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 4 - Federal Financial Participation
Article 1 - General
Section 1840.100 - Definitions
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) "Claiming" means the process by which MHPs may obtain FFP for the expenditures they have made for specialty mental health services to Medi-Cal beneficiaries.
(b) "Health Care Procedure Coding System (HCPCS)" means a coded listing and description of health care services and items as defined in Title 22, Section 51050, which is prepared and updated annually by the Centers for Medicare and Medicaid Services. HCPCS consists of the Current Procedural Terminology (CPT) Standard Edition, American Medical Association, Fourth Edition, 2001, and each of its subsequent revisions, and other codes and descriptions authorized by the Centers for Medicare and Medicaid Services to describe services and items not contained in the CPT. Unless a different definition is adopted by the Department in Title 22, Division 3, Subdivision 1, Chapter 3, beginning with Section 51000, the definitions of individual HCPCS codes used in this Subchapter are the definitions provided in HCPCS in accordance with Title 22, Section 51050.
(c) "Legal entity" means each MHP and each of the corporations, partnerships, agencies, or individuals providing specialty mental health services under contract with the MHP, except that legal entity does not include individual or group providers, Fee-For-Service/Medi-Cal hospitals or psychiatric nursing facilities.
(d) "Lockout" means a situation or circumstance under which FFP is not available for a specific specialty mental health service. Lockout as used in this Subchapter does not address whether or not the provider of a specific specialty mental health service is entitled to payment for that service from the MHP.
(e) "Reimbursement" means a payment of FFP.
(f) "Service functions" mean mental health services, medication support services, day treatment intensive, day rehabilitation, crisis intervention, crisis stabilization, psychiatric health facility services, and targeted case management in the context of claiming FFP.
(g) "Short-Doyle/Medi-Cal system" means the system operated by the Department for the purpose of claiming FFP for specialty mental health services covered by the MHP other than psychiatric inpatient hospital services in a Fee-For-Service/Medi-Cal hospital or psychiatric nursing facility services.
1. New
subchapter 4, article 1 (sections
1840.100-1840.115) 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 subchapter 4,
article 1 (sections
1840.100-1840.115) 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 subchapter 4,
article 1 (sections
1840.100-1840.115) 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 subsections (b) and (g) 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 14718, Welfare and Institutions Code.
