Screening and Transition of Care Tools for Medi-Cal Mental Health Services
Frequently Asked Questions
Purpose of Tools
Requirement for Use of Tools
Tool Administration
Scoring
Referrals
Translation
Compliance
Intersection with other Policies
Why are Screening and Transition of Care Tools for Medi-Cal Mental Health Services being implemented?
The Department of Health Care Services (DHCS) California Advancing and Innovating Medi-Cal (CalAIM) initiative for “Screening and Transition of Care Tools for Medi-Cal Mental Health Services" aims to ensure individuals receive coordinated services across Medi-Cal mental health delivery systems and improve health outcomes. The goal is to ensure access to the right care, in the right place, at the right time.
What is the purpose of the Adult and Youth Screening Tools for Medi-Cal Mental Health Services?
The purpose of the Adult and Youth Screening Tools for Medi-Cal Mental Health Services (hereafter referred to as Screening Tools) is to determine the appropriate Medi-Cal mental health delivery system to refer an individual who is not currently receiving mental health services. Medi-Cal Managed Care Plans (MCPs) or county Behavioral Health Plans (BHPs) are required to use the tools when contacted by an individual, or a person on their behalf if under age 21, seeking mental health services.
Is the Youth Screening Tool the same as the DHCS-approved Youth Trauma Screening Tools?
No. The Youth Screening Tool for Medi-Cal Mental Health Services and the DHCS-approved Youth Trauma Screening Tools are separate and distinct.
The Youth Screening Tool for Medi-Cal Mental Health Services (Youth Screening Tool) was developed by DHCS in partnership with stakeholders with the purpose of determining the appropriate Medi-Cal mental health delivery system to refer a youth member who is not currently receiving mental health services. MCPs/BHPs are required to use the Youth Screening Tool when they are contacted by a youth member under the age of 21, or a person on their behalf, seeking mental health services.
The DHCS-approved Youth Trauma Screening Tools are a list of existing tools approved by DHCS that may be used for youth members regardless of whether they are currently receiving mental health services in order to determine whether the youth member meets access criteria to the SMHS delivery system. The DHCS-approved Youth Trauma Screening Tools are not administered by the MCP/MHP access line but may be used by providers or other community members. See APL 22-006 and BHIN 21-073 for more information.
Below are two examples to help clarify the difference between the Youth Screening Tool for Medi-Cal Mental Health Services and the DHCS-approved Youth Trauma Screening Tools:
Example 1:
- A youth member who is not currently receiving mental health services reaches out to their local MCP.
- The MCP administers the Youth Screening Tool.
- The member's Youth Screening Tool score leads the MCP to refer the member to the BHP for an assessment within the SMHS.
- During the assessment, the SMHS provider determines that it may be appropriate to screen the member for trauma. The provider administers a DHCS-approved Youth Trauma Screening Tool as part of the determination of eligibility for SMHS.
- The member is determined to be eligible for SMHS. Following assessment, a care plan is created and treatment is initiated.
Example 2:
- A pediatrician determines that it is appropriate to screen a youth for trauma. The pediatrician uses the DHCS-approved Youth Trauma Screening Tool and, after reviewing the results, then refers the member directly to the BHP for SMHS (bypassing the Youth Screening Tool).
- The BHP refers the member to a network SMHS provider, who begins the assessment process.
Are the Screening Tools intended to function as assessments to determine medically necessary services?
No. The Screening Tools are not assessments and do not replace assessments. The Screening Tools identify initial indicators for the mental health needs of an individual who is not currently receiving mental health services. The Screening Tools determine whether an individual should be referred to the Managed Care Plan (MCP) or Behavioral Health Plan (BHP) to receive an assessment. Once the Screening Tool has been administered, the individual will be referred to the appropriate Medi-Cal mental health delivery system for a clinical assessment.
Do the Screening Tools address substance use disorder service needs?
The primary purpose of the Screening Tools is to identify the most appropriate Medi-Cal mental health delivery system when a member is not currently receiving mental health services. The Screening Tools include questions related to substance use disorder (SUD) that do not impact the screening score but would require a referral for an SUD assessment if an individual responds affirmatively.
