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 5 - Problem Resolution Processes › Article 2 - Fair Hearing and Notice of Action › Section 1850.215 - Continuation of Services Pending Fair Hearing Decision

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A
					 beneficiary receiving specialty mental health services pursuant to this Chapter
					 shall have a right to file for continuation of specialty mental health services
					 pending fair hearing pursuant to Title 22, Section
					 51014.2. The time limits for filing for
					 a continuation of services pursuant to Title 22, Section
					 51014.2 shall not be extended by a
					 beneficiary's decision to pursue an MHP's beneficiary problem resolution process as
					 described in Section
					 1850.205.
(b) The MHP shall provide continuation of
					 specialty mental health services pending a fair hearing in accordance with Title 22,
					 Section 51014.2. If an MHP allows providers to
					 deliver specialty mental health services for a set number of visits or a set
					 duration of time without prior authorization, the MHP shall provide continuation of
					 specialty mental health services pending a fair hearing when the MHP denies an MHP
					 payment authorization request from a provider requesting continuation of services
					 beyond the number or duration permitted without prior authorization and the
					 beneficiary files a timely request for fair hearing pursuant to Subsection
					 (a).
(c) For the purpose of this
					 Section, each reference to Medi-Cal managed care plan in Title 22, Section
					 51014.2, shall mean the MHP.
(d) Before requesting a state fair hearing, the
					 beneficiary must exhaust the MHP's problem resolution processes as described in
					 Section 1850.205.
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						will be repealed by operation of law on the following day.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						language will be repealed by operation of law on the following day.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).
Note: Authority cited: Section
						  14680,
						  Welfare and Institutions Code. Reference: Section
						  14684,
						  Welfare and Institutions Code.