Behavioral Health

Carelon also manages behavioral health resources for Alliance Care In-Home Supportive Services (IHSS). For Alliance Care IHSS members, the Alliance covers both inpatient and outpatient mental health and substance abuse disorder services provided by a participating mental health professional or hospital. Some services require prior authorization.

Note: In Merced County, all behavioral health services for IHSS members will go to Carelon for follow-up.

Counties are responsible for provision of specialty mental health services, as well as a continuum of substance use disorder services. Eligibility for specialty mental health services is defined in Behavioral Health Information Notice 21-073. The behavioral health access department in each county is a helpful resource to explore which services would be most beneficial based on individual needs.

Providers should refer Medi-Cal members to their county behavioral health department if the member:

• Requires specialty mental health treatment.
• Requires substance use disorder treatment other than acute medical detoxification.

For county-specific behavioral health referral information, view the section for your service area.

Mariposa County

Merced County

Monterey County

San Benito County

Santa Cruz County

Maternal Mental Health (MMH) disorders include a range of disorders and symptoms including depression, anxiety and psychosis. These disorders and symptoms can occur during pregnancy and/or the perinatal period. Perinatal depression is one of the most common medical complications during pregnancy and the postpartum period. OB-GYNs, primary care providers and other obstetric care providers play a critical role in identifying and initiating treatment for this pervasive complication.

The Alliance recommends the following MMH screening resources for providers:

• The Edinburgh Postnatal Depression Scale is a 5-minute questionnaire designed specifically for pre- and post-natal screening. It is available in multiple languages from the Massachusetts Child Psychiatry Access Program. Please note that not all versions are validated — use at your discretion.
• The Health Plan of San Mateo (HPSM) Behavioral Health Screening Tool (Part A, Part B and Part C) integrates the PHQ-9 questionnaire with additional screening questions from GAD-2, PHQ-2, AUDIT-C and CRAFFT. You can use the Behavioral Health Screening Scoresheet to record member results.
• The Patient Health Questionnaire-9 (PHQ9) is a general screening tool for depression.

If you’re looking for education resources, the California nonprofit organization 2020 Mom is focused on closing gaps in maternal mental health care through education, advocacy and collaboration. They offer many resources for providers.

Behavioral health treatment is a covered benefit for eligible Medi-Cal members.

Services are provided to members under the age of 21 when deemed medically necessary according to EPSDT guidelines. PCPs play an important role in identifying and referring children who need behavioral health treatment. It is critical that PCPs provide medical follow-up for co-occurring disorders.

Prior authorization from Carelon is required for Applied Behavioral Analysis (ABA) services. BHT services are provided to members when a recommendation is made by a licensed physician, psychologist or surgeon, regardless of diagnosis. BHT services include ABA and other evidence-based services aimed at shaping behavior.

If a member is receiving care from a Carelon provider, the providers will ask members to sign a statement authorizing the clinician to share clinical status information with a PCP and for the PCP to respond with additional member status information, to the extent permitted by law. Members may elect to authorize or refuse to authorize release of information except as required by federal, state and local laws.

The Alliance recommends the following resources:

• Behavioral Health Treatment Medi-Cal Primary Care Provider FAQs

CalHOPE Connect offers safe, secure and culturally sensitive emotional support for Californians in issues related to COVID-19.

• PCP Toolkit: resources on behavioral health conditions commonly managed by PCPs.
• Referral card: at-a-glance referral information for Carelon, in English and Spanish.

Referrals

• Carelon Behavioral Health Primary Care Provider (PCP) Referral Form
• Carelon Care Management Referral Form

Screening and Evaluation

• Carelon Diagnostic Evaluation Form (Medi-Cal)

Patient Information

• Authorization for Carelon Behavioral Health to Release Confidential Information (required to receive patient updates).
• Autorización para que Carelon Behavioral Health of California divulgue información confidencial (Spanish).
• Authorization for Provider to Release Confidential Information to Carelon Behavioral Health
• Authorization for Behavioral Health Provider and Primary Care Provider to Share Confidential Information

For information on how to become a behavioral health provider serving the communities in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties, visit Carelon’s Join our Network page or call the National Provider Service Line at 800-397-1630, Monday-Friday, 8 a.m. to 8 p.m. ET.

Carelon is the managed behavioral health organization that administers behavioral health services on behalf of the Alliance. Please start by registering with Carelon’s Provider Enrollment to initiate the credentialing process.