reglab/statecodes huggingface dataset:
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 1 - General Provisions › Article 3 - Administration › Section 1810.321 - Contract Renewal

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
					 Department may, in its sole discretion renew an MHP contract.
(b) If the MHP chooses non-renewal of the
					 contract, then the MHP shall give the Department at least 180 calendar days prior
					 notice of non-renewal.
(c) If the
					 Department chooses non-renewal of the contract, the Department shall give the MHP at
					 least 180 calendar days prior notice of non-renewal, unless the Department
					 determines that the MHP has not complied with the requirements of law or regulation
					 or terms of the contract, in which case the Department must give at least 90 days
					 prior notice of non-renewal.
(d) Prior
					 to the nonrenewal of this contract and upon request by the Department, the MHP shall
					 assist the State in the orderly transfer of beneficiaries' mental health care. In
					 doing this, the MHP shall make available to the Department copies of medical
					 records, patient files, and any other pertinent information, including information
					 maintained by any subcontractor, necessary for efficient case management of
					 beneficiaries, as determined by the Department. Costs of reproduction shall be borne
					 by the Department. In no circumstance shall a beneficiary be billed for this
					 service.
1. New section
						filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20).
2. New
						subsection (d) filed 10-18-2010; operative 11-17-2010 (Register 2010, No.
						43).
Note: Authority cited: Section
						  14680,
						  Welfare and Institutions Code. Reference: Sections
						  5775,
						  5777
						  and
						  5778,
						  Welfare and Institutions Code.
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 1 - General Provisions › Article 3 - Administration › Section 1810.326 - Practice Guidelines

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The MHP shall comply with title 42 Code of Federal Regulations
						(CFR) section 438.236. This regulation implements,
						interprets and makes specific state statute sections
						5777,
						5778
						and
						14684,
						Welfare and Institutions Code.
1. New section
						filed 10-18-2010; operative 11-17-2010 (Register 2010, No. 43).
Note: Authority cited: Section
						  14684,
						  Welfare and Institutions Code. Reference: Title 42 Code of Federal Regulations,
						  Section 438.236.
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 1 - General Provisions › Article 3 - Administration › Section 1810.330 - Allocation of State Funds to MHPs

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
In consultation with a statewide organization representing
						counties, the Department shall determine the methodology for allocating state funds
						to the MHPs annually. The methodology shall include a determination of the level for
						the Small County Reserve allocation as provided in Section
						5778(j)(2)(A) and (k)
						of the Welfare and Institutions Code. The allocation shall include state funds for
						specialty mental health services covered by the MHP pursuant to Section
						1810.345 that are not eligible for
						federal financial participation pursuant to Subchapter 4, subject to the
						appropriation of such funds by the legislature. State funds based on the allocation
						process shall be provided to each MHP annually in accordance with the terms of its
						contract with the Department and to the Small County Reserve as provided in Section
						5778(j)(2)(A) and (k)
						of the Welfare and Institutions Code.
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: Sections
						  5777
						  and
						  5778,
						  Welfare and Institutions Code.
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 1 - General Provisions › Article 3 - Administration › Section 1810.341 - Small County Reserve Allocation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) MHPs in
					 small counties shall establish the Small County Reserve with funds allocated by the
					 Department pursuant to Section
					 1810.330.
(b) The Small County Reserve may only be used for:
(1) Reimbursement of MHPs in small counties for
					 the cost of psychiatric inpatient hospital services in excess of their
					 allocation.
(2) Purchase of risk
					 reinsurance for MHPs in small counties.
(3) Alternatives to hospitalization as determined
					 by the MHPs in small counties.
(4) Costs
					 associated with the administration of the Reserve.
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 1 - General Provisions › Article 3 - Administration › Section 1810.345 - Scope of Covered Specialty Mental Health Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(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.
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 1 - General Provisions › Article 3 - Administration › Section 1810.350 - Scope of Covered Psychiatric Inpatient Hospital Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An MHP
					 shall be responsible for the MHP payment authorization for psychiatric inpatient
					 hospital services as described in Subsections (b) and (c) and Section
					 1810.345.
(b) Psychiatric Inpatient Hospital Services for a
					 Fee-for-Service/Medi-Cal hospital shall include:
(1) Routine hospital services and
(2) All hospital-based ancillary
					 services.
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 1 - General Provisions › Article 3 - Administration › Section 1810.355 - Excluded Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
MHPs shall not be responsible to provide or arrange and pay
						for the following services:
(a) Medi-Cal
					 services, which are those services described in Title 22, Division 3, Subdivision
					 1, Chapter 3, Section
					 51001 et seq., that are not specialty
					 mental health services for which the MHP is responsible pursuant to Section
					 1810.345.
(1) Prescribed drugs as described in Title 22,
					 Section 51313, and laboratory, radiological, and
					 radioisotope services as described in Title 22, Section
					 51311, are not the responsibility of the
					 MHPs, except when provided as hospital-based ancillary services. Medi-Cal
					 beneficiaries may obtain Medi-Cal covered prescription drugs and laboratory,
					 radiological, and radioisotope services prescribed by licensed mental health
					 professionals acting within their scope of practice and employed by or contracting
					 with the MHP under provisions of Title 22, Division 3, Subdivision
					 1, beginning with Section
					 50000.
(2) Medical transportation services as described
					 in Title 22, Section
					 51323, are not the responsibility of the
					 MHP, except when the purpose of the medical transportation service is to transport a
					 beneficiary receiving psychiatric inpatient hospital services from a hospital to
					 another hospital or another type of 24 hour care facility because the services in
					 the facility to which the beneficiary is being transported will result in lower
					 costs to the MHP.
(3) Physician services
					 as described in Title 22, Section
					 51305, that are not psychiatric services
					 as defined in Section
					 1810.240, even if the services are
					 provided to treat a diagnosis included in Sections
					 1820.205 or
					 1830.205, are not the responsibility of
					 the MHP.
(4) Personal care services as
					 defined in Title 22, Section
					 51183, and as defined by the Department
					 as EPSDT supplemental services pursuant to Title 22, Section
					 51340(e)(3) are not the
					 responsibility of the MHP.
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 1 - General Provisions › Article 3 - Administration › Section 1810.360 - Notification of Beneficiaries

