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 3 - Administration
Section 1810.355 - Excluded Services

Universal Citation: 9 CA Code of Regs 1810.355

Current through Register 2024 Notice Reg. No. 38, September 20, 2024

MHPs shall not be responsible to provide or arrange and pay for the following services:

(a) Medi-Cal services, which are those services described in Title 22, Division 3, Subdivision 1, Chapter 3, Section 51001 et seq., that are not specialty mental health services for which the MHP is responsible pursuant to Section 1810.345.

(1) Prescribed drugs as described in Title 22, Section 51313, and laboratory, radiological, and radioisotope services as described in Title 22, Section 51311, are not the responsibility of the MHPs, except when provided as hospital-based ancillary services. Medi-Cal beneficiaries may obtain Medi-Cal covered prescription drugs and laboratory, radiological, and radioisotope services prescribed by licensed mental health professionals acting within their scope of practice and employed by or contracting with the MHP under provisions of Title 22, Division 3, Subdivision 1, beginning with Section 50000.

(2) Medical transportation services as described in Title 22, Section 51323, are not the responsibility of the MHP, except when the purpose of the medical transportation service is to transport a beneficiary receiving psychiatric inpatient hospital services from a hospital to another hospital or another type of 24 hour care facility because the services in the facility to which the beneficiary is being transported will result in lower costs to the MHP.

(3) Physician services as described in Title 22, Section 51305, that are not psychiatric services as defined in Section 1810.240, even if the services are provided to treat a diagnosis included in Sections 1820.205 or 1830.205, are not the responsibility of the MHP.

(4) Personal care services as defined in Title 22, Section 51183, and as defined by the Department as EPSDT supplemental services pursuant to Title 22, Section 51340(e)(3) are not the responsibility of the MHP.

(b) Out-of-state specialty mental health services except when it is customary practice for a California beneficiary to receive medical services in a border community outside the State.

(c) Specialty mental health services provided by a hospital operated by the Department or the State Department of Developmental Services.

(d) Specialty mental health services provided to a beneficiary eligible for Medicare prior to the exhaustion of beneficiary's Medicare mental health benefits, unless the services have been denied by Medicare. Administrative day services are excluded only if the beneficiary is in a hospital reimbursed through Medicare (Part A) based on Diagnostic Related Groups (DRGs), when the DRG reimbursement covers administrative day services according to Medicare (Part A).

(e) Specialty mental health services provided to a beneficiary enrolled in a Medi-Cal Managed Care Plan to the extent specialty mental health services are covered by the Medi-Cal Managed Care Plan.

(f) Psychiatric inpatient hospital services received by a beneficiary when services are not billed to an allowable psychiatric accommodation code as defined in Section 1820.100(a).

(g) Medi-Cal services that may include specialty mental health services as a component of a larger service package as follows:

(1) Psychiatrist and psychologist services provided by adult day health centers pursuant to Title 22, Section 54325.

(2) Home and community based waiver services as defined in Title 22, Section 51176.

(3) Psychiatrist services, psychologist services, and EPSDT supplemental specialty mental health services payable by the Medi-Cal fiscal intermediary that are authorized by the California Children's Services (CCS) Program to treat CCS eligible beneficiaries or the Genetically Handicapped Persons Program (GHPP) to treat GHPP eligible beneficiaries.

(4) Local Education Agency (LEA) services as defined in Title 22, Section 51190.4.

(5) Specialty mental health services provided by Federally Qualified Health Centers, Indian Health Centers, and Rural Health Clinics.

(6) Home health agency services as described in Title 22, Section 51337.

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).
8. Change without regulatory effect amending subsection (a)(4) and NOTE filed 8-24-2015 pursuant to section 100, title 1, California Code of Regulations (Register 2015, No. 35).

Note: Authority cited: Sections 10725, 14680 and 14700, Welfare and Institutions Code. Reference: Sections 14681, 14683, 14684, 14685, 14712, 14713, 14714, 14718 and 14721, Welfare and Institutions Code.

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