§ 14105.405. — 14105.405. (Amended by Stats. 2002, Ch. 1161, Sec. 66.)

California § 14105.405.

• Jurisdiction: California
• Code WIC: Welfare and Institutions Code - WIC
• Div. 9.: DIVISION 9. PUBLIC SOCIAL SERVICES
• Part 3.: PART 3. AID AND MEDICAL ASSISTANCE
• Ch. 7.: CHAPTER 7. Basic Health Care
• Art. 3.: ARTICLE 3. Administration

Text

(a)
A Medi-Cal beneficiary, within 90 days of receipt of the director’s notice to beneficiaries pursuant to subdivision (i) of Section 14105.33, informing them of the decision to delete or suspend a drug from the list of contract drugs, may request a fair hearing pursuant to Chapter 7 (commencing with Section 10950) of Part 2.
(b)
Any beneficiary filing a fair hearing request regarding the deletion or suspension of a drug from the list of contract drugs shall be granted a
treatment authorization request for that drug until a final decision is adopted by the director. Should the beneficiary seek judicial review of the director’s decision, a treatment authorization request shall be granted for that drug until a final decision is issued by the court.
(c)
(1)
Any Medi-Cal beneficiary, within one year of the director’s decision pursuant to Section 10959, may file a petition with the superior court, under the provisions of Section 1094.5 of the Code of Civil Procedure, praying for a review of both the legal and factual basis for the director’s decision.
(2)
The director shall be the sole respondent in these proceedings.
(d)
Any Medi-Cal beneficiary injured as a result of being denied a drug which is determined to be medically necessary may sue for injunctive or
declaratory relief to review the director’s decision to delete or suspend a drug from the list of contract drugs.

Legislative History

Amended by Stats. 2002, Ch. 1161, Sec. 66. Effective September 30, 2002.