To provide guidelines to certify that all claims for mental health services submitted for reimbursement under various funding programs are accurate, complete, truthful, and are in compliance with applicable statutory, regulatory, and policy requirements, and, as appropriate, are reasonable and medically necessary based upon program expectations. |
The Director of the Department of Mental Health (DMH), or his/her designee, shall certify to the best of his/her knowledge and belief, that all claims submitted for reimbursement under Short-Doyle/Media-Cal (SD/MC) are accurate, complete, truthful, and are in compliance with applicable statutory, regulatory, and policy requirements, and, as appropriate, are reasonable and medically necessary. -
A Mental Health Claim Certification form (MH1982 A) shall be submitted by DMH to the State of California concurrent with the submission of any claim for SD/MC reimbursement. -
The DMH Director's certification shall be based on signed certifications for compliant services completed by clinical service providers, supervisors, and managers consistent with the implementation of this policy. The Director of Financial Services for DMH shall certify that there are sufficient eligible funds available to satisfy the various program instructions for required matching funds. All DMH Program Managers who submit or oversee the submission of claims for reimbursement under various funding programs shall be responsible to certify to the best of their knowledge and belief that all claims submitted for reimbursement programs are accurate, complete, truthful, and are in compliance with applicable statutory, regulatory, and policy requirements, and, as appropriate, are reasonable and medically necessary. -
DMH Program Managers shall complete a Mental Health Plan (MHP) Claim Certification for Program Managers form. -
The specific mechanisms chosen by Program Managers to ensure program compliance shall be at the discretion of the Program Manager. -
Mental Health Clinical Program Manager III shall approve the Program Managers' Certification form for those Program Managers who report to them. -
Deputy Directors shall approve the Program Managers' Certification form for those Program Managers who report to them. All DMH employees who provide mental health services that are reimbursable under various funding programs shall certify to the best of their knowledge and belief that all services rendered by them, and subsequently submitted for reimbursement, are accurate, complete, truthful, and are in compliance with applicable statutory, regulatory, and policy requirements, and, as appropriate, are reasonable and medically necessary. Applicable elements of DMH services must include the following: -
An assessment of the beneficiary was conducted in compliance with the requirements established in the MHP contract with the State Department of Mental Health. -
The beneficiary was eligible to receive services at the time the services were provided to the beneficiary. -
The services included in the claim were provided to the beneficiary and documented in accordance with applicable requirements. -
Medical necessity, or other criteria for program participation, was established for the beneficiary for the timeframe in which the services were provided. -
A Client Treatment Plan was developed and maintained for the beneficiary that met all Client Care Plan requirements in accordance with the clinical documentation policies and procedures (DMH Policies 401.02, 401.03, and 401.04). -
All payment authorization requirements were fulfilled. Mental Health Clinical Program Manager III and Deputy Directors shall be responsible to monitor compliance with this policy and procedure and to ensure that appropriate mechanisms have been instituted and maintained at the program level to ensure monitoring and compliance with all applicable statutory, regulatory, and policy requirements. DMH employees are responsible to notify their immediate manager in any situation/event in which reason exists to believe that any elements of compliance with applicable statutes, regulations, or program instructions are not being fulfilled. -
DMH employees may provide notification to higher level managers, following the principles of chain-of-command, in instances where their immediate manager is either inaccessible or, in the employee's best judgment, would not be the appropriate individual for purposes of reporting. -
In the event notification of this nature occurs, management shall follow their reporting chain-of-command, up to and including notification to the Director or his/her designee. -
In the event an employee feels the need for anonymity, notification of the situation/event may be made via the County Fraud Hotline or a direct call to the DMH Compliance Program Office. |