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 3 - Specialty Mental Health Services Other than Psychiatric Inpatient Hospital Services
Article 2 - Provision of Services
Section 1830.245 - Psychiatric Health Facility Services

Universal Citation: 9 CA Code of Regs 1830.245

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

(a) Notwithstanding any other provision of this Chapter, the medical necessity criteria that apply to psychiatric health facility services are the medical necessity criteria of Section 1820.205.

(b) The MHP may not require a psychiatric health facility to obtain prior authorization for an admission when the beneficiary has an emergency psychiatric condition.

(c) If the MHP requires MHP payment authorization for psychiatric health facility services, MHP payment authorization for the admission of a beneficiary with an emergency psychiatric condition shall be made in accordance with the terms of the contract between the MHP and the psychiatric health facility or with the terms of the contract between another MHP and the psychiatric health facility, if the MHP does not have a contract with the psychiatric health facility and the contract between another MHP and the psychiatric health facility covers the admission. Where there is no contract between an MHP and the psychiatric health facility that covers the admission, the MHP payment authorization shall be approved by the MHP when:

(1) The psychiatric health facility notified the MHP's Point of Authorization within 24 hours of admission of a beneficiary to the facility.

(2) Written documentation that certifies that a beneficiary met the criteria in Section 1820.225(b) at the time of admission, for the day of admission, and for any additional days prior to discharge during which the beneficiary received psychiatric health facility services, has been provided to the MHP within 14 calendar days of discharge or after the beneficiary has received 99 continuous calendar days of psychiatric health facility services, whichever is sooner.

(3) If, after the emergency admission, the MHP of the beneficiary requests transfer of the beneficiary to a psychiatric health facility contracting with the MHP, a contract hospital, or a psychiatric health facility or hospital owned or operated by the MHP of the beneficiary and the psychiatric health facility does not transfer the beneficiary, documentation shall include evidence that the beneficiary could not be safely transferred. An acute patient shall be considered stable when no deterioration of the patient's condition is likely, within reasonable medical probability, to result from or occur during the transfer of the patient from the psychiatric health facility.

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 and 14684, Welfare and Institutions Code.

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