Statutes, codes, and regulations
California Code Of Regulations
Title 22 - Social SecurityDivision 3 - Health Care ServicesSubdivision 1 - California Medical Assistance ProgramChapter 3 - Health Care Services
Article 3 - Standards for Participation
Section 51200 - Basic Requirement for Program Participation

Cal. Code Regs. tit. 22 § 51200

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Current through Register 2024 Notice Reg. No. 49, December 6, 2024
Section 51200 - Basic Requirement for Program Participation
(a) In addition to any other statutory or regulatory conditions for participation in the Medi-Cal program and any federal requirements for participation in Medicaid, as a condition for enrollment, or continued enrollment, an applicant or provider also shall meet the standards specified in this Article, applicable to their provider type, and the requirements specified in Sections 51000.30 through 51000.55. Failure to meet applicable standards for participation shall result in the denial of the applicant's or provider's application for enrollment, or continued enrollment, as specified in Section 51000.50.
(b) Any provider who violates any provision of law or regulation that governs the Medi-Cal program shall be subject to temporary or permanent suspension from the Medi-Cal program, as permitted by Section 14123, Welfare and Institutions (W&I) Code.
(c) All providers shall be subject to temporary suspension, including temporary deactivation of all provider numbers used by the provider to obtain reimbursement from the Medi-Cal program, under any of the following circumstances:
(1) The provider has failed to disclose all information required in federal Medicaid regulations or any other information required by the Department, or has disclosed false information, as specified in Section 14043.2, W&I Code.
(2) The provider is discovered to be under investigation for fraud or abuse, as specified in Section 14043.36.
(3) The provider has failed to remediate discrepancies that are discovered as a result of an unannounced visit to the provider, as specified in Section 14043.7, W&I Code.
(d) All applicants applying for enrollment, or providers applying for continued enrollment, in the Medi-Cal program shall be certified for participation in the Medicare program of the Federal Social Security Act (Title XVIII), if they provide services that are included in the Medicare scope of benefits and if they provide those services to persons who are eligible beneficiaries of the Medicare program.
(e) Any provider who requests the performance of a clinical laboratory test or examination for a Medi-Cal beneficiary, or upon a biological specimen derived from a Medi-Cal beneficiary, shall provide with the request to the clinical laboratory diagnostic information relevant to the test or examination for which the request is made, including the latest International Classification of Diseases, 9th Revision, or the latest published editions or amendments thereto, Clinical Modification (ICD-9-CM) code numbers, to the highest level of specificity indicating medical necessity for all laboratory tests as required under the Medicare program pursuant to 42, U.S.C., Section 1395 u(p) and 42, CFR, Section 424.32.
(f) In addition to meeting and complying with all applicable requirements specified in Articles 1, 2, and 3, any place where a provider, as defined in Section 51051(a), renders laboratory or clinical laboratory services as defined in Section 51137.2 and any person performing, supervising, consulting on, or directing such laboratory or clinical laboratory services shall meet and maintain compliance with the requirements of Section 51211.2.

Cal. Code Regs. Tit. 22, § 51200

1. New section filed 4-30-74; effective thirtieth day thereafter (Register 74, No. 18).
2. Designation of subsection (a), new subsection (b) and NOTE filed 1-20-94 as an emergency; operative 1-20-94 (Register 94, No. 3). A Certificate of Compliance must be transmitted to OAL by 5-20-94 or emergency language will be repealed by operation of law on the following day.
3. Certificate of Compliance as to 1-20-94 order transmitted to OAL 5-19-94 and filed 7-1-94 (Register 94, No. 26).
4. Amendment of subsection (b) and NOTE filed 8-28-97 as an emergency; operative 8-28-97 (Register 97, No. 35). A Certificate of Compliance must be transmitted to OAL by 12-26-97 or emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 8-28-98 order transmitted to OAL 12-24-97 and filed 2-9-98 (Register 98, No. 7).
6. Amendment of section and NOTE filed 10-24-2000 as an emergency and submitted to OAL for printing only pursuant to Section 78, Chapter 146, Statutes of 1999; operative 10-24-2000 (Register 2000, No. 43). A Certificate of Compliance must be transmitted to OAL by 4-23-2001 or emergency language will be repealed by operation of law on the following day.
7. Editorial correction of HISTORY 6 (Register 2001, No. 14).
8. Amendment of section and NOTE refiled 4-4-2001 as an emergency and submitted to OAL for printing only pursuant to Section 78, Chapter 146, Statutes of 1999; operative 4-4-2001 (Register 2001, No. 14). A Certificate of Compliance must be transmitted to OAL by 8-2-2001 or emergency language will be repealed by operation of law on the following day.
9. Certificate of Compliance as to 4-4-2001 order, including further amendment of subsection (e), transmitted to OAL 7-31-2001 and filed 9-5-2001 (Register 2001, No. 36).
10. New subsection (g) filed 2-3-2003 as an emergency; operative 2-3-2003 (Register 2003, No. 6). Emergency amendments exempt from OAL review pursuant to Welfare and Institutions Code section 14043.75. Amendments to remain in effect for 180 days pursuant to section 78, chapter 146, Statutes of 1999 (AB 1107). A Certificate of Compliance must be transmitted to OAL by 8-4-2003 or emergency language will be repealed by operation of law on the following day.
11. New subsection (g) refiled 8-5-2003 as an emergency; operative 8-5-2003 (Register 2003, No. 32). Emergency amendments exempt from OAL review pursuant to Welfare and Institutions Code section 14043.75. Amendments to remain in effect for 180 days pursuant to section 78, chapter 146, Statutes of 1999 (AB 1107). A Certificate of Compliance must be transmitted to OAL by 2-2-2004 or emergency language will be repealed by operation of law on the following day.
12. New subsection (g) refiled 2-3-2004 as an emergency; operative 2-3-2004 (Register 2004, No. 6). Emergency amendments exempt from OAL review pursuant to Welfare and Institutions Code section 14043.75. A Certificate of Compliance must be transmitted to OAL by 6-2-2004 or emergency language will be repealed by operation of law on the following day.
13. Reinstatement of section as it existed prior to 2-3-2004 emergency amendment by operation of Government Code section 11346.1(f) (Register 2004, No. 24).
14. New subsection (g) refiled 6-8-2004 as an emergency; operative 6-8-2004 (Register 2004, No. 24). A Certificate of Compliance must be transmitted to OAL by 10-6-2004 or emergency language will be repealed by operation of law on the following day.
15. Reinstatement of section as it existed prior to 6-8-2004 emergency amendment by operation of Government Code section 11346.1(f) (Register 2004, No. 41).
16. Change without regulatory effect amending NOTE filed 12-16-2013 pursuant to section 100, title 1, California Code of Regulations (Register 2013, No. 51).

