Cal. Code Regs. Tit. 9, § 1810.345 - Scope of Covered Specialty Mental Health Services

Current through Register 2021 Notice, Register No. 40, October 1, 2021

(a) 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 1830.210 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
(2) Have met their share of cost obligations under Title 22, Sections 50651-50659.
(b) Except 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.
(d) In accordance with title 42 CFR section 438.210(a)(3)-(4), the MHP may place appropriate limits on a service.
(e) 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 422.113(c)(1)-(3).
(f) The MHP 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.
(1) 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 provide.
(2) If the Department does not approve the request, the MHP may terminate the contract in accordance with section 1810.323.
(g) 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.

Notes

Cal. Code Regs. Tit. 9, § 1810.345

Note: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5775, 5777, 14007.5, 14011, 14142, 14145 and 14682, 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 day.
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 following day.
4. Editorial correction of History 3 (Register 98, No. 39).
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 section 14680 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).

The following state regulations pages link to this page.



State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.