| I. PURPOSE
| | To establish policy and procedures for Los Angeles County Department of Mental Health regarding coordination of Medi-Cal beneficiaries' access to care and services with their assigned Los Angeles County Medi-Cal Managed Care Plan (MCP).
The intent is to guide referrals of Adult and Youth beneficiaries to the appropriate Medi-Cal mental health delivery system and ensure that beneficiaries requiring transition between delivery systems receive timely coordinated care.
Contracted agencies shall develop an internal policy and associated procedures that are consistent with their organizational practices and meet the requirements set forth in this policy.
| | II. DEFINITIONS
| | Assessment: A service activity designed to evaluate the functioning of a client, which may include a mental status exam, testing results, clinical history, cultural factors, biopsychosocial summary, and diagnosis.
Closed Loop Referral Report: Monthly report customized for each LA County Medi-Cal Managed Care Plan that tracks screening and transition of care tools sent by each MCP for referral tracking.
Managed Care Plan (MCP): State contracted health plans that deliver Medi-Cal benefits to enrollees under a managed care network of providers.
Managed Care Plan Providers: The entities that deliver the services to the beneficiary under their assigned Managed Care Plan.
No Wrong Door: Policy which allows beneficiaries to receive Specialty Mental Health Services and non-Specialty Mental Health Services concurrently when all of the services are clinically appropriate, and the treatment is coordinated between the systems and not duplicative.
Screening Tool: The State standardized form required to determine the appropriate mental health delivery system for referral when a beneficiary is seeking yet not currently receiving mental health services.
Transition of Care Tool: The State standardized form required when an existing beneficiary needs a transition of care/service referral; the tool ensures beneficiaries who are receiving mental health services from one delivery system receive timely and coordinated care when transitioning to another care system or when additional services need to be added to their current treatment.
| | III. POLICY
| | When agencies act as the Mental Health Plan (MHP) for mental health services, they shall use standardized, state-wide Screening and Transition of Care tools from the Department of Health Care Services to facilitate transition of care for beneficiaries when changing service needs. DMH MHP Providers shall utilize the Adult and Youth Screening Tools for Medi-Cal Mental Health Services to determine the appropriate mental health delivery system referral for beneficiaries who are seeking mental health services yet are not currently enrolled.
DMH MHP Providers shall utilize the Transition of Care Tool for Medi-Cal Mental Health Services to ensures beneficiaries who are currently receiving mental health services, receive timely and coordinated care when transitioning to another care system.
DMH MHP Providers shall establish a No Wrong Door referral process for members and works collaboratively with the beneficiary’s assigned MCP to ensure access to services through multiple pathways. DMH MHP Providers shall provide referrals to the MCP for Assessment and will share the completed screening tool to the MCP
DMH shall send Closed Loop Referral Reports to the MCPs on a monthly basis.
| | IV. PROCEDURES
| | | | V. AUTHORITIES
| | | | VI. ATTACHMENTS
| | No attachments are associated with this policy. | |
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