Mental health services for Medi-Cal
Mental health services for Medi-Cal
Your Health 6 www.cencalhealth.org To report FRAUD call 1-866-775-3944. YOUR HEALTH is published for the members and community partners of CENCAL HEALTH, 4050 Calle Real, Santa Barbara, CA 93110, telephone 1-800-421-2560, website www.cencalhealth.org. Information in YOUR HEALTH comes from a wide range of medical experts. If you have any concerns or questions about specific content that may aff ect your health, please contact your health care provider. Models may be used in photos and illustrations. Donna Slimak Director of Member Services Suzanne Michaud, M.P.H. Health Promotion Educator, Newsletter Editor Pat Tyler Member Services Operations Manager Your Health Plan Mental health services for Medi-Cal T here is a change in Medi-Cal coverage that expands mental health and substance use disorder benefits for CenCal Health members.
Starting January 1, 2014, Medi-Cal will cover services for substance use disorder, through the County Alcohol and Drug Program, and mental health services through CenCal Health. Specialty mental health services will continue to be provided by the County Mental Health Department. What are the Mental Health benefits?
Medi-Cal members will be able to receive expanded mental health benefits through your Medi-Cal Managed Care Plan which is CenCal Health. We provide these services through our Mental and Behavioral Health Provider, the Holman Group. The services include but are not limited to: • Individual and group mental health evaluation and treatment (psychotherapy) • Psychological testing when clinically indicated to evaluate a mental health condition • Psychiatric consultation for the purposes of monitoring drug therapy • Outpatient laboratory, drugs, supplies and supplements • Screening and brief intervention What are the Substance Use Disorder benefits?
These services are provided through the County Alcohol and Drug Program, and include: • Voluntary inpatient detoxification • Intensive outpatient treatment services • Residential treatment services • Outpatient drug free services • Narcotic treatment services If you or a family member are in crisis and need immediate attention, call 911 or go to the nearest hospital emergency room. What are the Specialty Mental Health benefits? These services will continue to be provided by the County Mental Health Department also known as the Mental Health Plan. These services are for mem- bers who meet the medically necessary criteria.
Services include but are not limited to: Outpatient Services • Mental health services (assessments, plan development, individual or group therapy, rehabilitation and collateral services) • Medication support • Day treatment services and day rehabilitation • Crisis intervention and crisis stabilization • Targeted case management •Therapeutic behavior services Residential Services • Adult and crisis residential treatment services Inpatient Services • Acute psychiatric inpatient hospital services • Psychiatric inpatient hospital & professional services • Psychiatric health facility services Where can I find out more information about the expanded benefits? Talk with your Primary Care Provider about services or treatment, or call CenCal Health, Member Services at 1-877-814-1861 Monday through Friday, 8 a.m.
to 5 p.m. YOUR HEALTH NEWSLETTER, JANUARY 2014
Su Salud 6 www.cencalhealth.org SU SALUD se publica para los miembros y socios comunitarios de CENCAL HEALTH, 4050 Calle Real, Santa Barbara, CA 93110, teléfono 1-800-421-2560, Web site www.cencalhealth.org. La información de SU SALUD proviene de una gran variedad de expertos médicos. Si tiene cualquier inquietud o pregunta sobre el contenido específico que pueda afectar su salud, por favor comunicarse con su proveedor de atención médica. Se pueden utilizar modelos en fotos e ilustraciones.
Para reportar un FRAUDE llame al 1-866-775-3944. Suzanne Michaud, M.P.H. Educadora de Promoción de la Salud, Editora Donna Slimak Directora de Servicios para Miembros Pat Tyler Administradora de Operaciones de Servicios para Miembros Servicios de salud mental para Medi–Cal H ay un cambio en la cober- tura de Medi-Cal que expande los beneficios de salud mental y de trastorno de uso de sustancias para los miembros de CenCal Health.