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The MHP
					 shall develop, implement and maintain written policies that address the
					 beneficiary's rights in accordance with title
					 42 CFR section
					 438.100 and shall communicate these policies to
					 its beneficiaries and providers.
(b)
					 Prior to the date the MHP begins operation, the Department shall mail a notice to
					 all beneficiaries in a county containing the following information:
(1) The date the MHP will begin
					 operation.
(2) The name and statewide,
					 toll-free telephone number of the MHP.
(3) The availability of a booklet and provider
					 list that contain the information required by Title 42, Code of Federal Regulations,
					 Section 438.10(f)(6) and
					 (g).
(4) The availability of problem resolution
					 processes, including fair hearings.
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 1 - General Provisions › Article 3 - Administration › Section 1810.365 - Beneficiary Billing

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The MHP of
					 a beneficiary, or an affiliate, vendor, contractor, or sub-subcontractor of the MHP
					 shall not submit a claim to, demand or otherwise collect reimbursement from, the
					 beneficiary or persons acting on behalf of the beneficiary for any specialty mental
					 health services provided under this Chapter or related administrative services such
					 as billing for missed appointments or making copies of client records, except to
					 collect:
(1) Other health care coverage pursuant
					 to Title 22, Section
					 51005.
(2) Share of cost as provided in Title 22,
					 Sections 50657 through
					 50659.
(3) Copayments in accordance with Section
					 14134
					 of the Welfare and Institutions Code and Title 22, Section
					 51004.
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 1 - General Provisions › Article 3 - Administration › Section 1810.370 - MOUs with Medi-Cal Managed Care Plans

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The MHP
					 shall enter into an MOU with any Medi-Cal Managed Care Plan that enrolls
					 beneficiaries covered by the MHP. The MOU shall, at a minimum, address the
					 following:
(1) Referral protocols between plans,
					 including:
(A) How the MHP will provide a referral
					 to the Medi-Cal managed care plan when the MHP determines that the beneficiary's
					 mental illness would be responsive to physical health care based treatment
					 and
(B) How the Medi-Cal managed care
					 plan will provide a referral when the Medi-Cal managed care plan determines
					 specialty mental health services covered by the MHP may be
					 required.
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 1 - General Provisions › Article 3 - Administration › Section 1810.376 - Health Information Systems

