CALIFORNIA CODE OF REGULATIONS - State of California

Page 501
TITLE 9. DIVISION 1 — DEPARTMENT OF MENTAL HEALTH § 1727
reimbursement are subsequently approved.
NOTE: Authority cited: Section 14680, Welfare and Institutions
Code. Reference: Sections 5778, 14680 and 14684, Welfare and Institutions
Code.
§ 1720. Receipt or Date of Receipt.
“Receipt” means the receipt or date of receipt of a Treatment
Authorization Request or other document. The date of receipt shall be
as indicated by a time stamp or fax time and date recorded on that
document. In the absence of a date/time stamp made by the receiver,
the postmark date shall be used as the date of receipt.
NOTE: Authority cited: Section 14680, Welfare and Institutions
Code. Reference: Sections 5777, 5778 and 14684, Welfare and Institutions
Code.
§ 1721. Routine Services.
“Routine Services” means bed, board and all medical, nursing and
other support services usually provided to an inpatient by a psychiatric
inpatient hospital. Routine services do not include hospital–based
ancillary services or physician or psychologist services.
NOTE: Authority cited: Section 14680, Welfare and Institutions
Code. Reference: Sections 5777, 5778 and 14684, Welfare and Institutions
Code.
§ 1722. Short–Doyle/Medi–Cal Provider.
“Short–Doyle/Medi–Cal Provider” means a provider that submits
claims for Medi–Cal psychiatric inpatient hospital services through
the Department to the Department of Health Services and not to the
fiscal intermediary.
NOTE: Authority cited: Section 14680, Welfare and Institutions
Code. Reference: Sections 5777, 5778 and 14684, Welfare and Institutions
Code.
§ 1723. Submit or Date of Submission.
“Submit” or “date of submission” means to transmit a document by
mail, fax, or hand delivery. The date of submission shall be as
indicated by the postmark date, fax date, or the date of hand delivery
as shown by a time stamp on the document. In the absence of a
date/time stamp by the receiver, the postmark date shall be used as the
date of submission.
§ 1724. Traditional Hospital Provider.
“Traditional Hospital Provider” means a provider that, according
to the latest historical Medi–Cal payment data collected by the
Department of Health Services, provides services to beneficiaries of
an MHP that account for five (5) percent or twenty thousand dollars
($20,000), whichever is more, of the total fiscal year Medi–Cal
psychiatric inpatient hospital service payments made for beneficiaries
of an MHP.
NOTE: Authority cited: Section 14680, Welfare and Institutions
Code. Reference: Sections 5777, 5778, 14680 and 14684, Welfare
and Institutions Code.
Article 2.
Administration
§ 1725. Applicability of Laws and Regulations.
(a) Each MHP shall comply with all applicable Federal regulations
and guidelines and all applicable State Medi–Cal regulations in Title
22 of the California Code of Regulations, except as provided in
Section 5776 of the Welfare and Institutions Code, for MHP payment
authorization and funding of psychiatric inpatient hospital services.
(b) Except for Short–Doyle/Medi–Cal hospital services, this
chapter shall not apply to a beneficiary enrolled in a Medi–Cal
Managed Care Plan which includes the provision of
Fee–for–Service/Medi–Cal (FFS/MC) psychiatric inpatient hospital
services to beneficiaries.
(c) Unless specifically allowed by this chapter, provisions of the
contract between the MHP and the Provider shall not be in conflict
with this chapter.
NOTE: Authority cited: Section 14680, Welfare and Institutions
Code. Reference: Sections 5775, 5776, 5777, 5778 and 14684, Welfare
and Institutions Code.
§ 1726. Designation of MHPs.
(a) A county that wishes to be designated as the MHP for the
beneficiaries of that county shall communicate its intent in a
resolution from the county board of supervisors which shall be
transmitted to the Department. The resolution shall state:
(1) The county assumes responsibility for Medi–Cal authorization
and payment for all psychiatric inpatient hospital services for
beneficiaries of that MHP.
(2) The county recognizes and agrees that the allocation of State
funds pursuant to Section 5778 Welfare and Institutions Code is
payment in full from the State for the services specified in (a)(1)
except as described in Section 1750 of this chapter.
(3) The county shall utilize a public planning process that involves
various constituency groups to assist in formulating policies and
procedures for the operation of the MHP insofar as these policies and
procedures are not specifically prescribed in law and regulation.
(4) The county shall submit to the Department an Implementation
Plan for Psychiatric Inpatient Hospital Services pursuant to Section
1727 of this chapter.
(b) If a county declines to be the MHP for the beneficiaries of that
county, other qualifying entities including other counties acting
jointly, or governmental, and non–governmental entities, may be
selected as the MHP by the Department pursuant to Section 5775
Welfare and Institutions Code. The entity selected shall meet the same
duties and obligations required of a county in (a)(1)–(4).
NOTE: Authority cited: Section 14680, Welfare and Institutions
Code. Reference: Sections 5775, 5777, 5778 and 14684, Welfare and
Institutions Code.
§ 1727. Implementation Plan for Psychiatric Inpatient
Hospital Services.
(a) An entity applying to become the MHP for beneficiaries who
are residents of a specific county, including counties which have
submitted a resolution, shall submit within sixty (60) calendar days
prior to implementation an Implementation Plan for Psychiatric
Inpatient Hospital Services to the Department that includes:
(1) Procedures for MHP payment authorization of psychiatric
inpatient hospital services by the MHP including the point of
authorization.
(2) A process for:
(A) Screening, referral and coordination with other necessary
services, including, but not limited to, educational, health, housing
and vocational rehabilitation services.
(B) Outreach efforts for the purpose of providing information
regarding access under the MHP to beneficiaries and providers.
(3) The processes for problem resolution as required in Article 5 of
this chapter.
(4) A description of the provider selection process, including
provider selection criteria consistent with Section 1729. The MHP
shall include a Request for Exemption from Contracting in
accordance with Section 1730(c) of this chapter if the MHP decides
not to contract with a Traditional Hospital Provider or DSH.
(5) A description of the provision, to the extent feasible, of
culturally competent and age–appropriate services to beneficiaries.
(6) A description of a process for planned admissions in
non–contract hospitals if such an admission is determined to be
necessary by the MHP.
(b) The Department shall review and either approve, disapprove,
or request additional information for each Implementation Plan for
Psychiatric Inpatient Hospital Services. Notices of approval,
disapproval and requests for additional information shall be
forwarded to applicant MHP entities within sixty (60) calendar days
of the receipt of the Implementation Plan. Upon approval by the
Department, the Implementation Plan becomes a binding contract