BEACON HEALTH STRATEGIES

BEACON HEALTH STRATEGIES PROVIDER OVERVIEW AND INFORMATION

Agenda 1.

Introduction to Beacon and CHIPA

2.

Review of the new Medi-Cal managed care mental health benefits

3.

Beacon and CHIPAs role in managing new benefit

4.

How beneficiaries will access the benefits

5.

Identifying members managed by Beacon and CHIPA

6.

Review of screening tool

7.

Contact information

8.

FAQs

California Provider Training| December 2013| 2 BEACON HEALTH STRATEGIES | 5665 Plaza Drive Cypress, CA | beaconhealthstrategies.com | chipa.com

The Beacon-CHIPA Relationship •

Partnership Health Plan contracts with Beacon and CHIPA to administer the new mental health benefits.

•

Beacon and College Health IPA (CHIPA) work collaboratively to perform all behavioral health plan management functions on behalf of our California health plans.

• College Health IPA (CHIPA) is the clinical arm of the partnership. e.g. contracting and any utilization management decisions come from CHIPA. • The relationship and operations are seamless to members and providers. Beacon – CHIPA Division of Responsibility

Beacon (Admin)

Function

CHIPA (Clinical) X

Contracting for Outpatient Professional services Credentialing

X

Member Services

X

Utilization Management

X

Claims Adjudication/Payment

X California Provider Training| December 2013| 3

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Beacon Behavioral Health Services: Core Values •

Promote person-centered approach to care that improves member well-being and quality of life

•

Improve communication between behavioral and physical health care providers to ensure proper coordination/transitions of care for members to improve outcomes and reduce hospital and nursing home admissions/readmissions

•

Encourage use of preventive and screening programs to decrease the occurrence, emergence or worsening of behavioral health disorders

•

Build collaborative relationships with in-network practitioners to ensure satisfaction and adherence to evidence-based guidelines & standards of care

•

Focus on recovery: Consumers should live and thrive in the community, with family and friends, engaging in gainful activity.


Beacon Phone Numbers by Medi-Cal Managed Care Plan Geographic Service Area

Health Plan

Beacon Number

Orange County

CalOptima

(800) 723-8641

Alameda County

Alameda Alliance

(855) 856-0577

Sonoma, Solano, Marin, Yolo, Mendocino, Napa, Del Norte, Humboldt, Lake, Lassen, Modoc, Shasta, Siskiyou, Trinity counties

Partnership Health Plan

(855) 765-9703

Merced, Monterey and Santa Cruz counties

Central California Alliance

(855) 765-9700

Ventura County

Gold Coast Health Plan

(855) 765-9702

LA County

LA Care

(877) 344-2858

LA County

Care 1st

(855) 765-9701

Kern County

Kern Family Health Plan

(855) 971-3938

Stanislaus and San Joaquin Counties

San Joaquin Health Plan

(855) 371-8091

California Provider Training| December 2013 | 5 BEACON HEALTH STRATEGIES | 5665 Plaza Drive Cypress, CA | beaconhealthstrategies.com | chipa.com

Review of the Medi-Cal managed care plan benefits

New Medi-Cal Managed Care Mental Health Benefits Target population: Medi-Cal beneficiaries with a diagnosis in the DSM and “mild to moderate” impairments in mental, emotional or behavioral functioning 1. Individual and group mental health treatment (psychotherapy) 2. Psychological testing to evaluate a mental health condition

Managed by Beacon

3. Outpatient services to monitor drug therapy 4. Psychiatric consultation 5. Outpatient laboratory, supplies and supplements 6. Prescription drugs carved into Medi-Cal managed care

Managed by Health Plan, as they are today

 Atypical Psychiatric Medications remain the responsibility of DHCS 7. Children -- Beacon is responsible for services to children with “mild to moderate” impairments. 8. Family Therapy is NOT covered for family relational issues Note: Beacon does not cover any substance use services for Medi-Cal beneficiaries. Screening, Brief Intervention, Referral and Treatment (SBIRT) is managed by the Medi-Cal managed care plan and not Beacon. California Provider Training| December 2013| 7 BEACON HEALTH STRATEGIES | 5665 Plaza Drive Cypress, CA | beaconhealthstrategies.com | chipa.com

Financial responsibility for Medi-Cal mental health services This chart shows how responsibility for the mental health benefits is divided between Medi-Cal managed care plans and County MHPs.

