Medi-Cal: mental health services. Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, including specialty mental health services and nonspecialty mental health services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Existing law requires the department to implement managed mental health care for Medi-Cal beneficiaries through contracts with county mental health plans. Under existing law, the county mental health plans are responsible for providing specialty mental health services to enrollees, and Medi-Cal managed care plans deliver nonspecialty mental health services to enrollees. Existing law requires county mental health plans and Medi-Cal managed care plans to be governed by various guidelines, including network adequacy standards and a requirement that a county mental health plan that provides Medi-Cal specialty mental health services enter into a memorandum of understanding with a Medi-Cal managed care plan that provides Medi-Cal health services to some of the same Medi-Cal recipients served by the county mental health plan. Existing regulations provide for a dispute resolution process to be used to resolve matters between a Medi-Cal managed care plan and a county mental health plan.
This bill would require a county mental health plan and a Medi-Cal managed care plan to provide, on a monthly basis, to the respective Medi-Cal managed care plan and county mental health plan a list that identifies specified information, including the contact information of the patient and provider, relating to the members of the respective plans who are receiving, or have received, any specialty mental health services. The bill would require the department to consult with specified subject matter experts, including Medi-Cal beneficiary advocates, to develop implementing guidance to assist plans in meeting these requirements. The bill would require the department to implement, by July 1, 2020, these provisions by any of various means, including plan letters, that direct county mental health plans and Medi-Cal managed care plans to exchange the required information.
This bill would require a county mental health plan and Medi-Cal managed care plan that are unable to resolve a dispute to submit a request for resolution to the department, and to ensure that there is no delay in the provision of medically necessary services pending the resolution of the dispute. The bill would require the department to issue a written decision to the plans within 30 calendar days from receipt of the request.