Cal. Code Regs. Tit. 22, § 51000.51 - Provisional Provider and Preferred Provisional Provider Status

Current through Register 2021 Notice, Register No. 40, October 1, 2021

(a) The Department shall grant provisional provider status for a period of 12 months, or preferred provisional status for a period of 18 months, subject to the provisions of Welfare and Institutions Code Sections 14043.26 through 14043.29, when:
(1) An application for enrollment of a new provider is approved.
(2) An application for continued enrollment of a provider is approved.
(3) An application for enrollment of an additional location, or change of location for a provider is approved.
(4) An application for any change pursuant to Section51000.30(b) is approved.
(5) The Department fails to take any action listed in Section 51000.50(e) within 180 days after receiving an application package. The applicant or provider shall be granted provisional provider status, effective on the 181st day.
(b) When a provider currently enrolled in the Medi-Cal program at one or more locations, who has submitted an application package for enrollment at an additional or change in location, begins billing for services provided at an additional or change of location, using their existing provider number, the provider shall be considered to be on provisional provider status. If the provider is subject to Welfare and Institutions Code Section 14043.47(c), the provider shall submit documentation in the application package that identifies the physician providing services at every three locations.
(c) Provisional provider status or preferred provisional provider status shall be terminated, by the Department, pursuant to Welfare and Institutions Code Section 14043.27(c)(1) - (12), regardless of whether the period of time for which the provisional provider status or preferred provisional provider status was granted has elapsed.
(d) Termination of provisional provider status or preferred provisional provider status, by the Department, shall include deactivation of all provider numbers used by the provider at any location, to obtain reimbursement from the Medi-Cal program, except where the termination is based upon a ground related solely to a specific location.

Notes

Cal. Code Regs. Tit. 22, § 51000.51

Note: Authority cited: Section 20, Health and Safety Code; and Sections 10725, 14043.75 and 14124.5, Welfare and Institutions Code. Reference: Sections 14043.2, 14043.26, 14043.27, 14043.36, 14043.37, 14043.4 and 14043.7, Welfare and Institutions Code; 42 U.S.C. Sections 1320a-3, 1320a-7, 1396a(a)(38) and 1396b(i)(2); and 42 Code of Federal Regulations Part 455.

1. New section filed 9-29-2004 as an emergency; operative 10-7-2004 (Register 2004, No. 41). A Certificate of Compliance must be transmitted to OAL by 2-4-2005 or emergency language will be repealed by operation of law on the following day. Deemed emergency exempt from OAL pursuant to Welfare and Institutions Code section 14043.75.
2. New section refiled 1-27-2005 as an emergency; operative 2-5-2005 (Register 2005, No. 4). A Certificate of Compliance must be transmitted to OAL by 6-6-2005 or emergency language will be repealed by operation of law on the following day. Deemed emergency exempt from OAL review pursuant to Welfare and Institutions Code section 14043.75.
3. New section refiled 6-2-2005 as an emergency; operative 6-7-2005 (Register 2005, No. 22). A Certificate of Compliance must be transmitted to OAL by 10-5-2005 or emergency language will be repealed by operation of law on the following day. Deemed emergency exempt from OAL review pursuant to Welfare and Institutions Code section 14043.75.
4. Certificate of Compliance as to 6-2-2005 order transmitted to OAL 9-29-2005 and filed 11-10-2005 (Register 2005, No. 45).
5. Change without regulatory effect amending subsection (a)(5) and Note filed 1-23-2009 pursuant to section 100, title 1, California Code of Regulations (Register 2009, No. 4).

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