Cal. Welf. & Inst. Code §§ 14195 through 14196: Medi-Cal Therapeutic Drug Utilization Review – California
Status: Enacted Year Enacted: 1984
It is the intent of the Legislature to provide medical assistance, including prescribed drugs, to the state’s eligible poor in a manner consistent with the provisions of the federal Medicaid Act, provided for under Title …
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Cal. Welf. & Inst. Code §§ 14197 through 14197.5: Medi-Cal Managed Care Plans – California
Status: Enacted Year Enacted: 2017
It is the intent of the Legislature that the department implement and monitor compliance with the time and distance requirements set forth in Sections 438.68, 438.206, and 438.207 of Title 42 of the Code of …
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Cal. Welf. & Inst. Code §§ 14300 through 14316: Medi-Cal Prepaid Plans — Administration – California
Status: Enacted Year Enacted: 1974
The department shall determine, by actuarial methods, prospective per capita rates of payment for services provided under this chapter for Medi-Cal beneficiaries enrolled in a prepaid health plan.
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Cal. Welf. & Inst. Code §§ 14300 through 14316: Prepaid Plans — Administration – California
Status: Enacted Year Enacted: 1984
For rates established on or after August 1, 2007, the department shall pay capitation rates to health plans participating in the Medi-Cal managed care program using actuarial methods and may establish healthplan- and county-specific rates. …
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Cal. Welf. & Inst. Code §§ 14591 through 14594: Program of All-Inclusive Care for the Elderly – California
Status: Enacted Year Enacted: 2011
Steadily increasing health care costs for the frail elderly provide incentive to develop programs providing quality services at reasonable costs. Capitated “risk-based” financing provides an alternative to the traditional fee-for-service payment system by providing a …
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Colo. Rev. Stat. § 25.5-4-401. Providers-Payments-Rules: Colorado Medical Assistance Act – Colorado
Status: Enacted Year Enacted: 2006
Establishes rules for the payment of providers, that payments should be reasonable. Provider payments may include provisions that encourage the highest quality of medical benefits and the provision of the least expense possible, including the …
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Colo. Rev. Stat. § 25.5-8-110. Participation by managed care plans: Children’s Basic Health Plan Act – Colorado
Status: Enacted Year Enacted: 2006
Allows managed care plans to participate in the Children’s Health Insurance Plan, as long as they offer an adequate provider network.
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Colo. Rev. Stat. § 6-18-302. Health care coverage cooperatives-creation of provider networks-requirements: Health Care Coverage Collaboratives – Provider Networks – Colorado
Status: Enacted Year Enacted: 1994
Authorizes providers to conduct business collaboratively as provider networks. All provider networks that do business as insurance companies must hold a certificate of authenticity from the insurance commissioner. Also contains requirements for all providers that …
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Colo. Rev. Stat. §§ 25.5-8-101 through 25.5-8-112: Children’s Basic Health Plan Act – Colorado
Status: Enacted Year Enacted: 2006
The general assembly hereby finds and declares that a significant percentage of children are uninsured. This lack of health insurance coverage decreases children’s access to preventive health care services, compromises the productivity of the state’s …
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Conn. Gen. Stat. § 17b-266. Purchase of insurance. Contracts for comprehensive health care on a prepayment or per capita basis. Certification of providers by commissioner. Payment of capitation claims. Deposit of funds for expenditures for children’s health programs and services: Medical Assistance – Connecticut
Status: Enacted Year Enacted: 1958
The Commissioner of Social Services may require recipients of Medicaid or other public assistance to receive medical care on a prepayment or per capita basis, in accordance with federal law and regulations, if such prepayment …
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Conn. Gen. Stat. § 38a-478c. Managed care organization’s report to the commissioner: Data, reports and information required: Health Insurance: Managed Care – Connecticut
Status: Enacted Year Enacted: 1997
States that each managed care organization shall submit before May 1st of each year, a report on its quality assurance plan, a model contract that contains provisions currently in force in contracts between the managed …
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Conn. Gen. Stat. § 38a-550. Copayments re in-network imaging services: Group Health Insurance – Connecticut
Status: Enacted Year Enacted: 2006
States that no health insurers and other organizations that provide coverage may require total copayments in excess of three hundred seventy-five dollars for magnetic resonance imaging or computed axial tomography in-network imaging services annually or …
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Conn. Gen. Stat. § 38a-550a. Copayments re in-network physical therapy services and in-network occupational therapy services: Group Health Insurance – Connecticut
Status: Enacted Year Enacted: 2013
States that no individual health insurance policy shall impose copayments that exceed a maximum of thirty dollars per visit for in-network physical therapy services and occupational therapy services.
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D.C. Code § 1-307.03. Medical assistance expansion program establishment: Special Programs — General – District of Columbia
Status: Enacted Year Enacted: 1999
The Mayor shall establish a program to expand medical assistance to adult District residents with an annual family income up to 200% of the federal poverty level.
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Fla. Stat. § 641.2342. Contract providers: Health Maintenance Organization Act – Florida
Status: Enacted Year Enacted: 1988
Requires health maintenance organizations to file upon the request of the office, financial statements for all contract providers of comprehensive health care services who have assumed, through capitation or other means, more than 10 percent …
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Fla. Stat. §§ 391.011 through 391.097: Children’s Medical Services Act – Florida
Status: Enacted Year Enacted: 1978
States that the departmentof health shall establish the criteria to designate health care providers to participate in the Children’s Medical Services network. The program shall apply managed care methods to ensure the efficient operation of …
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