Medi-Cal Managed Care Plan

County Operated Mental Health Plan

Significant impairment

8. Rehabilitative and habilitative services (for mental health services)

9. Emergency mental health services

•Medication management

•Targeted case management

•Crisis intervention

•Assessment and treatment planning

•Adult residential treatment services

•Individual and group therapy

•Full service partnerships

7. Mental Health Services

1. Maternity and newborn care 2. Pediatric services, including oral and vision care

Mild to Moderate Impairment •Medication management

3. Ambulatory patient services 4. Prescription drugs (carved in)

•Individual and group therapy

5. Laboratory services

•Psychological testing

6. Preventive and wellness services and chronic disease management

•Crisis stabilization •Adult crisis residential services

To receive Specialty Mental Health Services through a county MHP, a Medi-Cal beneficiary must be determined by the county to meet the following medical necessity criteria set in state regulation : 1. Diagnosis: Must fall within one or more of the 18 specified diagnostic ranges 2. Impairment. The mental disorder must result in one of the following: a) Significant impairment or probability of significant deterioration in an important area of life functioning b) For those under 21, a probability that the patient will not progress developmentally as appropriate, or when specialty mental health services are necessary to ameliorate the patient’s mental illness or condition 3.

Intervention: Services must address the impairment, be expected to significantly improve the condition, and the condition would not be responsive to physical health care–based treatment.

Title 9, California Code of Regulations (CCR), Sections 1820.205, 1830.205, and 1830.210 California Provider Training| December 2013| 8 BEACON HEALTH STRATEGIES | 5665 Plaza Drive Cypress, CA | beaconhealthstrategies.com | chipa.com

10. Inpatient Services •Acute Psychiatric Hospital Services •Inpatient Professional Services •IMD Psychiatric Services

Review of Beacon’s Clinical Model


Overview of Beacon’s Screening of New Medi-Cal Enrollees Member calls to access mental health treatment

Beacon licensed clinician will conduct a screening to determine appropriate level of care for member referral

Mild to Moderate Impairment Refer to Beacon Contracted provider

Included Diagnosis &Significant Impairment Refer to County Mental Health Plan

Note: FQHC/RHC/IHC have the option to conduct screening internally.


Accessing Services: Beacon’s initial intake workflow


Authorization Process •

Beacon/CHIPA does not require prior authorization for most outpatient services.

•

The exception is psychological testing, which does require online or telephonic prior authorization.

•

Upon completion of screening, a six-month open registration for outpatient mental health services with no limit on # of visits is generated, subject to ongoing clinical review.

Covered Services Service

Requirement

Psychiatric Diagnostic Evaluation

Patient screening through Beacon

New Patient Evaluation and Management (60 min): -

A Comprehensive History A Comprehensive Examination Medical decision making of high complexity Develop an appropriate treatment plan

Psychological testing

Patient screening through Beacon

Phone or online prior-authorization. Patient screening through Beacon

Medication management

Psychotherapy: individual and group

No limit on number of visits Patient screening + six-month registration No limit on number of visits


Covered Providers and Services Provider Type

Covered Service

MD/DO, ARNPs and PAs with DEA

90791 - Diagnostic evaluation with no medical 90792 - Diagnostic evaluation with medical Medical Evaluation Management (E/M): 99205 - New Patient, Evaluation and Management (60 min) 99212 - Medication Management (10 min) 99213 - Medication Management (15 min) 99214 - Medication Management (25 min) 99215 - Medication Management (45 min)

