More information is available on the Information for Medi-Cal Providers resource document. Subscribers receive subject-specific emails for urgent announcements and other updates shortly after they post to the Medi-Cal website. To subscribe, please click on this website link. Other health and mental health plan letters — These letters are issued to Medi-Cal managed care plans that serve Medi-Cal beneficiaries, and include requirements for providing services under EPSDT.
Left Column Content Row1. Alternatively, managed care plans could arrange for their providers to be located at school sites. Overall, partnerships between schools and managed care plans are very rare. The incentive payments provided under this proposal would be provided to managed care plans for a variety of activities. In addition to the activities managed care plans would receive incentive payments for described above, managed care plans also would receive higher incentive payments for a subset of specific activities.
The specific allocation methodology that would determine how incentive payments would be distributed to managed care plans has not yet been determined. The administration has indicated that development of this methodology will begin July 1, Key Details of Proposal Are Missing. Further key details are necessary to fully evaluate this proposal. These details would include specifics about 1 t he methodology that will be used to determine how incentive payments will be allocated to managed care plans, 2 t he final set of specific metrics managed care plans will be required to meet to receive incentive payments, and 3 h ow funding made available by the incentive payments to managed care plans will flow to schools or county behavioral health.
Our understanding is that budget bill language is forthcoming, however trailer bill language will not be proposed. While this proposal could have merit, budget bill language is insufficient for establishing a new program of this magnitude and novelty.
Typically, budget bill language has much less specificity than a trailer bill. If the Legislature wishes to move forward with this proposal, we suggest the Legislature adopt trailer bill language to govern the development of key structural details of this program and provide more opportunities for oversight—like through reporting to the Legislature on development of the allocation methodology for incentive payments.
Although schools and counties who currently have partnerships with schools may already provide similar services as those that managed care plans can provide, the degree to which they do is unclear. In order to improve access to such services—given the fragmented nature of the behavioral health service delivery—increasing partnerships between schools and managed care plans could have merit.
The following contains information for Healthy Kids providers regarding screening exams, referrals from a screening exam and treatment provided as a result of a screening exam. Healthy Kids screening exams are preventative and diagnostic services designed to evaluate the general physical and mental health, growth, development and nutritional status of eligible recipients under the age of 21 years old.
The Healthy Kids program encourages providers to follow the recommended periodicity schedule set forth by the American Academy of Pediatrics. Interperiodic exams may be performed when requested or based on medical necessity. A screening form is available as an option for providers to use when performing the Healthy Kids screening exams. The form acts as a reminder by listing all the components of the screening, making it more streamlined for providers to complete the exam.
Links for the form, along with a guideline, can be found at the bottom of this webpage. Screening services including examinations and diagnostics do not require prior authorization, however, ongoing treatment or services beyond the initial screening may require prior authorization based on specific program requirements.
The following services are included in the screening exam and should not be billed separately: office visit, consultations, hematocrit, urinalysis dip stick, PPD or tine test, lead screening, objective vision and hearing. Medically necessary health care, treatment or other measures to correct or ameliorate defects and physical and mental illnesses or conditions discovered by Healthy Kids screening services are a covered benefit, even if those services are not included as part of the covered services in the state plan.
Requests for services that are beyond specific program policy or not covered under state plan must be made to the QIO-like vendor.
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