Section 1850.530 - Financial Liability(a) When the resolution of a dispute under this Article includes a determination that the unsuccessful party in the dispute has a financial liability to the other party for services rendered by the successful party, financial liability and the liquidation of that liability shall follow the criteria of Subsections (b)-(d).(b) Unless determined otherwise as provided in Subsection (c), financial liability shall not exceed the lower of the following rates, in effect at the time the services were rendered: (1) The usual and customary charges made to the general public by the provider who rendered the service.(2) The fee-for-service rates for similar services under the Medi-Cal program. Upon determination of the financial liability, if no final rate has been established for the providers who rendered the services for the period and type of services in question, then the applicable interim rate shall be used for the final determination of financial liability.(c) The rate of payment included in the request pursuant to Section 1850.505(d)(1) shall be presumed correct, and the successful party shall be entitled to the full rate requested in its request should it prevail, unless the other party disputed the rate of payment in its response under Section 1850.505(e), which places the rates in issue.(d) A plan determined to be financially liable shall within 30 calendar days of the effective date of the decision:(1) Reimburse the successful party for the full amount of the determined liability.(2) Provide proof of reimbursement in such form as the written decision of the Department requires.Cal. Code Regs. Tit. 9, § 1850.530
1. New section filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20).
2. Change without regulatory effect amending subsection (d)(2) and NOTE filed 8-24-2015 pursuant to section 100, title 1, California Code of Regulations (Register 2015, No. 35). Note: Authority cited: Sections 10725, 14680 and 14700, Welfare and Institutions Code. Reference: Sections 14681, 14683, 14684, 14718 and 14721, Welfare and Institutions Code.
1. New section filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20).
2. Change without regulatory effect amending subsection (d)(2) and Note filed 8-24-2015 pursuant to section 100, title 1, California Code of Regulations (Register 2015, No. 35).