Section 51002 - Beneficiary Billing(a) A provider of service under the Medi-Cal program shall not submit claims to or demand or otherwise collect reimbursement from a Medi-Cal beneficiary, or from other persons on behalf of the beneficiary, for any service included in the Medi-Cal program's scope of benefits in addition to a claim submitted to the Medi-Cal program for that service, except to: (1) Collect payments due under a contractual or legal entitlement pursuant to Section 14000(b) of the Welfare and Institutions Code.(2) Bill a long-term care patient for the amount of his liability.(3) Collect copayment pursuant to Welfare and Institutions Code Section 14134.(b) In the event that a beneficiary willfully refuses to provide current other health care coverage billing information as described in Section 50763(a) (5) to a provider, upon giving the beneficiary written notice of intent, the provider may bill the beneficiary as a private pay patient. This shall not apply for beneficiaries covered under Medi-Cal capitated contracting arrangements. Capitated contractor or subcontractor billing beneficiaries covered under Medi-Cal capitated contracting arrangements shall be governed by applicable laws including Welfare and Institutions Code and by; the terms of the contract.Cal. Code Regs. Tit. 22, § 51002
1. Amendment filed 1-18-74; effective thirtieth day thereafter (Register 74, No. 3). For prior history, see Register 72, No. 5.
2. Amendment filed 8-8-78; effective thirtieth day thereafter (Register 78, No. 32).
3. New subsection (2)(3) filed 11-17-81 as an emergency; effective upon filing (Register 81, No. 47). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 3-17-82.
4. Certificate of Compliance transmitted to OAL 3-16-82 and filed 4-16-82 (Register 82, No. 16).
5. Amendment filed 6-28-89; operative 7-28-89 (Register 89, No. 26). Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions Code; Section 133.5 of Chapter 102, Statutes of 1981; and Section 2 of Chapter 237, Statutes of 1981. Reference: Section 14134, Welfare and Institutions Code.
1. Amendment filed 1-18-74; effective thirtieth day thereafter (Register 74, No. 3). For prior history, see Register 72, No. 5.
2. Amendment filed 8-8-78; effective thirtieth day thereafter (Register 78, No. 32).
3. New subsection (2)(3) filed 11-17-81 as an emergency; effective upon filing (Register 81, No. 47). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 3-17-82.
4. Certificate of Compliance transmitted to OAL 3-16-82 and filed 4-16-82 (Register 82, No. 16).
5. Amendment filed 6-28-89; operative 7-28-89 (Register 89, No. 26).