Cov Lus Nug Feem Ntau Txog Kev Kho Mob Kev Noj Qab Haus Huv
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?
Cov kev pab cuam BHT muaj xws li Kev Tshawb Fawb Txog Kev Coj Tus Kheej thiab lwm cov txheej txheem uas lees txais los ntawm cov pov thawj uas tiv thaiv lossis txo cov teeb meem tsis zoo ntawm cov cwj pwm uas cuam tshuam rau kev kawm thiab kev sib raug zoo hauv zej zog thiab txhawb nqa, kom ntau li ntau tau, kev ua haujlwm ntawm ib tug tswv cuab, suav nrog cov neeg uas muaj lossis tsis muaj autism spectrum disorder (ASD).
Leej twg tsim nyog tau txais cov Kev Pabcuam BHT?
Cov tswv cuab Medi-Cal uas muaj hnub nyoog qis dua 21 xyoos uas muaj lossis tsis muaj ASD uas tus kws kho mob lossis tus kws kho mob puas siab puas ntsws txiav txim siab tias nws yog qhov tsim nyog rau kev kho mob, txawm tias kuaj mob li cas los xij.
Leej twg thiaj sau tau daim ntawv sau tshuaj 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.
Cov menyuam yaus siv tau cov kev pabcuam BHT li cas?
Cov Tswv Cuab ntawm Medi-Cal uas tau sau npe rau hauv kev saib xyuas kev tswj hwm thiab tau muab tso rau hauv Medi-Cal txoj kev npaj saib xyuas kev tswj hwm (MCP) tau txais cov kev pabcuam BHT los ntawm lawv cov Medi-Cal MCP.
Cov tswv cuab ntawm Medi-Cal Fee-for-Service (FFS) uas ua tau raws li cov qauv tshwj xeeb rau kev tsim nyog rau BHT cov kev pabcuam, uas yog ntxiv rau cov qauv tsim nyog rau Medi-Cal, yuav tau txais cov kev pabcuam BHT uas tau teeb tsa los ntawm lawv lub Chaw Haujlwm Hauv Cheeb Tsam hauv zos. Txij lub Xya Hli 1, 2025, cov tswv cuab Medi-Cal uas muaj FFS uas hnub nyoog qis dua 21 xyoos tuaj yeem xaiv tau txais cov kev pabcuam BHT ncaj qha los ntawm cov neeg muab kev pabcuam Medi-Cal Qualified Autism Services (QAS) uas tau sau npe es tsis txhob mus dhau lawv lub Chaw Pabcuam Hauv Cheeb Tsam hauv zos.
Ib tug me nyuam yuav ua li cas thiaj li ua tau raws li cov qauv kev kho mob uas yuav tsum tau muaj rau BHT?
Tus kws kho mob lossis tus kws kho mob puas siab puas ntsws txiav txim siab seb BHT puas yog qhov tsim nyog rau kev kho mob rau tus menyuam raws li seb cov kev pabcuam BHT puas yuav kho lossis txhim kho cov mob ntawm lub cev thiab/lossis tus cwj pwm uas tus menyuam muaj.
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.
Puas yog Medi-Cal yuav tsum kom niam txiv/tus saib xyuas koom nrog rau cov kev pabcuam BHT?
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?
Cov menyuam yaus uas muaj kev pov hwm ob npaug yuav tau txais cov kev pabcuam BHT los ntawm lawv lub tuam txhab pov hwm ntiag tug thiab Medi-Cal yuav npog cov kev pabcuam uas lub tuam txhab pov hwm ntiag tug tsis them.
Lub sijhawm twg rau cov menyuam Medi-Cal yuav raug soj ntsuam rau cov kev pabcuam BHT?
Cov MCPs ntawm Medi-Cal yuav tsum muab cov kev pabcuam BHT tib yam li cov qauv kev nkag mus rau lwm cov kev pabcuam raws sijhawm. Tsis muaj lub sijhawm teev tseg hauv Medi-Cal FFS rau lub sijhawm uas Lub Chaw Haujlwm Hauv Cheeb Tsam lossis tus neeg muab kev pabcuam QAS uas tau sau npe yuav tsum ua qhov kev ntsuam xyuas rau cov kev pabcuam BHT.
Cov menyuam yaus uas raug tso rau hauv qhov chaw zov menyuam puas tsim nyog tau txais cov kev pabcuam BHT?
Yog, cov menyuam yaus/hluas hluas uas raug saib xyuas thiab cov menyuam yaus uas raug saib xyuas yav dhau los uas muaj hnub nyoog qis dua 21 xyoo uas muaj Medi-Cal yuav tau txais cov kev pabcuam BHT thaum tus kws kho mob lossis tus kws kho mob puas siab puas ntsws txiav txim siab tias tsim nyog kho mob.
Yog tias kuv tsis pom zoo rau qhov tsis kam lees lossis hloov kuv cov kev pabcuam BHT, kuv muaj cai dab tsi?
- 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:
Lub Chaw Haujlwm Saib Xyuas Kev Pabcuam Zej Zog ntawm California Lub Chaw Saib Xyuas Kev Mloog Lus hauv Xeev
Chaw Xa Ntawv Lub thawv ntawv 944243, MS 19-37
Sacramento, CA 94244-2430
Koj kuj tseem tuaj yeem hu xov tooj mus thov kom muaj Lub Rooj Sib Hais Plaub Hauv Xeev. Tus xov tooj no tej zaum yuav muaj neeg coob heev yog li koj yuav tau txais lus kom hu rov qab tom qab.
Hu dawb xwb: (800) 952-5253
TTY: (800) 952-8349
Lub Sijhawm Txwv rau Kev Thov Kom Muaj Lub Rooj Sib Hais Hauv Xeev Yog Dab Tsi?
- Koj tsuas muaj 90 hnub los thov kom rov hais dua.
- Lub 90 hnub pib hnub ntawm tsab ntawv tsis kam lees.
Kuv puas tseem tuaj yeem tau txais kuv cov kev pabcuam BHT thiab thov kom muaj kev sib hais plaub hauv xeev?
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.
Nws yuav siv sijhawm txog li 90 hnub kom txiav txim siab txog koj rooj plaub thiab xa cov lus teb tuaj rau koj.
Kuv puas thov tau kom muaj kev sib hais sai sai?
Yog. Qhov no hu ua kev sib hais "ua sai". Yog koj xav tias kev tos txog 90 hnub yuav muaj kev pheej hmoo rau koj lossis koj tus menyuam txoj kev noj qab haus huv, thov koj tus kws kho mob kom sau ntawv rau koj. Tsab ntawv yuav tsum piav qhia tias kev tos txog li 90 hnub yuav ua rau muaj kev pheej hmoo rau koj lossis koj tus menyuam lub neej lossis kev noj qab haus huv. Tom qab ntawd koj tuaj yeem thov kom muaj kev sib hais sai dua. Koj yuav tsum xa tsab ntawv nrog koj daim ntawv thov kev sib hais.
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