14184.402.
(a) (1) Section 14059.5 does not preclude coverage for, or reimbursement of, a clinically appropriate and covered mental health or substance use disorder assessment, screening, or treatment service under any of the following circumstances:(A) Before a provider renders their diagnosis.
(B) During a provider’s treatment of a Medi-Cal beneficiary as part of an assessment.
(C) For a provider treating a Medi-Cal beneficiary who has a co-occurring
cooccurring mental health condition and substance use disorder.
(D) For a provider who provides specialty mental health services to a Medi-Cal beneficiary under a contract with a county mental health plan when that beneficiary concurrently receives nonspecialty mental health services from a Medi-Cal managed care plan or under the Medi-Cal fee-for-service delivery system, if those services are coordinated between the specialty and nonspecialty mental health systems and those services are not duplicated.
(E) For a provider who provides nonspecialty mental health services to a Medi-Cal beneficiary pursuant to a contract with a Medi-Cal managed care plan or under the fee-for-service delivery system when that beneficiary concurrently receives
specialty mental health services from a county mental health plan, if those services are coordinated between the nonspecialty and specialty mental health systems and those services are not duplicated.
(2) Section 14059.5 shall not preclude clinically appropriate and covered mental health or substance use disorder services during the assessment process.
(b) The department shall not impose a requirement for a covered diagnosis, such as the diagnoses described under paragraph (1) of subdivision (a) of Section 1820.205, or paragraph (2) of subdivision (b) of Section 1830.205, of Title 9 of the California Code of Regulations, as a condition to receive Medi-Cal specialty mental health services.
(c) (1) The medical necessity criteria for a Medi-Cal beneficiary under 21 years of age in the Drug Medi-Cal Treatment Program and the Drug Medi-Cal organized delivery system shall be consistent with paragraph (1) of subdivision (b) of Section 14059.5.
(2) A provider who treats a Medi-Cal beneficiary under 21 years of age shall only apply the American Society of Addiction Medicine placement criteria when that provider determines placement level following their determination of medical necessity.
(d) A county that does not participate in the Drug Medi-Cal organized delivery system shall provide, or arrange for the provision of all medically necessary services required under the Drug Medi-Cal organized delivery system.
system for an individual under 21 years of age, consistent with the federal requirements for Early and Periodic Screening, Diagnostic, and Treatment services set forth in Section 1396d(r) of Title 42 of the United States Code.
(e) A dispute between a county mental health plan and a Medi-Cal managed care health plan shall not delay the provision of medically necessary services by the county mental health plan or the Medi-Cal managed care health plan. Pending resolution of the dispute, those plans shall comply with Section 1850.525 of Title 9 of the California Code of Regulations.
(f) For the 2022–23 and 2023–24 fiscal years, the department shall include as part of the Medi-Cal program assumptions and estimates, as described under Section 14100.5, a description of all
of the following as it relates to Medi-Cal specialty mental health services:
(1) Documentation requirements, including changes to the documentation requirements for the treatment plan and chart notes.
(2) The status of the proposed transition to Healthcare Common Procedure Coding System Level 1 Code.
(3) Changes to the department’s clinical auditing standards.
(g) (1) The department shall develop, in consultation with county behavioral health directors, consumer advocates, labor organization representing county mental health workers, mental health and substance use disorder treatment providers, standardized screening tools to guide a
referral to a behavioral health delivery system. The department shall develop a standardized screening tool for Medi-Cal beneficiaries who are under 21 years of age and those who are over 21 years of age. The department shall require the use of these standardized screening tools.
(2) The department shall develop, in consultation with county behavioral health directors, consumer advocates, labor organization representing county mental health workers, mental health and substance use disorder treatment providers, standardized statewide transition tools to ensure that Medi-Cal beneficiaries requiring transition between delivery systems receive timely coordinated care. The department shall develop standardized statewide transition tools for Medi-Cal beneficiaries who are under 21 years of age and those who are over 21 years of age.
The department shall require the use of these statewide transition tools.
(3) The department shall field test the tools described under paragraphs (1) and (2) before implementing these tools.
(h) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department, without taking any further regulatory action, shall implement, interpret, and make specific this subdivision by means of all-county letters, plan letters, plan provider bulletins, manuals, plan contract amendments, or similar instructions until regulations are revised or adopted.
(i) By July 1, 2023, the department shall promulgate regulations, as necessary, in accordance with the requirements of
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code.