Cal. Code Regs. tit. 22 § 51006

Current through Register 2024 Notice Reg. No. 16, April 19, 2024

Section 51006 - Out-of-State Coverage

(a) Necessary out-of-state medical care, within the limits of the program, is covered only under the following conditions:

(1) When an emergency arises from accident, injury or illness; or

(2) Where the health of the individual would be endangered if care and services are postponed until it is feasible that he return to California; or

(3) Where the health of the individual would be endangered if he undertook travel to return to California; or

(4) When it is customary practice in border communities for residents to use medical resources in adjacent areas outside the State; or

(5) When an out-of-state treatment plan has been proposed by the beneficiary's attending physician and the proposed plan has been received, reviewed and authorized by the Department before the services are provided. The Department may authorize such out-of-state treatment plans only when the proposed treatment is not available from resources and facilities within the State.

(6) Prior authorization is required for all out-of-state services, except:

(A) Emergency services as defined in Section 51056.

(B) Services provided in border areas adjacent to California where it is customary practice for California residents to avail themselves of such services. Under these circumstances, program controls and limitations are the same as for services from providers within the State.

(b) No services are covered outside the United States, except for emergency services requiring hospitalization in Canada or Mexico.

Cal. Code Regs. Tit. 22, § 51006

1. Amendment of subsection (a)(5) filed 1-18-74; effective thirtieth day thereafter (Register 74, No. 3). For prior history, see Register 72, No. 5.
2. Change without regulatory effect adding NOTE (Register 86, No. 49).

Note: Authority cited: Sections 10725 and 14125.5, Welfare and Institutions Code. Reference: Section 14122, Welfare and Institutions Code.