O
n January 1, 2014, eligible
Medi-Cal beneficiaries
will be offered expanded
mental health benefits through
Medi-Cal Managed Care Plans
(MCPs), the FFS delivery systems
and county-administered specialty
mental health services. The DHCS
is in the process of planning
enhancements to managed care
benefits, so in addition to mental
health services determined to be
within the scope of practice of
the PCP, additional outpatient
counseling, testing and psychiatric
consultation are to be made
available.
PCPs will continue to provide
care for Medi-Cal beneficiaries
diagnosed with mild behavioral
disorders and will be relied upon
to offer annual substance use
screening and brief counseling
interventions when indicated in
those with Substance Use Disorder
(SUD). Those who are determined
in need of treatment will be referred
to an appropriate SUD provider
as enhanced SUD counseling
benefits will be administered by
county alcohol and drug programs
under Medi-Cal. In addition to
SUD counseling services, Medi-
Cal FFS is planning improvements
for the availability of medication
treatments to strengthen
detoxification and maintenance
treatments.
Augmentation of behavioral
health interventions available
to PCPs is planned. Medi-Cal
managed care plans will now be
providing group therapy for non-
specialty mental health qualifying
beneficiaries and psychology
services will be broadly available by
licensed psychologists. Managed
care plans will offer the following
non-specialty Mental Health
Services excluding those benefits
provided by county mental health
plans to Medi-Cal beneficiaries:
●●
Individual and group mental
health evaluation and treatment
(psychotherapy).
●●
Psychological testing when
clinically indicated to evaluate a
mental health condition.
●●
Psychiatric consultation.
Changes to the Medi-Cal
mental health and SUD benefits as
described above are in process and
not fully developed. Much work
will need to be completed in a
short time period to further define
responsibilities and programs,
develop provider panels, and
implement these changes. It is
hoped that by offering expanded
services in these areas we can better
coordinate needed care, improve
care in areas that are currently
marginally addressed and improve
the overall health of the population.
Behavioral Health Update
DECEMBER 2013
PAGE
11
of
12
CL INI CAL CORNER
ENSURING ACCESS TO TRANSGENDER SERVICES
Transgender services are available to Medi-Cal beneficiaries.
These services may include psychotherapy, continuous hormonal
therapy, laboratory testing to monitor hormone therapy and
gender reassignment surgery that is not cosmetic in nature. These
services have been available to Medi-Cal beneficiaries since 2001.
Providers must determine the medical necessity of each claim
on a case-by-case basis, in order to determine if the requested
service is covered under Medi-Cal.
