Statewide Multi-Payer School-Linked Fee Schedule
Announcements
On July 3, 2024, the Department of Health Care Services (DHCS) announced the Local Educational Agencies (LEAs) approved to participate in the second cohort of the Children and Youth Behavioral Health Initiative (CYBHI) statewide multi-payer school-linked fee schedule (Fee Schedule) and statewide provider network. DHCS implemented an operational readiness review process for all interested County Offices of Education (COE) and LEAs. In determining LEA readiness for this cohort, DHCS considered a variety of factors, including, but not limited to: Medi-Cal enrollment, service delivery infrastructure and capacity building, data collection and documentation, and billing infrastructure.
See PDF list of selected LEAs.
*Please note: DHCS anticipates announcing the approved California Community Colleges for Cohort 2 by late July 2024.
Background
The Department of Health Care Services (DHCS), in collaboration with the Department of Managed Health Care (DMHC), will develop and maintain an multi-payer, school-linked statewide fee schedule for outpatient mental health or substance use disorder services provided to a student 25 years of age or younger at or near a school site. DHCS will also develop and maintain a school-linked statewide provider network of behavioral health counselors.
The state statute (W&I Code section 5961.4) requires commercial health plans and the Medi-Cal delivery system, as applicable, to reimburse, at or above the published rates, these school-linked providers, regardless of network provider status, for services furnished to students pursuant to the fee schedule. Further, services provided as part of the fee schedule shall not be subject to copayment, coinsurance, deductible, or any other form of cost sharing.
To leverage the CYBHI fee schedule as a sustainable funding source for school-linked behavioral health services that:
- Increases access to school-linked behavioral health services for children and youth;
- Creates a more approachable billing model for schools and local educational agencies (LEAs);
- Eases burdens related to contracting, rate negotiation, and navigation across delivery systems; and,
- Reduces uncertainty around students’ coverage.
CYBHI Fee Schedule - Cohort 1 Details
On December 1, 2023, the Department of Health Care Services (DHCS) announced the first cohort of forty-seven (47) Local Education Agencies (LEAs) approved to participate in the Children and Youth Behavioral Health Initiative (CYBHI) statewide multi-payer school-linked fee schedule (Fee Schedule) and statewide provider network. The Welfare and Institutions Code § 5961.4(b) authorizes DHCS to “develop and maintain a school-linked statewide provider network of school-site behavioral health counselors." To develop the CYBHI Fee Schedule provider network, DHCS implemented an operational readiness review process for all interested County Offices of Education (COE) and LEAs. In determining LEA readiness for this cohort, DHCS considered a variety of factors, including, but not limited to: Medi-Cal enrollment, service delivery infrastructure and capacity building, data collection and documentation, and billing infrastructure.
These 47 LEAs were determined by DHCS to meet the readiness review requirements and will comprise the first cohort of the CYBHI fee schedule, which will launch in January 2024. The first cohort will participate in a learning collaborative to inform state level policy and operational guidance for the CYBHI fee schedule program.
See PDF list of selected LEAs.
Fee Schedule Scope of Services, Codes, and Reimbursement Rates
On Friday, December 22, the Department of Health Care Services (DHCS) posted the draft rates for the Children and Youth Behavioral Health Initiative (CYBHI) statewide multi-payer fee schedule.
The fee schedule establishes the minimum rates at which MCPs must reimburse LEAs and school-linked providers for the provision of services to a student under the age of 26 at a school site, including on-campus, off-campus and mobile clinic locations. It includes the appropriate billing codes, rates, and provider types for each service type billable as part of the CYBHI fee schedule program. Note: The draft rates are pending approval of a State Plan Amendment by the Centers for Medicare and Medicaid Services and are subject to change.
Please see the CYBHI Fee Schedule Scope of Services, Codes, and Reimbursement Rates PDF to learn more.
Resources
Behavioral Health Services Template Excel Download
Cohort 2 Operational Readiness Standards PDF
Fee Schedule Workgroup
DHCS, in collaboration with the DMHC, established a workgroup to inform the development of the statewide multi-payer school-linked fee schedule for school-based behavioral health services under the CYBHI.
Through this workgroup, DHCS and DMHC are seeking to engage partners representing K-12 education, institutions of higher education, Medi-Cal managed care plans, commercial health plans, county behavioral health departments, behavioral health providers, associations, advocates, youth and parents/caregivers. DHCS and DMHC will engage workgroup members on a variety of policy and operational topics to inform the development and refinement of the program design.
This workgroup aims to meet virtually on a monthly basis (for approximately 4-5 sessions). Each session will be 2-3 hours in duration. Meetings will be open to members of the public.
DHCS will post information about this workgroup, including meeting dates and registration links on the Meetings and Events webpage. The workgroup member list and biographies can be found on this PDF.
Workgroup Meeting Details
October 24, 2022 - Initial Fee Schedule Workgroup meeting summary can be found on our Fee Schedule Workgroup Session 1 Synthesis PDF. See Fee Schedule Working Group Session 1 PowerPoint slides.
December 5, 2022 - Second Fee Schedule Workgroup meeting summary can be found on our Fee Schedule Workgroup Session 2 Synthesis PDF. See Fee Schedule Working Group Session 2 PowerPoint slides.
February 15, 2023 - Third Fee Schedule Workgroup meeting summary can be found on our Fee Schedule Workgroup Session 3 Synthesis PDF. See Fee Schedule Working Group Session 3 PowerPoint slides.
May 25, 2023 - The Fourth Fee Schedule Workgroup meeting summary and slides to be posted at a later date.
October 30, 2023 - The Fifth Fee Schedule Workgroup meeting summary and slides to be posted at a later date.
*Any person who wishes to request a meeting notice or other meeting materials in an alternative format, requires translation services, or needs any disability-related modification or accommodation, including auxiliary aids or services, which would enable that person to participate at the meeting must make that request at least five (5) business days prior to the meeting date to: Sarah Aguirre, California Health & Human Services Agency 1215 O Street, MS 08, Sacramento, CA 95814 or Sarah.Aguirre@chhs.ca.gov.
Questions
If you have questions regarding the Statewide Multi-Payer School-Linked Fee Schedule, please contact DHCS.SBS@dhcs.ca.gov.