PhD/PsyD and LCSW/LMFTs*

90791 - Diagnostic evaluation with no medical 90832 - Psychotherapy 30 (16-37) min. 90834 - Psychotherapy 45 (38-52) min. 90837 - Psychotherapy 60 (53+) min. 90853 - Group Therapy

PhD/PsyD

96101 - Psychological Testing 96111 - Developmental Testing, Extended 96116 - Neurobehavioral Status Exam 96118 - Neuropsychological Testing (per hour of face-toface time

*Partnership HealthPlan also allows services to be rendered by LPCCs and interns who are either registered with the BBS or in a CAPIC program. California Provider Training| December 2013| 13 BEACON HEALTH STRATEGIES | 5665 Plaza Drive Cypress, CA | beaconhealthstrategies.com | chipa.com

Clinical Review of Services Beacon will be completing clinical review of services This process is in place to ensure that members continue to appear appropriate for services with the managed care plan, with a “mild to moderate” impairment. •

To ensure members meet ongoing medical necessity

•

To ensure that members do not qualify for Specialty Mental Health Services

Review based on claims based triggers, including: •

A SMHS qualified diagnosis

•

A co-occurring substance abuse diagnosis

•

Concurrent or sequential same/similar licensed provider visits

•

Visit thresholds:

•

o

More than 4 visits in 30 days

o


o


Members with more than 2 medication management visits in a 6 month period that have had no therapy visits

* Claims triggers will not deny claims, but just trigger CHIPA for clinical review California Provider Training| December 2013| 14 BEACON HEALTH STRATEGIES | 5665 Plaza Drive Cypress, CA | beaconhealthstrategies.com | chipa.com

Therapy Services Therapeutic Model •

No single specific modality required for services under the Managed Care Plan

•

Expectation is therapy is evidenced based, solution-focused and targeted to member’s mental health diagnosis

•

Therapy should be short-term and episodic related to member’s mental health needs

* If intensive services appear indicated, please contact CHIPA CM to consult on need for County level services

Services with both the Managed Care Plan and the County •

Members should only be receiving services in one system of care at a time

•

If member is transitioned to the County for more intensive services, current services with the Managed Care Plan would terminate

•

Member can transition back to the Managed Care Plan when impairments are reduced to a mild to moderate level

•

The expectation is that many members will transition back and forth between systems as impairments increase and decrease


Determining Mild to Moderate Impairments How do I determine if a member's mental health disorder is mild to moderate or severe? •

A screening tool has been created to assist in making determinations regarding a "mild to moderate" or a "severe" level of impairment related to the mental health diagnosis.

•

Someone with a "severe" level of impairment will have significant impairments in areas of life functioning due to the mental health diagnosis.

•

This can include but is not limited to frequent psychiatric hospitalizations, housing instability, incarcerations and/or violent or aggressive behavior, difficulty/inablility managing activities of daily living.

•

The level of services needed also will indicate the severity of impairment. If a member needs more than weekly therapy to manage mental health issues, he or she may be appropriate for County level services.


Screening Tool


Screening Tool Screening Tool Overview The screening tools for adults and children were developed through collaboration with the Health Plan, Beacon Health Strategies and county Mental health Plans (MHPs). The screening tools reflect the need to quickly gather a provisional diagnosis, gauge functional impairment and identify additional risk factors in order to refer members to the appropriate level of care.

Goal of Screening Tool The screening tool does not take the place of a face to face assessments with either a contracted Beacon provider or the County MHP. The screening tool is to be used to assist in making an initial determination on the appropriate level of care for members. This screening does not replace the county MHP’s assessment of eligibility for specialty mental health services.


Using the Screening tool How do I use the screening tool? Step 1: Administer screening tool. Complete as much info as you can. Step 2: Use the algorithm to determine the appropriate referral source. Step 3: If algorithm indicates mild-to-moderate condition, refer the member to a provider contracted with Beacon, and send the completed screening form with the name of the treating provider to Beacon via eFax at 866-422-3413 or secure e-mail [email protected] Step 4: If algorithm indicates severe condition, refer the member to the County access center for an assessment at the number above. Fax the screening tool to the county. * If you are unclear about how to refer a member to the County, you can contact Beacon for assistance Step 5: If algorithm indicates need for substance use treatment, refer the member to the county number above for substance use disorder treatment.

