Sức khỏe hành vi

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 Thông báo Thông tin Sức khỏe Hành vi 21-073. Phòng tiếp cận sức khỏe hành vi ở mỗi quận là nguồn tài nguyên hữu ích để khám phá những dịch vụ nào sẽ có lợi nhất dựa trên nhu cầu cá nhân.

Các nhà cung cấp nên giới thiệu các thành viên Medi-Cal đến sở y tế hành vi của quận nếu thành viên đó:

• Yêu cầu điều trị sức khỏe tâm thần đặc biệt.
• Yêu cầu điều trị rối loạn do sử dụng chất gây nghiện ngoài việc cai nghiện y tế cấp tính.

Để biết thông tin giới thiệu về sức khỏe hành vi cụ thể theo quận, hãy xem phần dành cho khu vực dịch vụ của bạn.

Quận Mariposa

Quận Merced

Quận Monterey

Quận San Benito

Quận Santa Cruz

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:

Trầm cảm

• Thang đo trầm cảm sau sinh ở Edinburgh 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
• Các Bảng câu hỏi sức khỏe bệnh nhân-9 (PHQ9) is a general screening tool for depression with 9 questions.

Sự lo lắng

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

PTSD

• Các Primary Care PTSD Screen for DSM-5 (PC-PTSD) is a brief 5 item screen to nhận dạng 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

• Các Columbia-Suicide Severity Rating Scale (C-SSRS) is a short questionnaire to help nhận dạng 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. 

Điều trị sức khỏe hành vi là một phúc lợi được chi trả cho các thành viên Medi-Cal đủ điều kiện.

Các dịch vụ được cung cấp cho các thành viên dưới 21 tuổi khi được coi là cần thiết về mặt y tế theo hướng dẫn của EPSDT. PCP đóng vai trò quan trọng trong việc xác định và giới thiệu những trẻ cần điều trị sức khỏe hành vi. Điều quan trọng là PCP phải cung cấp dịch vụ theo dõi y tế đối với các rối loạn xảy ra đồng thời.

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.

Liên minh đề xuất các nguồn lực sau:

• 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

Kết nối CalHOPE cung cấp hỗ trợ tinh thần an toàn, đảm bảo và nhạy cảm về mặt văn hóa cho người dân California trong các vấn đề liên quan đến COVID-19.

Giới thiệu

• For a Care Management Referral, please nộp đây: Care Management Referral Form - Central California Alliance for Health.

Sàng lọc và đánh giá

• 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 [email protected] or the Alliance's Join our network trang.

• Phiên họp thông tin về sức khỏe hành vi – Nhà cung cấp dịch vụ sức khỏe tâm thần (Băng hình | Các slide) 
• Phiên họp thông tin về sức khỏe hành vi – Nhà cung cấp dịch vụ điều trị sức khỏe hành vi (Băng hình | Các slide) 

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.