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 2 - Medi-Cal Psychiatric Inpatient Hospital Services › Article 2 - Provision of Services › Section 1820.225 - MHP Payment Authorization for Emergency Admissions by a Point of Authorization

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The MHP
					 shall not require a hospital to obtain prior MHP payment authorization for an
					 emergency admission, whether voluntary or involuntary.
(b) The hospital providing emergency psychiatric
					 inpatient hospital services shall assure that the beneficiary meets the criteria for
					 medical necessity in Section
					 1820.205, and due to a mental disorder,
					 is:
(1) A current danger to self or others,
					 or
(2) Immediately unable to provide
					 for, or utilize, food, shelter or clothing.
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 1820.230 - MHP Payment Authorization by a Utilization Review Committee

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) MHP payment
					 authorization for psychiatric inpatient hospital services provided by a
					 Short-Doyle/Medi-Cal hospital, if not made by an MHP's Point of Authorization
					 pursuant to Section
					 1820.220, shall be made by the
					 hospital's Utilization Review Committee.
(1) The
					 hospital's Utilization Review Committee shall meet the Federal requirements for
					 participants pursuant to Title 42, Code of Federal Regulations, Chapter IV,
					 Subchapter C, Part 456, Subpart D.
(2)
					 The decision regarding MHP payment authorization shall be documented in writing by
					 the hospital's Utilization Review Committee.
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 › Section 1830.100 - General Provisions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
This Subchapter applies to specialty mental health services
					 other than psychiatric inpatient hospital services.
1. New subchapter
					 3 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 3 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 3 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).
Note: Authority cited: Section
						14680,
						Welfare and Institutions Code. Reference: Sections
						5777
						and
						14684,
						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 3 - Specialty Mental Health Services Other than Psychiatric Inpatient Hospital Services › Article 1 - Fiscal Provisions › Section 1830.115 - Psychiatric Nursing Facility Services Rates

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Except as approved by the Department pursuant to Section
						1810.438, the rate for psychiatric
						nursing facility services shall be the rate established by the Department in
						accordance with Title 22, Sections
						51510,
						51511,
						51511.1,
						51535, and
						51535.1. The nursing facility shall bill
						its usual and customary charges. The rate established by this Section less third
						party liability and beneficiary share of cost shall be considered payment in full
						for the scope of services described in those Sections provided to the
						beneficiary.
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).
8.
						Change without regulatory effect amending section 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: Sections
						  14684,
						  14714
						  and
						  14718,
						  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 3 - Specialty Mental Health Services Other than Psychiatric Inpatient Hospital Services › Article 2 - Provision of Services › Section 1830.205 - Medical Necessity Criteria for MHP Reimbursement of Speciality Mental Health Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
					 following medical necessity criteria determine Medi-Cal reimbursement for specialty
					 mental health services that are the responsibility of the MHP under this Subchapter,
					 except as specifically provided.
(b) The
					 beneficiary must meet criteria outlined in Subsections (1)-(3) below to be eligible
					 for services:
(1) Have one of the following
					 diagnoses in the
Diagnostic and Statistical Manual of Mental Disorders,
					 DSM-IV
T
, Fourth Edition (1994)
, published by the American
					 Psychiatric Association:
(A) Pervasive
					 Developmental Disorders, except Autistic Disorders
(B) Disruptive Behavior and Attention Deficit
					 Disorders
(C) Feeding and Eating
					 Disorders of Infancy and Early Childhood
(D) Elimination Disorders
(E) Other Disorders of Infancy, Childhood, or
					 Adolescence
(F) Schizophrenia and other
					 Psychotic Disorders, except Psychotic Disorders due to a General Medical
					 Condition
(G) Mood Disorders, except
					 Mood Disorders due to a General Medical Condition
(H) Anxiety Disorders, except Anxiety Disorders
					 due to a General Medical Condition
(I)
					 Somatoform Disorders
(J) Factitious
					 Disorders
(K) Dissociative
					 Disorders
(L) Paraphilias
(M) Gender Identity Disorder
(N) Eating Disorders
(O) Impulse Control Disorders Not Elsewhere
					 Classified
(P) Adjustment
					 Disorders
(Q) Personality Disorders,
					 excluding Antisocial Personality Disorder
(R) Medication-Induced Movement Disorders related
					 to other included diagnoses.
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 1830.210 - Medical Necessity Criteria for MHP Reimbursement for Specialty Mental Health Services for Eligible Beneficiaries Under 21 Years of Age

