1. (a) The organization of each plan shall provide the capability to furnish in a reasonable and efficient manner the health care services for which subscribers and enrollees have contracted. Such organization shall include:

   1. (1) separation of medical services from fiscal and administrative management sufficient to assure the Director that medical decisions will not be unduly influenced by fiscal and administrative management,
   2. (2) staffing in medical and other health services, and in fiscal and administrative services sufficient to result in the effective conduct of the plan's business, and
   3. (3) written procedures for the conduct of the business of the plan, including the provision of health care services, so as to provide effective controls.

Note: Authority cited: Section 1344, Health and Safety Code. Reference: Section 1367, Health and Safety Code.

History

1. Amendment filed 1-12-83; effective thirtieth day thereafter (Register 83, No. 3).

2. Change without regulatory effect amending subsection (a)(1) filed 7-18-2000 pursuant to section 100, title 1, California Code of Regulations (Register 2000, No. 29).