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Organization and Administration.

22 CCR 56200

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22 CCR 56200

22 CCR 56200

§ 56200. Organization and Administration. Each PCCM plan shall have the organizational and administrative ability to carry out its contractual obligations.To demonstrate this ability, each PCCM plan shall maintain the following:

(a)

A license to provide medical care.

(b)

An approved Medi-Cal provider number.

(c)

A grievance procedure as specified in section 56260.

(d)

Member and enrollment reporting systems which fulfill the PCCM plan's contractual obligations.

(e)

A data-reporting system which provides reports required under the contract to the Department on a timely basis.

(f)

Financial records and books of account fully disclosing the disposition of all Medi-Cal program funds received under the PCCM contract. These records and books shall be maintained on the accrual basis and in a uniform accounting system in accordance with generally accepted accounting principles.

(g)

A medical director as specified in section 56246.