Medi-Cal behavioral health coverage through the Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) is managed by Health Plan and is available to members in San Joaquin and Stanislaus counties. Please review the grid below to make the appropriate referrals.
| Referral | Action(s) |
Outpatient treatment for mild to moderate mental health conditions, for all ages:
|
Call Health Plan at 1-888-581-7526
Complete and submit to Health Plan the Behavioral Health Services Referral Form. Email: BHCM@hpsj.com |
Behavioral Health treatment for members under 21 years of age:
|
Call Health Plan at 1-888-581-7526 |
Specialty mental health services for serious mental health conditions:
|
Medi-Cal members can self-refer, and/or providers can offer these resources to their patients so their patients can contact:
San Joaquin ACCESS Line: 1-888-468 9370 Stanislaus ACCESS line: 1-888-376-6246 Alpine ACCESS line: 1-800-318-8212 El Dorado ACCESS line: 1-800-929-1955
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| Health Plan is also available to work with the member’s provider to help coordinate the above listed resources on behalf of the member. | |
Substance use disorder services
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San Joaquin
ACCESS Line: 1-888-468 9370 Stanislaus ACCESS line: 1-888-376-6246 Alpine ACCESS line: 1-800-318-8212 El Dorado ACCESS line: 1-800-929-1955
|
For more information on the above services, visit their respective pages:
Health Plan’s Social Services team is available to help with the following:
To make a referral, complete the Case Management Referral Form and send it to Health Plan Behavioral Health and Social Services Department via email or fax, as directed above.
As part of our compliance with the National Committee for Quality Assurance (NCQA) and to ensure alignment with best practices, Health Plan monitors and encourages strong collaboration in the coordination of care between medical and behavioral health care to encourage continuity.
Health Plan provides these services:
Your practice provides these services:
Health Plan covers all medically necessary behavioral health treatment (BHT) for eligible beneficiaries under 21 years of age. This may include children with autism spectrum disorder (ASD) as well as children for whom a physician or psychologist determines it is medically necessary. Consistent with state and federal requirements, a physician or a psychologist must recommend BHT services as medically necessary based on whether BHT services will correct or ameliorate any physical and/or behavioral conditions.
BHT Services are evidenced-based and can include:
Steps for Referral and Evaluation:
Contact Health Plan by calling 1-888-581-7526 (PLAN)
Resources
Department of Health Care Services:
In response to low utilization rates of the Non-Specialty Mental Health Services (NSMHS)/Behavioral Health Benefit, Health Plan developed a NSMHS Outreach and Education Plan to ensure that Members and Primary Care Providers (PCPs) receive annual outreach and education on covered behavioral health services available to members, and how members can access these services.
The goal is to increase member access and utilization of behavioral health services. The PCP outreach and education components of the plan were informed by the Quality Improvement Health Equity Committee (QIHEC).
The Plan was developed with:
Health Plan is dedicated to ensuring that PCPs are updated on covered Non-Specialty Mental Health Services (NSMHS)/Behavioral Health Benefit to ensure that our members get connected to behavioral health services that they need.
For more information, please review:
Health Plan offers support to members and providers through prenatal and postpartum care for our Medi-Cal members through our Me & My Baby Program in order to promote maternal wellbeing.
This includes that, Licensed Health Care Practitioners who offer prenatal and postpartum care, offer:
| Clinical Practice Guidelines and Resource learning The Centers for Medicaid and Medicare have developed a toolkit of many resources for various practices who serve the prenatal and postnatal populations. To learn more, go here. |
Importance of Maternal Mental Health
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| Frequency | Billing | Follow-Up Plan |
|
Required Frequency
|
G8431 should be applied when the screening for depression is being documented as positive and a follow-up plan is documented. |
All members whose screening results indicate a positive identification of potential depression or other mental health condition, may be referred for mental health services.Members may refer directly to our network of providers: |
Substance Use services include Alcohol and Drug Screening, Assessment, Brief Interventions and Referral to Treatment (SABIRT) for members 11 years old and older, including pregnant women. These services are provided by PCPs.
Annual screenings for alcohol and drug use
Unhealthy alcohol and drug use screening must be conducted using validated screening tools. Validated screening tools include, but are not limited to:
Brief Assessment
When a screening is positive, validated assessment tools should be used to determine if unhealthy alcohol use or SUD is present. Validated alcohol and drug assessment tools may be used without first using validated screening tools. Validated assessment tools include, but are not limited to:
NIDA-Modified Alcohol, Smoking and Substance Involvement Screening Test (NM-ASSIST)
Drug Abuse Screening Test (DAST-20)
Alcohol Use Disorders Identification Test (AUDIT)
Brief intervention
Discussing negative consequences that have occurred and the overall severity of the problem;
Supporting the patient in making behavioral changes; and
Discussing and agreeing on plans for follow-up with the patient, including referral to other treatment if indicated.
Referral to treatment
Medi-Cal members have access for Treatment beyond the Scope of a PCP through the Access line available within their county:
San Joaquin
ACCESS Line: 1-888-468-9370
Stanislaus
ACCESS line: 1-888-376-6246
Services within the scope of mental health providers can connect to Carelon at 1-888-581-PLAN (7526)
HPSJ covers a variety of transgender-specific services (gender-affirming care) as a benefit when services are medically necessary. These services include:
Coverage for treatment
Primary care doctor for routine preventative care, regardless of gender marker
Medi-Cal Transgender-specific care
Mental health therapy (unrelated to assessments for gender-affirming care) through HPSJ’s mental health network
For more information about specific coverage for behavioral health services
Behavioral healthcare services are coordinated through Carelon Behavioral Health at 1-888-581-7526 (PLAN)
Posted on October 11th, 2023 and last modified on December 24th, 2024.
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