Find Legal Information

14095

WELFARE AND INSTITUTIONS CODE
SECTION 14095

14095.   (a) For any entity or program that seeks to contract with
the department to provide, or arrange for the provision of, managed
health care services, disease management, or other health services
contracted for on a basis other than fee-for-service, the department
may consider, but shall not be limited to considering, all of the
following:
   (1) Whether the applicant is of reputable and responsible
character. The department may consider any available information that
the applicant has demonstrated a pattern and practice of violations
of state or federal laws and regulations.
   (2) Whether the applicant has the ability to provide, or arrange
for the provision of, health care benefits or services. The
department may consider evidence that may include all of the
following:
   (A) Any prior history of providing, or arranging for the provision
of, health care services or benefits in this state, the applicant's
history of substantial compliance with the requirements imposed under
that license, and applicable federal laws, regulations, and
requirements.
   (B) Any prior history in this state or any other state, of
providing, or arranging for the provision of, health care services or
benefits authorized to receive Medicare Program reimbursement or
Medicaid Program reimbursement, the applicant's history of
substantial compliance with that state's requirements, and applicable
federal laws, regulations, and requirements.
   (C) Any prior history of providing, or arranging for the provision
of, health services as a licensed health professional or an
individual or entity contracting with a health care service plan or
insurer, and the applicant's history of substantial compliance with
state requirements, and applicable federal law, regulations, and
requirements.
   (b) The department may also require the entity described in
subdivision (a) to furnish other information or documents for the
proper administration and enforcement of the licensing laws.
   (c) For purposes of paragraph (1) of subdivision (a), "applicant"
shall include the applicant's management company, any affiliate of
the applicant, and any controlling person, officer, director, or
other person occupying a principal management or supervisory position
for the applicant, its management company, or an affiliate of the
applicant.
   (d) Nothing in this section shall be construed to restrict or
limit the department in any way from considering any other factor
required by law, or determined by the department to be necessary for
consideration, prior to entering into a contract for the provision of
managed health care services.