2019, a Medi-Cal managed care plan shall comply with a minimum 85 percent medical loss ratio (MLR) consistent with Section 438.8 of Title 42 of the Code of Federal Regulations. The ratio shall be calculated and reported for each MLR reporting year by the Medi-Cal managed care plan consistent with Section 438.8 of Title 42 of the Code of Federal Regulations.

(c)(1) Effective for contract rating periods commencing on or after July 1, 2023, a Medi-Cal managed care plan shall provide a remittance for an MLR reporting year if the ratio for that MLR reporting year does not meet the minimum MLR standard of 85 percent. The department shall determine the remittance amount on a plan-specific basis for each rating region of the plan and shall calculate the federal and nonfederal share amounts associated with each remittance.

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Legislative history

Amended by Stats. 2022, Ch. 738, Sec. 18. (AB 204) Effective September 29, 2022.