If an individual responds affirmatively to an SUD question, the Managed Care Plan (MCP) or Behavioral Health Plan (BHP) must offer them a referral to the county BHP for an SUD assessment in addition to completing the Screening Tool and making an appropriate mental health delivery system referral. The member may decline the referral for SUD assessment without impact to their mental health delivery system referral.
What is the purpose of the Transition of Care Tool for Medi-Cal Mental Health Services?
The Transition of Care Tool for Medi-Cal Mental Health Services (hereafter referred to as Transition of Care Tool) supports timely and coordinated care when individuals who are currently receiving mental health services from either the Managed Care Plan (MCP) or Behavioral Health Plan (BHP) need services transitioned to the other Medi-Cal mental health delivery system or need to add services provided by the other delivery system.
Is the Transition of Care Tool intended to function as an assessment to determine medically necessary services?
No. The Transition of Care Tool is not an assessment and does not replace assessments. Furthermore, the Transition of Care Tool is not designed to determine whether an individual should transition between Medi-Cal mental health delivery systems or whether additional services provided by the other Medi-Cal mental health delivery system should be added to an individual's existing mental health treatment. These determinations must be made by a clinician through a patient-centered decision process. The Transition of Care Tool leverages existing clinical information to document an individual's mental health needs and support a referral for a transition of care or addition of services from the Managed Care Plan (MCP) or Behavioral Health Plan (BHP) as determined through an individualized clinical assessment of need.
Are the Screening Tools and Transition of Care Tool intended to be used together?
No. The Screening Tools and the Transition of Care Tool are distinct tools with distinct purposes. The Screening Tools are for individuals who are not currently receiving mental health services and contact a Managed Care Plan (MCP) or Behavioral Health Plan (BHP) to be connected to services. The Transition of Care Tool is for individuals who are currently receiving mental health services from either the MCP or BHP, and who need their services transitioned from one Medi-Cal mental health delivery system to the other, or who need services added to their treatment from the other Medi-Cal mental health delivery system.
Will DHCS make updates to the tools? If so, when?
DHCS may make updates to the tools to improve clinical quality, incorporate related policy changes, address issues identified in implementation monitoring, or respond to stakeholder feedback. There is no set timeframe for tool updates. Managed Care Plans (MCPs) and Behavioral Health Plans (BHPs) will be informed in writing of any updates in advance.
Who is required to use the Screening Tools?
Managed Care Plans (MCPs) and Behavioral Health Plans (BHPs) are required to use the Screening Tools as outlined in APL 25-010 and BHIN 25-020 . The Screening Tools are not required for use by mental health providers (or other community practitioners) when individuals contact them directly to seek mental health services.
Contracted mental health providers who are contacted directly by members seeking mental health services may begin the assessment process and provide services to members during the assessment period without using the Screening Tools, which is allowed by Managed Care Plans (MCPs) and Behavioral Health Plans (BHPs), consistent with the No Wrong Door for Mental Health Services Policy described in APL 22-005 and BHIN 22-011. DHCS strongly encourages providers to minimize the burden on members and initiate assessment and services in a timely manner.
Are Managed Care Plans (MCPs) and Behavioral Health Plans (BHPs) required to use the Screening Tools with everyone who contacts them for any purpose?
No. MCPs and BHPs are only required to use the Screening Tools when individuals who are not currently receiving mental health services from either Medi-Cal mental health delivery system contact them seeking mental health services. The Screening Tools are not required for use in the following scenarios:
- The member is currently receiving mental health services;
- The member contacts the MCP or BHP for purposes other than to seek mental health services; or
- A practitioner refers a member specifically to the MCP for NSMHS, or BHP for SMHS, based on an understanding of the member's needs. If a practitioner refers a member directly to the MCP for NSMHS or the BHP for SMHS, the MCP/BHP should follow existing protocols for referrals in these scenarios.
Additionally, the Screening Tools do not replace MCP or BHP policies and procedures that address urgent or emergency care needs. If an individual is in crisis or experiencing a psychiatric emergency, the MCP or BHP should follow their emergency and crisis protocols.
Is the Screening Tool required for use for members who call or walk into clinics seeking mental health services?