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The MHP
					 shall maintain a health information system that collects, analyzes, integrates, and
					 reports data and provides information on areas including, but not limited to,
					 utilization, grievances and appeals as required by title
					 42 CFR section
					 438.242(a).
(b) The basic elements of the health information
					 system as required by title 42
					 CFR section 438.242(b) shall, at
					 a minimum:
(1) collect data on a beneficiary and
					 provider and on services furnished to beneficiaries;
(2) ensure that data received from providers is
					 accurate and complete by verifying the accuracy and timeliness of reported data;
					 screening the data for completeness, logic, and consistency; and collecting service
					 information in standardized formats to the extent feasible and
					 appropriate.
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 1 - General Provisions › Article 3 - Administration › Section 1810.380 - State Oversight

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The MHPs
					 shall be subject to state oversight, including the following:
(1) Site visits and monitoring of data reports
					 from MHPs and claims processing.
(2)
					 Reviews of program and fiscal operations and the books and records of each MHP to
					 verify that medically necessary services are provided in compliance with this
					 Chapter and the contract between the Department and the MHP.
(A) These books and records shall disclose the
					 quantity of covered services provided under this contract, the quality of those
					 services, the manner and amount of payment made for those services, the
					 beneficiaries eligible to receive covered services, the manner in which the MHP
					 administered its daily business, and the cost thereof.
(B) Such books and records shall include, but
					 shall not be limited to, all physical records originated or prepared pursuant to the
					 performance under the MHP's contract including working papers, reports submitted to
					 the Department, financial records, all medical and treatment records, medical charts
					 and prescription files, and other documentation pertaining to services rendered to
					 beneficiaries.
(C) These books and
					 records shall be maintained for a minimum of three years after the final payment is
					 made and all pending matters closed, or, in the event the MHP has been duly notified
					 that the Department, the U.S. Department of Health and Human Services, or the
					 Comptroller General of the United States, or their duly authorized representatives,
					 have commenced an audit or investigation of the contract, until such time as the
					 matter under audit or investigation has been resolved, whichever is
					 later.
(3) Immediate on-site
					 reviews of MHP program operations whenever the Department obtains information
					 indicating that there is a threat to the health or safety of
					 beneficiaries.
(4) Monitoring compliance
					 with problem resolution process requirements contained in Subchapter 5 and the MHP's
					 Implementation Plan.
(5) Monitoring
					 provider contracts to ensure that the MHP enters into necessary contracts with DSH
					 and Traditional Hospitals and that, pursuant to title
					 42 CFR section
					 438.230(a)(1), the MHP is
					 accountable for any functions and responsibilities it has delegated to any
					 subcontractor or another MHP.
(6)
					 Monitoring denials of MHP payment authorizations.
(7) Annual, external, independent reviews of the
					 quality outcomes of, timeliness of, and access to, the services covered by the MHPs
					 as required by Title 42, Code of Federal Regulations, Section
					 438.204.
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 1 - General Provisions › Article 3 - Administration › Section 1810.385 - Civil Penalties

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
					 Department may impose one or more of the civil penalties specified in Subsection (b)
					 upon an MHP that fails to comply with the provisions of Sections
					 5775
					 through
					 5780
					 and
					 14680
					 through
					 14685
					 of the Welfare and Institutions Code, the provisions of this Chapter, or the terms
					 of the MHP's contract with the Department.
(b) Civil penalties imposed by the Department
					 shall be in the amounts specified below with respect to violation of:
(1) The provisions of Sections
					 1810.360,
					 1850.205,
					 1850.210, and
					 1850.215.
(A) First violation: $1,000.
(B) Second and each subsequent violation:
					 $5,000.
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 1 - General Provisions › Article 4 - Standards › Section 1810.405 - Access Standards for Specialty Mental Health Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The MHP of
					 the beneficiary shall be responsible for assuring that the beneficiary has access to
					 specialty mental health services as provided in Section
					 1810.345 and Section
					 1810.350.
(b) Referrals to the MHP for Specialty Mental
					 Health Services may be received through beneficiary self-referral or through
					 referral by another person or organization, including but not limited to:
(1) Physical health care providers
(2) Schools
(3) County welfare departments
(4) Other MHPs
(5) Conservators, guardians, or family
					 members
(6) Law enforcement
					 agencies.
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 1 - General Provisions › Article 4 - Standards › Section 1810.410 - Cultural and Linguistic Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Definitions:
(1) "Key points of contact" means
					 common points of access to specialty mental health services from the MHP, including
					 but not limited to the MHP's beneficiary problem resolution process, county owned or
					 operated or contract hospitals, and any other central access locations established
					 by the MHP.
(2) "Primary language" means
					 that language, including sign language, which must be used by the beneficiary to
					 communicate effectively and which is so identified by the beneficiary.
(3) "Threshold Language" means a language that has
					 been identified as the primary language, as indicated on the MEDS, of 3,000
					 beneficiaries or five percent of the beneficiary population, whichever is lower, in
					 an identified geographic area.
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 1 - General Provisions › Article 4 - Standards › Section 1810.415 - Coordination of Physical and Mental Health Care