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) For
					 beneficiaries under 21 years of age who are eligible for EPSDT supplemental
					 specialty mental health services, and who do not meet the medical necessity
					 requirements of Section
					 1830.205(b)(2)-(3),
					 medical necessity criteria for specialty mental health services covered by this
					 Subchapter shall be met when all of the following exist:
(1) The beneficiary meets the diagnosis criteria
					 in Section 1830.205(b)(1),
(2) The beneficiary has a condition that would not
					 be responsive to physical health care based treatment, and
(3) The requirements of Title 22, Section
					 51340(e)(3)(A) are met
					 with respect to the mental disorder; or, for targeted case management services, the
					 service to which access is to be gained through case management is medically
					 necessary for the beneficiary under Section
					 1830.205 or under Title 22, Section
					 51340(e)(3)(A) with
					 respect to the mental disorder and the requirements of Title 22, Section
					 51340(f) are
					 met.
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 1830.230 - Psychiatric Inpatient Hospital Professional Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Notwithstanding any other provisions of this Chapter, the medical necessity criteria
					 that apply to psychiatric inpatient hospital professional services are the medical
					 necessity criteria in Section
					 1820.205.
(b) When the beneficiary is admitted to a
					 Fee-for-Service/Medi-Cal hospital, the MHP shall not require prior authorization of
					 psychiatric inpatient hospital professional services that do not exceed one service
					 per day of acute psychiatric inpatient hospital services. On the day of admission,
					 the MHP shall not require prior authorization of a psychiatrist service or a mental
					 health or medication support service by a physician in addition to a service by an
					 admitting licensed mental health professional who is not a physician.
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
						  14684,
						  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 3 - Specialty Mental Health Services Other than Psychiatric Inpatient Hospital Services › Article 2 - Provision of Services › Section 1830.245 - Psychiatric Health Facility Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Notwithstanding any other provision of this Chapter, the medical necessity criteria
					 that apply to psychiatric health facility services are the medical necessity
					 criteria of Section
					 1820.205.
(b) The MHP may not require a psychiatric health
					 facility to obtain prior authorization for an admission when the beneficiary has an
					 emergency psychiatric condition.
(c) If
					 the MHP requires MHP payment authorization for psychiatric health facility services,
					 MHP payment authorization for the admission of a beneficiary with an emergency
					 psychiatric condition shall be made in accordance with the terms of the contract
					 between the MHP and the psychiatric health facility or with the terms of the
					 contract between another MHP and the psychiatric health facility, if the MHP does
					 not have a contract with the psychiatric health facility and the contract between
					 another MHP and the psychiatric health facility covers the admission. Where there is
					 no contract between an MHP and the psychiatric health facility that covers the
					 admission, the MHP payment authorization shall be approved by the MHP when:
(1) The psychiatric health facility notified the
					 MHP's Point of Authorization within 24 hours of admission of a beneficiary to the
					 facility.
(2) Written documentation that
					 certifies that a beneficiary met the criteria in Section
					 1820.225(b) at the time
					 of admission, for the day of admission, and for any additional days prior to
					 discharge during which the beneficiary received psychiatric health facility
					 services, has been provided to the MHP within 14 calendar days of discharge or after
					 the beneficiary has received 99 continuous calendar days of psychiatric health
					 facility services, whichever is sooner.
(3) If, after the emergency admission, the MHP of
					 the beneficiary requests transfer of the beneficiary to a psychiatric health
					 facility contracting with the MHP, a contract hospital, or a psychiatric health
					 facility or hospital owned or operated by the MHP of the beneficiary and the
					 psychiatric health facility does not transfer the beneficiary, documentation shall
					 include evidence that the beneficiary could not be safely transferred. An acute
					 patient shall be considered stable when no deterioration of the patient's condition
					 is likely, within reasonable medical probability, to result from or occur during the
					 transfer of the patient from the psychiatric health facility.
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 1830.250 - MHP Payment Authorization for Psychiatric Nursing Facility Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
					 following conditions apply to the provisions of psychiatric nursing facility
					 services by the MHP:
(1) The MHP of the
					 beneficiary shall not exclude any nursing facility that is licensed and certified to
					 provide psychiatric nursing facility services and is in good standing with the
					 Medi-Cal program from providing services to the beneficiary on the grounds that the
					 facility would be providing out-of-plan services pursuant to Section
					 1830.220.
(2) Psychiatric nursing facility services shall be
					 billed by the psychiatric nursing facility to the fiscal intermediary, rather than
					 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 4 - Federal Financial Participation › Article 1 - General › Section 1840.105 - General