No. The Screening Tool is not required for use for members who call or walk into clinics seeking mental health services. Mental health providers who are contacted directly by members seeking mental health services may begin the assessment process and provide services during the assessment period without using the Screening Tools, consistent with the No Wrong Door for Mental Health Services policy described in APL 22-005 and BHIN 22-011. The Screening Tools are not required for use by mental health providers, and MCPs/BHPs cannot require mental health providers to use the Screening Tools. The Screening and Transition of Care Tool policy shall not impact operational processes for members seeking services at clinics.
Are the Screening Tools required when individuals are referred by a provider or practitioner to a Managed Care Plan (MCP) for non-specialty mental health services (NSMHS) or a Behavioral Health Plan (BHP) for specialty mental health services (SMHS)?[LK2]
No. If a provider or practitioner (e.g., a primary care physician or school nurse) specifically refers an individual to an MCP for NSMHS or to a BHP for SMHS based on an understanding of the individual's needs, the MCP/BHP is not required to use the Screening Tools.
MCPs/BHPs should follow existing protocols for provider referrals in these scenarios. For example, counties may have established referral pathways whereby schools or other service providers that have already conducted some level of screening send individuals who likely require SMHS to the BHP, or MCPs may be contacted by individuals who have been referred by their provider specifically for individual psychotherapy services. If the referral already includes sufficient information about the individual's needs, additional screening is not required.
Alternatively, if a third party (including but not limited to a health care provider) simply connects the individual to the MCP/BHP as a resource (e.g., gives them the MCP/BHP phone number for more information about what services may be available to them) without having conducted a screening or brief assessment to determine the appropriate delivery system for referral, the Screening Tools must be used.
Are Managed Care Plans (MCPs)/Behavioral Health Plans (BHPs) required to use the Screening and Transition of Care Tools with uninsured and/or privately insured individuals?
No. DHCS does not require use of the Screening and Transition of Care Tools with individuals who are not enrolled in Medi-Cal.
Are Managed Care Plans (MCPs)/Behavioral Health Plans (BHPs) required to use the Screening and Transition of Care Tools when Medicare is the primary payer, even if the facility also service Medi-Cal members?
For people who have both Medicare and Medi-Cal, Medicare is the primary payer. Medi-Cal may cover costs for some copayments or additional services not covered by Medicare. If a patient has a significant mental health need, they may be eligible to receive specialty mental health services through their local County Mental Health Plans. MCPs and BHP health agencies provide the delivery systems for Medi-Cal behavioral health services.
DHCS requires the use of the Screening and Transition of Care Tools with individuals who are enrolled in Medi-Cal. While DHCS has not published guidance on the screening tool and dual eligibles, it is advisable to use the Screening Tools to ensure that they receive an assessment in the appropriate delivery system.
For more information on dual eligibles and behavioral health, please reference this fact sheet.
Who is required to use the Transition of Care Tool?
Managed Care Plans (MCPs) and Behavioral Health Plans (BHPs) are required to use the Transition of Care Tool to coordinate care transitions between the two delivery system as outlined in APL 25-010 and . MCPs and BHPs may choose to require providers to use the Transition of Care Tool when transitioning an individual to, or adding services from, the other Medi-Cal mental health delivery system. MCPs and BHPs must ensure that their Subcontractors and Network Providers comply with all applicable state and federal laws and regulations, contract requirements, and other DHCS guidance.
Who can determine if an individual that is currently receiving mental health services covered by either the Managed Care Plan (MCP) or Behavioral Health Plan (BHP) needs to receive additional services covered by the other Medi-Cal mental health delivery system (i.e., MCP or BHP) or needs to have their care transitioned to the other Medi-Cal mental health delivery system (i.e., MCP or BHP)?
The determination to transition services to and/or add services from the other mental health delivery system (i.e., MCP or BHP) must be made by a clinician via a patient-centered shared decision-making process in accordance with APL 25-010 and BHIN 25-020. The clinician shall be acting within their scope of practice under California law and be one of the provider types listed in the California Medicaid State Plan, Supplement 3 to Attachment 3.1-A, pages 2m-2p as providers of Rehabilitative Mental Health Services. Existing scope of practice laws are not changed or superseded by APL 25-010 or BHIN 25-020.
How will providers know if they are supposed to use the Transition of Care Tool?
