California Welfare and Institutions Code

§ 14197.3

WIC § 14197.3 Effective Jan 1, 2018Div. 9 · Part 3 · Ch. 7 · Art. 6.3

Statute text

(a)A Medi-Cal managed care plan shall give a beneficiary timely and adequate notice of an adverse benefit determination in writing consistent with the requirements in Sections 438.404, 438.408, and 438.10 of Title 42 of the Code of Federal Regulations. For purposes of this subdivision, “adverse benefit determination” means either of the following:

(1)Any action described in Section 10950.

(2)Any health care service eligible for coverage and payment under a Medi-Cal managed care plan contract that has been denied, modified, or delayed by a decision of the Medi-Cal managed care plan, or by one of its contracting providers.

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Legislative history

Added by Stats. 2017, Ch. 738, Sec. 7. (AB 205) Effective January 1, 2018.