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The MHP
					 shall make clinical consultation and training, including consultation and training
					 on medications, available to a beneficiary's health care provider for beneficiaries
					 whose mental illness is not being treated by the MHP or for beneficiaries who are
					 receiving treatment from another health care provider in addition to receiving
					 specialty mental health services from the MHP.
(b) The MHP shall arrange appropriate management
					 of a beneficiary's care, including the exchange of medical information, with a
					 beneficiary's other health care providers or providers of specialty mental health
					 services. The MHP shall maintain the confidentiality of medical records in
					 accordance with State and federal laws and regulations governing the confidentiality
					 of personal or medical information, including mental health information, relating to
					 beneficiaries.
(c) The MHP shall
					 coordinate with pharmacies and Medi-Cal managed care plans as appropriate to assist
					 beneficiaries to receive prescription drugs and laboratory services prescribed
					 through the MHP, including ensuring that any medical justification of the services
					 required for approval of payment to the pharmacy or laboratory is provided to the
					 authorizing entity in accordance with the authorizing entity's procedures.
(d) When the MHP determines that the beneficiary's
					 diagnosis is not included in Section
					 1830.205(b)(1) or is
					 included but would be responsive to physical health care based treatment, the MHP of
					 the beneficiary shall refer the beneficiary to:
(1) A provider outside the MHP, which may include:
(A) Whenever possible, a provider with whom the
					 beneficiary already has a patient-provider relationship;
(B) The Medi-Cal managed care plan in which the
					 beneficiary is enrolled;
(C) A provider
					 in the area who has indicated to the MHP a willingness to accept MHP referrals,
					 including federally qualified health centers, rural health clinics, and Indian
					 health clinics; or
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 1 - General Provisions › Article 4 - Standards › Section 1810.425 - Hospital Selection Criteria

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
An MHP shall establish a hospital selection process that meets
						the following criteria:
(a) The MHP shall
					 require that each hospital:
(1) Comply with federal
					 Medicaid laws, regulations and guidelines and State statutes and regulations and not
					 violate the terms of the contract between the MHP and the Department.
(2) Sign a provider agreement with the
					 Department.
(3) Provide psychiatric
					 inpatient hospital services, within its scope of licensure, to all beneficiaries who
					 are referred by the MHP, unless compelling clinical circumstances exist that
					 contraindicate admission, or the MHP negotiates a different arrangement with the
					 hospital.
(4) Refer beneficiaries for
					 other services when necessary.
(5) Not
					 refuse an admission solely on the basis of age, sex, race, religion, physical or
					 mental disability, or national origin.
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 1 - General Provisions › Article 4 - Standards › Section 1810.430 - Contracting for Psychiatric Inpatient Hospital Service Availability

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An MHP
					 shall contract with DSH and Traditional Hospitals when:
(1) The DSH or Traditional Hospital meets the
					 hospital selection criteria described in the MHP's Implementation Plan as required
					 by Section 1810.310(a)(4).
(2) The DSH is located:
(A) In the same county as the MHP, or
(B) In a different county than the MHP and
					 according to the latest historical Medi-Cal paid claims data, the DSH provides
					 services to beneficiaries of the MHP that account for five percent or twenty
					 thousand dollars, whichever is more, of the total fiscal year
					 Fee-For-Service/Medi-Cal psychiatric inpatient hospital service payments for
					 beneficiaries of the MHP.
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 1 - General Provisions › Article 4 - Standards › Section 1810.435 - MHP Individual, Group and Organizational Provider Selection Criteria