A partir del 1 de enero de 2014, Medi-Cal cubrirá los servicios para trastorno de uso de sus- tancias, a través del County Alcohol and Drug Program, y los servicios de salud mental a través de CenCal Health. Los servicios especializados de salud mental continuarán siendo proporcionados por el Departa- mento de Salud Mental del Condado.
¿Cuáles son los beneficios de salud mental? Los miembros de Medi-Cal podrán recibir los beneficios de salud mental expandidos a través de su Plan de Servicios Coordinados de Medi-Cal que es CenCal Health. Proveemos estos servicios a través de nuestro Proveedor de Salud Mental y de la Conducta, Holman Group. Los servicios incluyen, pero no se limitan a: • Evaluación individual y grupal de salud mental y tratamiento (psicoterapia) • Pruebas psicológicas cuando sean clínicamente indicadas para evaluar una condición de salud mental • Consulta psiquiátrica con el propósito de monitorear la terapia de medicamentos • Laboratorio para pacientes ambulatorios, medicamentos, suministros y suplementos • Pruebas de detección e intervención breve ¿Cuáles son los beneficios para trastorno de uso de sustancias?
Estos servicios se ofrecen a través del County Alcohol and Drug Program, e incluyen: • Desintoxicación voluntaria hospitalizada • Servicios de tratamiento ambulatorio intensivo • Servicios de tratamiento residencial • Servicios para pacientes ambulatorios libres de drogas • Servicios de tratamiento para uso de narcóticos Su Plan DE salud Si usted o un miembro de la familia está en crisis y necesita atención inmediata, llame al 911 o vaya a la sala de emergencias del hospital más cercano. ¿Cuáles son los beneficios de servicios especializados para salud mental?
Estos servicios seguirán siendo proporcionados por el Departamento de Salud Mental del Condado también conocido como el Plan de Salud Mental.
Estos servicios son para miembros que cumplen los criterios médicamente necesarios. Los servicios incluyen, pero no se limitan a: Serviciosparapacientesambulatorios • Servicios de salud mental (evaluaciones, desarrollo de plan, terapia individual o gru- pal, rehabilitación y servicios colaterales) • Apoyo con medicamentos • Servicios de tratamiento y rehabilitación diurnos • Intervención de crisis y estabilización de crisis • Manejo enfocado de casos • Servicios terapéuticos de comportamiento Servicios residenciales • Servicios de tratamiento residencial para adultos y crisis Servicios para pacientes hospital- izados • Servicios de hospitalización psiquiátrica aguda • Servicios psiquiátricos hospitalizados y profesionales • Servicios en centro de salud psiquiátrica ¿Dónde puedo encontrar más información acerca de los beneficios expandidos?
Hable con su Proveedor de Cuidado Pri- mario acerca de servicios o tratamiento, o llame a CenCal Health, Servicios para Miembros al 1-877-814-1861 de lunes a viernes, de, 8 a.m. a 5 p.m. YOUR HEALTH NEWSLETTER, JANUARY 2014
Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services Rev 2/25/14 ST/RH In May 2013, the United States Preventive Services Task Force (USPSTF) updated its alcohol screening recommendation (listed at http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm.
The USPSTF recommends that clinicians screen adults ages 18 years or older for alcohol misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse and/or referral to mental health and/or alcohol use disorder services, as medically necessary. As a contracted PCP with CenCal Health, you are required to provide Screening, Brief Intervention, and Referral to Treatment (SBIRT) services for members ages 18 and older who misuse alcohol. Coverage of SBIRT services by CenCal Health took effect January 1, 2014. Note: The new SBIRT benefit only targets misuse of alcohol.
