سوالات متداول درمان سلامت رفتاری (BHT)
The following FAQs provide additional guidance and clarification to Medi-Cal members regarding BHT services. As the Department of Health Care Services (DHCS) receives additional questions, this FAQ will be updated.
خدمات BHT چیست؟
BHT services consist of Applied Behavioral Analysis and other generally accepted evidence-based approaches that prevent or minimize the adverse effects of behaviors that interfere with learning and social interaction and promote, to the maximum extent practicable, the functioning of a member, including those with or without autism spectrum disorder (ASD).
Who is eligible for BHT Services?
Medi-Cal members under 21 years of age with or without ASD for whom a physician or psychologist determines it is medically necessary, regardless of diagnosis.
Who can prescribe BHT?
A referral for an evaluation for BHT services can be made by any ordering, rendering, or treating provider for evaluation. Only physician or a psychologist, following an evaluation, can determine if BHT services are medically necessary for the child and make the recommendation to a BHT provider for services.
How do children access BHT services?
Medi-Cal Members enrolled in managed care and are assigned to a Medi-Cal managed care plan (MCP) receive BHT services from their Medi-Cal MCP.
Medi-Cal Fee-for-Service (FFS) members who meet specific eligibility criteria for BHT services, which is in addition to Medi-Cal eligibility criteria, may receive BHT services coordinated through their local Regional Center. Starting July 1, 2025, Medi-Cal members with FFS who are under 21 years of age may choose to receive BHT services directly from enrolled Medi-Cal Qualified Autism Services (QAS) providers instead of going through their local Regional Center.
How does a child meet medically necessity criteria for BHT?
A physician or psychologist determines whether BHT is medical necessity for the child based on whether BHT services will correct or ameliorate any physical and/or behavioral conditions the child may have.
Who can provide BHT services?
As defined in Health & Safety Code section 1374.73, treatment services must be provided by a QAS provider, QAS professional, or QAS paraprofessional. QAS provides may be a board-certified behavior analyst or a licensed provider with training in treating BHT. QAS professionals must be supervised by a QAS professional or QAS provider, while QAS paraprofessionals must be supervised by either a QAS provider or QAS professional.
Does Medi-Cal require parent/guardian participation for BHT services?
A Medi-Cal member cannot be denied BHT services for lack of parent participation. However, BHT services may include optional parent/guardian training when it is part of the treatment plan.
Who is responsible for providing BHT services if the child has private insurance and Medi- Cal?
Children with dual coverage would receive BHT services from their private insurance and Medi-Cal will wrap around those services that are not covered by the private insurance.
What are the timelines for Medi-Cal children to be assessed for BHT services?
Medi-Cal MCPs must provide BHT services in the same manner as timely access standards for other services. There are no specified timelines in Medi-Cal FFS for when a local Regional Center or enrolled QAS provider must conduct an assessment for BHT services.
Are children placed in foster care settings eligible for BHT services?
Yes, foster children/youth and former foster youth under the age 21 years with Medi-Cal may receive BHT services when determined medically necessary by a physician or psychologist.
What are my rights if I do not agree with a denial or change of my BHT services?
- اگر فرزندتان تحت مراقبتهای مدیریتشده قرار گرفته است، ابتدا باید نسبت به این تصمیم به Medi-Cal MCP خود اعتراض کنید. شما میتوانید پس از تکمیل فرآیند تجدیدنظر داخلی MCP و دریافت نامهای مبنی بر عدم ارائه خدمات توسط طرح درمانی خود، یا پس از گذشت بیش از 30 روز از دریافت نامهای مبنی بر اطلاع از تصمیم اتخاذ شده، درخواست جلسه رسیدگی ایالتی دهید.
- اگر فرزند شما دارای Medi-Cal FFS است و شما با رد یا تغییر خدمات موافق نیستید، میتوانید درخواست جلسه رسیدگی ایالتی (State Hearing) بدهید.
جلسه رسیدگی ایالتی
To ask for a State Hearing, you can fill out the “State Hearing Request” form at www.dhcs.ca.gov/services/medi-cal/Pages/Medi-CalFairHearing.aspx and send it to:
California Department of Social Services State Hearings Division
P.O. Box 944243, MS 19-37
ساکرامنتو، CA 94244-2430
You may also call to ask for a State Hearing. The number can be very busy so you may get a message to call back later.
تلفن رایگان: (800) 952-5253
تله تایپ: (800) 952-8349
What Are the Time Limits to Ask for a State Hearing?
- شما فقط ۹۰ روز فرصت دارید تا درخواست جلسه رسیدگی بدهید.
- این ۹۰ روز از تاریخ نامهی رد درخواست شروع میشود.
Can I Still Get My BHT Services and Ask for a State Hearing?
To still get your BHT services that the denial notice is stopping or changing, you must:
ظرف ده روز از تاریخ زیر درخواست جلسه رسیدگی ایالتی بدهید:
تاریخ الصاق اخطاریه، یا
تاریخ ارائه اخطاریه به شما، یا
قبل از تاریخی که در اخطاریه آمده است که خدمات BHT شما متوقف یا تغییر خواهد کرد.
لطفاً بگویید که میخواهید در طول فرآیند دادرسی به دریافت خدمات BHT ادامه دهید.
It can take up to 90 days for your case to be decided and an answer sent to you.
Can I Ask for a Quick Hearing?
Yes. This is called an “expedited” hearing. If you think waiting up to 90 days may be risky for you or your child’s health, ask your doctor for a letter. The letter must explain how waiting for up to 90 days could be risky for you or your child’s life or health. Then you can ask for an expedited hearing. You need to send the letter with your hearing request.
You do not have to attend the State Hearing alone. You may bring someone with you. You can bring a friend, a relative, a lawyer, or anyone you choose. You can speak for yourself or have someone else speak for you.
برای کسب اطلاعات بیشتر، به صفحه فرآیند رسیدگی ایالتی مراجعه کنید.