Medi-Cal Fiscal Penalties.

22 CCR 50116

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22 CCR 50116

§ 50116. Medi-Cal Fiscal Penalties.

(a)

The Department shall assess fiscal penalties to counties whenever the state dollar error rate exceeds the federal standard.

(b)

A county's case error rate shall be determined based on reviews by Department staff of a random sample of a minimum number of cases for each period, as follows:

(1)

All cases shall be sampled in any county with less than 50 Medi-Cal cases.

(2)

Fifty cases in any county with greater than 0.01 percent and less than or equal to 0.50 percent of the Medi-Cal cases in the state.

(3)

Seventy-five cases in any county with greater than 0.50 percent and less than or equal to 1.0 percent of the Medi-Cal cases in the state.

(4)

One hundred cases in any county with greater than 1.0 percent and less than or equal to 3.0 percent of the Medi-Cal cases in the state.

(5)

One hundred twenty-five cases in any county with greater than 3.0 percent and less than or equal to 10.0 percent of the Medi-Cal cases in the state.

(6)

Six hundred fifty cases in any county with greater than 10.0 percent of the Medi-Cal cases in the state.

(c)

Medi-Cal fiscal penalties established under this Section shall apply only to those counties for which case error rates are established.

(d)

The Department shall determine which counties in the state are liable for fiscal penalties as follows:

(1)

The 60 percent of counties in the state with the highest case error rates shall be liable if the state's dollar error rate exceeds the federal standard by 0.01 percent to 1.0 percent.

(2)

The 70 percent of counties in the state with the highest case error rates shall be liable if the state's dollar error rate exceeds the federal standard by greater than 1.0 percent and less than or equal to 2.0 percent.

(3)

The 80 percent of counties in the state with the highest case error rates shall be liable if the state's dollar error rate exceeds the federal standard by greater than 2.0 percent and less than or equal to 3.0 percent.

(4)

The 90 percent of counties in the state with the highest case error rates shall be liable if the state's dollar error rate exceeds the federal standard by greater than 3.0 percent and less than or equal to 4.0 percent.

(5)

All counties in the state shall be liable if the state's dollar error rate exceeds the federal standard by greater than 4.0 percent.

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