California Department of Social Services - State Hearings
Division
Notes from the Training Bureau - August 29, 1997
| Item 97-08-01A MC 177S Form and Medi-Cal Paper Cards Are Obsolete |
Effective June 1, 1997, all 58 counties in California are using the Benefit Identification Card (BIC). This card eliminates the need for the MC 177S form. The MC 177S share of cost form is now obsolete in all counties. Some regulations such as Title 22 CCR §50653.3 or §50657 still refer to the MC 177S form. Judges are advised not to cite any reference to the MC 177S form in such regulations.
The following language may be used in the conclusion and order of decisions to advise the claimant what to do if he/she has a share of cost:
CONCLUSION
The county must adjust the claimant’s future shares of cost, or at the claimant’s option, issue the claimant an MC 1054 form to give to the Medi-Cal provider. Once the provider’s claim for services is reimbursed by the fiscal intermediary, the provider is required to refund the difference in the adjusted share of cost to the claimant. However, this state hearing process has no authority to compel a Medi-Cal provider to process the MC 1054 and/or issue such refunds.
ORDER
The claim is granted.
[County name] County at the claimant’s option shall:
Reduce the claimant’s future share of cost as soon as possible to account for all months in which funds in excess of the correct share of cost was paid or obligated toward medical bills.
Or
Issue the claimant an MC 1054 form, with instructions for the claimant to give it to the Medi-Cal provider.