Free Prohibitions

Providers are prohibited from charging Medi-Cal members for the completion of any form that is required by, or is necessary for the administration of, the Medi-Cal benefit. This includes, but is not limited to, PM-160 Information Only (INF) forms, CMS 1500 and UB-04 claim forms, health education behavioral assessment tools (HEBAT), health histories, patient consent forms, and medical record transfer forms.

The prohibition also extends to the completion of any form related to services covered under the Medi-Cal program. This may include sports physical forms for school athletics, physical exam forms for employment, school or preschool enrollment forms, tuberculosis (TB) testing, and health insurance forms. A provider may not charge a member for completion of a form that certifies that a Medi-Cal-covered service was rendered or documents the findings of the covered service. For example, a provider is reasonably expected to complete a physical release form for a child entering a school athletic program, provided that the child is eligible for the service at the time of request. The provider is expected to complete the release form at no charge, qualifying the release with the date of the covered exam. The prohibition does not apply to the completion of forms and services that are not covered under the Medi-Cal program, in a case where the collection of payments is permitted under a contractual or legal entitlement. Providers also retain the right to charge reasonable fees for copying portions of or complete medical records for a member's use (does not apply if the provider is transferring records to another provider).

All medical services are covered under the Medi-Cal program, including urgent, emergent and preventive services, in addition to screenings, exams or treatments provided off-cycle from the usual periodicity schedule for the provision of pediatric preventive health care services. Child Health and Disability Prevention (CHDP) providers can use the tracking mechanism on the periodicity schedule for the provision of pediatric preventive health care services and as a reminder for when to deliver recommended services. For medically necessary interperiodic health assessments (MNIHAs), complete health assessments may be performed before the next regularly scheduled physical examination when the following situations exist:

• There is a need for a sports or camp physical examination
• The individual is in foster care or out-of-home placement
• There is a need for a school or preschool entrance examination
• There is a need for providing additional anticipatory guidance to the individual or the parent or legal guardian
• There is a history of perinatal problems
• There is evidence of significant developmental disability

For additional information about CHDP health assessment guidelines, refer to the CHDP provider manual.