Current through Register 2024 Notice Reg. No. 52, December 27, 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.