BACKGROUND: Approximately 21 percent of US adults report engaging in risky or hazardous drinking,1 and the prevalence of current alcohol dependence is about four percent.2 Alcohol misuse plays a contributing role in a wide range of health conditions, such as hypertension, gastritis, liver disease and cirrhosis, pancreatitis, certain types of cancer (for example, breast and esophageal), cognitive impairment, anxiety, and depression.3 Research findings implicate alcohol misuse as a major risk factor for trauma, including falls, drowning, fires, motor vehicle crashes, homicide, and suicide.4 Research findings also link alcohol use in pregnancy to fetal alcohol syndrome, which occurs in about 0.2 to 1.5 per 1,000 live births in the United States.5 Counseling interventions in the primary care setting can positively affect risky drinking behaviors in adults by reducing weekly alcohol consumption and increasing long-term adherence to recommended drinking limits.6 Brief behavioral counseling interventions decrease the proportion of persons who engage in episodes of heavy drinking.7 Indirect evidence supports the effect of screening and brief behavioral counseling interventions on reducing the probability of traumatic injury or death especially those related to motor vehicles.8 For adults, PCPs must offer the Staying Healthy Assessment (SHA) or other approved tool within 120 days after enrollment and every three years, with annual reviews of the member’s answers.
The SHA contains a single alcohol screening question recommended by the USPSTF, and is posted on CenCal Health’s website in the “Health Education” section, at http://www.cencalhealth.org/for_providers/HEprovider/stayinghealthytools.ht ml. REQUIREMENTS: Beginning January 1, 2014, CenCal Health will cover and pay for an expanded alcohol screening for members 18 years of age and older who answer “yes” to the alcohol question in the SHA (considered a “pre-screen”), or at any time the PCP identifies a potential alcohol misuse problem. When a member answers “yes” to the SHA alcohol pre-screen question, PCP’s must offer the member an expanded, validated alcohol screening questionnaire.
While any validated screening tool is acceptable, CenCal Health recommends the use of the Alcohol Use Disorder Identification Test (AUDIT) or Alcohol Use Disorder Identification Test—Consumption (AUDIT-C). Each member is allowed at least one expanded screening, using a validated screening tool, per year (billable as procedure code H0049). (Note: that
Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services Rev 2/25/14 ST/RH administration of the alcohol question on the SHA is considered part of routine primary care) PCPs must maintain documentation of the SHA and the expanded screening. When a member transfers to another PCP, you must obtain prior records. If no documentation is found, you must provide and document this service. CenCal Health will cover and pay for brief intervention(s) for members who screen positively for risky or hazardous alcohol use or a potential alcohol use disorder. Each member is allowed three brief intervention sessions per year.
You may combine these sessions in one or two visits or administer the sessions as three separate visits. Brief Intervention CenCal Health will cover and pay for brief intervention(s) for members who screen positively for risky or hazardous alcohol use or a potential alcohol use disorder. Brief intervention(s) typically include one to three sessions, 15 minutes in duration per session (each session billable as procedure code H0049), offered in-person, by telephone, or by telehealth modalities. Each member is allowed three brief intervention sessions per year, and you may combine these sessions in one or two visits or administer the sessions as three separate visits.
You may refer offsite for brief interventions; however, CenCal Health encourages all PCPs and their teams to offer the service within the primary care clinic, to increase the likelihood of members following through on the interventions.
Referral to Treatment Members who are found, upon screening and evaluation, to meet criteria for an alcohol use disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM), or whose diagnosis is uncertain, must be referred for further evaluation and treatment. Treatment for alcohol use disorders is not a service covered by CenCal Health. For further diagnostic evaluation and treatment, refer to the alcohol and drug program of the county in which the member resides. The DHCS website has information about SBIRT services and training materials at http://www.dhcs.ca.gov/services/medi- cal/Pages/SBIRT.aspx .
On this webpage the header Referral to Treatment links to a list of California county contacts for local substance use disorder treatment information and referrals.
