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 4 - Federal Financial Participation › Article 1 - General › Section 1840.100 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) "Claiming"
					 means the process by which MHPs may obtain FFP for the expenditures they have made
					 for specialty mental health services to Medi-Cal beneficiaries.
(b) "Health Care Procedure Coding System (HCPCS)"
					 means a coded listing and description of health care services and items as defined
					 in Title 22, Section
					 51050, which is prepared and updated
					 annually by the Centers for Medicare and Medicaid Services. HCPCS consists of the
Current Procedural Terminology (CPT) Standard Edition, American Medical
					 Association, Fourth Edition, 2001
, and each of its subsequent revisions,
					 and other codes and descriptions authorized by the Centers for Medicare and Medicaid
					 Services to describe services and items not contained in the CPT. Unless a different
					 definition is adopted by the Department in Title 22, Division 3, Subdivision
					 1, Chapter 3, beginning with Section
					 51000, the definitions of individual
					 HCPCS codes used in this Subchapter are the definitions provided in HCPCS in
					 accordance with Title 22, Section
					 51050.
(c) "Legal entity" means each MHP and each of the
					 corporations, partnerships, agencies, or individuals providing specialty mental
					 health services under contract with the MHP, except that legal entity does not
					 include individual or group providers, Fee-For-Service/Medi-Cal hospitals or
					 psychiatric nursing facilities.
(d)
					 "Lockout" means a situation or circumstance under which FFP is not available for a
					 specific specialty mental health service. Lockout as used in this Subchapter does
					 not address whether or not the provider of a specific specialty mental health
					 service is entitled to payment for that service from the MHP.
(e) "Reimbursement" means a payment of
					 FFP.
(f) "Service functions" mean mental
					 health services, medication support services, day treatment intensive, day
					 rehabilitation, crisis intervention, crisis stabilization, psychiatric health
					 facility services, and targeted case management in the context of claiming
					 FFP.
(g) "Short-Doyle/Medi-Cal system"
					 means the system operated by the Department for the purpose of claiming FFP for
					 specialty mental health services covered by the MHP other than psychiatric inpatient
					 hospital services in a Fee-For-Service/Medi-Cal hospital or psychiatric nursing
					 facility services.
1. New
						subchapter 4, article 1 (sections
						1840.100-1840.115) 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 subchapter 4,
						article 1 (sections
						1840.100-1840.115) 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 subchapter 4,
						article 1 (sections
						1840.100-1840.115) 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 subsections (b) and (g) 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
						  14718,
						  Welfare and Institutions Code.