I.  PURPOSE
 

To ensure timely coordination of care and services for shared Members served by Los Angeles County Department of Mental Health, the local Mental Health Plan (MHP), and are concurrently enrolled in a Los Angeles County Medi-Cal Managed Care Plan (MCP).
 

To ensure that Members receive MHP services in a coordinated manner and to provide a process to continuously evaluate the quality of the care coordination for medically necessary Non-Specialty Mental Health Services (NSMHS) and Specialty Mental Health Services (SMHS) that are non-duplicative.
 

II.  DEFINITIONS
 

Covered Service: Medical service, item, or supply that is eligible for reimbursement by an insurance plan or government program. 
 

Member: An eligible Medi-Cal beneficiary who is enrolled in a Medi-Cal Managed Care Plan (MCP). 
 

Managed Care Plan (MCP): State contracted health plan that deliver Medi-Cal benefits to enrollees under a managed care network of providers.  
 
Medical Necessity:  Pursuant to Welfare and Institutions Code section 14184.402(a), for individuals 21 years of age or older, a service is “medically necessary” or a “medical necessity” when it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain as set forth in Welfare and Institutions.
 

Mental Health Plan (MHP): A County Mental Health Plan that is responsible for providing specialty mental health services. 
 

Primary Contact: An individual practitioner assigned to a Member through a provider and designated for care coordination.
 

Treatment Team: Practitioners assigned to Members to provide services, coordinate services, and monitor the health and well-being of the Members. 
 

III.  POLICY
 

Care Coordination 

MHP Health Plan Operations Unit will address the following at least quarterly with Los Angeles County Medi-Cal MCPs: 

• Discuss and address care coordination issues or barriers to care coordination efforts; 
• Ensure appropriate communication, care coordination, and provide updates; 
• Identify strategies to monitor and assess the coordination of inpatient and outpatient medical and mental health care for all Members enrolled in MCP and receiving SMHS through the MHP, in accordance with federal and State law, regulations, and guidance.  

MHP will discuss and address barriers to care coordination and ensure ongoing monitoring and improvement of such care coordination at least quarterly with contracted MCPs, including, but not limited to: 

• Provision of medically necessary services 
• Treatment planning 
• Clinical consultation 
• Enhanced Care Management (ECM) 
• Community Supports 
• Eating disorder services 

MHP will coordinate care with MCPs for their Members who meet access criteria for, and are concurrently receiving, NSMHS and SMHS consistent with the “No Wrong Door for Mental Health Services” to ensure the care is clinically appropriate and non-duplicative and considers the Member’s established therapeutic relationships with MCPs. 
 

MHP will have a process for coordinating with the MCPs for the delivery of Medically Necessary Covered Services.
 

MHP will permit Members to concurrently receive NSMHS and SMHS when clinically appropriate, coordinated, and not duplicative consistent with the “No Wrong Door for Mental Health Services.” 
 

MHP will have a process to coordinate with the MCPs to ensure Members and Network Providers can coordinate coverage of Covered Services and carved-out services outside normal business hours, as well as providing or arranging for 24/7 emergency access to psychiatric inpatient hospital admission with contracted Los Angeles County Medi-Cal Managed Care Plans (MCP):. 

• 24/7 MHP emergency services ACCESS Center: 1-800-854-7771.  

IV.  PROCEDURES
 

V.  AUTHORITIES
 

State of California, Health and Human Services Agency, Department of Health Care Services, All Plan Letter: 22-005 No Wrong Door.

State of California, Health and Human Services Agency, Department of Health Care Services, All Plan Letter: 22-006 Medi-Cal Managed Care Health Responsibilities for Non-Specialty Mental Health Services.

State of California, Department of Health Care Services Behavioral Health Information Notice: 22-011 No Wrong Door.

State of California, Department of Health Care Services Base Memoranda of Understanding Between Medical Managed Care Plans and Third-Parties Entities Template
 

VI.  ATTACHMENTS