(a)A contract between the department and a Medi-Cal managed care plan shall require the Medi-Cal managed care plan to do both of the following:
(1)Identify, on a quarterly basis, every enrollee who is a child without a record of completing the blood lead screening tests required pursuant to Chapter 9 (commencing with Section 37100) of Division 1 of Title 17 of the California Code of Regulations.
(2)On a quarterly basis, remind the contracting network provider who is a health care provider responsible for performing the periodic health assessment of the child enrollee pursuant to Section 37100 of Title 17 of the California Code of Regulations of the
requirement to perform required blood lead screening tests for that child, and the requirement to provide oral or written anticipatory Free access — add to your briefcase to read the full text and ask questions with AI
(a)
A contract between the department and a Medi-Cal managed care plan shall require the Medi-Cal managed care plan to do both of the following:
(1)
Identify, on a quarterly basis, every enrollee who is a child without a record of completing the blood lead screening tests required pursuant to Chapter 9 (commencing with Section 37100) of Division 1 of Title 17 of the California Code of Regulations.
(2)
On a quarterly basis, remind the contracting network provider who is a health care provider responsible for performing the periodic health assessment of the child enrollee pursuant to Section 37100 of Title 17 of the California Code of Regulations of the
requirement to perform required blood lead screening tests for that child, and the requirement to provide oral or written anticipatory guidance to a parent or guardian of the child, including at a minimum, the information that children may be harmed by exposure to lead.
(b)
The department shall develop and implement procedures, and may impose sanctions pursuant to Section 14197.7, to ensure that a Medi-Cal managed care plan is compliant with the requirements specified in subdivision (a).
(1)
As part of these procedures, the department shall require a Medi-Cal managed care plan to maintain a record of all child enrollees six years of age or younger who have missed a required blood lead screening and identify the age at which the required blood lead screenings were missed, including which children are without any record of a completed blood lead screening at each age, and provide
that record to the department annually and upon request for auditing and compliance purposes.
(2)
If the child enrollee, or the child enrollee’s parent, guardian, or authorized representative refuses a required blood lead screening test, the Medi-Cal managed care plan shall ensure a statement of voluntary refusal is signed by the child enrollee, if an emancipated minor, or by the child enrollee’s parent, guardian, or authorized representative, and is documented in the child enrollee’s medical record. If the refusing party declines to sign the statement of voluntary refusal, it shall be noted in the child enrollee’s medical record. Documented unsuccessful attempts to provide the blood lead screening tests shall be considered evidence of the Medi-Cal managed care plan meeting the requirements in subdivision (a).
(c)
For purposes of this section, the following definitions apply:
(1)
“Medi-Cal managed care plan” means an individual, organization, or entity that enters into a contract with the department to provide general health care services to enrolled Medi-Cal beneficiaries pursuant to any of the following:
(A)
Chapter 3 (commencing with Section 101675) of Part 4 of Division 101 of the Health and Safety Code.
(B)
Article 2.7 (commencing with Section 14087.3), excluding dental managed care programs developed pursuant to Section 14087.46.
(C)
Article 2.8 (commencing with Section 14087.5).
(D)
Article 2.81 (commencing with Section 14087.96).
(E)
Article 2.82 (commencing with Section 14087.98).
(F)
Article 2.9 (commencing with Section 14088).
(G)
Article 2.91 (commencing with Section 14089).
(H)
Chapter 8 (commencing with Section 14200), excluding dental managed care programs developed pursuant to Section 14087.46.
(2)
“Network provider” has the same meaning as in Section 438.2 of Title 42 of the Code of Federal Regulations.
(d)
Notwithstanding Chapter 3.5 (commencing Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, in whole or in part, by means of plan or county letters, information notices, plan or provider bulletins, or other similar instructions, without taking any further regulatory
action.