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Except as
					 provided in this Subchapter, FFP for specialty mental health services shall be based
					 on the lowest of the following:
(1) The provider's
					 usual and customary charge to the general public for the same or similar services,
					 unless the provider is a nominal charge provider pursuant to Medicare rules at Title
					 42, Code of Federal Regulations, Section
					 413.13.
(2) The provider's reasonable and allowable cost
					 of rendering the services, based on year-end cost reports and Medicare principles of
					 reimbursement pursuant to Title 42, Code of Federal Regulations, Part 413 and as
					 described in HCFA Publication 15-1, for providers not contracting on a negotiated
					 rate basis.
(3) The negotiated rates for
					 providers, including the MHP, contracting on a negotiated rate basis pursuant to
					 Subchapter 2, Article 1, beginning with Section
					 1820.100; Subchapter 3, Article 1,
					 beginning with Section
					 1830.100; or Sections
					 5705
					 or
					 5716
					 of the Welfare and Institutions Code.
(4) The maximum allowances established by Title
					 22, Section 51516, except that the definitions of
					 individual specialty mental health services shall be the definitions in this
					 Chapter. When crisis stabilization is claimed under this Subchapter, the maximum
					 allowance provided in Title 22, Section
					 51516, for "crisis
					 stabilization-emergency room" shall apply when the service is provided in a 24-hour
					 facility, including a hospital outpatient department. The maximum allowance for
					 "crisis stabilization-urgent care" shall apply when the service is provided in any
					 other appropriate site.
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 1840.110 - Claims Submission

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Except as
					 otherwise provided in this Subchapter, the MHP shall submit all claims for specialty
					 mental health services provided to Medi-Cal beneficiaries by the MHP through the
					 Short-Doyle/Medi-Cal system.
(b) Except
					 for good cause, as specified in Title 22, Section
					 51008.5, and approved by the State
					 Department of Health Services, claims for specialty mental health services shall be
					 presented to the Department no later than six months after the month of service. The
					 Department shall present such claims to the State Department of Health Services no
					 later than seven months after the date of service.
(c) The Department shall resubmit a claim, which
					 has been returned by the State Department of Health Services for correction or
					 additional information, no later than three months after the month in which the
					 claim was returned by the State Department of Health Services.
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
						  5778
						  and
						  14021.5,
						  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 4 - Federal Financial Participation › Article 1 - General › Section 1840.112 - MHP Claims Certification and Program Integrity

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each MHP
					 shall comply with all state and federal statutory and regulatory requirements for
					 certification of claims, including Title 42, Code of Federal Regulations Sections
					 438.604,
					 438.606, and Section
					 438.608, which are hereby incorporated
					 by reference.
(b) Each MHP shall certify
					 to the Department, in writing, each monthly claim prior to submission to the State
					 for reimbursement. The certification shall attest to the following for each
					 beneficiary with services included in the claim:
(1) An assessment of the beneficiary was conducted
					 in compliance with the requirements established in the MHP contract with the
					 Department.
(2) The beneficiary was
					 eligible to receive Medi-Cal services at the time the services were provided to the
					 beneficiary.
(3) The services included
					 in the claim were actually provided to the beneficiary.
(4) Medical necessity was established for the
					 beneficiary as defined under this chapter for the service or services provided, for
					 the timeframe in which the services were provided.
(5) A client plan was developed and maintained for
					 the beneficiary that met all client plan requirements established in the MHP
					 contract with the Department
(6) For
					 each beneficiary with day rehabilitation, day treatment intensive or EPSDT
					 supplemental specialty mental health services included in the claim, all
					 requirements for MHP payment authorization in the MHP contract for day
					 rehabilitation, day treatment intensive and EPSDT supplemental specialty mental
					 health services were met, and any reviews for such service or services were
					 conducted prior to the initial authorization and any re-authorization periods as
					 established in the MHP contract with the Department.
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 1840.115 - Alternative Contract Provider Rates

