Plain English Breakdown
The official text mentions a 'specified reason' for waiving reimbursement but does not define that reason within the provided summary or digest.
Extending Health Care Provider Credentialing Rules to Medi-Cal Plans
This law requires Medi-Cal managed care plans to follow the same rules as other health service plans for using a standard credentialing form and making decisions on provider applications within specific timeframes.
What This Bill Does
- Requires Medi-Cal managed care plans to use the Council for Affordable Quality Healthcare credentialing form starting January 1, 2028.
- Mandates that Medi-Cal managed care plans make a decision on completed provider credentialing applications within 90 days of receiving them starting January 1, 2027.
- Applies existing rules making willful violations crimes to Medi-Cal managed care plans.
Who It Names or Affects
- Medi-Cal managed care plans
- Health care providers applying to join Medi-Cal networks
Terms To Know
- Credentialing
- The process of checking a health care provider's qualifications before allowing them to treat patients.
- Medi-Cal managed care plan
- A type of health service plan that provides coverage under the Medi-Cal system, which was previously excluded from certain credentialing rules.
Limits and Unknowns
- The bill states no state reimbursement is required for a specified reason but does not list what that specific reason is.
- The official text notes this creates a state-mandated local program due to criminal penalties, though it waives the usual cost reimbursement.