Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) The MHP
shall enter into an MOU with any Medi-Cal Managed Care Plan that enrolls
beneficiaries covered by the MHP. The MOU shall, at a minimum, address the
following:
(1) Referral protocols between plans,
including:
(A) How the MHP will provide a referral
to the Medi-Cal managed care plan when the MHP determines that the beneficiary's
mental illness would be responsive to physical health care based treatment
and
(B) How the Medi-Cal managed care
plan will provide a referral when the Medi-Cal managed care plan determines
specialty mental health services covered by the MHP may be
required.
(2) The availability
of clinical consultation, including consultation on medications, to the Medi-Cal
managed care plan for beneficiaries whose mental illness is being treated by the
Medi-Cal managed care plan.
(3)
Management of a beneficiary's care, including procedures for the exchange of medical
information. The procedures shall ensure that the confidentiality of medical records
is maintained in accordance with State and federal laws and regulations governing
the confidentiality of personal or medical information, including mental health
information, relating to beneficiaries.
(4) Procedures for providing beneficiaries with
services necessary to the treatment of mental illnesses covered by the MHP when
those necessary services are covered by the Medi-Cal managed care plan. The
procedures shall address, but are not limited to:
(A) Prescription drugs and laboratory services
covered by the Medi-Cal managed care plan and prescribed through the MHP.
Prescription drug and laboratory service procedures shall include:
1. The MHP's obligation to provide the names and
qualifications of the MHP's prescribing physicians to the Medi-Cal managed care
plan, if the Medi-Cal managed care plan covers prescription drugs.
2. The Medi-Cal managed care plan's obligation to
provide the Medi-Cal managed care plan's procedures for obtaining authorization of
prescribed drugs and laboratory services and a list of available pharmacies and
laboratories to the MHP, if the Medi-Cal managed care plan covers these
services.
3. The MHP's obligation to
designate a process or entity to receive notices of actions, denials, or deferrals
from the Medi-Cal managed care plan and to provide any additional information
requested in the deferral notice as necessary for a medical necessity determination
by the Medi-Cal managed care plan.
4.
The MHP's obligation to respond by the close of the business day following the day
the deferral notice is received by the MHP.
(B) Emergency room facility and related services
other than specialty mental health services, home health agency services as
described in Title 22, Section
51337, non-emergency medical
transportation, and services to treat the physical health care needs of
beneficiaries who are receiving psychiatric inpatient hospital services, including
the history and physical required upon admission.
(C) Direct transfers between psychiatric inpatient
hospital services and inpatient hospital services required to address a
beneficiary's medical problems based on changes in the beneficiary' mental health or
medical condition.
(5) A
process for resolving disputes between the MHP and the Medi-Cal managed care plan
that includes a means for beneficiaries to receive medically necessary services,
including specialty mental health services and prescription drugs, while the dispute
is being resolved. When the dispute involves the Medi-Cal managed care plan
continuing to provide services to a beneficiary the Medi-Cal managed care plan
believes requires specialty mental health services from the MHP, the MHP shall
identify and provide the Medi-Cal managed care plan with the name and telephone
number of a psychiatrist or other qualified licensed mental health professional
available to provide clinical consultation, including consultation on medications to
the Medi-Cal managed care plan provider responsible for the beneficiary's
care.
(b) If the MHP does not
enter into an MOU with the Medi-Cal managed care plan, the MHP shall not be out of
compliance with this Section provided the MHP establishes to the satisfaction of the
Department that it has made good faith efforts to enter into an MOU.
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
5777.5
and
14681,
Welfare and Institutions Code.
