Service Requirements for Mental Health/Rehabilitation Services. Evaluation and Assessment CONTRACTOR shall perform a thorough clinical assessment for all children and youth referred for services. This assessment will serve as the basis of the CONTRACTOR’S treatment and Client Service Plan. An assessment of the child or youth must be conducted in compliance with the requirements established in the Mental Health Plan (MHP) contract between COUNTY and DHCS which will be provided to the CONTRACTOR under separate cover. Children and youth must be active Medi-Cal recipients, with the exception of children and youth referred due to their status in the Child Welfare System. The child or youth served due to their status in the Child Welfare System will be referred by the Child Welfare social worker, but must meet medical necessity to receive treatment. COUNTY will verify Medi-Cal eligibility prior to commencement of services. CONTRACTOR shall verify that the child/youth continues to be an active Medi-Cal recipient throughout the course of services. The assessment must establish medical necessity for the child or youth as defined in the California Code of Regulations, Title 9, which guides service and documentation provisions. Further, medical necessity must be maintained for all services provided, and for the timeframe in which the services were provided. Medical necessity includes three elements: a covered Diagnostic and Statistical Manual (American Psychiatric Association – DSM 5) diagnosis, significant impairment in an important area of life functioning or development, and an ability to benefit from the proposed specialty mental health intervention. CONTRACTOR shall use either its own assessment form or the COUNTY Biopsychosocial Assessment form, CARE015. CONTRACTOR must develop and maintain a client service plan for the child or youth that meets all client service plan requirements established in the MHP. CONTRACTOR shall use either its own client service plan form, if it has all the Medi-Cal required elements, or the COUNTY USP CARE008 form. Individual Client Service Plans shall be developed no less than annually.
Service Requirements for Mental Health/Rehabilitation Services. 2.3.1. Evaluation and Assessment: • All adults referred for services shall have received a biopsychosocial assessment performed by the CONTRACTOR. This assessment will serve as the basis of the treatment and service plan as developed by the CONTRACTOR. • An assessment of the adult must be conducted in compliance with the requirements established in the Mental Health Plan (MHP) contract between COUNTY and DHCS, a copy of which will be provided to CONTRACTOR under separate cover. • The assessment must establish medical necessity and eligibility criteria for the individual as defined in Welfare and Institution Code Sections 14059.5, and 14184.402. Further, medical necessity and eligibility must be maintained for all services provided, and for the timeframe in which the services were provided. Medical Necessity includes three elements: a covered DSM-V diagnosis, significant impairment in an important area of life functioning or development, and an ability to benefit from the proposed specialty mental health intervention. CONTRACTOR shall use COUNTY Biopsychosocial Assessment form, CARE 015. • A client plan must be developed and maintained for the adults that meet all client plan requirements established in the MHP. CONTRACTOR may use its own client plan form, if it has all the Medi-Cal required elements. These shall be developed no less than annually.
Service Requirements for Mental Health/Rehabilitation Services
