Behavioral Health Treatment (BHT)​​  Câu hỏi thường gặp (FAQ)​​  

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.​​  

What are BHT services?​​  

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?​​  

• If your child has managed care, you must first appeal the decision to your Medi-Cal MCP. You may request a State Hearing after you have completed the MCP’s internal appeal process and received a letter telling you that your health plan will not provide the service, or you did not receive a letter telling you of the decision and it has been more than 30 days.​​  
• If your child has Medi-Cal FFS and you do not agree with a denial or change of services, you can request a State Hearing.​​  

• You only have 90 days to ask for a hearing.​​  
• The 90 days start the date of the denial letter.​​  

Can I Still Get My BHT Services and Ask for a State Hearing?​​