Where do I find the screening tool? Go to www.beaconhealthstrategies.com. Click on “for providers” at the top of the page, and then on the left hand side of the page, click on “tools.” When it asks for plan name, type in the relevant health plan in your county. Under forms, click on screening form. There are versions for adults and children. The screening tools vary by county and health plan.

After I fax in the screening form, what do I do? Will Beacon communicate with me? Beacon will contact you regarding the screening if there are any questions or concerns related to the information provided. The registrations are generally completed within 48 hours of receipt of the tool. If you have any questions about receipt of the screening tool or the member's appropriateness, you can contact Beacon at the plan specific phone number listed above. California Provider Training| December 2013| 19 BEACON HEALTH STRATEGIES | 5665 Plaza Drive Cypress, CA | beaconhealthstrategies.com | chipa.com

Explanation of Screening Tool Components. BRIEF DESCRIPTIONS OF THE MAJOR AREAS ON THE SCREENING TOOL

Member Info: Collects demographic information on member being screened. List A: Contains all eligible diagnoses included for services with the Mental Health Plan. If a mental health diagnosis is identified that is not on this list, the referral will be sent to Beacon without needing to complete List B or C of the tool. List B: Identifies key domains of life functioning that can be impacted by mental illness. Any areas that a member that is impaired due to a mental illness should be marked. If an area is identified on List B, further determination on severity impairment will need to be made. Determination on “mild to moderate” impairment or “significant” will be identified to complete the algorithm. List C: Any of these factors identified would trigger a referral to the Mental Health Plan/County-level services for an assessment. List D: Any factors identified on List D (not applicable for 0-5 screening tool) would result in a referral to County Alcohol and Other Drug programs. Referral Algorithm: Identifies referral to be made based on outcome of List A-D. Provides contact information for referral. If you have any questions regarding appropriateness of referral or referral algorithm, you can contact Beacon at the number on page 1. Additional Relevant Clinical Information: Can be used to describe any additional factors including but not limited to current medications, psychosocial factors or specific information related to impairments and/or risk factors. For Receiving Clinician Use ONLY: This area is for Beacon and the County to communicate acceptance into system of care

Screening Tool Summary FOLLOWING THE ALGORITHM

List A = Diagnosis List B= Impairment List C= Risk Factors List D = Substance Abuse List A + List B+ List C+ List D (if applicable) = initial referral determination

Screening Tool Example of tool format:

List A: List A is the same for the Adult, 0-5 and 6-17 tools.

List A: Provisional Diagnosis/Diagnosis if known Schizophrenia Bipolar Disorder Depression Anxiety Disorder Impulse Control Disorder Adjustment Disorder Personality Disorder (except Antisocial Personality Disorder) Eating Disorder Pervasive Development Disorder (except Autism Disruptive Behavior/Attention Deficit Disorder Feeding and Eating D/O, Elimination D/O Other disorders of infancy, childhood, adolescence Somatoform Disorders Factitious Disorders Dissociative Disorders Paraphilias Gender Identity Disorder

List B: Adult Tool List B: Functional impairment in life domain below resulting from the mental disorder Independent living skills (e.g. notable difficulty cooking, cleaning, selfmanagement) Social Relations (current interference that affects current relationships) Physical condition (chronic medical condition) Vocational/Employment (disruptive behavioral problems with work performance) Sexuality (significant problems/high risk behavior) Self-care (moderate to severe disruption in multiple self-care skills)

Child: 0-5 Tool

Child: 6-17 Tool

List B: Functional impairment in life domain resulting from mental disorder

List B: Functional impairment in life domain resulting from mental disorder

Family/Social Relations (frequent arguing, difficulty maintaining positive relationships)

Sexuality (significant problems/high risk behavior)

