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 2 - Medi-Cal Psychiatric Inpatient Hospital Services › Article 2 - Provision of Services › Section 1820.200 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) "Adverse
					 Decision" means denial or termination of an MHP payment authorization by the MHP's
					 Point of Authorization or by a Short-Doyle/Medi-Cal hospital's Utilization Review
					 Committee that determines the MHP's authorization for payment.
(b) "Continued Stay Services" means psychiatric
					 inpatient hospital services for beneficiaries that occur after admission.
(c) "County Medical Services Program" means the
					 service delivery and payment system for health care for low-income persons who are
					 not eligible for Medi-Cal and which is administered by the Department for
					 counties.
(d) "Emergency Admission"
					 means an admission of a beneficiary to a hospital due to an emergency psychiatric
					 condition for psychiatric inpatient hospital services.
(e) "Planned Admission" means an admission of a
					 beneficiary to a hospital with a contract with an MHP for the purpose of providing
					 medically necessary treatment that cannot be provided in another setting or a lower
					 level of care and is not an emergency admission. Planned admissions may occur in a
					 non-contract hospital pursuant to the MHP's Implementation Plan, as provided in
					 Section 1810.310(a)(7) of this
					 Chapter.
(f) "Utilization Review
					 Committee" means a committee that reviews services provided to determine
					 appropriateness for psychiatric inpatient hospital services, identifies problems
					 with quality of care, and meets the requirements of Title 42, Code of Federal
					 Regulations, Chapter IV, Subchapter C, Part 456, Subpart D.
1. New article
						2 (sections 1820.200-1820.230) and 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						repealed by operation of law on the following day.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 article 2
						(sections 1820.200-1820.230) and 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 article 2
						(sections 1820.200-1820.230) and 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.
						Change without regulatory effect amending subsection (c) and NOTE filed 8-24-2015
						pursuant to section
						100, title 1, California Code of
						Regulations (Register 2015, No. 35).
Note: Authority cited: Sections
						  10725,
						  14680
						  and
						  14700,
						  Welfare and Institutions Code. Reference: Section
						  14714,
						  Welfare and Institutions Code.