Section 1366.4 Of Article 4. Solicitation And Enrollment From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 4.
1366.4
. (a) A medical group, physician, or independent practice
association that contracts with a health care service plan may enter
into contracts with licensed nonphysician providers to provide
services, as defined in Section 1300.67(a)(1) of Title 28 of the
California Code of Regulations, to plan enrollees covered by the
contract between the plan and the group, physician, or association.
(b) The licensed nonphysician provider described in subdivision
(a) that contracts with a medical group, physician, or independent
practice association may directly bill, if direct billing is
otherwise permitted by law, a health care service plan for covered
services pursuant to a contract with the health care service plan
that specifies direct billing. Direct billing pursuant to this
subdivision is permitted only to the extent that the same services
are not billed for by the medical group, physician, or independent
practice association.
(c) A health care service plan may require the nonphysician
provider to complete an appropriate credentialing process.
(d) Every health care service plan may either list licensed
nonphysician providers that contract with medical groups, physicians,
and independent practice associations pursuant to subdivision (b) in
any listing or directory of plan health care providers that is
provided to enrollees or to the public, or may include a notification
in the plan's evidence of coverage or provider list that the health
care service plan has contracts with nonphysician providers, pursuant
to subdivision (b), and may list the types of contracted
nonphysician providers. The notification may inform an enrollee that
he or she may obtain a list of the nonphysician providers by
contacting his or her primary or specialist medical group. The
listing may indicate whether licensed nonphysician providers may be
accessed directly by enrollees.
(e) Nothing in this section shall be construed to authorize, or
otherwise require the director to approve, a risk-sharing arrangement
between a plan and a provider.