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each MHP
					 shall establish individual, group, and organizational provider selection criteria
					 that comply with the requirements of this Section, the terms of the contract between
					 the MHP and the Department, and the MHP's Implementation Plan pursuant to Section
					 1810.310.
(b) In selecting individual or group providers
					 with which to contract, the MHP shall require that each individual or group
					 provider:
(1) Possess the necessary license or
					 certification to practice psychotherapy independently. Each individual practicing as
					 part of a group provider shall possess the necessary license or
					 certification.
(2) Maintain a safe
					 facility.
(3) Store and dispense
					 medications in compliance with State and federal laws and regulations.
(4) Maintain client records in a manner that meets
					 state and federal standards.
(5) Meet
					 the MHP's Quality Management Program standards.
(6) Meet any additional requirements established
					 by the MHP as part of a credentialing or other evaluation
					 process.
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 1 - General Provisions › Article 4 - Standards › Section 1810.436 - MHP Individual, Group and Organizational Provider Contracting Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) At a
					 minimum, a contract between an MHP and a provider shall meet federal contracting
					 requirements as provided in Title 42, Code of Federal Regulations, Section
					 438.6 (
l
), and shall
					 include the following provisions:
(1) Treatment
					 requirements, as a condition for reimbursement, that ensure beneficiaries will
					 receive the same level of services as provided to all other patients
					 served.
(2) Assurances that
					 beneficiaries will not be discriminated against in any manner.
(3) Specifics of how the provider shall make
					 records available for authorized review for fiscal audits, program compliance and
					 beneficiary complaints.
(4) Language
					 specifying that the rate included in the contract is considered to be payment in
					 full, subject to third party liability and beneficiary share of cost, for the
					 specialty mental health services provided to a beneficiary.
(5) Requirements that the provider adhere to Title
					 XIX of the Social Security Act and conform to other federal and State statutes and
					 regulations.
(6) If the contract is in
					 excess of $10,000 and utilizes State funds, a provision that: "The contracting
					 parties shall be subject to the examination and audit of the Auditor General for a
					 period of three years after final payment under contract (Government Code section
					 8546.7)." The
					 MHP shall also be subject to the examination and audit of the State Auditor General
					 for a period of three years after final payment under contract (Government Code
					 section
					 8546.7).
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 1 - General Provisions › Article 4 - Standards › Section 1810.438 - Alternative Contracts and Payment Arrangements Between MHPs and Providers

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Except as
					 provided in Subsection (d), the MHP shall request approval from the Department to
					 establish a contract with a provider for specialty mental health services where that
					 provider is held financially responsible for specialty mental health services
					 provided to beneficiaries by one or more other providers or to establish a payment
					 arrangement with contract or non-contract providers that would not be allowed under
					 this Chapter absent approval under this Section.
(b) The MHP may request approval from the
					 Department under this Section by submitting a written request to the Department
					 containing a description of:
(1) The proposed
					 contract terms concerning reimbursement or the proposed payment arrangement. For
					 providers that will conduct utilization management activities, the MHP must ensure
					 that the compensation arrangements in the contract are not structured so as to
					 provide incentives for the provider to deny, limit, or discontinue medically
					 necessary services to any beneficiary.
(2) A complete description of the administrative
					 system of the provider and the MHP that will ensure proper payment to the provider,
					 claiming of the FFP available for services provided to Medi-Cal beneficiaries under
					 the Medi-Cal program, and MHP and provider cost reporting. If the contract is in
					 excess of $10,000 and utilizes State funds, a provision that: "The contracting
					 parties shall be subject to the examination and audit of the Auditor General for a
					 period of three years after final payment under contract (Government Code section
					 8546.7)." The
					 MHP shall also be subject to the examination and audit of the State Auditor General
					 for a period of three years after final payment under contract (Government Code
					 section
					 8546.7).
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 1 - General Provisions › Article 4 - Standards › Section 1810.439 - Provider-Beneficiary Communications