Managed Care Plans (MCPs)/Behavioral Health Plans (BHPs) are required to use the Transition of Care Tool to ensure individuals who are receiving mental health services from one Medi-Cal mental health delivery system receive timely and coordinated care when either: (1) their existing services need to be transitioned to the other delivery system; or (2) when services need to be added to their existing mental health treatment from the other delivery system (consistent with concurrent treatment under No Wrong Door (NWD) policies described in APL 22-005 and BHIN 22-011).
MCPs/BHPs must update policies and procedures as needed to ensure compliance with the NWD policies and STT policies (APL 25-010 and BHIN 25-020) as MCPs/BHPs are responsible for clarifying expectations for use of the Transition of Care Tool with providers and providing training on how and when to use the tool.
Is the Transition of Care Tool required for use when an individual is being referred within the same delivery system?
No. The Transition of Care Tool is only required for use when an individual's care is being transitioned to the other Medi-Cal mental health delivery system (i.e., Managed Care Plan (MCP) or Behavioral Health Plan (BHP)) or services are being added from the other mental health delivery system.
Is the Transition of Care Tool required if an individual screens into the Managed Care Plan (MCP) or Behavioral Health Plan (BHP) but their clinical assessment indicates that they belong in the other system?
Yes. If an individual's screening score from either the Adult or Youth Screening Tool results in a referral to the MCP/ BHP and their subsequent clinical assessment indicates that they should receive services in the other Medi-Cal mental health delivery system, the MCP/BHP should ensure the Transition of Care Tool is completed and the individual is referred to the other delivery system. Consistent with No Wrong Door policy described in APL 22-005 and BHIN 22-011, all clinically appropriate NSMHS and SMHS services delivered during the assessment process are covered and reimbursable, prior to the determination of a diagnosis or a determination that the member meets access criteria for NSMHS or SMHS, even if the assessment ultimately determines they need to be referred to the other Medi-Cal mental health delivery system, or that the member does not meet access criteria for NSMHS or SMHS.
Will there be training on how to use the Screening Tools and Transition of Care Tools?
Managed Care Plans (MCPs) and Behavioral Health Plans (BHPs) are responsible for training their staff on how to use the tools. DHCS has hosted technical assistance webinars to provide information on the purpose and contents of the tools, as well as related requirements. Webinar recordings are available on the DHCS Screening and Transition of Care Tools for Medi-Cal Mental Health Services webpage, as well as trainings on the California Mental Health Services Authority (CalMHSA) website.
Can additional questions or fields be added to the Screening and Transition of Care Tools and/or can the tools be integrated with existing tools?
No. Additional questions or fields may not be added to or removed from the Screening Tools or the Transition of Care Tool. Further, the specific wording and ordering of the questions/fields in the tools must remain intact and unedited and the scoring methodology for the Screening Tools may not be altered. Managed Care Plan (MCP) or Behavioral Health Plan (BHP) must have processes that follow administration of the tools and do not alter these components of the tools, such as collecting identification information or asking questions to coordinate referrals, are allowable.
The Screening Tools determine the appropriate mental health delivery system prior to assessment and should not be integrated with existing tools that serve this same purpose. The Transition of Care Tool supports documentation and timely coordination for transitions of care to, or addition of services from, the other mental health delivery system and should not be integrated with existing tools that serve this same purpose. The Transition of Care tool does not determine whether care should be transitioned, or whether services should be added from the other delivery system and, thus, does not replace tools or other resources that may support a clinician in making such determinations.
Can additional demographic fields be added to the Screening Tools?
No. Additional questions and fields cannot be added to the Screening Tools. If Managed Care Plans (MCPs) or Behavioral Health Plans (BHPs) collect demographic information prior to or following the screening (e.g. as part of the initial member intake or referral coordination) those processes are not considered part of screening and would not constitute an addition to the Screening tools. However, any processes to collect demographic information prior to screening should be brief in nature and must be immediately followed by the administration of the Adult or Youth Screening Tool. DHCS strongly encourages MCPs and BHPs to adjust policies, procedures, and workflows as necessary to improve the member experience. MCPs and BHPs must avoid duplication of screening processes for mental health services that are in excess of or inconsistent with the Screening and Transition of Care Tools and accompanying guidance.
Can additional information be provided as notes or attachments to the Screening Tools?[LK4]
MCPs/BHPs may share additional information as part of the referral, such as notes taken during the screening, if available and appropriate. However, the content of the Screening Tools may not be altered. Managed Care Plans (MCPs)/Behavioral Health Plans (BHPs) may not alter the order or wording of questions within the Screening Tools and additional questions may not be added to the tools.
