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 2 - Medi-Cal Psychiatric Inpatient Hospital Services
Article 2 - Provision of Services
Section 1820.200 - Definitions
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) "Adverse Decision" means denial or termination of an MHP payment authorization by the MHP's Point of Authorization or by a Short-Doyle/Medi-Cal hospital's Utilization Review Committee that determines the MHP's authorization for payment.
(b) "Continued Stay Services" means psychiatric inpatient hospital services for beneficiaries that occur after admission.
(c) "County Medical Services Program" means the service delivery and payment system for health care for low-income persons who are not eligible for Medi-Cal and which is administered by the Department for counties.
(d) "Emergency Admission" means an admission of a beneficiary to a hospital due to an emergency psychiatric condition for psychiatric inpatient hospital services.
(e) "Planned Admission" means an admission of a beneficiary to a hospital with a contract with an MHP for the purpose of providing medically necessary treatment that cannot be provided in another setting or a lower level of care and is not an emergency admission. Planned admissions may occur in a non-contract hospital pursuant to the MHP's Implementation Plan, as provided in Section 1810.310(a)(7) of this Chapter.
(f) "Utilization Review Committee" means a committee that reviews services provided to determine appropriateness for psychiatric inpatient hospital services, identifies problems with quality of care, and meets the requirements of Title 42, Code of Federal Regulations, Chapter IV, Subchapter C, Part 456, Subpart D.
1. New article
2 (sections 1820.200-1820.230) and 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repealed by operation of law on the following day.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 article 2
(sections 1820.200-1820.230) and 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repealed by operation of law on the following day.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 article 2
(sections 1820.200-1820.230) and 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 (c) 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: Section 14714, Welfare and Institutions Code.