Note: Authority cited: Section 20, Health and Safety Code; and Sections 10725, 14105 and 14124.5, Welfare and Institutions Code; and Section 78, Chapter 146, Statutes of 1999. Reference: Sections 14021, 14043.1, 14043.36, 14043.75, 14053, 14123, 14124.24, 14131 and 14132, Welfare and Institutions Code; Sections 101150- 101160, Health and Safety Code; and Sections 1200- 1327, Business and Professions Code.

1. New section filed 4-30-74; effective thirtieth day thereafter (Register 74, No. 18).
2. Designation of subsection (a), new subsection (b) and Note filed 1-20-94 as an emergency; operative 1-20-94 (Register 94, No. 3). A Certificate of Compliance must be transmitted to OAL by 5-20-94 or emergency language will be repealed by operation of law on the following day.
3. Certificate of Compliance as to 1-20-94 order transmitted to OAL 5-19-94 and filed 7-1-94 (Register 94, No. 26).
4. Amendment of subsection (b) and Note filed 8-28-97 as an emergency; operative 8-28-97 (Register 97, No. 35). A Certificate of Compliance must be transmitted to OAL by 12-26-97 or emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 8-28-98 order transmitted to OAL 12-24-97 and filed 2-9-98 (Register 98, No. 7).
6. Amendment of section and Note filed 10-24-2000 as an emergency and submitted to OAL for printing only pursuant to Section 78, Chapter 146, Statutes of 1999; operative 10-24-2000 (Register 2000, No. 43). A Certificate of Compliance must be transmitted to OAL by 4-23-2001 or emergency language will be repealed by operation of law on the following day.
7. Editorial correction of History 6 (Register 2001, No. 14).
8. Amendment of section and Note refiled 4-4-2001 as an emergency and submitted to OAL for printing only pursuant to Section 78, Chapter 146, Statutes of 1999; operative 4-4-2001 (Register 2001, No. 14). A Certificate of Compliance must be transmitted to OAL by 8-2-2001 or emergency language will be repealed by operation of law on the following day.
9. Certificate of Compliance as to 4-4-2001 order, including further amendment of subsection (e), transmitted to OAL 7-31-2001 and filed 9-5-2001 (Register 2001, No. 36).
10. New subsection (g) filed 2-3-2003 as an emergency; operative 2-3-2003 (Register 2003, No. 6). Emergency amendments exempt from OAL review pursuant to Welfare and Institutions Code section 14043.75. Amendments to remain in effect for 180 days pursuant to section 78, chapter 146, Statutes of 1999 (AB 1107). A Certificate of Compliance must be transmitted to OAL by 8-4-2003 or emergency language will be repealed by operation of law on the following day.
11. New subsection (g) refiled 8-5-2003 as an emergency; operative 8-5-2003 (Register 2003, No. 32). Emergency amendments exempt from OAL review pursuant to Welfare and Institutions Code section 14043.75. Amendments to remain in effect for 180 days pursuant to section 78, chapter 146, Statutes of 1999 (AB 1107). A Certificate of Compliance must be transmitted to OAL by 2-2-2004 or emergency language will be repealed by operation of law on the following day.
12. New subsection (g) refiled 2-3-2004 as an emergency; operative 2-3-2004 (Register 2004, No. 6). Emergency amendments exempt from OAL review pursuant to Welfare and Institutions Code section 14043.75. A Certificate of Compliance must be transmitted to OAL by 6-2-2004 or emergency language will be repealed by operation of law on the following day.
13. Reinstatement of section as it existed prior to 2-3-2004 emergency amendment by operation of Government Code section 11346.1(f) (Register 2004, No. 24).
14. New subsection (g) refiled 6-8-2004 as an emergency; operative 6-8-2004 (Register 2004, No. 24). A Certificate of Compliance must be transmitted to OAL by 10-6-2004 or emergency language will be repealed by operation of law on the following day.
15. Reinstatement of section as it existed prior to 6-8-2004 emergency amendment by operation of Government Code section 11346.1(f) (Register 2004, No. 41).
16. Change without regulatory effect amending Note filed 12-16-2013 pursuant to section 100, title 1, California Code of Regulations (Register 2013, No. 51).