Are those administering the Screening Tools able to deviate from the specific wording if they are asked to clarify a question?
Questions in the Screening Tools must be asked in full using the specific wording provided in the tool and in the specific order the questions appear in the tools, to the extent that the individual is able to respond. There may be instances where the person administering the screening is asked to clarify a question for the individual to be able to respond. As part of the implementation of the Screening Tools, Managed Care Plans (MCPs) and Behavioral Health Plans (BHPs) are expected to train staff on approaches to respond to requests for clarification that are aligned with the intent of the question(s) and existing internal policies.
Is deviation from the specific wording in the Screening Tools allowable as part of translation?
Yes. Deviation from the specific wording of screening questions is allowable as part of translation into another language. However, Managed Care Plans (MCPs)/Behavioral Health Plans (BHPs) may only deviate from the wording in the translated versions if they, or an entity on their behalf, have facilitated additional testing of translations in the local community that indicates the need for associated shifts in language to meet member needs. DHCS has provided translated versions of the Screening Tools available on the Screening and Transition of Care Tools webpage.
For additional information on cultural and linguistic requirements, BHPs should reference California Code Regulations (CCR) Title 9 section 1810.410 and BHIN 20-070, Threshold Languages Data, or subsequent updates.
For additional information on federal and state requirements regarding nondiscrimination, discrimination grievance procedures, language assistance, and communications with individuals with disabilities, MCPs should reference APL 25-005 , Standards for Determining Threshold Languages, Nondiscrimination Requirements, and Language Assistance Services, and Alternative Formats, or subsequent updates.
When an individual answers yes to questions 6, 7, or 9 on the Youth Screening Tool, why do the instructions require the screener to stop the screening? Can the screener still ask the remaining screening questions?
If a child/youth, or the person responding on their behalf, responds “Yes" to question 6, 7, or 9, in the Youth Screening Tool, they meet criteria to access specialty mental health services per APL 22-006 and BHIN 21-073, or subsequent updates. In these cases, the appropriate delivery system for clinical assessment (i.e., the Behavioral Health Plans (BHP)) has already been determined and, therefore, the remainder of the screening is not required. To minimize burden on the individual, the screener must conclude the screening and refer the individual to the BHP for clinical assessment and must not ask the remaining screening questions.
Are Managed Care Plans (MCPs) and Behavioral Health Plans (BHPs) required to build the Screening and Transition of Care Tools into their electronic health record systems?
No. DHCS has provided the Screening and Transition of Care Tools as fillable PDF documents but is not requiring MCPs and BHPs use a particular format to administer the tools. MCPs and BHPs may choose to use the fillable PDF format or may build the tools into existing systems, such as electronic health records, as long as the specific wording, order of questions, and scoring methodologies in the Screening Tools remain intact and unedited and the specific wording and order of fields in the Transition of Care Tool remain intact and unedited.
How should Behavioral Health Plans (BHPs) claim for activities completed as part of Screening and Transition of Care Tools?
Screening and Transition of Care Tools standardize activities that are already taking place in counties, including determining the appropriate system of care for individuals seeking mental health services and facilitating transitions of care when service needs change. Counties may be reimbursed for these activities, including tool administration and referral coordination, as appropriate through a variety of existing pathways, such as Medi-Cal administrative costs, Mental Health Medi-Cal Administrative Activities (MH MAA), and/or Targeted Case Management, when applicable. Pathways utilized by BHPs may vary depending on individual county processes, member eligibility for services, and other factors.
For reimbursements under MH MAA, Activity 4: Medi-Cal Outreach (MH-MAA Implementation Plan, p. 8) is appropriate to claim for screening and referrals by non-licensed staff, whereas Activity 16: Case Management of Non-Open Cases (p. 14) is appropriate to claim when the screening and referral coordination is performed by Skilled Professional Medical Personnel.
What does the Screening Tools score determine?
The score generated by the Screening Tools determines whether the individual will be referred to the Managed Care Plan (MCP) or the Behavioral Health Plans (BHP) for clinical assessment. The screening score does not determine level of care or which services are medically necessary. These determinations are made during clinical assessment and clinically appropriate services may be provided during the assessment period, consistent with the No Wrong Door policy as described in APL 22-005 and BHIN 22-011.
