California Welfare and Institutions Code

§ 14301.1

WIC § 14301.1 Effective Jan 1, 2023Div. 9 · Part 3 · Ch. 8 · Art. 3

Statute text

(a)For rates established on or after August 1, 2007, the department shall pay capitation rates to health plans participating in the Medi-Cal managed care program using actuarial methods and may establish health-plan- and county-specific rates. Notwithstanding any other law, this section shall apply to any managed care organization, licensed under the Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code), that has contracted with the department as a primary care case management plan pursuant to Article 2.9 (commencing with Section 14088) of Chapter 7 to provide services to beneficiaries who are HIV positive or who have been diagnosed with AIDS for rates established on or after July 1, 2012. The department shall utilize a county- and model-specific rate methodology to develop Medi-Cal managed care capitation rates for contracts entered into between the department and any entity pursuant to Article 2.7 (commencing with Section 14087.3), Article 2.8 (commencing with Section 14087.5), and Article 2.91 (commencing with Section 14089) of Chapter 7 that includes, but is not limited to, all of the following:

(1)Health-plan-specific encounter and claims data.

(2)Supplemental utilization and cost data submitted by the health plans.

…

Legislative history

Amended by Stats. 2022, Ch. 28, Sec. 163. (SB 1380) Effective January 1, 2023.