Current through Register 2021 Notice, Register No. 40, October 1, 2021
The MHP of a beneficiary shall provide or
arrange and pay for specialty mental health services to the beneficiary when
the medical necessity criteria in Sections 1820.205, 1830.205, or
are met and when specialty
mental health services are required to assess whether the medical necessity
criteria are met. The MHP of a beneficiary shall be required to provide
specialty mental health services only to beneficiaries who:
(1) Are eligible to receive Medi-Cal funded
services in a Medi-Cal program under Title 22, Division 3, Subdivision 1,
Chapter 2, Article 5, Section 50201 et seq., or Article 7, Section 50301 et
seq., which includes the provision of specialty mental health services, and
only to the extent the specific specialty mental health services are included
in that Medi-Cal program, and
Have met their share of cost obligations under Title 22, Sections
as provided elsewhere in this Chapter, the MHP shall not be required to
establish a formal arrangement within the MHP's organization or through
contracts with providers for any specific specialty mental health service, but
shall ensure that the type or types of specialty mental health services
provided to each individual beneficiary are adequate to meet the needs of the
beneficiary as described in the medical necessity criteria in Sections
1820.205,1830.205, or 1830.210.
(c) When appropriate based on the mental
health condition of the beneficiary, the MHP of a beneficiary shall ensure that
covered specialty mental health services described in Section 1810.247(a) are
directed toward the maximum reduction of the mental disability and restoration
of the beneficiary to the best possible functional level to the extent required
by the Medi-Cal State Plan under rehabilitative mental health services. The
Medi-Cal State Plan is California's State plan for medical assistance as
described in Title 42, Section 1396 and 1396a, United States Code.
In accordance with title 42 CFR section
(a)(3)-(4), the MHP may place appropriate limits on a service.
Notwithstanding section 1830.220
regarding out-of-plan services, the MHP is financially responsible for
post-stabilization care services obtained within or outside of the MHP's
provider network that are provided in compliance with title 42 CFR section
shall obtain prior approval from the Department if the MHP intends to refuse to
provide or arrange and pay for a covered service because the MHP objects to the
service on moral or religious grounds.
The Department shall approve the request only if the State is able to provide
adequate access to the service or services the MHP does not intend to
(2) If the Department does
not approve the request, the MHP may terminate the contract in accordance with
The Department may exclude psychiatric nursing facility services from the
specialty mental health services covered by the MHP until the Department
determines that all necessary systems are in place at the State level to ensure
proper payment of the providers of psychiatric nursing facility services and
proper claiming of federal funds pursuant to Subchapter 4, beginning with
Section 1840.100. The Department shall insure that the contract between the MHP
and the Department and the allocation to the MHP pursuant to Section 1810.330
reflect the exclusion or inclusion of these services.
Cal. Code Regs.
Tit. 9, §
Note: Authority cited: Section
Welfare and Institutions Code. Reference: Sections
Welfare and Institutions Code; Title 42, United States Code, Section1396 and
1396a; and Title 42 Code of Federal Regulations, Sections438.102(a)(2),
422.113(c)(1)-(3) and 438.114.
1. New section
filed 10-31-97 as an emergency; operative 11-1-97 (Register 97, No. 44). A
Certificate of Compliance must be transmitted to OAL by 3-2-98 or emergency
language will be repealed by operation of law on the following day.
2. New section refiled 3-2-98 as an emergency; operative 3-2-98 (Register 98,
No. 10). A Certificate of Compliance must be transmitted to OAL by 6-30-98 or
emergency language will be repealed by operation of law on the following
3. New section refiled 6-17-98 as an emergency; operative
6-30-98 (Register 98, No. 25). Pursuant to Chapter 324 (Statutes of 1998) Item
4440-103-0001(4), a Certificate of Compliance must be transmitted to OAL by
7-1-99 or emergency language will be repealed by operation of law on the
4. Editorial correction of History 3 (Register 98,
5. Editorial correction extending Certificate of
Compliance date to 7-1-2001 pursuant to Chapter 50 (Statutes of 1999) Item
4440-103-0001(4) (Register 99, No. 33). Notwithstanding any other provision of
law, emergency regulations adopted pursuant to Welfare and Institutions Code
to implement the second phase of mental health managed care as provided in this
part shall remain in effect until permanent regulations are adopted, or June
30, 2006, whichever occurs first.
6. Editorial correction of
History 5 (Register 2000, No. 42).
7. Editorial correction of
History 5 and repealer and new section filed 5-19-2006; operative 6-18-2006
(Register 2006, No. 20).
8. New subsections (d)-(f)(2), subsection
relettering and amendment of Note filed 10-18-2010; operative 11-17-2010
(Register 2010, No. 43).