PROVIDER REQUIREMENTS: 1. All licensed providers, as well as non-licensed providers who meet the requirements below, may offer SBIRT services in the primary care setting. Registered Nurses are licensed clinical professionals, so are not required to complete SBIRT training, and do not need to meet the non-licensed provider requirements. 2. Non-licensed health care providers must provide SBIRT under the supervision of a licensed health care provider. Licensed health care providers eligible to supervise staff are currently limited to a: a. Licensed Physician; b. Physician Assistant; c. Nurse Practitioner; and d.
Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services Rev 2/25/14 ST/RH 3. At least one supervising licensed provider per clinic or practice must take four hours of SBIRT training within 12 months after initiating SBIRT services. a. On a continual basis beyond the first 12 months of service, at least one supervisor per clinic or practice must have the completed training. b. For solo physician practices, the physician is highly encouraged, but not required, to take the training within 12 months after initiating SBIRT services. 4. Trained non-licensed providers (including but not limited to health educators, Certified Addiction Counselors, health coaches, medical assistants, and non-licensed behavioral assistants) may provide SBIRT services if they meet the following requirements, which must be met before rendering services: a.
Be under the supervision of a licensed provider listed in #2 above. b. Complete a minimum of 60 documented hours of professional experience such as coursework, internship, practicum, education or professional work within their respective field. This experience should include a minimum of 4 hours of training directly related to SBIRT services (such as motivational interviewing). c. Complete a minimum of 30 documented hours of face-to-face client contact within his or her respective field. (This requirement is in addition to the 60 hours of clinical professional experience described above). This may include internships, on-the-job- training, or professional experience and SBIRT services training.
d. Supervising licensed providers (one per clinic or practice) must attest that they have obtained the required training on SBIRT within 12 months after initiating the provision of SBIRT services (one-time requirement) e. Non-licensed providers must attest that they have completed training and other requirements, prior to initiating services.
HOW TO OBTAIN TRAINING: Training materials concerning the Staying Healthy Assessment and SBIRT services are located on CenCal Health’s website under Educational Trainings & Seminars: http://www.cencalhealth.org/for_providers/educational.html In addition to SBIRT training provided by CenCal Health, any program that is accepted for CME or other professional CE credits meets the requirements for training, including online and in-person sessions. ATTESTATIONS OF TRAINING: Providers who administer and bill CenCal Health for SBIRT services must keep documentation on file that demonstrates compliance with the requirements described under items #3 and #4, above.
Questions on these services can be directed to your Provider Services Representative at 805.562.1676.
The Holman Group Managed Behavioral Health Care Quick Reference Guide Referral to Mental Health Services for CenCal Health Medi-Cal Members Eligible Patients: CenCal Health children and adults who need mental health services not covered by County Mental Health Eligible Patients: Children and adults who meet medical necessity or EPSDT criteria for Medi-Cal Specialty Mental health Services Individual mental health evaluation and treatment (psychotherapy) Group mental health evaluation and treatment services Psychological testing when clinically indicated to evaluate a mental health condition Psychiatric consultation for medication management Crises Intervention and Stabilization Mental Health Services (assessments plan development, therapy, rehabilitation) Medication Support Day Treatment Services and Day Rehabilitation Targeted Case Management and Therapeutic Behavior Services Crises and Adult Residential Treatment Acute Psychiatric Inpatient Hospital and Health Facility Services Professional Services in Psychiatric Inpatient Hospital - If The Holman Group suspects a severe condition, will refer to County Mental Health - - If County Mental Health suspects a mild to moderate condition, will refer to Holman Group THE HOLMAN GROUP COUNTY MENTAL HEALTH
Hoja de Datos Departamento de Servicios de Alcohol, Drogas y Salud Mental del Condado. ADMHS (por sus siglas en ingles) ¡¡Estamos en la Red!! Visítenos en www.admhs.org haz clic donde dice “en español” Fundado en 1962, El departamento de Servicios de Alcohol, Drogas y Salud Mental del Condado de Santa Barbara (ADMHS) promueve la prevención y/o recuperación de adicciones y/o dificultades de Salud Mental en las personas, familias y comunidades, ofreciendo servicios avanzados y culturalmente apropiados..
