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 1 - General Provisions
Article 2 - Definitions, Abbreviations and Program Terms
Section 1810.200 - Action
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
"Action", in the case of a mental health plan (MHP), means:
(a) A denial, modification, reduction or termination of a provider's request for MHP payment authorization of a specialty mental health service covered by the MHP.
(b) A determination by the MHP or its providers that the medical necessity criteria in Section 1830.205(b)(1), (b)(2), (b)(3)(C), or 1830.210(a) have not been met and the beneficiary is not entitled to any specialty mental health services from the MHP.
(c) A failure by the MHP to provide a specialty mental health service covered by the MHP within the timeframe for delivery of the service established by the MHP; or
(d) A failure by the MHP to act within the timeframes for resolution of grievances, appeals, or the expedited appeals established in Subchapter 5, Article 1.
1. Relocation of article 2 heading from preceding section 1810.201 to preceding section 1810.200 and new section filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20).
Note: Authority: Section 14680, Welfare and Institutions Code. Reference: Section 14684, Welfare and Institutions Code; and Title 42, Code of Federal Regulations, Part 438, Subpart F.
