Cal. Code Regs. tit. 10 § 6902

Current through Register 2024 Notice Reg. No. 45, November 8, 2024

Section 6902 - Application

(a) A Medi-Cal Managed Care Plan may apply to register as a Certified Medi-Cal Managed Care Plan according to the following process:

(1) The entity shall submit an application containing all information, documentation, and declarations required in subdivision (b) of this section.

(2) The application shall demonstrate that the entity is capable of carrying out at least those duties described in section 6906 and has existing relationships, or could readily establish relationships, with employers and employees, consumers (including uninsured and underinsured consumers), or self-employed individuals likely to be eligible for enrollment in a Qualified Health Plan (QHP) or an insurance affordability program.

(3) The Exchange shall review the application and, if applicable, request any additional or missing information necessary to determine eligibility.

(4) Entities who have submitted a completed application and demonstrated ability to meet the above requirements shall:

(A) Submit the following:

1. An executed agreement conforming to the Roles and Responsibilities defined in section 6906; and

2. Proof of general liability insurance with coverage of not less than $1,000,000 per occurrence with the Exchange named as an additional insured, and workers' compensation insurance.

(5) Entities who are eligible based on their completed application and whose designee completes and passes the training requirements established pursuant to section 6905 shall be registered as a Certified Medi-Cal Managed Care Plan by the Exchange and assigned a Certified Medi-Cal Managed Care Plan Number. If the designee fails to complete the training requirements set forth in section 6905 within 30 calendar days of completing the requirements in (a)(4)(A) of this section, the applicant shall be deregistered.

(b) A Certified Medi-Cal Managed Care Plan application shall contain the following information:

(1) Full name;

(2) Legal name;

(3) Primary e-mail address;

(4) Primary phone number;

(5) Secondary phone number;

(6) Federal Employment Identification Number;

(7) State Tax Identification Number;

(8) Identification of applicant's status as a Medi-Cal Managed Care Plan and a copy of supporting documentation;

(9) Identification of the type of organization and, if applicable, a copy of the license or other certification;

(10) A certification that the applicant and all of its employees who will be acting pursuant to this Article comply with section 6907;

(11) An attestation that the entity will serve families of mixed immigration status;

(12) An attestation that the entity will serve individuals with disabilities.

(13) For the primary site and each sub-site, the following information:

(A) Site Location Address;

(B) Mailing Address;

(C) County;

(D) Primary Contact name;

(E) Primary e-mail address;

(F) Primary phone number;

(G) Secondary phone number; and

(H) Hours of operation.

(14) A certification by the Authorized Contact that the information presented is true and correct to the best of the signer's knowledge;

(15) For each Enroller to be affiliated with the applicant:

(A) All information required by section 6903 that is not already included elsewhere in the application required by this section; and

(B) An indication of whether he or she is certified by the Exchange and, if applicable, the certification number.

Cal. Code Regs. Tit. 10, § 6902

1. New section filed 4-27-2015 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 4-27-2015 (Register 2015, No. 18). A Certificate of Compliance must be transmitted to OAL by 4-27-2017 pursuant to Government Code section 100504, or emergency language will be repealed by operation of law on the following day.
2. Senate Bill 75 (Stats. 2015, Ch. 18) modified Government Code section 100504(a)(6) to change the date upon which a Certificate of Compliance must be transmitted to OAL. Pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 75 (Stats. 2015, Ch. 18), a Certificate of Compliance must be transmitted to OAL by 4-27-2018 or the language in the emergency order of 4-27-2015 will be repealed by operation of law on the following day (Register 2015, No. 38).
3. Refiling of 4-27-2015 order on 9-20-2017, including amendment of subsection (b), as a deemed emergency pursuant to Government Code section 100504(a)(6); operative 9-20-2017 (Register 2017, No. 38). Senate Bill 833 (stats 2016, c. 30) modified Government Code section 100504(a)(6) to extend the date upon which a Certificate of Compliance must be transmitted to OAL; a Certificate of Compliance must be transmitted to OAL by 4-27-2020 pursuant to Government Code section 100504(a)(6) or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 9-20-2017 order transmitted to OAL 2-5-2020 and filed 3-12-2020 (Register 2020, No. 11).

Note: Authority cited: Sections 100502 and 100504, Government Code. Reference: Sections 100502 and 100503, Government Code.