Section 1850.525 - Provision of Medically Necessary Services Pending Resolution of DisputeA dispute between an MHP and a Medi-Cal Managed Care Plan shall not delay medically necessary specialty mental health services, physical health care services, or related prescription drugs and laboratory, radiological, or radioisotope services to beneficiaries. Until the dispute is resolved, the following shall apply:
(a) The parties may agree to an arrangement satisfactory to both parties regarding how the services under dispute will be provided; or(b) When the dispute concerns the Medi-Cal Managed Care Plan's contention that the MHP is required to deliver specialty mental health services to a beneficiary either because the beneficiary's condition would not be responsive to physical health care based treatment or because the MHP has incorrectly determined the beneficiary's diagnosis to be a diagnosis not covered by the MHP, the Medi-Cal Managed Care Plan shall manage the care of the beneficiary under the terms of its contract with the State until the dispute is resolved. The MHP shall identify and provide the Medi-Cal managed care plan with the name and telephone number of a psychiatrist or other qualified licensed mental health professional available to provide clinical consultation, including consultation on medications to the Medi-Cal managed care plan provider responsible for the beneficiary's care.(c) When the dispute concerns the MHP's contention that the Medi-Cal Managed Care Plan is required to deliver physical health care based treatment of a mental illness, or to deliver prescription drugs or laboratory, radiological, or radioisotope services required to diagnose or treat the mental illness, the MHP shall be responsible for providing or arranging and paying for those services to the beneficiary until the dispute is resolved.Cal. Code Regs. Tit. 9, § 1850.525
1. New section filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20). Note: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5778, 5780, 14681, 14683 and 14684, Welfare and Institutions Code.
1. New section filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20).