§ 12693.61
266 words·~1 min read·
/ca/insurance-code/12693-61A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
The following provisions apply for subscribers who have been identified by the participating health plans as potentially seriously emotionally disturbed.
(a)Participating plans, to the extent feasible, including plans receiving purchasing credits shall develop memoranda of understanding, consistent with criteria established by the board in consultation with the State Department of Health Care Services, for referral of subscribers who are seriously emotionally disturbed to a county mental health department. This referral does not relieve a participating plan from providing the mental health coverage specified in its contract, including assessment of, and development of, a treatment plan for serious emotional disturbance. Plans may contract with county mental health departments to provide for all, or a portion of, the services provided under the program’s mental health benefit.
(b)The board shall establish an accounting process under which counties providing services to subscribers who have been determined to be seriously emotionally disturbed pursuant to Section 5600.3 of the Welfare and Institutions Code can claim federal reimbursement for the services. The board shall reimburse counties pursuant to the rates set by the State Department of Health Care Services in accordance with Sections 5705, 14705.7, 14705, 14708, 14711, and 14718 of the Welfare and Institutions Code. The actual amount reimbursed by the board shall be the federal share of the cost of the subscriber.
(c)This section shall only become operative with federal approval of the State Child Health Plan and the approval of federal financial participation.
(d)Counties choosing to enter into a memorandum of understanding pursuant to subdivision
(a)shall provide the nonfederal share of cost for the subscriber.