Kev Kho Mob Kev Noj Qab Haus Huv (BHT) Cov Lus Nug Feem Ntau (FAQs)
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.
Cov kev pabcuam BHT yog dab tsi?
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?
- Yog tias koj tus menyuam tau txais kev saib xyuas, koj yuav tsum xub thov rov hais dua qhov kev txiav txim rau koj Medi-Cal MCP. Koj tuaj yeem thov Lub Xeev Lub Rooj Sib Hais tom qab koj tau ua tiav MCP cov txheej txheem rov hais dua sab hauv thiab tau txais tsab ntawv qhia rau koj tias koj txoj kev npaj khomob yuav tsis muab kev pabcuam, lossis koj tsis tau txais tsab ntawv qhia koj txog qhov kev txiav txim siab thiab nws tau dhau 30 hnub.
- Yog tias koj tus menyuam muaj Medi-Cal FFS thiab koj tsis pom zoo nrog qhov tsis kam lees lossis hloov cov kev pabcuam, koj tuaj yeem thov Lub Rooj Sib Hais Hauv Lub Xeev.
Lub Rooj Sib Hais Plaub Hauv Xeev
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
Sacramento, 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.
Hu dawb xwb: (800) 952-5253
TTY: (800) 952-8349
What Are the Time Limits to Ask for a State Hearing?
- Koj tsuas muaj 90 hnub los thov kom rov hais dua.
- Lub 90 hnub pib hnub ntawm tsab ntawv tsis kam lees.
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:
Thov kom muaj Lub Rooj Sib Hais Plaub Hauv Xeev tsis pub dhau kaum hnub txij li:
Hnub uas daim ntawv ceeb toom raug xa ntawv xa tuaj, lossis
Hnub uas daim ntawv ceeb toom tau muab rau koj, lossis
Ua ntej hnub uas daim ntawv ceeb toom hais tias koj cov kev pabcuam BHT yuav tsum nres lossis hloov pauv.
Thov hais tias koj xav tau txais cov kev pabcuam BHT txuas ntxiv mus thaum lub sijhawm sib hais.
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.
Saib nplooj ntawv txheej txheem ntawm Lub Rooj Sib Hais Plaub Hauv Xeev kom paub ntau ntxiv.
Rov qab mus rau Kev Kho Tus Cwj Pwm Kev Noj Qab Haus Huv Lub Vev Xaib