If an individual has a total screening score of “0" does that mean they do not require mental health services in either delivery system?
No. If an individual has a screening score of “0," they should be referred to the Managed Care Plan (MCP) for clinical assessment. Please refer to the scoring rubrics located in the Adult Screening Tool for Medi-Cal Mental Health Services and the Youth Screening Tool for Medi-Cal Mental Health Services for additional information and instruction.
What if the person administering the Screening Tool disagrees with the screening score? Are Managed Care Plans (MCPs) and Behavioral Health Plans (BHPs) required to adhere to the delivery system referral indicated by the screening score?
Individuals shall be referred to the appropriate Medi-Cal mental health delivery system (i.e., the MCP or the BHP) for a clinical assessment based on their screening score. The Screening Tools are designed for administration by MCP and BHP staff, licensed or unlicensed, and do not require clinical judgment to be administered. Once referred to the MCP or BHP, the individual will receive a clinical assessment that will determine the level of care and medically necessary services.
In certain circumstances, the MCP or BHP may override the Screening Tool score when the result is inconsistent with the member's clinical presentation (e.g., the Screening Tool score does not capture the need for specialty mental health services (SMHS) in members who are unable to respond to the Screening Tool questions due to serious mental health symptoms). Overriding the Screening Tool score shall only be conducted by specified practitioners of SMHS as defined in the State Plan or specified practitioners of non-specialty mental health services (NSMHS). MCPs/BHPs are responsible for ensuring that all practitioners deliver services within their scope of practice under California law. See APL 25-010 and BHIN 25-020 for MCP/BHP practitioner types that may override the Screening Tool score.
Are specialty or non-specialty mental health providers allowed to override the Screening Tool score?
Overriding the Screening Tool score shall be conducted by specified practitioners on staff with the MCP/BHP or contractors as outlined within APL 25-010 and BHIN 25-020.. MCPs/BHPs are responsible for ensuring that all practitioners deliver services within their scope of practice under California law.
See APL 25-010 or BHIN 25-020 for more information on practitioner types allowed to override the Screening Tool score.
Can Managed Care Plans(MCPs)/Behavioral Health Plans (BHPs) add a section to the Screening Tools with score override information?
No. MCPs/BHPs should not alter the content of the Screening Tool forms. MCPs and BHPs must record overrides as well as the rationale through the MCP/BHP's preferred monitoring method (Electronic Health Records (EHRs), excel spreadsheets, etc.). Override rationale and other information (additional override notes) should be shared when referring a member to the appropriate Medi-Cal mental health delivery system following administration of the Screening Tool
Is there a scoring methodology for the Transition of Care Tool?
No. The Transition of Care Tool supports timely and coordinated care when adding a service from the other Medi-Cal mental health delivery system (i.e., Managed Care Plan (MCP) or Behavioral Health Plan (BHP)) or completing a transition of care to the other Medi-Cal mental health delivery system. The tool does this by providing a standardized process for sharing information and facilitating timely coordination across delivery systems. The tool is not meant to be diagnostic, and it is also not meant to replace existing DHCS criteria for access to specialty and non-specialty mental health services. MCPs and BHPs should follow existing access criteria and processes when determining whether a transition of care to, or addition of services from, the other delivery system is necessary for a member. Importantly, the determination as to whether a transition of care or addition of services should occur must be made by a clinician. This approach preserves flexibility for MCPs and BHPs; if an MCP or BHP uses an existing rubric that aligns with the access criteria, this policy does not prohibit them from continuing to use it to support determination of whether a referral for a transition of care to, or addition of services from, the individual's MCP or BHP is needed. Once a determination has been made to transition care to, and/or add services from, the other delivery system, MCPs and BHPs are required to use the Transition of Care Tool to facilitate the referral.
Can Managed Care Plans (MCPs) and Behavioral Health Plans (BHPs) use a rubric or methodology when completing the Transition of Care Tool?
The Transition of Care Tool is not meant to be diagnostic or to replace existing DHCS criteria for access to specialty and non-specialty mental health services as outlined in APL 22-006 and BHIN 21-073, or subsequent updates. Rather, the Transition of Care Tool provides a standardized process for sharing information and facilitating timely coordination across delivery systems when adding a service from, or completing a transition of care to, the other Medi-Cal mental health delivery system.