Hay una serie de servicios que se ofrecen en todo el condado para niños, jóvenes y adultos.
ADMHS ofrece servicios para personas con dificultades de Salud mental y/o problemas del alcohol y otro uso de substancias, para personas que están pasando por una crisis de salud mental. Estos servicios se ofrecen con o sin hospitalización de acuerdo con la situación de cada persona. Para más información detallada por favor visite la página de internet www.admhs.org y haga clic en la parte de arriba donde dice “En Español” después haga clic donde dice “como obtener servicios.” ADMHS tiene aproximadamente un equivalente de 292 empleados de tiempo completo. En unos cuantos meses más este número de empleados aumentara cuando el nuevo programa de evaluación de crisis sea implementado.
El número de empleados aumentara aproximadamente a un equivalente de 315 empleados de tiempo completo. ADMHS también tiene contratos con diferentes proveedores de servicios en la comunidad así como también tiene contrato con otros profesionales de la red de proveedores que ofrecen servicios adicionales.
Hay tres formas de acceso a los servicios: 1.- Si una persona está pasando por una crisis de salud mental y esta persona está en riesgo de hacerse daño a si mismo (a) o a otras personas, llame al 9-1-1. 2.- Si una persona está pasando por una crisis de salud mental y no esta en riesgo de hacerse daño a si mismo (a) o alguna otra persona y la persona que está en crisis tiene cobertura de a seguranza médica. Por favor de llamar directamente al plan de a seguranza para que le den una referencia a un proveedor de servicios de salud mental cubierto por la a seguranza. 3.- y para otras crisis de salud mental favor de llamar a ADMHS al número de acceso gratuito 1-888-868-1649 este número está disponible 24 horas al día, Siete días a la semana.
¿Cómo se puede tener acceso a los servicios?
ADMHS anualmente, provee tratamiento, rehabilitación y servicios de apoyo a aproximadamente 7,600 pacientes con dificultades de salud mental y 4,500 personas con desordenes del uso de substancias. Los pacientes del Departamento de Servicios de Alcohol, Drogas y Salud Mental del Condado de Santa Barbara incluye niños que sufren de desórdenes emocionales severos, Adultos con dificultades de Salud Mental severos. Y personas con condiciones conjuntas de salud mental y de uso de substancias. 300 N. San Antonio Road Building 3 Santa Barbara, CA 93110 (805) 681-5200 www.admhs.org Takashi Wada, M.D., M.P.H.
Director Provisional Información de ADMHS ¿Qué Servicios hay disponibles? ¿A quién provee servicios ADMHS? ¿Quién Provee los Servicios?
Fact Sheet SANTA BARBARA COUNTY DEPARTMENT OF ALCOHOL, DRUG AND MENTAL HEALTH SERVICES We are on the Web! Visit us at www.admhs.org Founded in 1962, the Santa Barbara County Department of Alcohol, Drug and Mental Health Services (ADMHS) promotes the prevention of, and recovery, from addiction and mental illness among individuals, families and communities, by providing effective leadership and delivering state- of-the-art, culturally competent services. An array of services are provided countywide for adults, children and transition-age youth. ADMHS serves persons with mental health and/or alcohol and substance use conditions and individuals experiencing mental health crises.
Services are provided on an inpatient, outpatient and crisis basis. For detailed information about programs and services, please visit www.admhs.org and place your cursor over the “Services” tab at the top of the page. ADMHS employs approximately 292 full-time equivalent (FTE) employees. In several months when the new Crisis Triage program is implemented, this number will increase to approximately 315 FTE employees. ADMHS also contracts with a number of community-based alcohol, drug and mental health providers, as well as with individual practitioners called "network providers,” to offer additional services countywide.