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
FFP for payments to providers by the MHP based on Section
						1810.438 shall be claimed on the basis
						of actual services provided in accordance with articles 2 and 3 of this
						Subchapter.
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
						  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 4 - Federal Financial Participation › Article 2 - Psychiatric Inpatient Hospital Services › Section 1840.205 - General

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) FFP for
					 Short-Doyle/Medi-Cal hospitals shall be claimed through the Short-Doyle/Medi-Cal
					 system in accordance with Section
					 1840.110.
(b) FFP for Fee-For-Service/Medi-Cal hospitals
					 shall be claimed by the State Department of Health Services in the same manner as
					 FFP is claimed for other Medi-Cal services billed to the fiscal
					 intermediary.
1. New article
						2 (sections 1840.205-1840.215) 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 1840.205-1840.215) 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 1840.205-1840.215) 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 NOTE filed 7-29-2014 pursuant to section
						100, title 1, California Code of
						Regulations (Register 2014, No. 31).
Note: Authority cited: Sections
						  14680
						  and
						  14700,
						  Welfare and Institutions Code. Reference: Section
						  14718,
						  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 4 - Federal Financial Participation › Article 2 - Psychiatric Inpatient Hospital Services › Section 1840.210 - Non-Reimbursable Psychiatric Inpatient Hospital Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The MHP may
					 claim FFP for psychiatric inpatient hospital services in a psychiatric health
					 facility that is larger than 16 beds and is certified by the Department as a
					 Medi-Cal provider of inpatient hospital services or an acute psychiatric hospital
					 that is larger than 16 beds only under the following conditions:
(1) The beneficiary is 65 years of age or older,
					 or
(2) The beneficiary is under 21 years
					 of age, or
(3) The beneficiary was
					 receiving such services prior to his/her twenty-first birthday and the services are
					 rendered without interruption until no longer required or his/her twenty-second
					 birthday, whichever is earlier.
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 2 - Psychiatric Inpatient Hospital Services › Section 1840.215 - Lockouts for Psychiatric Inpatient Hospital Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
					 following services are not reimbursable on days when psychiatric inpatient hospital
					 services are reimbursed, except for the day of admission to psychiatric inpatient
					 hospital services:
(1) Adult Residential Treatment
					 Services,
(2) Crisis Residential
					 Treatment Services,
(3) Crisis
					 Intervention,
(4) Day Treatment
					 Intensive,
(5) Day
					 Rehabilitation,
(6) Psychiatric Nursing
					 Facility Services, except as provided in Subsection (b),
(7) Crisis Stabilization, and
(8) Psychiatric Health Facility
					 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 4 - Federal Financial Participation › Article 3 - Specialty Mental Health Services Other than Psychiatric Inpatient Hospital Services › Section 1840.302 - Psychiatric Nursing Facility Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
FFP for psychiatric nursing facility services shall be claimed
						by the Department in the same manner as FFP is claimed for other Medi-Cal services
						billed to the fiscal intermediary.
1. New article
						3 (sections 1840.302-1840.374) 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 3
						(sections 1840.302-1840.374) 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 3
						(sections 1840.302-1840.374) 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 section 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.
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 3 - Specialty Mental Health Services Other than Psychiatric Inpatient Hospital Services › Section 1840.306 - Psychiatrist, Psychologist, and EPSDT Supplemental Specialty Mental Health Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
FFP for psychiatrist, psychologist, and EPSDT supplemental
						specialty mental health services shall be claimed through the Short-Doyle/Medi-Cal
						system in accordance with Section
						1840.110, based on the provisions of
						Section 1840.304, including the crosswalk
						identified in Section
						1840.304(a), unless the
						terms of the contract between provider and the MHP require the provider to provide
						and bill for services in accordance with Section
						1840.308. The dollar amount claimed
						shall be in accordance with Section
						1840.105.
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
						  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 4 - Federal Financial Participation › Article 3 - Specialty Mental Health Services Other than Psychiatric Inpatient Hospital Services › Section 1840.308 - Service Functions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
FFP for service functions shall be claimed through the
						Short-Doyle/Medi-Cal system in accordance with Section
						1840.110. To be eligible for
						reimbursement, each service function shall have been provided in accordance with
						Sections 1840.314 through
						1840.372. The services may be delivered
						either by individual, group, or organizational providers. The dollar amount claimed
						shall be in accordance with Section
						1840.105.
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
						  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 4 - Federal Financial Participation › Article 3 - Specialty Mental Health Services Other than Psychiatric Inpatient Hospital Services › Section 1840.312 - Non-Reimbursable Services-General

