DHCS has provided new guidance on how Medi-Cal managed care plans cover BHT services to beneficiaries under 21 through EPSDT. Beginning 2/1/16, BHT services for those who received them at regional centers prior to 9/15/14 will transition to managed care plans over a six-month period. For those who do not meet regional center criteria, managed care plans must cover medically necessary services upon enrollment.
For those transitioning from regional centers, plans must automatically generate a continuity of care request and proactively contact providers to begin the process. Plans must offer up to 12 months of continuity in accordance to existing contract requirements. BHT services will not be discontinued until a new treatment plan has been completed and approved by the plan. If continuity of care cannot be reached, the plan must transition the beneficiary in-network and ensure no gap or change in services occurs. Plans are supposed to contact beneficiaries starting 12/1/15 on a rolling basis over the transition period.
To receive BHT services, a Medi-Cal beneficiary must be under 21, have a diagnosis of autism spectrum disorder based on a comprehensive diagnostic evaluation, have a recommendation for BHT from a licensed physician/psychologist, be medically stable, and be without a need for 24-hour monitoring. BHT services must be medically necessary and provided and supervised under a plan-approved behavioral treatment plan developed by a contracted and credentialed qualified autism service provider. DHCS APL 15-025 (12/3/15).