There are three ways to access services: (1) If an individual is experiencing a mental health crisis that places anyone in immediate danger, call 911. (2) If an individual is experiencing a mental health crisis that does not involve immediate danger, and if the person in crisis has insurance coverage through a health plan, call the health plan to get a referral to a covered mental health provider. (3) For all others, call ADMHS’ 24-Hour Toll Free Access Line at (888) 868-1649. The call is toll free, and someone will answer to assist you 24 hours per day, seven days per week. How are services accessed?
ADMHS provides treatment, rehabilitation and support services to approximately 7,600 clients with mental illness and 4,500 clients with substance use disorders annually. ADMHS clients include children experiencing severe emotional disorders, adults with severe mental illness and individuals with co-occurring mental health and substance use conditions. Revised February 21, 2014 300 N. San Antonio Road Building 3 Santa Barbara, CA 93110 (805) 681-5200 www.admhs.org Takashi Wada, M.D., M.P.H. Interim Director ABOUT ADMHS What services are available? Whom does ADMHS serve? Who provides services?
Rev 2‐20‐15 BEHAVIORAL/MENTAL HEALTH SERVICES Definitions (Regarding Medi-Cal Mental Health Services) “Specialty Mental Health Criteria” means the criteria that identify service need based on inclusion of specific signs, symptoms, and conditions and proposed treatment associated with mental illness.
Medical necessity is defined by the California Code of Regulations: Determination of Medical Necessity: Specialty Mental Health Services Criteria A: Covered Plan Diagnosis o Schizophrenia o Schizoaffective Disorder o Bipolar Disorders o Major Depression, Recurrent, With or Without Psychotic Features o Psychotic Disorder NOS o Borderline Personality Disorder o Post Traumatic Stress Disorder (PTSD) Exclusions: Clients with a primary diagnosis of substance abuse and those with a sole diagnosis of developmental disability. The criteria exclude those with organic brain syndromes such as dementia or delirium.
Criteria B: Functional Impairment Criteria - Must also meet Criteria A o Definition: Severe impairment in community functioning that includes consideration of sociocultural issues in one or more areas as a result of a mental health plan covered diagnosis. The specific functional impairment(s) must be clearly evident. o Functional areas include; Basic self-care Independent living skills Consistent behaviors of endangerment of self or others P Productive activities; employment, education, volunteer, parent, caregiver, or other meaningful activities Interpersonal Relationships Co-morbidity (substance use and medical conditions along with a covered primary mental health condition Criteria C: Focus of the proposed intervention will be to significantly diminish impairment or prevent significant deterioration in an identified important area of functioning Criteria D: Impairments and conditions require specialty mental health services and would not be responsive to physical health care based treatment.
“Specialty Mental Health Provider” means a person or entity that is licensed, certified or otherwise recognized or authorized under the State law governing the healing arts to provide Specialty Mental Health Services. Specialty Mental Health Providers include but are not limited to: (i) clinics; (ii) hospital outpatient departments; (iii) certified residential treatment facilities; (iv) skilled nursing facilities; (V) psychiatric health facilities; (vi) hospitals; and (vii) licensed mental health professionals, including psychiatrists, psychologists, licensed clinical social workers, marriage, family and child counselors, therapists and registered nurses authorized to provide Specialty Mental Health Services.
Rev 2‐20‐15 “Specialty Mental Health Services” means: 1. Rehabilitative services; 2. Psychiatric inpatient hospital services; 3. Psychiatrist services; 4. Psychologist services; and 5. Psychiatric nursing facility services. Referral Protocols CenCal Health’s Medi-Cal Membership: Children and Adults Referring Primary Care Physician and/or Attending Physician (when applicable) will: 1. Provide for the diagnostic assessments to rule out general medical conditions causing psychiatric symptoms, identify and treat those general medical conditions that are causing or exacerbating psychiatric symptoms.