Living Situation (moderate problems maintaining behavior, creating problems for other residents. Parent concerned w/ irritability) Preschool/ Daycare – (difficulty maintaining behavior in this setting, creating significant problems for others). Recreational – (resists play, shows little enjoyment or interest in activities within or outside the home and can only be engaged in play with ongoing adult interaction)

Self care/Independent living skills (e.g. notable difficulty with self care/selfmanagement) Family/Social Relations (frequent arguing, difficulty maintaining positive relationships) Physical/medical condition (medical condition that notably impacts activities) Job Functioning/Vocational (problems developing voc and pre-voc skills) Communication (limited receptive and expressive communication skills)

Decision making (unable to think through problems and anticipate consequences)

Physical/medical condition (medical condition that notably impacts activities and requires ongoing medical intervention)

Judgment (makes decisions that may be harmful to development or well being)

Legal (serious current or pending difficulties with risk of incarceration)

Communication (limited receptive and expressive communication skills)

Residential instability (unable to maintain housing in last 6 months /homelessness in past 30 days)

Relationship Permanence (experienced instability through factors such as divorce, moving, removal from home, and death.

Living Situation (moderate problems with maintaining behavior creating problems for other residents)

WHODAS Score _______________

Sleep –child must be 12 mos. or older (difficulty falling asleep, night waking, nightmares on a regular basis) Motor – (fine or gross motor skill delays)

Legal (current or pending involvement)

School (moderate problems of attendance, behavior, achievement, disruptive, receiving sanctions) Sleep (seldom obtains full night sleep)

List C: Adult Tool List C: Probability of deterioration/Risk factors linked to mental disorder Psychiatric hospitalization in past 6 months (I or more) Criminal behavior (severe level of criminal activity; engaged in violent crime in the past 6 months) Suicidal/Violent Behaviors current or in the last 6 months. Transitional Age Youth with acute psychotic episode Self-injurious behaviors that required medical attention in last 6 months Sexual aggression with acute risk of re-offending

Child: 0-5 Tool

Child: 6-17 Tool

List C: Probability of deterioration/Risk factors linked to mental disorder

List C: Probability of deterioration/Risk factors linked to mental disorder

Birth Weight (considerably underweight eg. 2.23.3 lbs)

Suicidal/Violent Behaviors (recent ideation or gesture)

Pica— child eats unusual or dangerous materials consistent with a diagnosis of Pica in the last 30 days

Self-mutilation

Prenatal Care - Biological mother had poor prenatal care Labor and Delivery - Child or mother had problems during delivery that resulted in temporary functional difficulties for the child or mother Substance Exposure - exposed to significant alcohol or drugs/ tobacco in utero. Parent/Sibling Problems - child has a sibling who is experiencing a significant developmental or behavioral problem. Maternal Availability -significantly less emotionally and physically available to child in 12 weeks following birth Abuse/Neglect – parental history of this behavior without treatment Self-harm - Moderate level of self harm behavior such as head banging not impacted by caregiver and interferes with child’s functioning Aggressive Behavior - clear evidence of aggressive behavior towards animals or others. Social Behavior - Causing problems in child’s life; child is intentionally getting in trouble in school or at home

Other self harm (engaged in behavior that places him/her in danger of self harm (reckless, intentional risk taking) Sexual aggression (engaged in aggressive behavior in the past year) Psychiatric hospitalization in past 6 months (1 or more) Delinquency (recent acts: vandalism, shoplifting, etc.) Acute psychotic episode Fire setting: recent (in the past 6 months) or repeated fire setting behavior) Social Behavior – intentionally engaging in problematic social behaviors causing problems in child’s life Bullying (bullied others individually or led a group) Runaway behavior or ideation (recent) Risk to not meet developmental milestones

List D: Adult Tool

Child: 0-5 Tool (not applicable)

Child: 6-17 Tool

List D: Substance Use Disorder

List D: Substance Use Disorder

Drug abuse or alcohol addiction

Drug abuse or alcohol addiction

Failed SBI(screening & brief intervention at primary care)

