Article 4 - THE MEDI-CAL BENEFITS PROGRAM

Section 14131 - Generally
Section 14131.05 - Hearing aid benefits
Section 14131.07 - [Repealed]
Section 14131.10 - Optional benefit exclusions
Section 14131.11 - Increase in amount charged directly related to identifiable provider-preventable condition exclusion
Section 14131.15 - Benefits and services designated as covered benefit
Section 14132 - Schedule of benefits
Section 14132.01 - Reimbursement to community clinic or free clinic
Section 14132.02 - Alternative benefit package offered to person eligible pursuant to section 14005.60
Section 14132.03 - Mental health and substance abuse disorder services covered benefits
Section 14132.05 - Evaluation regarding Family PACT federal waiver
Section 14132.06 - Services provided by local educational agency covered benefits
Section 14132.07 - Choice of family planning services
Section 14132.09 - Coverage for medically necessary biomarker testing
Section 14132.1 - Surgical center defined
Section 14132.10 - Pediatric day health care
Section 14132.100 - Federally qualified health center services and rural health clinic services
Section 14132.101 - Filing scope-of-service change request
Section 14132.102 - Transition to prospective payment system required of certain federally qualified health centers
Section 14132.105 - [Repealed]
Section 14132.107 - Time for finalizing claims for reimbursement
Section 14132.108 - Time for filing rate adjustment requests for scope-of-service rate changes
Section 14132.11 - Pharmacogenomic testing a covered benefit
Section 14132.15 - Rehabilitation services defined
Section 14132.16 - Mammography
Section 14132.17 - Annual cervical cancer tests
Section 14132.171 - Annual cognitive health assessment
Section 14132.18 - Community supported living arrangement services
Section 14132.19 - Advisory group focusing on screening of children for trauma
Section 14132.195 - Inclusion of developmental screening services for individuals zero to three years of age in EPSDT benefit
Section 14132.20 - Continuous skilled nursing care to persons with developmental disabilities
Section 14132.21 - Targeted case management for pregnant substance abusing women and women giving birth to drug-exposed or alcohol exposed infants
Section 14132.22 - Dental restoration materials
Section 14132.23 - Active and retentive phases of orthodontic treatment
Section 14132.24 - [Effective Until 1/1/2026] Workgroup to examine implementation of doula benefit provided under the Medi-Cal program
Section 14132.25 - Subacute care program
Section 14132.26 - Assisted living benefit
Section 14132.27 - Disease management benefit
Section 14132.275 - [Effective until 1/1/2025] Contract to operate Medicare and Medicaid benefits in demonstration project
Section 14132.276 - [Effective until 1/1/2025] Nursing facility services
Section 14132.277 - [Effective until 1/1/2025] D-SNP contracts and D-SNP plans
Section 14132.28 - Termination or nonrenewal of subacute health services
Section 14132.29 - Patient transfer and discharge requirements
Section 14132.3 - Reimbursement for service requiring special permit or supplemental service approval
Section 14132.34 - Human milk and human milk derivatives supplied by mothers' milk bank
Section 14132.35 - Outpatient rehabilitation services
Section 14132.36 - Community health worker services
Section 14132.38 - [Repealed]
Section 14132.39 - Midwifery services
Section 14132.4 - Nurse-midwifery services
Section 14132.41 - Services provided by certified nurse practitioner
Section 14132.42 - Time period for inpatient hospital care following normal vaginal delivery or caesarean section
Section 14132.44 - Local government agency provided targeted case management (TCM)
Section 14132.45 - Regulations regarding section 14132(z)
Section 14132.46 - Recovery of cost of targeted case management services
Section 14132.47 - Administrative Claiming Process
Section 14132.48 - Targeted case management services subject to utilization controls
Section 14132.49 - Targeted case management for pregnant and parenting adolescents and their children
Section 14132.5 - [Repealed]
Section 14132.55 - Licensing requirement for speech pathologists or audiologists
Section 14132.56 - Behavioral health treatment (BHT)
Section 14132.57 - Qualifying community-based mobile crisis intervention services for eligible Medi-Cal beneficiaries
Section 14132.58 - Vision services for low-income children; Vision Services CHIP-HSI Special Fund; implementation
Section 14132.6 - External prostheses constructed of silicon or other comparable materials, prosthetic implants and reconstructive surgery incident to mastectomy
Section 14132.62 - Reconstructive surgery
Section 14132.63 - Certification requirement for orthotists and prosthetists
Section 14132.69 - Donor and recipient organ transplant surgeries
Section 14132.70 - Antirejection medication
Section 14132.7 - [Repealed]
Section 14132.71 - Standards for approval of facilities performing donor and recipient organ transplant surgeries
Section 14132.72 - Telehealth
Section 14132.723 - Patient's presence not required during or immediately after state of emergency
Section 14132.724 - Guidance for enrolled community clinics and other enrolled fee-for-service Medi-Cal providers, clinics, or facilities to facilitate reimbursement
Section 14132.725 - Telehealth under the Medi-Cal program
Section 14132.73 - Fee-for-service reimbursement for psychiatrists
Section 14132.731 - Drug Medi-Cal Treatment Program contract; reimbursable services; teleheatlh
Section 14132.74 - Pediatric palliative care
Section 14132.75 - Palliative care services
Section 14132.755 - Dyadic behavioral health visits a covered benefit under Medi-Cal program
Section 14132.76 - Continuation of pediatric palliative and hospice care after 21 years of age
Section 14132.765 - Treatment authorization requests for prosthetic devices or orthotic devices or replacement or repair of devices
