Who is impacted and when: No sooner than Feb 1, 2016, approximately 13,000 California children under 21 with ASD who currently receive behavioral health treatments services from a regional center will be transitioned to a MediCal managed care plan. All of those 13,000 children however will continue to receive any other non-behavioral health treatment services from their regional center. Children who are MediCal eligible with ASD but not eligible for regional center services are also eligible to receive behavioral health services under a MediCal managed care plan. For example, in Santa Clara County, Santa Clara County Family Health, a managed MediCal health care plan would begin to provide the behavioral health care.
Who is not impacted: Those children with autism spectrum disorders who receive or who need similar behavioral health treatment services but are not eligible for Medi-Cal or regional center funded services. Additionally, children who are regional center clients but have private health insurance. The private health insurance company would continue to pay for behavioral health services. Co pays and deductibles may be paid by the RC. Adults who are receiving behavioral health services would continue to be under the RC for services.
Continuity of Care: To ensure no disruption in behavioral health treatment services, the transition plan provides those children and their families with an “opportunity to stay with their same provider and assist with a smooth transition for those children when accessing new services through Medi-Cal managed care”. The transition plan requires that the new Managed Care plan must initiate a continuity of care agreement.
According to the final transition plan, the Medi-Cal managed health care plan must enter into a continuity of care agreement for up to 12 months when the following conditions are met:
- The beneficiary has a pre-existing relationship with the provider;
- The Medi-Cal managed care plan and the provider can agree to a rate that, at the minimum, is equal to the Medi-Cal fee-for-service provider rate;
- The provider meets the Medi-Cal managed care plan’s applicable professional standards and has no disqualifying quality of care issues (i.e., the provider would not be eligible to provide services to any other Medi-Cal managed care plan beneficiaries as documented by the Medi-Cal managed care plan);
- The provider is a Medi-Cal State Plan approved provider as defined in California Health & Safety Code Section 1374.739; and
- Documents (i.e., assessment and treatment plan) are provided to the Medi-Cal managed care plan by the provider to facilitate continuity of care.
If the family of the ASD child has issues with the continuity of care plan (quality or level of service ) they should discuss this with the managed care plan.
FOR MORE INFORMATION: The 14 page transition document includes information on the State’s approach to this transition; how it will communicate and implement outreach; notification to the families of the 13,000 children currently receiving behavioral health treatment through the regional centers; how the State will engage with stakeholders through the process; required continuity of care; health plan readiness; how the State will monitor the transition; guidance to the Medi-Cal managed care health plans; communications with the regional centers and inter-department communications through the transition process. The transition plan will be posted on the Department of Health Care Services webpage on Behavioral Health Treatment: http://www.dhcs.ca.gov/services/medi-cal/Pages/BehavioralHealthTreatment.a
QUESTIONS - Persons having questions about this transition can send email to the Department of Health Care Services at: [email protected]
BEHAVIORAL HEALTH TREATMENT WEBPAGE – Department of Health Care Services website that includes webpage covering the implementation and transition plans, schedules and other documents for Behavioral Health Treatment:
Submitted by Connie Boyar Frenzel, RN MS, with thanks to Marty Omoto, CD-CAN.