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
In compliance with title
						42 CFR section
						438.102(a)(1), the MHP shall not
						prohibit, or otherwise restrict, a licensed, waivered or registered professional as
						defined in sections
						1810.223 and
						1810.254 acting within the lawful scope
						of practice, from advising or advocating on behalf of a beneficiary for whom the
						provider is providing mental health services.
1. New section
						filed 10-18-2010; operative 11-17-2010 (Register 2010, No. 43).
Note: Authority cited: Section
						  14680,
						  Welfare and Institutions Code. Reference: Sections
						  5777,
						  5778
						  and
						  14684,
						  Welfare and Institutions Code, and Title 42 Code of Federal Regulations, Section
						  438.102(a)(1).
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 1 - General Provisions › Article 4 - Standards › Section 1810.440 - MHP Quality Management Programs

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The MHP shall establish a Quality Management Program in
						accordance with the terms of the contract between the MHP and the Department that
						includes at least the following elements:
(a) A Quality Improvement Program responsible for
					 reviewing the quality of specialty mental health services provided to beneficiaries
					 by the MHP that:
(1) Is accountable to the director
					 of the MHP.
(2) Has active involvement
					 in planning, design and execution from:
(A)
					 Providers;
(B) Beneficiaries who have
					 accessed specialty mental health services through the MHP; and
(C) Parents, spouses, relatives, legal
					 representatives, or other persons similarly involved with beneficiaries who have
					 accessed specialty mental health services.
(3) Ensures that the persons participating in the
					 Quality Improvement Program under Subsection (a)(2) shall not be subject to
					 discrimination or any other penalty in their other relationships with the MHP as a
					 result of their role in representing themselves and their constituencies in the
					 Quality Improvement Program.
(4)
					 Includes substantial involvement of a licensed mental health professional.
(5) Conducts monitoring activities including but
					 not limited to review of beneficiary grievances, appeals, expedited appeals, fair
					 hearings, expedited fair hearings, provider appeals, and clinical records
					 review.
(6) Is reviewed by the MHP and
					 revised as appropriate annually.
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 1 - Fiscal Provisions › Section 1820.110 - Rate Setting for Psychiatric Inpatient Hospital Services for Negotiated Rate, Fee-for-Service/Medi-Cal Hospitals

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Except as
					 approved by the Department pursuant to Section
					 1810.438, reimbursement for acute
					 psychiatric inpatient hospital services for each Fee-for-Service/Medi-Cal hospital
					 with a contract with any MHP, shall be based on a per diem rate established through
					 negotiations between the hospital and the MHP in the county in which the hospital is
					 located except when:
(1) The MHP from the county
					 in which the hospital is located delegates the rate negotiation responsibilities to
					 an MHP in another county with the agreement of that MHP.
(2) The MHP from the county in which the hospital
					 is located declines to contract with the hospital or is otherwise exempt from
					 contracting under this Subchapter and another MHP wants to negotiate rates. The MHP
					 shall request approval from the Department to be designated as the negotiator. The
					 Department shall approve the request unless approval has already been given to
					 another MHP.
(3) The hospital is located
					 in a border community and an MHP wants to negotiate rates. The MHP shall request
					 approval from the Department to be designated as the negotiator.
(4) A hospital is owned or operated by the same
					 organizational entity as the MHP. The per diem rate must be submitted by the MHP and
					 approved by the Department. The Department shall approve a per diem rate submitted
					 by the MHP if it is not greater than the highest per diem rate within the State,
					 negotiated by a different MHP for a different hospital.
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 1 - Fiscal Provisions › Section 1820.115 - Rate Setting for Psychiatric Inpatient Hospital Services for Non-Negotiated Rate, Fee-for-Service/Medi-Cal Hospitals

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Reimbursement rates for acute psychiatric inpatient hospital services for each
					 Fee-for-Service/Medi-Cal hospital with no contract with any MHP shall be determined
					 by the Department.
(1) The reimbursement rates in
					 Subsection (a) shall be calculated by the Department prior to the beginning of each
					 fiscal year and shall not be modified for subsequent rate changes among
					 Fee-for-Service/Medi-Cal contract hospitals or the addition of new Fee-for
					 Service/Medi-Cal contract hospitals.
(2)
					 One rate per allowable psychiatric accommodation code per non-negotiated rate,
					 Fee-for-Service/Medi-Cal hospital per Rate Region listed in Subsection (i) shall be
					 established and shall be used by all MHPs.
(3) The rates shall not be subject to
					 retrospective adjustment to cost.
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 1 - Fiscal Provisions › Section 1820.120 - Rate Setting for Psychiatric Inpatient Hospital Services for Short-Doyle/Medi-Cal Hospitals