2. Refer their patients to the appropriate resource following a diagnostic assessment when a psychiatric condition is not responsive to physical health care. For members who meet criteria for Specialty Mental Health Services, refer them to their local county mental health plan’s Access Team. Referrals to the Access Team can be made over the phone or for Santa Barbara County, complete the Alcohol, Drug, and Mental Health Services (ADMHS) Referral Form. If the member is experiencing a mild to moderate condition, refer the Member to The Holman Group. Referrals to The Holman Group will be made in the form of a phone call to The Holman Group at 1-800-321- 2843.
The Holman Group will: 1. Maintain a network of qualified mental health providers to provide quality behavioral health services to CenCal Health’s members. 2. Accept referrals from CenCal Health staff, enrollee’s Primary Care Physician (PCP), and/or specialist, and directly from Members. 3. Will conduct an initial screening and arrange for the Member to have a face to face assessment with a mental professional or refer to another appropriate resource. 4. Refer the Member to the appropriate County Mental Health Program when they suspect the Member m.
San Luis Obispo and Santa Barbara (ADMHS) Mental Health Plans will: 1.
Accept referrals from CenCal Health staff, enrollee’s Primary Care Physician (PCP), and/or specialist, and directly from Members. 2. Determine eligibility for Specialty Mental Health Services and provide specialty mental health diagnostic assessments. When required Medical Necessity criteria are met, they will provide for Specialty Mental Health Services through their provider network. 3. Request each Member’s consent to share information gathered from specialty mental health assessments and/or treatment with the Member’s PCP or treating physician.
Rev 2‐20‐15 4. Refer Members to The Holman Group when they do not meet criteria for specialty mental health services. 5. Contact member’s PCP requesting any necessary authorizations in the event that the diagnosis and/or treatment of an included specialty mental health condition requiring diagnostic services. 6. Process a Member or their appointed representative’s appeal on their behalf of coverage decisions by the county’s Mental Health Plan when the Access Team informs the member, the Member’s PCP or attending physician (when applicable) that a Member does not meet specialty mental health medical necessity criteria.
The Holman Group: 1-800-321-2843 (24 hours) Santa Barbara Mental Health, Alcohol & Drug Access Team: 1-888-868-1649 (24 hours) http://www.countyofsb.org/admhs/admhs.aspx?id=37340 San Luis Obispo Mental Health Access Team: 1-800-838-1381 San Luis Obispo Drug & Alcohol: (805) 473- 7080 (south SLO county) (805) 781-4753 (central SLO county) (805) 461-6080 (north SLO county) http://www.slocounty.ca.gov/health/mentalhealthservices/medical_beneficiary _informa tion.htm CenCal Health’s Other State Programs Membership (Access to Infants and Mother (AIM), and Healthy Kids- Santa Barbara): Children and Pregnant Women Holman Professional Counseling Centers (HPCC), also known as Holman will: 1.
Accept referrals from CenCal Health staff, a member’s Primary Care Physician (PCP), and/or specialist, and directly from members for all mental health and substance abuse treatment services.
2. Members may contact Holman at their toll free telephone number, 1-800-321- 2843, for assistance in finding a mental health provider and obtaining an authorization for their first counseling visit. www.holmangroup.com Please note that Healthy Kids SED-qualified children will continue to be treated by their local county mental health plan in Santa Barbara County and San Luis Obispo Counties.
1 February 2014 Frequently Asked Questions Mental Health Services for CenCal Health Medi‐Cal Members 1. I thought mental health services were carved‐out. Why is CenCal Health now offering mental health benefits? The Affordable Care Act (ACA) builds on the mental health parity law by expanding mental health services for many patients, including those covered by the Medi‐Cal Program.
The State has provided funding for CenCal Health to cover psychology services. Mild to moderate behavioral and physical health conditions are co‐occurring. Improving access to mental health services positively impacts physical health conditions and the health and well‐ being of our members.
