All Plan Letter 22-006 Medi-Cal Managed Care Health Plan Responsibilities for Non-Specialty Mental Health Services
| Date: | October 20, 2023 |
| To: | Health Plan of San Joaquin (HPSJ) Practitioners and Facilities |
| Type: | Informational/Educational |
| Subject: | All Plan Letter 22-006 Medi-Cal Managed Care Health Plan Responsibilities for Non-Specialty Mental Health Services |
| Business: | Medi-Cal Managed Care |
This is being sent as a reminder on how you can apply the information to your practice or facility operations, where appropriate.
The Department of Health Care Services (DHCS) issued All Plan Letter 22-06 (APL-22-06): https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2022/APL22-006.pdf, “Medi-Cal Managed Care Health Plan Responsibilities for Non-Specialty Mental Health Services” on April 8, 2022. Please see the APL itself for the complete guidance.
This policy was created to explain the responsibilities of Medi-Cal managed care health plans (MCPs) for the provision of arrangement of clinically appropriate and covered non-specialty mental health services (NSMHS) and the regulatory requirements for the Medicaid Mental Health Parity Final Rule (CMS-2333-F). The APL also delineates MCP responsibilities for referring to, and coordinating with, County Mental Health Plans (MHPs) for the delivery of specialty mental health services (SMHS).
Key Information
- Non-specialty mental health (NSHMS) for individuals under 21 years of age are medically necessary if they are needed to correct or ameliorate health conditions, including behavioral health conditions.
- For individuals 21 years of age or older, a service is medically necessary when it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain.
- Guidance for MCP provision of the following NSMHS:
– Mental Health evaluation and treatment, including individual, group and
family psychotherapy
– Psychological and neuropsychological testing, when clinical indicated to evaluate a mental health condition
– Outpatient services for the purposes of monitoring drug therapy
– Psychiatric consultation
– Outpatient laboratory, drugs, supplies, and supplements - Additional guidance for coverage under MCPs:
– Up to 20 individual and/or group counseling sessions for pregnant and postpartum individuals with specified risk factors for perinatal depression
– Emergency room professional services
– Substance use disorder services for members 11 years of age or older - To ensure parity, treatment limitations for mental health benefits may not be more restrictive than the predominant treatment limitations applied to medical or surgical benefits.
- MCP guidance to not require prior authorization for a referral for an initial mental health assessment.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan of San Joaquin and our services is always available on our website https://www.hpsj.com/