Failed SBI(screening & brief intervention at primary care)

Algorithm: Adult Referral Algorithm 1

Remains in PCP care/ Therapy only with Beacon

Diagnosis with none in List B or C

2

Refer to Beacon Health Strategies (eFax (866) 422-3413)

Uncertain diagnosis or diagnosis not in List A Mild – Moderate impairment in List B and none in list C

3

Refer to County Mental Health Plan for assessment

Diagnosis in List A and 1+ Significant impairment in List B Diagnosis in List A and 1+ in List C

4

Refer to County Alcohol & Drug Program

1 from list D

Child 0-5 Referral Algorithm 1


Diagnosis with none in List B or C Mild impairment in List B and none in list C

2

Refer to Beacon Health Strategies (eFax (866) 422-3413)

Uncertain diagnosis or diagnosis not in List A Moderate impairment in List B and none in list C

3



Child 6-17 Referral Algorithm 1


Diagnosis with none in List B or C

2

Refer to Beacon Health Strategies (eFax (866) 4223413)

Uncertain diagnosis or diagnosis not in List A Mild – Moderate impairment in List B and none in list C

3



4

Refer to County Alcohol & Drug Program

1 from list D

Contact Information Questions Bonita Meredith

Senior Manager of Network Operations

Kelly Coleman

Manager of Provider Relations 562.467.5531

[email protected]

Kristen Slater, LCSW

Clinical Director, Medi-Cal

[email protected]

•

562.293.0660

562.467.5565

[email protected]

Provider Relations - assisting providers with any issues or questions in a timely manner. •

Provider Relations can be reached at: 800-779-3825 option 6, then 3, or [email protected]


Frequently Asked Questions


Frequently Asked Questions: Referrals Q1:

What level of care criteria does Beacon use to make coverage determinations?

A:

Providers can access CHIPA’s level of care criteria through eServices or can request a copy at [email protected] or by calling 877.344.2858. Note: This LOCC is not used to determine medical necessity for specialty mental health services but rather to determine medical necessity for the mild to moderate level of care provided by Beacon.

Q2:

How do I make a referral for psychological testing?

A:

Call Beacon Member/Provider Services line through the number above to request authorization or complete the on-line Beacon Prior Authorization form available at www.beaconhealthstrategies.com. Click on “for providers” at the top of the page, and then on the left hand side of the page, click on “tools.” When it asks for plan name, type in the relevant health plan. Under forms, click on psychological/neurological testing form. Fax this form to Beacon at 866.422.3413.

Q3:

What psychiatric consultation is available from Beacon?

A:

Beacon has a panel of psychiatrists available to provide consultations to primary care providers. To access this service, call the Plan specific number for Beacon and make a request. A service coordinator will arrange a convenient time for the two practitioners to discuss the patient. Providers may submit background information on the client to facilitate the consultation.


Frequently Asked Questions: Determining Mild to Moderate Q1:

How do I determine if a member's mental health disorder is mild to moderate or severe?

A:

A screening tool has been created to assist in making determinations regarding a "mild to moderate" or a "severe" level of impairment related to the mental health diagnosis. Someone with a "severe" level of impairment will have significant impairments in areas of life functioning due to the mental health diagnosis. This can include but is not limited to frequent psychiatric hospitalizations, housing instability, incarcerations and/or violent or aggressive behavior. The level of services needed also will indicate the severity of impairment. If a member needs more than weekly therapy to manage mental health issues, he or she may be appropriate for County level services.

Q2:

I am contracted with both the County and with Beacon. How do I know where to send my claim?

A:

Determining the member's level of functioning is important to determine where you should send your claim. If the member has been screened as being "mild to moderate" the claim will come to Beacon. If the member has been screened and identified as having a significant impairment, that claim will go to the County. Depending on your county, this may require an authorization to serve the member.

Q3:

Can someone be served by both the county for SMI and Beacon?