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Except as
					 approved by the Department pursuant to Section
					 1810.438, reimbursement for acute
					 psychiatric inpatient hospital services for Short-Doyle/Medi-Cal hospitals shall be
					 established in accordance with Section
					 1840.105.
(b) Except as approved by the Department pursuant
					 to Section 1810.438, reimbursement for
					 administrative day services for Short-Doyle/Medi-Cal hospitals shall be established
					 in accordance with Title 22, Section
					 51542.
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: Sections
						  5720
						  and
						  5724,
						  Welfare and Institutions Code.
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 1820.205 - Medical Necessity Criteria for Reimbursement of Psychiatric Inpatient Hospital Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) For
					 Medi-Cal reimbursement for an admission to a hospital for psychiatric inpatient
					 hospital services, the beneficiary shall meet medical necessity criteria set forth
					 in Subsections (a)(1)-(2) below:
(1) One of the
					 following diagnoses in the
Diagnostic and Statistical Manual of Mental
					 Disorders, Fourth Edition, DSM-IV
T
(1994)
, published by
					 the American Psychiatric Association:
(A)
					 Pervasive Developmental Disorders
(B)
					 Disruptive Behavior and Attention Deficit Disorders
(C) Feeding and Eating Disorders of Infancy or
					 Early Childhood
(D) Tic
					 Disorders
(E) Elimination
					 Disorders
(F) Other Disorders of
					 Infancy, Childhood, or Adolescence
(G)
					 Cognitive Disorders (only Dementias with Delusions, or Depressed Mood)
(H) Substance Induced Disorders, only with
					 Psychotic, Mood, or Anxiety Disorder
(I)
					 Schizophrenia and Other Psychotic Disorders
(J) Mood Disorders
(K) Anxiety Disorders
(L) Somatoform Disorders
(M) Dissociative Disorders
(N) Eating Disorders
(O) Intermittent Explosive Disorder
(P) Pyromania
(Q) Adjustment Disorders
(R) Personality Disorders
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 1820.210 - Hospital Utilization Control

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
All hospitals shall comply with Federal requirements for
						utilization control pursuant to Title 42, Code of Federal Regulations, Chapter IV,
						Subchapter C, Part 456, Subpart D. These requirements include certification of need
						for care, evaluation and medical review, plans of care and utilization review plan.
						Each hospital shall establish a Utilization Review Committee to determine whether
						admission and length of stay are appropriate to level of care and to identify
						problems with quality of care. Composition of the committee shall meet the
						requirements of Title 42, Code of Federal Regulations, Chapter IV, Subchapter C,
						Part 456, Subpart D.
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 subsection (a) (Register 2000,
						No. 44).
8. 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: Sections
						  5777
						  and
						  5778,
						  Welfare and Institutions Code.
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 1820.215 - MHP Payment Authorization-General Provisions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The MHP
					 payment authorization shall be determined for:
(1)
					 Fee-for-Service/Medi-Cal hospitals, by an MHP's Point of Authorization.
(2) Short-Doyle/Medi-Cal hospitals contracting
					 with the MHP, by either:
(A) An MHP's Point of
					 Authorization, or
(B) The hospital's
					 Utilization Review Committee, as agreed to in the contract.
(3) Short-Doyle/Medi-Cal hospitals that do not
					 have a contract with the MHP, by an MHP's Point of
					 Authorization.
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 1820.220 - MHP Payment Authorization by a Point of Authorization

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A hospital
					 shall submit a separate written request for MHP payment authorization of psychiatric
					 inpatient hospital services to the Point of Authorization of the beneficiary's MHP
					 for each of the following:
(1) The planned
					 admission of a beneficiary.
(2)
					 Ninety-nine calendar days of continuous service to a beneficiary, if the hospital
					 stay exceeds that period of time.
(3)
					 Upon discharge.
(4) Services that
					 qualify for Medical Assistance Pending Fair Hearing (Aid Paid Pending).
(5) Administrative day services that are requested
					 for a beneficiary.