California Code of Regulations › Title 9 - Rehabilitative and Developmental Services › Division 1 - Department of Mental Health › Chapter 11 - Medi-Cal Specialty Mental Health Services › Subchapter 3 - Specialty Mental Health Services Other than Psychiatric Inpatient Hospital Services › Article 2 - Provision of Services › Section 1830.215 - MHP Payment Authorization

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The MHP may
					 require that providers obtain MHP payment authorization of any or all specialty
					 mental health services covered by this Subchapter as a condition of reimbursement
					 for the service in accordance with the provisions of this Section. MHP payment
					 authorization under this Section shall be provided in compliance with timelines and
					 other provisions in title 42, Code of Federal Regulations, Section
					 438.210.
(b) The MHP's authorization function may be
					 assigned to a person, an identified staffing unit, a committee, or an organizational
					 executive who may delegate the authorization function; including any such persons or
					 entities affiliated with a contracting provider to which the MHP has delegated the
					 authorization function.
(c) The
					 individuals who review and approve or deny requests from providers for MHP payment
					 authorization shall be licensed mental health professionals or waivered/registered
					 professionals of the MHP of the beneficiary. Licensed psychiatric technicians and
					 licensed vocational nurses may approve or deny such requests only when the provider
					 indicates that the beneficiary to whom the specialty mental health services will be
					 delivered has an urgent condition as defined in Section
					 1810.253.
(d) The MHP may require that providers obtain MHP
					 payment authorization prior to rendering any specialty mental health service covered
					 by this Subchapter as a condition of reimbursement for the service, except for those
					 services provided to beneficiaries with emergency psychiatric conditions as provided
					 in Sections 1830.230 and
					 1830.245.
(e) Notwithstanding the provisions of Subsections
					 (a) and (d), the MHP shall require that providers obtain MHP payment authorization
					 for day rehabilitation, day treatment intensive and EPSDT supplemental specialty
					 mental health services as required in the MHP contract with the
					 Department.
(f) Notwithstanding the
					 discretion given to MHPs in Subsections (a) and the requirements of Subsection (c),
					 the MHP shall comply with the specific MHP payment authorization requirements of
					 Sections 1830.230,
					 1830.245, and
					 1830.250.
(g) Whether or not the MHP payment authorization
					 of a specialty mental health service is required pursuant to this Section, the MHP
					 may require that providers notify the MHP of their intent to provide the service
					 prior to the delivery of the service.
(1) If the
					 MHP does not require notice or has not informed providers of the notice requirement,
					 MHP payment authorization requests presented for authorization beyond the timelines
					 established by the MHP shall be accepted for consideration by the MHP when the MHP
					 determines that the provider was prevented from submitting a timely request because
					 of a reason that meets one of the criteria specified in Subsections (g)(1)(A)-(B).
					 The MHP may accept MHP payment authorizations requests presented beyond the
					 timelines specified in the Subchapter for other acceptable reasons as determined by
					 the MHP. The provider shall submit factual documentation deemed necessary by the MHP
					 with the MHP payment authorization request. Any additional documentation requested
					 by the MHP shall be submitted within 60 calendar days of the MHP's request. The
					 documentation shall verify that the late submission was due to:
(A) A natural disaster that has:
1. Destroyed or damaged the provider's business
					 office or records, or
2. Substantially
					 interfered with the provider's agent's processing of requests for MHP payment
					 authorization; or