Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) An entity
designated to be an MHP shall submit an Implementation Plan to the Department,
within the time frame established by the Department. The time frame shall be no more
than 180 days and no less than 90 calendar days prior to the date on which the
entity proposes to begin operations. The Implementation Plan shall include:
(1) Procedures for MHP payment authorization of
specialty mental health services by the MHP, including a description of the point of
authorization.
(2) A description of the
process for:
(A) Screening, referral and
coordination with other necessary services, including, but not limited to, substance
abuse, educational, health, housing and vocational rehabilitation
services.
(B) Outreach efforts for the
purpose of providing information to beneficiaries and providers regarding access
under the MHP.
(C) Assuring continuity
of care for beneficiaries receiving specialty mental health services prior to the
date the entity begins operation as the MHP.
(D) Providing clinical consultation and training
to beneficiaries' primary care physicians and other physical health care
providers.
(3) A description
of the processes for problem resolution as required in Subchapter 5.
(4) A description of the provider selection
process, including provider selection criteria consistent with Sections
1810.425 and
1810.435. The entity designated to be
the MHP shall include a Request for Exemption from Contracting in accordance with
Section 1810.430(c) if the
entity decides not to contract with a Traditional Hospital or DSH.
(5) Documentation that demonstrates that the
entity:
(A) Offers an appropriate range of
specialty mental health services that is adequate for the anticipated number of
beneficiaries that will be served by the MHP, and
(B) Maintains a network of providers that is
sufficient in number, mix, and geographic distribution to meet the needs of the
anticipated number of beneficiaries that will be served by the
MHP.
(6) A description of how
the MHP will deliver age-appropriate services to beneficiaries.
(7) The proposed Cultural Competence Plan as
described in Section
1810.410, unless the Department has
determined that the Cultural Competence Plan will be submitted in accordance with
the terms of the contract between the MHP and the Department pursuant to Section
1810.410(c).
(8) A description of a process for planned
admissions in non-contract hospitals if such an admission is determined to be
necessary by the MHP.
(9) A description
of the MHP's Quality Improvement and Utilization Management Programs.
(10) A description of policies and procedures that
assure beneficiary confidentiality in compliance with State and federal laws and
regulations governing the confidentiality of personal or medical information,
including mental health information, relating to beneficiaries.
(11) Other policies and procedures identified by
the Department as relevant to determining readiness to provide specialty mental
health services to beneficiaries as described in this Chapter.
(b) The Department shall review and either
approve, disapprove, or request additional information for each Implementation Plan.
Notices of Approval, Notices of Disapproval and requests for additional information
shall be forwarded to applicant MHP entities within 60 calendar days of the receipt
of the Implementation Plan.
(c) An MHP
shall submit proposed changes to its approved Implementation Plan in writing to the
Department for review.
(1) An MHP shall submit
proposed changes in the policies, processes or procedures that would modify the
MHP's current Implementation Plan prior to implementing the proposed
changes.
(2) An MHP shall submit
documentation establishing its continued capacity to meet the Implementation Plan
requirements of Subsection (a)(5) whenever there is a change in the MHP's operation
that would require a change in services or providers by 25 percent or more of the
beneficiaries who are receiving services from the MHP or a reduction of an average
of 25 percent or more in provider rates for providers of outpatient mental health
services that paid on a fee-for-service basis.
(3) If the changes are consistent with this
Chapter, the changes shall be approved by the Department.
(4) The Department shall provide a Notice of
Approval or a Notice of Disapproval, including the reasons for disapproval, to the
MHP within 30 calendar days after the receipt of the notice from the MHP.
(5) The MHP may implement the proposed changes 30
calendar days from submission to the Department if the Department fails to provide a
Notice of Approval or Disapproval.
1. New section
filed 10-31-97 as an emergency; operative 11-1-97 (Register 97, No. 44). A
Certificate of Compliance must be transmitted to OAL by 3-2-98 or emergency language
will be repealed by operation of law on the following day.
2. New section
refiled 3-2-98 as an emergency; operative 3-2-98 (Register 98, No. 10). A
Certificate of Compliance must be transmitted to OAL by 6-30-98 or emergency
language will be repealed by operation of law on the following day.
3.
New section refiled 6-17-98 as an emergency; operative 6-30-98 (Register 98, No.
25). Pursuant to Chapter 324 (Statutes of 1998) Item 4440-103-0001(4), a Certificate
of Compliance must be transmitted to OAL by 7-1-99 or emergency language will be
repealed by operation of law on the following day.
4. Editorial
correction of HISTORY 3 (Register 98, No. 39).
5. Editorial correction
extending Certificate of Compliance date to 7-1-2001 pursuant to Chapter 50
(Statutes of 1999) Item 4440-103-0001(4) (Register 99, No. 33). Notwithstanding any
other provision of law, emergency regulations adopted pursuant to Welfare and
Institutions Code section
14680
to implement the second phase of mental health managed care as provided in this part
shall remain in effect until permanent regulations are adopted, or June 30, 2006,
whichever occurs first.
6. Editorial correction of HISTORY 5 (Register
2000, No. 42).
7. Editorial correction of HISTORY 5 and repealer and new
section filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20).
Note: Authority cited: Section
14680,
Welfare and Institutions Code. Reference: Sections
5775,
5777,
5778,
14683
and
14684,
Welfare and Institutions Code; and Title 42, Code of Federal Regulations, Section
438.207.
