§ 2699.6703. Excluded Health Benefits.
10 CA ADC § 2699.6703Barclays Official California Code of Regulations
10 CCR § 2699.6703
§ 2699.6703. Excluded Health Benefits.
(6) Experimental or investigational services, including any treatment, therapy, procedure, drug or drug usage, facility or facility usage, equipment or equipment usage, device or device usage, or supply which is not recognized as being in accordance with generally accepted professional medical standards, or for which the safety and efficiency have not been determined for use in the treatment of a particular illness, injury or medical condition for which the item or service in question is recommended or prescribed. This section does not exclude clinical trials for cancer patients as provided pursuant to subsection 2699.6700(a)(21).
(10) Long-term care benefits including long-term skilled nursing care in a licensed facility and respite care are excluded except as a participating health plan shall determine they are less costly, satisfactory alternatives to the basic minimum benefits. This section does not exclude short-term skilled nursing care or hospice benefits as provided pursuant to Subsection 2699.6700(a)(13) and (a)(18).
Credits
Note: Authority cited: Sections 12693.21 and 12693.755, Insurance Code. Reference: Sections 12693.21, 12693.60 and 12693.755, Insurance Code.
History
1. New section filed 2-20-98 as an emergency; operative 2-20-98 (Register 98, No. 8). A Certificate of Compliance must be transmitted to OAL by 6-22-98 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 2-20-98 order transmitted to OAL 6-5-98 and filed 7-15-98 (Register 98, No. 29).
3. Amendment of subsections (a)(8)-(a)(11), new subsection (a)(13) and amendment of Note filed 4-29-2002 as an emergency; operative 4-29-2002 (Register 2002, No. 18). Pursuant to Chapter 946, Statutes of 2000, section 2, a Certificate of Compliance must be transmitted to OAL by 10-28-2002 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 4-29-2002 order, including repealer of subsection (a)(10) and subsection renumbering, transmitted to OAL 10-28-2002 and filed 12-12-2002 (Register 2002, No. 50).
5. Amendment filed 9-15-2008; operative 10-15-2008 (Register 2008, No. 38).
This database is current through 6/7/24 Register 2024, No. 23.
Cal. Admin. Code tit. 10, § 2699.6703, 10 CA ADC § 2699.6703
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