Section 14132.77 - Rural hospital to participation in pilot project to perform delegated acute inpatient hospital treatment authorization review
Section 14132.8 - Rehabilitative services for stoke patients or patients with brain injury
Section 14132.81 - Purchase of ID bracelets for recipient with Alzheimer's Disease or other cognitive defect
Section 14132.85 - Duties of complex rehabilitation technology providers; certificate of medical necessity
Section 14132.86 - Purchase of prescribed enteral nutrition products
Section 14132.88 - Dental prophylaxis cleanings and dental examinations
Section 14132.89 - Other dental procedures
Section 14132.9 - Mandatory examination by person not licensed as dentist
Section 14132.90 - [Repealed]
Section 14132.905 - Day care services to alcohol and drug exposed pregnant women and women in postpartum period
Section 14132.91 - Dental outreach and education program
Section 14132.915 - Performance measures for dental fee-for-service program
Section 14132.92 - Services provided to beneficiary with developmental disability
Section 14132.925 - Day treatment and transportation services provided by facility providing services to developmental disabled
Section 14132.93 - Services reimbursed by General Fund
Section 14132.94 - PACE program services
Section 14132.95 - Personal care services provided to categorically needy person
Section 14132.951 - In-Home Supportive Services program
Section 14132.952 - IHSS Plus Option
Section 14132.955 - Personal care services in recipient's place of employment
Section 14132.956 - Assistance with activities for daily living (ADLs), instrumental activities of daily living (IADLs) and health-related tasks
Section 14132.957 - [Repealed]
Section 14132.96 - Review of personal care services provider rates by county in-home supportive services authority
Section 14132.966 - Physician assistants
Section 14132.968 - Pharmacist services
Section 14132.969 - Medication therapy management (MTM) reimbursement methodology
Section 14132.97 - Waiver personal care services
Section 14132.971 - Employer
Section 14132.98 - Routine patient care costs related to cancer clinical trial
Section 14132.985 - Funding costs of services provided pursuant to Health and Safety Code provisions
Section 14132.99 - Expediting processing of waiver applications
Section 14132.991 - Renewal of waivers; authority of director
Section 14132.992 - [Repealed]
Section 14132.993 - Retention of place on waiting list for waiver program for military service member transferred out of state
Section 14132aa - Services provided by congregate living health facilities to individuals with AIDS
Section 14133 - Utilization controls applied services set forth in section 14132
Section 14133.01 - Treatment authorization request (TAR)
Section 14133.05 - Review of treatment authorization request
Section 14133.07 - Prior authorization for podiatric services not required
Section 14133.1 - Determination of which utilization controls applied
Section 14133.10 - Case management of elective nonemergency acute care hospital admissions
Section 14133.12 - Utilization controls applied to skilled nursing care services
Section 14133.14 - Criteria for placing provider on prior authorization for noninvasive testing procedures
Section 14133.15 - Recipient placed on utilization controls for abusing drugs or services
Section 14133.16 - Hearing aids
Section 14133.2 - Drugs approved for treatment of cancer included in list of contract drugs
Section 14133.22 - [Repealed]
Section 14133.225 - Prescription drug or other therapy to treat erectile dysfunction
Section 14133.23 - Provision of drug benefits to full-benefit dual eligible beneficiaries
Section 14133.25 - Procedures capable of outpatient performance
Section 14133.3 - Documented justification that requested services medically necessary
Section 14133.37 - Time processing of drug prior authorization requests
Section 14133.4 - Portable X-ray services provided in nursing facilities and intermediate care facilities for developmentally disabled
Section 14133.45 - Renal dialysis treatment
Section 14133.5 - [Repealed]
Section 14133.51 - [Repealed]
Section 14133.6 - Acting upon prior authorization requests for nonemergency medical transportation services
Section 14133.61 - [Repealed]
Section 14133.65 - Nonemergency medical transportation services to patients to and from dialysis treatment
Section 14133.7 - Emergency certification statements not required
Section 14133.8 - Bone marrow transplant
Section 14133.85 - Hospice services
Section 14133.9 - Implementing prior authorization permitted by section 14133(a)
Section 14134 - Copayments
Section 14134.1 - Inability to pay copayment
Section 14134.2 - Three or more laboratory services for same patient on same day commonly performed in automated manner
Section 14134.25 - Tobacco cessation services
Section 14134.5 - Comprehensive perinatal services
Section 14134.55 - Access to lactation supports and breast pumps
Section 14134.6 - Charges to long-term care facility residents
Section 14135 - Establishment of enrollment fee, premium or similar charge
Section 14136 - Adoption of standards by cities or counties for nonemergency medical transportation services
Section 14136.1 - Transportation of patient requiring intravenous medication, medical monitoring or observation during transport
Section 14136.3 - Beneficiary transported from acute care hospital to nursing facility
Section 14136.4 - Transportation conditionally authorized via telephone by department medical consultant
Section 14136.5 - Reimbursement for medical transportation services
Section 14136.8 - Transportation services ordered by person with significant interest in services
Section 14137 - Waivers to provide in-home and community-based care
Section 14137.6 - Drugs classified as treatment Investigational New Drug (IND)
Section 14137.8 - Treatment not construed to be part of research study protocol
Section 14138 - Bulk purchase of vaccines and biological products by department