California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 4 - Scope and Duration of Benefits › Section 51341 - Short-Doyle Mental Health Medi-Cal Program Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Community mental health services, as
					 defined in this section, provided by Short-Doyle Medi-Cal providers to Medi-Cal
					 beneficiaries are covered by the Medi-Cal program.
(b) Community Mental Health Services.
(1) Acute inpatient hospital service means
					 those services provided by a hospital, including bed and board, to a Medi-Cal
					 beneficiary who needs intense diagnosis and/or treatment of an acute
					 psychiatric condition on a continuous 24-hour a day basis.
(2) Psychiatric health facility services
					 means therapeutic and/or rehabilitation services provided in a non-hospital 24
					 hour inpatient setting, on either a voluntary or involuntary basis. Services
					 are provided to individuals experiencing an acute psychiatric episode or
					 crisis, whose physical health needs can be met in an affiliated hospital or in
					 outpatient settings.
(3) Mental
					 health service means interventions designed to provide the maximum reduction of
					 mental disability and restoration or maintenance of functioning consistent with
					 the requirements for learning, development, independent living and enhanced
					 self-sufficiency. Services shall be directed toward achieving the individual's
					 goals/desired results/personal milestones.
(4) Medication support service means
					 prescribing, administering, dispensing and monitoring of psychiatric
					 medications necessary to alleviate the symptoms of mental illness which are
					 provided by a staff person within the scope of practice of his/her
					 profession.
(5) Day treatment
					 intensive service means services provided by an organized and structured
					 multi-disciplinary treatment program as an alternative to hospitalization, to
					 avoid placement in a more restrictive setting, or to maintain the individual in
					 a community setting. These services are provided to a distinct group of
					 individuals and occur in a therapeutic, organized and structured setting. Day
					 treatment intensive is a packaged program with service available at least three
					 hours and less than 24 hours each day the program is open.
(6) Day rehabilitation service means
					 evaluation, rehabilitation and therapy to maintain or restore personal
					 independence and functioning consistent with requirements for learning and
					 development. It is an organized and structured program which provides services
					 to a distinct group of individuals. Day rehabilitation is a packaged program
					 with service available at least three hours and less than 24 hours each day the
					 program is open.
(7) Adult
					 residential treatment service means rehabilitation services provided in a
					 non-institutional residential setting where individuals are supported in their
					 efforts to restore, maintain and apply interpersonal and independent living
					 skills, and access community support systems. Programs shall provide a
					 therapeutic community including a range of activities and services for
					 individuals who would be at risk of hospitalization or other institutional
					 placement if they were not in the residential treatment program. This is a
					 structured package program with services available day and night, seven days a
					 week.
(8) Crisis residential
					 treatment services means therapeutic and/or rehabilitation services provided in
					 a 24-hour residential treatment program for individuals experiencing an acute
					 psychiatric episode or crisis, and who do not present medical complications
					 requiring nursing care. Individuals are supported in their efforts to restore,
					 maintain and apply interpersonal and independent living skills, and access
					 community support systems. Interventions which focus on symptom reduction shall
					 also be available. This is a structured, packaged program with services
					 available day and night, seven days a week.
(9) Crisis intervention means quick emergency
					 response service enabling the individual to cope with a crisis, while
					 maintaining his/her status as a functioning community member to the greatest
					 extent possible. A crisis is an unplanned event that results in the
					 individual's need for immediate service intervention. Crisis intervention
					 services are limited to stabilization of the presenting emergency.
(10) Crisis Stabilization -- Emergency Room
					 means an immediate face-to-face response lasting less than 24 hours, to or on
					 behalf of an individual exhibiting acute psychiatric symptoms, provided in a
					 24-hour health facility or hospital based outpatient program. The goal is to
					 avoid the need for inpatient services by alleviating problems which, if not
					 treated, present an imminent threat to the individual or other's safety or
					 substantially increase the risk of the individual becoming gravely
					 disabled.
(11) Crisis Stabilization
					 -- Urgent Care means an immediate face-to-face response lasting less than 24
					 hours, to or on behalf of an individual exhibiting acute psychiatric symptoms,
					 provided at a certified Mental Health Rehabilitation provider site. The goal is
					 to avoid the need for inpatient services by alleviating problems and symptoms
					 which, if not treated, present an imminent threat to the individual or other's
					 safety or substantially increase the risk of the individual becoming gravely
					 disabled. Services provided to individuals in a Crisis stabilization -- Urgent
					 Care program are not based in 24-hour health care facilities or hospital based
					 outpatient programs. Services shall be available 24 hours per day.
(12) Case management brokerage means
					 activities provided by program staff to access medical, educational, social,
					 prevocational, vocational, rehabilitative, or other needed community services
					 for eligible individuals.