All Plan Letters

• This APL provides Medi-Cal managed care health plans (MCP) with guidance and clarification regarding the No Wrong Door for Mental Health Services policy. This policy ensures that members receive timely mental health services without delay regardless of the delivery system where they seek care and that members can maintain treatment relationships with trusted providers without interruption. You can find corresponding guidance to County Mental Health Plans (MHP) in Behavioral Health Information Notice (BHIN) No: 22-011.
• With the California Advancing and Innovating Medi-Cal (CalAIM) initiative, the Department of Health Care Services (DHCS) aims to address Medi-Cal beneficiaries’ needs across the continuum of care to ensure that all beneficiaries receive coordinated services and improve beneficiary health outcomes. DHCS’ goal is to ensure that beneficiaries have access to the right care, in the right place, at the right time.
• MCP criteria
  • Members who are 21 years and older with mild to moderate distress, or mild to moderate impairment of mental, emotional or behavioral functioning resulting from mental health disorders as defined by the current Diagnostic and Statistical Manual of Mental Disorders.
  • Members who are under 21 years, to the extent they are eligible for services through the Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, regardless of the level of distress or impairment, or the presence of a diagnosis.
  • Members of any age with potential mental health disorders not yet diagnosed.
• Required Services for Non-Specialty Mental Health Services (NSMHS)
  • Mental health evaluation and treatment, including individual, group and family psychotherapy.
  • Psychological and neuropsychological testing, when clinically indicated to evaluate a mental health condition.
  • Outpatient services for purposes of monitoring drug therapy.
  • Psychiatric consultation.
  • Outpatient laboratory, drugs, 4 supplies and supplements.
  • Consistent with W&I Code section 14184.402(f), clinically appropriate and covered NSMHS are covered by the Alliance even when:
• Services are provided prior to determination of a diagnosis, during the assessment period or prior to determination of whether NSMHS or SMHS access criteria are met.
• Services are not included in an individual treatment plan.
• The member has a co-occurring mental health condition and Substance Use Disorder (SUD).
• NSMHS and SMHS services are provided concurrently, if those services are coordinated and not duplicated.
• To facilitate the appropriate placement of Medi-Cal clients to either the SMHS or NSMHS system of care, DHCS is developing a set of statewide screening and transition tools which will go into effect in 2023. Using these tools, it is anticipated that most clients will then be assessed within the same system in which they receive treatment. Further details related to the statewide screening and transition tools, refer to pages 4-6 of DHCS APL 22-005.
• For more information, please refer to DHCS APL 22-005.
• Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.

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