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 1830.250 - MHP Payment Authorization for Psychiatric Nursing Facility Services
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) The following conditions apply to the provisions of psychiatric nursing facility services by the MHP:
(b) A psychiatric nursing facility shall submit a separate written request for MHP payment authorization of psychiatric nursing facility services to the Point of Authorization of the MHP of the beneficiary for each of the following:
(c) Unless there is a contract between the psychiatric nursing facility and the MHP that provides for different time frames, a psychiatric nursing facility shall submit the request for MHP payment authorization for psychiatric nursing facility services to the Point of Authorization of the beneficiary's MHP not later than:
(d) A written request for MHP payment authorization to the Point of Authorization shall be in the form of a Treatment Authorization Request (TAR).
(e) Approval or disapproval for each MHP payment authorization shall be documented by the Point of Authorization in writing on the same TAR on which the psychiatric nursing facility requested MHP payment authorization.
(f) A Point of Authorization shall approve, deny or defer the request for MHP payment authorization within three working days of the receipt of the request. If the request is deferred, the MHP shall advise the psychiatric nursing facility of the additional documentation required by the MHP. The Point of Authorization shall send an approved or denied TAR to the fiscal intermediary within 14 calendar days of the approval or denial.
(g) MHP payment authorizations shall be approved by the MHP's Point of Authorization as follows:
(h) The MHP that approves the MHP payment authorization shall have financial responsibility as described in this Chapter for the services authorized, unless financial responsibility is assigned to another entity pursuant to Sections 1850.405 and 1850.505.
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will be repealed by operation of law on the following day.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, 5778 and 14684, Welfare and Institutions Code; and Title 42, Code of Federal Regulations, Section 438.210.
