Психического здоровья

The Alliance also provides behavioral health resources for In-Home Supportive Services (IHSS) in Monterey County. 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.

While the Alliance is responsible for the provision of Non-Specialty Mental Health Services (NSMHS), previously known as mild to moderate services, the County Mental Health Plan (MHPs) are responsible for the provision of Specialty Mental Health Services (SMHS), previously known as moderate to severe services, for Medi-Cal members, as well as a continuum of substance use disorder services. Eligibility for SMHS is defined in Уведомление о поведенческом здоровье 21-073. Отделение поведенческого здоровья в каждом округе является полезным ресурсом для изучения того, какие услуги будут наиболее полезны с учетом индивидуальных потребностей.

Поставщики медицинских услуг должны направить участников Medi-Cal в отдел поведенческого здоровья своего округа, если участник:

• Требуется специализированное психиатрическое лечение.
• Требуется лечение расстройств, вызванных употреблением психоактивных веществ, кроме острой медицинской детоксикации.

Информацию о направлениях по поведенческому здоровью в конкретном округе см. в разделе, соответствующем вашей зоне обслуживания.

Округ Марипоса

Округ Мерсед

Округ Монтерей

Округ Сан-Бенито

Округ Санта-Крус

Maternal Mental Health (MMH) disorders include a range of disorders and symptoms including depression, anxiety, bipolar disorder, suicidality, OCD and psychosis. These disorders and symptoms can occur during pregnancy and/or during the perinatal period. Perinatal Mood and Anxiety Disorders (PMAD) are some 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, diagnosing and initiating treatment for these pervasive complications.

Along with good history taking, ACOG cites the following validated screenings in their toolkit for Perinatal Mental Health:

Депрессия

• Эдинбургская шкала послеродовой депрессии is a 5-minute questionnaire with 10 questions, 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 or
• The Анкета о состоянии здоровья пациента-9 (PHQ9) is a general screening tool for depression with 9 questions.

Беспокойство

• The General Anxiety Disorder 7 Screen (GAD-7) has 7 questions to assess anxiety symptoms over the past two weeks.

PTSD

• The Primary Care PTSD Screen for DSM-5 (PC-PTSD) is a brief 5 item screen to идентифицировать possible PTSD in the primary care setting.

Bipolar Disorder

• Mood Disorder Questionnaire (MDQ) is a self-report screening tool that looks at possible symptoms of mood disorders, particularly bipolar disorder.

In addition to the above, there are other validated screeners and assessments that can be used, such as:

Suicidal Risk

• The Columbia-Suicide Severity Rating Scale (C-SSRS) is a short questionnaire to help идентифицировать if someone is at risk for suicide, examine the severity and immediacy of the risk, and look at the level of support needed. Various screeners and further assessments are available. 

Лечение психических заболеваний является покрываемым пособием для участников Medi-Cal, имеющих право на участие в программе.

Услуги предоставляются участникам в возрасте до 21 года, когда они считаются необходимыми по медицинским показаниям в соответствии с рекомендациями EPSDT. PCP играют важную роль в выявлении и направлении детей, нуждающихся в лечении поведенческого здоровья. Крайне важно, чтобы PCP осуществляли медицинское наблюдение в случае сопутствующих расстройств.

Prior authorization from the Alliance is required for Applied Behavioral Analysis (ABA) services except for Functional Behavior Assessment (FBA) which can be conducted without prior authorization. BHT services are provided to members when a recommendation is made by a licensed physician, psychologist or surgeon and deemed to be medically necessary. It should be noted that in efforts to ensure accessibility to BHT services and minimize delays members may initiate an FBA with a servicing provider without prior authorization and regardless of diagnosis. BHT services include ABA and other evidence-based services aimed at shaping behavior.

If a member is receiving care from an Alliance 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.

Альянс рекомендует следующие ресурсы:

• Behavioral Health Treatment Medi-Cal Primary Care Provider FAQs.
• Behavioral Health Treatment FBA or Progress Report
• Autism Screening Guidelines
• Behavioral Health/Applied Behavior Analysis Treatment Plan Guidelines

CalHOPE Connect предлагает безопасную, надежную и учитывающую культурные особенности эмоциональную поддержку калифорнийцев в вопросах, связанных с COVID-19.

Рефералы

• For a Care Management Referral, please представлять на рассмотрение здесь: Care Management Referral Form - Central California Alliance for Health.

Отбор и оценка

• Autism Evaluation, BHT/ABA Referral Form.

For information on how to become a behavioral health provider serving the communities in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties, please reach out to the Alliance at присоединяйтесь к нам@thealliance.health or the Alliance's Join our network страница.

• Информационная сессия по поведенческому здоровью – поставщики услуг в области психического здоровья (видео | Слайды) 
• Информационная сессия по поведенческому здоровью – поставщики услуг по лечению поведенческого здоровья (видео | Слайды) 

Modifier Requirements for Covered Behavioral Health Services

Effective dates of service July 1, 2025, the Alliance will directly manage non-specialty behavioral health (BH) services for our Medi-Cal and IHSS members, as well as specialty mental health services for IHSS members. Claims for these services must include one the following modifiers: AF, AH, AS, AJ, HO, or HL. Claims submitted without one of these modifiers will be denied.

These modifiers are used to identify the Providers qualifications (professional level or credential). Proper use ensures accurate reimbursement and compliance.

Please note, these modifier requirements only apply to behavioral health services. Providers who are not classified as BH specialists and are delivering non-BH services are not expected to use these modifiers.