Behavioral Health Treatment Coverage for EPSDT Members
Date: 05/24/18
On March 2, 2018, the Department of Health Care Services (DHCS) issued All Plan Letter (APL) 18-006, notifying health plans that effective July 1, 2018, health plans must cover behavioral health treatment (BHT) services without an autism spectrum disorder (ASD) diagnosis for members under age 21 under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit. DHCS will transition the provision of BHT services for eligible members under age 21 without an ASD diagnosis from the Regional Centers to managed care plans.
Providers contracting with the Community Care Independent Practice Association (CCIPA) should consult the CCIPA for guidance.
REFERRAL COORDINATION
Primary care physicians (PCPs) are responsible for referring EPSDT-eligible members identified as needing BHT services, regardless of diagnosis, to Cenpatico, California Health & Wellness’ (CHWP’s) behavioral health partner, for assessment and referral to a mental health provider. CHWP coordinates with Cenpatico to manage the behavioral health benefits of our members.
BHT services may include, but are not limited to:
- Applied behavioral analysis
- Individual or family training
- Client/parent support behavioral intervention training
- Adaptive skills trainer by a qualified BHT provider
PRIOR AUTHORIZATION
Participating PCPs and behavioral health providers must contact Cenpatico at 1-866-896-5053 to obtain prior authorization for BHT Services, including applied behavioral analysis (ABA).
ADDITIONAL INFORMATION
Providers are encouraged to access CHWP’s provider portal online at www.CAHealthWellness.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact your Provider Relations representative or call 1-877-658-0305.