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 5 - Problem Resolution Processes
Article 2 - Fair Hearing and Notice of Action
Section 1850.215 - Continuation of Services Pending Fair Hearing Decision
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) A beneficiary receiving specialty mental health services pursuant to this Chapter shall have a right to file for continuation of specialty mental health services pending fair hearing pursuant to Title 22, Section 51014.2. The time limits for filing for a continuation of services pursuant to Title 22, Section 51014.2 shall not be extended by a beneficiary's decision to pursue an MHP's beneficiary problem resolution process as described in Section 1850.205.
(b) The MHP shall provide continuation of specialty mental health services pending a fair hearing in accordance with Title 22, Section 51014.2. If an MHP allows providers to deliver specialty mental health services for a set number of visits or a set duration of time without prior authorization, the MHP shall provide continuation of specialty mental health services pending a fair hearing when the MHP denies an MHP payment authorization request from a provider requesting continuation of services beyond the number or duration permitted without prior authorization and the beneficiary files a timely request for fair hearing pursuant to Subsection (a).
(c) For the purpose of this Section, each reference to Medi-Cal managed care plan in Title 22, Section 51014.2, shall mean the MHP.
(d) Before requesting a state fair hearing, the beneficiary must exhaust the MHP's problem resolution processes as described in Section 1850.205.
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will be repealed by operation of law on the following day.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language will be repealed by operation of law on the following day.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: Section 14684, Welfare and Institutions Code.
