For purposes of this article, and elsewhere in law where specified, the following definitions shall apply:
(a)“PPI” means the respective components of the Medi-Cal Provider Payment Increases and Investments Act authorized by this article or other sections of law amended by the act that added this subdivision, and, as applicable, approved by the federal Centers for Medicare and Medicaid Services in the PPI Terms and Conditions.
(b)“PPI Terms and Conditions” means those terms and conditions issued and approved by the federal Centers for Medicare and Medicaid Services, including any attachments, appendices, or similar documents, and subsequent amendments thereto, that govern implementation of the
respective components of PPI pursuant to this article or other sections of law amended by
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For purposes of this article, and elsewhere in law where specified, the following definitions shall apply:
(a)
“PPI” means the respective components of the Medi-Cal Provider Payment Increases and Investments Act authorized by this article or other sections of law amended by the act that added this subdivision, and, as applicable, approved by the federal Centers for Medicare and Medicaid Services in the PPI Terms and Conditions.
(b)
“PPI Terms and Conditions” means those terms and conditions issued and approved by the federal Centers for Medicare and Medicaid Services, including any attachments, appendices, or similar documents, and subsequent amendments thereto, that govern implementation of the
respective components of PPI pursuant to this article or other sections of law amended by the act that added this subdivision. PPI Terms and Conditions shall include, at a minimum, any terms and conditions specified in the following:
(1)
Any Medi-Cal Demonstration approved by the federal Centers for Medicare and Medicaid Services pursuant to Section 1315 of Title 42 of the United States Code that are necessary to implement a PPI component.
(2)
Any Medicaid Waivers as approved by the federal Centers for Medicare and Medicaid Services pursuant to Section 1396n of Title 42 of the United States Code that are necessary to implement a PPI component.
(3)
Any associated Medi-Cal State Plan amendments approved by the federal Centers for Medicare and Medicaid Services that are necessary to implement a PPI component.
(4)
Any provision of a comprehensive risk contract, nonrisk contract, or other similar managed care arrangement, including an intergovernmental agreement or directed payment authorized pursuant to Section 438.6(c) of Title 42 of the Code of Federal Regulations, approved by the federal Centers for Medicare and Medicaid Services to implement this article, or the authorities described in paragraph (1), (2), or (3).
(c)
“Abortion services” has the same meaning as set forth in subdivision (a) of Section 123464 of the Health and Safety Code.
(d)
“Comprehensive risk contract” has the same meaning as set forth in Section 438.2 of Title 42 of the Code of Federal Regulations.
(e)
“Medi-Cal managed care plan” means any individual, organization, or entity that enters
into a comprehensive risk contract with the department to provide covered full-scope health care services to enrolled Medi-Cal beneficiaries pursuant to any provision of this chapter or Chapter 8 (commencing with Section 14200).
(f)
“Network provider” has the same meaning as set forth in Section 438.2 of Title 42 of the Code of Federal Regulations.
(g)
“Nonrisk contract” has the same meaning as set forth in Section 438.2 of Title 42 of the Code of Federal Regulations.