Behavioral Health Treatment (BHT) FAQs

Primary care providers (PCPs) play a key role in identifying children and youth who may benefit from Behavioral Health Treatment (BHT). BHT services are designed to address developmental and behavioral challenges that may impact a child’s ability to function in daily life. Behaviors that may indicate a need for BHT include:

• Significant withdrawal or avoidance of social interaction.
• Delays in language or communication skills.
• High need for sameness, predictability, or rigid routines.
• Impaired thinking or organizational skills.
• Consistent failure to achieve age-appropriate self-care skills.
• Uneven developmental patterns.
• Lack of reciprocal, interactive or imaginative play.

If you observe two or more of these behavioral concerns, a referral for further evaluation and/or BHT services may be appropriate.

Note: A PCP can refer for both a Comprehensive Diagnostic Evaluation (CDE) and recommend BHT services at the same time. A request for evaluation does not delay the start of BHT services when medically necessary and recommended by a physician or psychologist.

PCPs may refer patients directly to BHT servicing providers listed in the Alliance Provider Directory. The referral may be initiated using the Alliance’s Provider Portal.

You do not need to obtain prior authorization for:

• A Functional Behavioral Assessment (FBA).
• A Comprehensive Diagnostic Evaluation (CDE).

The following resources are available to assist providers in determining the appropriateness of a BHT referral:

• M-CHAT Screening Checklist: Useful for identifying signs of Autism Spectrum Disorder (ASD) in children up to 30 months. Available in multiple languages at www.mchatscreen.com.
• Diagnostic Evaluation Form: Developed to support the collection of behavioral and developmental information for a CDE referral. Available on the Alliance website:
  Alliance Diagnostic Evaluation Form

Indicators of potential benefit from BHT services include, but are not limited to:

• Speech delay.
• Poor eye contact.
• Low social responsiveness.
• Repetitive or stereotypic behaviors.
• Aggression, elopement or self-injury.
• Hyperactivity or preoccupation with specific interests.
• Echolalia or other atypical language patterns.

Once a referral is submitted:

• The servicing provider should connect with the member to initiate steps to conduct their assessment.
• If a Diagnostic Evaluation Form is not included, the servicing provider may follow up with the PCP to gather the necessary information to support the referral.
• If BHT services are recommended, the servicing provider should connect with the member to initiate the Functional Behavioral Assessment (FBA) to develop an individualized treatment plan.
• For general information, Provider Services can be reached at 831-430-5504.

No. Prior authorization is not required for:

• Comprehensive Diagnostic Evaluations (CDE).
• Functional Behavioral Assessments (FBA).

These assessments are covered services under the Alliance’s non-specialty mental health benefit for Medi-Cal members under age 21.

You can locate servicing providers for BHT through the Alliance Provider Directory on the Alliance website. PCPs may refer directly to in-network providers without going through an intermediary.

With appropriate member consent, BHT providers will share treatment updates, including progress toward identified goals. Updates may be provided via secure communication channels such as fax or encrypted email. To facilitate communication, please ensure the Alliance Consent to Release Information form is completed and submitted.

Services provided by the California Regional Centers—such as respite care, school-based programs or in-home support services—will continue to be managed by those agencies. However, Behavioral Health Treatment (BHT) services for Medi-Cal members under the age of 21 are now administered by Central California Alliance for Health.