A:

No. A member should only be receiving services in one system for mental health issues. Members will transition between the County and Beacon as the member's level of functioning increases or decreases but a member should not be in both systems at the same time.


Frequently Asked Questions: Therapy Q1:

Does Beacon require therapists to use a certain type of evidenced-based therapy?

A:

No, Beacon does not prescribe a certain type of therapy. However, Beacon expects all contracted licensed therapists to provide short-term, evidence based, solution-oriented therapy. We have built in claims triggers that expect titration of services.

Q2:

Is there a limit on the number of therapy visits?

A:

There is no limit on the number of therapy visits but it is expected that members that fall into the "mild to moderate" level of impairment will receive targeted, episodic services to treat the mental health diagnosis. For members at the "mild to moderate" level, thresholds have been put in place to monitor visits. If a member is seen more than 4 times in the first 30 days, more than 7 times in the first 60 days or more than 9 times in the first 90 days, it will trigger a clinical review to ensure that the member is in the appropriate level of care.

Q3:

Can I provide home-based or school-based services?

A:

Services must be delivered in an office unless there are geographic access issues or other circumstances that make it appropriate and medically necessary. There is no extra reimbursement for home-based therapy to compensate for travel time.

Q4:

Can I include the parents in the therapy session with a child?

A:

The Medi-Cal benefit does not cover family therapy. For therapy with a child, when it is clinically appropriate for the child's treatment, parents can be involved in the therapy process as long as this is targeted to improvement of the child's mental health diagnosis. The therapy session should be billed for as individual therapy for the primary patient, the child. California Provider Training| December 2013| 32 BEACON HEALTH STRATEGIES | 5665 Plaza Drive Cypress, CA | beaconhealthstrategies.com | chipa.com

Frequently Asked Questions: FQHCs, RHCs, IHCs Q1:

Same day billing: Can a mental health provider bill Beacon on the same day the member saw another provider type?

A:

Clinics may bill Beacon for a service rendered by a mental health provider on the same day as another visit type and receive reimbursement. However, the clinics at this time are not able to receive a wrap-around payment from the state for both visits.

Q2:

Can FQHCs get reimbursed by Beacon for services provided a Licensed Marriage and Family Therapist (LMFT)?

A:

Yes, clinics may bill Beacon for a service rendered by a LMFT, however, the clinics at this time the clinics not able to receive a wrap-around payment from the state for services provided by LMFTs.

Q3:

How should FQHCs bill Beacon for group therapy sessions?

A:

Clinics should bill Beacon the appropriate CPT code for each member that participated in the group therapy session.

Q4:

Can FQHCs limit their BH staff to only those members who have a medical home at the FQHC?

A:

Yes, an FQHC seeing members assigned to other PCPs for behavioral health services. I just want to make sure you are aware, that MCC can elect to see their current members only, or be open to seeing members assigned to other PCPs, but just for behavioral health services. No referral is needed.


Frequently Asked Questions: Other health coverage & Share of Cost Q1:

What should I do with Medi-Cal beneficiaries who have other health care coverage (e.g. Medicare or private insurance)?

A:

Medi-Cal beneficiaries with other health care coverage should be referred to their non-Medi-Cal private health coverage plan or policy that provides or pays for health care services. When mental health services are not covered by a recipient’s other health coverage CHIPA providers are still encouraged to bill OHC first. The provider should submit claims to Beacon with a copy of the primary insurance’s explanation of benefits (EOB) within 180 days of the date on the EOB. Providers are required to exhaust the recipient’s OHC before billing Medi-Cal through Beacon when OHC covers mental health services.

Q2:

What should I do when Medi-Cal beneficiaries have a share of cost (SOC)?

A:

Providers treating a Medi-Cal beneficiary identified as having a Medi-Cal share of cost (SOC) should attempt to verify the SOC amount with the member and collect any unmet SOC at the time of services. Providers should encourage beneficiaries with a SOC to clear their SOC by routinely submitting healthcare receipts to their County Eligibility Worker.


BEACON HEALTH STRATEGIES

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