2. What new benefits are available for Medi‐Cal members? Beginning January 1, 2014 mental health and substance use disorder services were expanded for current and newly eligible Medi‐ Cal members. CenCal Health will now cover outpatient services for members impacted by mild to moderate mental health conditions and will also cover alcohol screening, brief intervention and referral for treatment when provided by Primary Care Providers (PCPs). These new benefits include individual and group evaluation and treatment (psychotherapy), testing, monitoring of drug therapy, outpatient lab services and psychiatric consultation.
3. Is CenCal Health providing these services directly? No. CenCal Health has partnered with The Holman Group to administer the new mental health benefits on behalf of the CenCal Health. The Holman Group, based out of Northridge, CA, is a well‐established Managed Behavioral Health Organization that arranges for quality mental health services.
4. What is not changing with regards to CenCal Health benefits? CenCal Health will continue to cover outpatient laboratory, supplies, supplements and drugs (excluding anti‐psychotic drugs) through our lab and pharmacy network. CenCal Health will also cover mental health services within the scope of primary care physician practice. 5. Is there a change to the services covered by County Mental Health? No. Specialty Mental Health services for severe mental illness (including crisis response, inpatient and residential treatment) will continue to be the responsibility of the respective County Mental Health Departments.
The Counties will also continue to be responsible for treatment of members that meet criteria for Alcohol and Substance Use Disorder Services.
6. Which providers can my CenCal Health Medi‐Cal members now see? Psychiatric and psychological services will be provided through The Holman Group’s provider network. The Holman Group has a contracted network of mental health providers throughout Santa Barbara and San Luis Obispo County to offer services to CenCal Health members with mild to moderate conditions and provide support to PCPs.
2 February 2014 Frequently Asked Questions Mental Health Services for CenCal Health Medi‐Cal Members 7. How do I refer my patients with mild to moderate mental health conditions? PCPs may refer members for mental health services by accessing The Holman Group 24 hours a day, 365 days a year via their toll‐free number (800) 321‐2843.
Members may also self refer by calling directly. No Referral Authorization Forms (RAFs) are needed. 8. What happens when my patients call The Holman Group? The Holman Group will conduct an initial screening and arrange for the member to have a face‐to‐face assessment with a mental professional or refer to another appropriate resource. They will also coordinate with the County Mental Health Departments for Specialty Mental Health services on the PCP’s behalf if it is determined that the member has severe mental illness.
9. Which CenCal Health Medi‐Cal patients can be referred to The Holman Group? Both current and newly eligible CenCal Health Medi‐Cal members. These programs are called Santa Barbara Health Initiative (SBHI) and San Luis Obispo Health Initiative (SLOHI). The Holman Group also takes referrals for CenCal Health’s non‐Medi‐Cal programs, including the Santa Barbara Healthy Kids Program. 10. Which CenCal Health Medi‐Cal patients should not be referred to The Holman Group? Members with Medicare or Other Health Coverage should access outpatient mental health through their primary carrier first prior to accessing their CenCal Health benefit.
11. Are medication consultations from a psychiatrist available to CenCal Health providers? Yes. The Holman Group provides psychiatric medication consultation. Providers can call The Holman Group via their toll‐free number (800) 321‐2843.
12. Are there visit limits for psychology services? No. There are no defined limits on the number of visits a member can have with a mental health professional. Benefits will be arranged and provided based upon medical necessity and the level of care needed to make progress towards treatment goals. The State has specified that couples counseling or family counseling for relational problems are not covered. 13. What if our practice has behavioral health providers? PCPs with integrated mental health providers that are interested in offering these services to members can join the Holman Group network.
To request a contract and credentialing application directly from The Holman Group, please contact Liz Santillan in Provider Relations at (800) 321‐2843 extension 258. 14. Where do I get additional education? If you have questions or to arrange for an on‐site visit at your office to discuss this new benefit and how you can assist your patients in accessing mental health services, please feel free to contact your CenCal Health Provider Services Representative at (805) 562‐1676.