Merced County California

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Provider Mandates
Overview

The State of California Extended Access Program (SCEAP) provides a limited source of last resort payments to health care providers for potentially and presently uncollectible amounts.

In order to receive SCEAP funds, providers must follow certain mandates set forth in State legislation. Public and private entities share goals to maintain the health and safety of our community.


Mandates
A few of these mandates include:
  • Welfare and Institutions Code: 16946(b)(1)(D) and 16818 
    • Participating hospitals are required to notify all patients of the availability of reduced cost care.
  • Welfare and Institutions Code: 16942(a) and 19801.1, Health and Safety Codes
    • They may not require a fee or assess a charge before they render medically-necessary services. Eligibility determinations can be made after services, and patients may still be responsible and billed after services are rendered.
  • Health and Safety Code: 1797.98(c)(1) and 1797.98(c)(c); Welfare and Institutions Code: 16947(a)-(c)
    • The provider is required by law to inquire of the patient if there is a responsible third party who will be the source of payment.
    • Payment must not have been made through any program funded in whole or in part by the federal government.
    • The provider must stop any current and waive any future collection efforts to obtain reimbursement from the patient upon receipt of SCEAP monies. (If a provider received payment from a client after having been reimbursed by SCEAP funds, the provider must notify the Merced County Health Department immediately for adjustments to future payments.)


Merced County 2222 M Street Merced, CA 9543 Ph. (209) 385-7434 Toll Free (800) 226-6452