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The following services are not eligible for FFP:
(a) Academic educational services.
(b) Vocational services that have as a purpose
					 actual work or work training.
(c)
					 Recreation.
(d) Socialization is not
					 reimbursable if it consists of generalized group activities that do not provide
					 systematic individualized feedback to the specific targeted behaviors of the
					 beneficiaries involved.
(e) Board and
					 care costs for Adult Residential Treatment Services, Crisis Residential Treatment
					 Services, and Psychiatric Health Facility Services.
(f) Medi-Cal program benefits that are excluded
					 from coverage by the MHP as described in Section
					 1810.355.
(g) Specialty mental health services covered by
					 this Article provided during the time a beneficiary 21 years of age through 64 years
					 of age resides in any institution for mental diseases, unless:
(1) The beneficiary was receiving, prior to
					 his/her twenty-first birthday, services in an institution for mental diseases and
					 the services are rendered without interruption until no longer required or his/her
					 twenty-second birthday, whichever is earlier; and
(2) The facility has been accredited in accordance
					 with Title 42, Code of Federal Regulations, Section
					 440.160, and complies with Title 42,
					 Code of Federal Regulations, 441.150 through 441.156. Facilities at which FFP may be
					 available include but are not limited to acute psychiatric hospitals and psychiatric
					 health facilities certified by the Department as a Medi-Cal provider of inpatient
					 hospital 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 4 - Federal Financial Participation › Article 3 - Specialty Mental Health Services Other than Psychiatric Inpatient Hospital Services › Section 1840.314 - Claiming for Service Functions-General

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
In order to receive FFP for provider payments made by the MHP
						or for services delivered directly by the MHP, the MPH must assure that the
						following requirements are met for all service functions:
(a) The provider must meet the standards for
					 participation in the Medi-Cal program as established under Titles XVIII and XIX of
					 the Social Security Act.
(b) Contacts
					 with significant support persons in the beneficiary's life are directed exclusively
					 to the mental health needs of the beneficiary.
(c) When services are being provided to or on
					 behalf of a beneficiary by two or more persons at one point in time, each person's
					 involvement shall be documented in the context of the mental health needs of the
					 beneficiary.
(d) Services shall be
					 provided within the scope of practice of the person delivering service, if
					 professional licensure is required for the service.
(e) Services shall be provided:
(1) Under the direction of one or more of the
					 following:
(A) Physician
(B) Psychologist
(C) Licensed Clinical Social Worker
(D) Marriage and Family Therapist
(E) Registered Nurse
(F) Waivered/Registered Professional when
					 supervised by a licensed mental health professional in accordance with laws and
					 regulations governing the registration or waiver.
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 3 - Specialty Mental Health Services Other than Psychiatric Inpatient Hospital Services › Section 1840.316 - Claiming for Service Functions Based on Minutes of Time

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) For the
					 following services the billing unit is the time of the person delivering the service
					 in minutes of time:
(1) Mental Health
					 Services
(2) Medication Support
					 Services
(3) Crisis
					 Intervention
(4) Targeted Case
					 Management
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 3 - Specialty Mental Health Services Other than Psychiatric Inpatient Hospital Services › Section 1840.318 - Claiming for Service Functions on Half Days or Full Days of Time

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Day
					 treatment intensive and day rehabilitation shall be billed as half days or full days
					 of service.
(b) The following
					 requirements apply for claiming of services based on half days or full days of time:
(1) A half-day shall be billed for each day in
					 which the beneficiary receives face-to-face services in a program with services
					 available four hours or less per day. Services must be available a minimum of three
					 hours each day the program is open.
(2)
					 A full day shall be billed for each day in which the beneficiary receives
					 face-to-face services in a program with services available more than four hours per
					 day.
(3) Although the beneficiary must
					 receive face-to-face services on any full day or half-day claimed, all service
					 activities during that day are not required to be face-to-face with the
					 beneficiary.
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 3 - Specialty Mental Health Services Other than Psychiatric Inpatient Hospital Services › Section 1840.320 - Claiming for Service Functions Based on Calendar Days

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
					 following services are reimbursed based on calendar days:
(1) Adult Residential Treatment Services
(2) Crisis Residential Treatment
					 Services
(3) Psychiatric Health Facility
					 Services.