Statutes, codes, and regulations
California Code Of Regulations
Title 15 - Crime Prevention and CorrectionsDivision 3 - Adult Institutions, Programs and ParoleChapter 2 - Rules and Regulations of Health Care ServicesSubchapter 1 - Health Care Governance and Administration
Article 2 - Health Care Program Governance
Section 3999.115 - Utilization Management Program

Cal. Code Regs. tit. 15 § 3999.115

Download
PDF
Current through Register 2024 Notice Reg. No. 45, November 8, 2024
Section 3999.115 - Utilization Management Program
(a) The Department shall maintain a Utilization Management (UM) Program to eliminate unnecessary cost and maintain consistency in the delivery of health care services.
(b) The UM Program shall review high cost, high risk, exceptional, and complex patient cases. This process includes up to three levels of review and shall cover prospective, concurrent, and retrospective reviews.
(c) Headquarters and institution committee structures shall be maintained to provide oversight of the UM Program.
(d) Records of committee proceedings shall be kept at a secure, accessible medical program site for a period of three years. At a minimum, the record shall describe all committee actions and recommendations.

Cal. Code Regs. Tit. 15, § 3999.115

1. New section filed 7-1-2019 as an emergency; operative 7-1-2019 (Register 2019, No. 27). Pursuant to Penal Code section 5058.3, a Certificate of Compliance must be transmitted to OAL by 12-9-2019 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 12-5-2019 as an emergency; operative 12-10-2019 (Register 2019, No. 49). Pursuant to Penal Code section 5058.3, a Certificate of Compliance must be transmitted to OAL by 3-9-2020 or emergency language will be repealed by operation of law on the following day.
3. New section refiled 3-9-2020 as an emergency; operative 3-10-2020 (Register 2020, No. 11). A Certificate of Compliance must be transmitted to OAL by 6-8-2020 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 3-9-2020 order transmitted to OAL 6-8-2020 and filed 7-20-2020 (Register 2020, No. 30).

Note: Authority cited: Section 5058, Penal Code. Reference: Section 5054, Penal Code; and Plata v. Newsom (No. C01-1351 JST), U.S. District Court, Northern District of California.

1. New section filed 7-1-2019 as an emergency; operative 7/1/2019 (Register 2019, No. 27). Pursuant to Penal Code section 5058.3, a Certificate of Compliance must be transmitted to OAL by 12-9-2019 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 12-5-2019 as an emergency; operative 12/10/2019 (Register 2019, No. 49). Pursuant to Penal Code section 5058.3, a Certificate of Compliance must be transmitted to OAL by 3-9-2020 or emergency language will be repealed by operation of law on the following day.
3. New section refiled 3-9-2020 as an emergency; operative 3/10/2020 (Register 2020, No. 11). A Certificate of Compliance must be transmitted to OAL by 6-8-2020 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 3-9-2020 order transmitted to OAL 6-8-2020 and filed 7/20/2020 (Register 2020, No. 30).