The determination of whether a transition of care or addition of services should occur must be made by a clinician as outlined in APL 25-010 and BHIN 25-020 . MCPs and BHPs may develop protocols, which could include the use of a rubric or other methodology, to support this determination. Once a clinician makes a determination to transition care to, and/or add services from, the other delivery system, MCPs and BHPs are required to use the Transition of Care Tool to facilitate the referral.
Service delivery disputes between MCPs and BHPs must be addressed consistent with DHCS guidance regarding the dispute resolution process outlined in APL 21-013 and BHIN 21-034.
Are Managed Care Plans (MCPs)/Behavioral Health Plans (BHPs) required to issue a Notice of Action (NOA)/Notice of Adverse Benefit Determination (NOABD) if an individual is referred to the other Medi-Cal mental health delivery system based on their screening score?
No. MCPs/BHPs should not issue an NOA/NOABD if an individual is referred to the other Medi-Cal mental health delivery system for assessment based on their screening score. The Screening Tools do not determine benefit or service eligibility, but instead determine the appropriate mental health delivery system referral for an initial assessment for Medi-Cal members who are not currently receiving mental health services when they contact the MCP/BHP seeking mental health services.
For additional information on NOA/NOABD requirements, MCPs and BHPs may refer to APL 21-011 and BHIN 25-014, respectively.
Who is responsible for coordinating referrals to the other delivery system?
While MCPs and BHPs are ultimately responsible for and required to ensure coordination of referrals between delivery systems, providers are permitted to coordinate referrals to the other delivery system on behalf of members transitioning between delivery systems to streamline this process, if applicable.
(Added July 2025) What should Managed Care Plans (MCPs)/Behavioral Health Plans (BHPs) do when a member is lost to follow-up, declines services during the referral process, or asks to stay in a certain delivery system? If an individual receives a screening in one delivery system (MCP or BHP) but declines the referral to the other delivery system for assessment or asks to stay in a certain delivery system, the delivery system (MCP or BHP) that administered the screening must provide an assessment. Consistent with the No Wrong Door for Mental Health Services policy described in APL 22-005 and BHIN 22-011, MCPs and BHPs can receive reimbursement for assessment and clinically appropriate services during the assessment period, regardless of whether the assessment results in the individual meeting access criteria.
Once assessed, if an individual does not meet access criteria for the delivery system that completed the assessment, the MCP or BHP should issue a Notice of Action (NOA)/Notice of Adverse Benefit Determination (NOABD) and use the Transition of Care Tool to facilitate a transition of care to the other mental health delivery system.
DHCS has not provided guidance around the minimum number of outreach attempts during intake to allow MCP/BHP flexibility but may do so in the future. DHCS encourages MCPs and BHPs to develop local processes to address this scenario and update their P&Ps and MOUs to ensure compliance.
What should a Behavioral Health Plan (BHP) do if a Medi-Cal member's screening score requires a referral to a Managed Care Plan (MCP), but the member is not enrolled in an MCP?
If a Medi-Cal member's screening score requires a referral to an MCP but the Medi-Cal member is not enrolled in an MCP, the BHP must provide an assessment or facilitate enrollment in an MCP and coordinate the Medi-Cal member's referral to ensure a timely clinical assessment.
Consistent with the No Wrong Door for Mental Health Services policy in APL 22-005 and BHIN 22-011, BHPs can receive reimbursement for the assessment and services provided during the assessment period, regardless of whether the assessment results in meeting access criteria of the other delivery system. If the BHP conducts the assessment and non-specialty mental health services (NSMHS) are recommended, BHPs should facilitate care coordination activities, including following existing processes for facilitating MCP enrollment and/or connecting the individual to a Fee-for-Service (FFS) provider for NSMHS.
Most Medi-Cal members are required to enroll in an MCP. The DHCS Health Care Options (HCO) Branch provides information and resources to support Medi-Cal member enrollment. HCO can also support Medi-Cal members in finding an FFS provider if appropriate. For more information, visit the following DHCS webpages:
- Who Must Enroll: Clarifies which Medi-Cal members are required to enroll in a plan and those who are exempt (e.g., members receiving services from an Indian Health Provider or through Foster Care).
