Cal. Code Regs. tit. 10 § 6903

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

Section 6903 - Certified Medi-Cal Managed Care Plan Enroller Application

(a) An individual may become a Certified Medi-Cal Managed Care Plan Enroller according to the following process:

(1) The individual shall:

(A) Submit the following:

1. All information, documentation, and declarations required in subdivision (b) of this section; and

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

(B) Within 90 calendar days of completing the requirements in (a)(1)(A) of this section:

1. Submit fingerprinting images in accordance with section 6904 (a);

2. Disclose to the Exchange all criminal convictions and administrative actions taken against the applicant;

3. Complete the required training established in section 6905; and

4. Pass the required certification exam pursuant to section 6660(d) of Article 8.

(2) Individuals who complete the above requirements and pass the Certified Medi-Cal Managed Care Plan Enroller Fingerprinting and Criminal Record Check described in section 6904 shall be certified as a Certified Medi-Cal Managed Care Plan Enroller by the Exchange.

(b) An individual's application to become a Certified Medi-Cal Managed Care Plan Enroller shall contain the following information:

(1) Name, e-mail address, primary and secondary phone number;

(2) Driver's License Number or Identification Number issued by the California Department of Motor Vehicles. If neither is available, the applicant may provide any other unique identifier found on an identification card issued by a federal, state, or local government agency or entity;

(3) Languages that the Certified Medi-Cal Managed Care Plan Enroller can speak;

(4) Languages that the Certified Medi-Cal Managed Care Plan Enroller can write;

(5) Disclosure of all criminal convictions and administrative actions taken against the individual;

(6) A certification by the individual that:

(A) The individual complies with the agreement required by section 6903(a)(1)(A)2. as well as all requirements as set forth in this Article, including but not limited to Section 6907;

(B) The individual is a natural person of not less than 18 years of age; and

(C) The statements made in the application are true, correct, and complete to the best of his or her knowledge and belief;

(D) The individual will abide by all applicable privacy and security requirements, including but not limited to those set forth in the agreement between the Medi-Cal Managed Care Plan and the Exchange; and

(E) The individual will adhere to all applicable State and Federal laws and regulations.

(7) For the individual applying to become a Certified Medi-Cal Managed Care Plan Enroller, signature and date signed; and

(8) For the Authorized Contact from the Certified Medi-Cal Managed Care Plan that the individual will be affiliated with, name, signature, and date signed.

(c) A Certified Medi-Cal Managed Care Plan shall notify the Exchange of every individual to be added or removed as an affiliated Certified Medi-Cal Managed Care Plan Enroller. Such notification shall include:

(1) Name of the Certified Medi-Cal Managed Care Plan and the Certified Medi-Cal Managed Care Plan Number;

(2) Name and signature of the Authorized Contact from the Certified Medi-Cal Managed Care Plan;

(3) Name, e-mail, and primary phone number of the individual to be added or removed;

(4) Effective date for the addition or removal of the individual; and

(5) An indication of whether the individual is certified as a Certified Medi-Cal Managed Care Plan Enroller.

Cal. Code Regs. Tit. 10, § 6903

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.