§ 97232. Definition of Data Element for Inpatients--Expected Source of Payment.
22 CA ADC § 97232Barclays Official California Code of Regulations
22 CCR § 97232
§ 97232. Definition of Data Element for Inpatients--Expected Source of Payment.
Effective with discharges on or after January 1, 1999, the patient's expected source of payment -- the entity or organization which is expected to pay or did pay the greatest share of the patient's bill -- shall be reported using the following:
(F) Other Government. Any form of payment from government agencies, whether local, state, federal, or foreign, except those in Subsections (1)(A), (1)(B), (1)(D), or (1)(E) of this section. Includes funds received through the California Children Services (CCS), the Civilian Health and Medical Program of the Uniformed Services (TRICARE), and the Veterans Administration.
(A) Managed Care -- Knox-Keene/Medi-Cal County Organized Health System. Health care service plans, including Health Maintenance Organizations (HMO), licensed by the Department of Managed Health Care under the Knox-Keene Health Care Service Plan Act of 1975. Includes Medi-Cal County Organized Health Systems (COHS).
(B) Managed Care -- Other. Health care plans, except those in Subsection (2)(A) of this section, which provide managed care to enrollees through a panel of providers on a pre-negotiated or per diem basis, usually involving utilization review. Includes Preferred Provider Organization (PPO), Exclusive Provider Organization (EPO), and Point of Service (POS).
(3) Health Plan Identification Number. If Type of Coverage is reported as category (A) above, report the specific plan providing coverage by listing the four digit health plan identification number assigned by the California Department of Managed Health Care (DMHC). If Type of Coverage is reported as category (A) above and if the health plan has a pending Knox-Keene license application with DMHC or if the health plan is a COHS that does not have a DMHC assigned number, the four digit health plan identification number shall be reported as 8000.
Credits
Note: Authority cited: Section 128810, Health and Safety Code. Reference: Section 128735, Health and Safety Code.
History
1. New section filed 10-14-93; operative 11-15-93 (Register 93, No. 42).
2. Amendment filed 7-23-97 pursuant to section 100, title 1, California Code of Regulations (Register 97, No. 30).
3. Amendment of section, including new subsection (a)(3)(A), filed 9-21-98; operative 10-21-98 (Register 98, No. 39).
4. Editorial correction of History 3 (Register 2000, No. 20).
5. Change without regulatory effect repealing subsections (a)-(a)(14), renumbering subsections, amending newly designated subsections (a)(1)(F), (a)(1)(G), (a)(1)(I), (a)(2), (a)(2)(B) and (a)(3)(A), and adopting new subsection (a)(2)(B) filed 5-17-2000 pursuant to section 100, title 1, California Code of Regulations (Register 2000, No. 20).
6. Change without regulatory effect repealing subsection (a)(3)(A), relettering subsections, amending newly designated subsection (a)(3)(A) and adopting new subsection (a)(3)(B) filed 3-8-2004 pursuant to section 100, title 1, California Code of Regulations (Register 2004, No. 11).
7. Amendment of section heading filed 5-5-2005; operative 5-5-2005 pursuant to Government Code section 11343.4 (Register 2005, No. 18).
8. Change without regulatory effect amending subsection (a)(1)(C), repealing subsection (a)(3)(A), relettering former subsection (a)(3)(B) to new subsection (a)(3)(A) and adopting new subsection (a)(3)(B) filed 8-11-2005 pursuant to section 100, title 1, California Code of Regulations (Register 2005, No. 32).
9. Amendment filed 12-31-2009; operative 12-31-2009 pursuant to Government Code section 11343.4 (Register 2010, No. 1).
10. Change without regulatory effect amending section filed 7-21-2010 pursuant to section 100, title 1, California Code of Regulations (Register 2010, No. 30).
11. Change without regulatory effect amending subsection (3) -- Table 1 filed 8-23-2011 pursuant to section 100, title 1, California Code of Regulations (Register 2011, No. 34).
12. Change without regulatory effect amending subsection (3) -- Table 1 filed 12-28-2011 pursuant to section 100, title 1, California Code of Regulations (Register 2011, No. 52).
13. Change without regulatory effect amending subsection (3) -- Table 1 filed 3-25-2013 pursuant to section 100, title 1, California Code of Regulations (Register 2013, No. 13).
14. Change without regulatory effect amending first paragraph, subsections (1) and (3) and subsection (3) -- Table 1 filed 9-23-2013 pursuant to section 100, title 1, California Code of Regulations (Register 2013, No. 39).
15. Change without regulatory effect amending subsection (3) -- Table 1 filed 8-5-2014 pursuant to section 100, title 1, California Code of Regulations (Register 2014, No. 32).
16. Change without regulatory effect amending subsection (3) and Table 1 filed 4-30-2015 pursuant to section 100, title 1, California Code of Regulations (Register 2015, No. 18).
17. Change without regulatory effect amending Table 1 in subsection (3) filed 3-17-2016 pursuant to section 100, title 1, California Code of Regulations (Register 2016, No. 12).
18. Change without regulatory effect amending subsections (1)(F)-(2), (2)(B) and (3) filed 2-8-2018 pursuant to section 100, title 1, California Code of Regulations (Register 2018, No. 6).
19. Editorial correction of subsection (3) -- Table (Register 2018, No. 12).
20. Change without regulatory effect amending subsections (1) and (3) filed 10-31-2018 pursuant to section 100, title 1, California Code of Regulations (Register 2018, No. 44).
21. Change without regulatory effect amending subsections (2)(A) and (3) filed 5-2-2019 pursuant to section 100, title 1, California Code of Regulations (Register 2019, No. 18).
22. Change without regulatory effect amending subsections (2)(A)-(B) and (3) filed 9-23-2019 pursuant to section 100, title 1, California Code of Regulations (Register 2019, No. 39).
This database is current through 5/10/24 Register 2024, No. 19.
Cal. Admin. Code tit. 22, § 97232, 22 CA ADC § 97232
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