Voluntary inpatient detoxification (VID) services are a Medi-Cal benefit carved out of managed care and covered through Medi-Cal fee for service. To be eligible, inpatient detoxification must be the primary reason for voluntary admission. DHCS’s All Plan Letter sets out medical criteria for inpatient admission for VID.
When a managed care plan sees a member who does not meet the medical necessity criteria, the plan should refer the member to the county’s behavioral health department for referral to other medically necessary substance use disorder treatment services. Plans must also provide care coordination to ensure appropriate referrals to available services.
To receive VID services, plans must refer members to VID service providers in general acute care hospitals. The VID service provider must submit a TAR to a local Medi-Cal field office with documentation verifying admission criteria and medical necessity.
DHCS APL 18-001 (January 11, 2018).