- Ways to Enroll: Outlines how Medi-Cal members can enroll in an MCP online, by phone, by mail, or in person.
- Contact Us: Provides contact information for HCO.
Are Managed Care Plans (MCPs) and Behavioral Health Plans (BHPs) allowed to re-screen individuals if they feel they were not scored appropriately?
No. Once an individual is referred to an MCP or BHP after using the Screening Tools, the receiving MCP or BHP may not re-screen individuals. If an individual is referred to an MCP or BHP based on the score generated by administration of the Screening Tool, the MCP or BHP must ensure the individual receives timely access to care, including a timely clinical assessment, in alignment with existing standards and medically necessary mental health services.
How soon after receiving a referral from the other delivery system must Managed Care Plans (MCPs) and Behavioral Health Plans (BHPs) offer an appointment for clinical assessment?
In accordance with AB 205, plans must comply with the appointment time standards pursuant to Section 1300.67.2.2 of Title 28 of the California Code of Regulations (CCR), as well as the standards set forth in contracts between DHCS and plans. Appointment time standards begin from the time of the initial request for health care services by an enrollee or the enrollee's treating provider. If one Medi-Cal mental health delivery system (i.e., MCP or BHP) is referring an individual to the other mental health delivery system based on their screening score, appointment time standards would begin the day the MCP or BHP receives the referral. If a Medi-Cal mental health delivery system (i.e., the MCP or BHP) is referring an individual for a clinical assessment within its own delivery system based on their screening score, appointment time standards would begin the day the individual contacted the MCP or BHP initially seeking services.
What if an individual is referred to the Managed Care Plan (MCP) or Behavioral Health Plan (BHP) based on their screening score, but their subsequent clinical assessment indicates that they belong in the other delivery system?
While the Screening Tools are intended to direct individuals to the most appropriate delivery system for clinical assessment and medically necessary services, there may be instances when the clinical assessment (which captures additional information) reveals that the individual should receive services in the other delivery system. In these cases, the determination of level of care and medically necessary services from the clinical assessment would take priority over the delivery system referral indicated by the screening score. If this occurs, the MCP or BHP would use the Transition of Care Tool to facilitate a transition of care to the other mental health delivery system. As part of this process, the MCP or BHP must coordinate with the other mental health delivery system, including ensuring that the referral process has been completed, the individual has been connected with a provider in the new system, the new provider accepts the care of the individual, and medically necessary services have been made available to the individual.
What should Managed Care Plans (MCPs)/Behavioral Health Plans (BHPs) do if they are having difficulty making contact with an individual who has been referred for MCP or BHP services?
MCPs and BHPs are required to coordinate with each other to facilitate referrals to the other Medi-Cal mental health delivery system. Such coordination should include processes for addressing scenarios where there are challenges making contact with an individual. In accordance with APL 25-010 and BHIN 25-020 , MCPs and BHPs must update policies, procedures, and memoranda of understanding in alignment with the other Medi-Cal mental health delivery system to ensure compliance. DHCS expects MCPs and BHPs to consistently implement their own policies and procedures, consistent with CalAIM policies, and to demonstrate good faith efforts to contact members to facilitate referrals.
Will DHCS be providing translated versions of the Screening Tools?
Yes. DHCS released translations of the Adult and Youth Screening Tools in the 12 threshold languages. Translations can be accessed on the Screening and Transition of Care Tools webpage.
Are there reporting requirements for the Screening and Transition of Care Tools?
DHCS intends to evaluate the Screening and Transition of Care Tools initiative over time to ensure individuals are receiving appropriate and timely access to care. As part of this process, additional reporting may be requested.
How do the Screening Tools align with the No Wrong Door policy?
The Screening and Transition of Care Tools do not contradict and should support the objectives of the No Wrong Door policy. The tools are focused on getting individuals to the “right" door from the start or helping transition members to their “next" door as seamlessly as possible. The objective is to ensure individuals are directed to the most appropriate delivery system for assessment and services using a standardized approach. In addition, mental health providers who are contacted directly by members seeking mental health services may begin the assessment process and provide services during the assessment period without using the Screening Tools, consistent with the No Wrong Door for Mental Health Services Policy described in APL 22-005 and BHIN 22-011.
