Common use of ACCESS TO SPECIALTY MENTAL HEALTH SERVICES Clause in Contracts

ACCESS TO SPECIALTY MENTAL HEALTH SERVICES. 4.1. In collaboration with the COUNTY, CONTRACTOR will work to ensure that individuals to whom the Contractor provides SMHS meet access criteria, as per DHCS guidance specified in BHIN 21-073. Specifically, the CONTRACTOR will ensure that the clinical record for each client includes information as a whole indicating that client’s presentation and needs are aligned with the criteria applicable to their age at the time of service provision as specified below. 4.2. For enrolled clients under 21 years of age, CONTRACTOR shall provide all medically necessary SMHS required pursuant to Section 1396d(r) of Title 42 of the United States Code. Covered SMHS shall be provided to enrolled clients who meet either of the following criteria, (I) or (II) below. If a client under age 21 meets the criteria as described in (I) below, the beneficiary meets criteria to access SMHS; it is not necessary to establish that the beneficiary also meets the criteria in (II) below. 4.2.1. The client has a condition placing them at high risk for a mental health disorder due to experience of trauma evidenced by any of the following: scoring in the high-risk range under a trauma screening tool approved by DHCS, involvement in the child welfare system, juvenile justice involvement, or experiencing homelessness. 4.2.2. The client has at least one of the following: 4.2.2.1. A significant impairment 4.2.2.2. A reasonable probability of significant deterioration in an important area of life functioning 4.2.2.3. A reasonable probability of not progressing developmentally as appropriate. 4.2.2.4. A need for SMHS, regardless of presence of impairment, that are not included within the mental health benefits that a Medi-Cal Managed Care Plan (MCP) is required to provide. 4.2.2.5. A diagnosed mental health disorder, according to the criteria in the current editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases and Related Health Problems (ICD). 4.2.2.6. A suspected mental health disorder that has not yet been diagnosed. 4.2.2.7. Significant trauma placing the client at risk of a future mental health condition, based on the assessment of a licensed mental health professional. 4.3. For clients 21 years of age or older, CONTRACTOR shall provide covered SMHS for clients who meet both of the following criteria, (I) and (II) below: 4.3.1. The client has one or both of the following: 4.3.1.1. Significant impairment, where impairment is defined as distress, disability, or dysfunction in social, occupational, or other important activities. 4.3.1.2. A reasonable probability of significant deterioration in an important area of life functioning. 4.3.2. The client’s condition as described in paragraph (I) is due to either of the following: 4.3.2.1. A diagnosed mental health disorder, according to the criteria in the current editions of the DSM and ICD. 4.3.2.2. A suspected mental disorder that has not yet been diagnosed.

ACCESS TO SPECIALTY MENTAL HEALTH SERVICES. 4.1. In collaboration with the COUNTY, CONTRACTOR will work to ensure that individuals to whom the Contractor CONTRACTOR provides SMHS meet access criteria, as per DHCS guidance specified in BHIN 21-073. Specifically, the CONTRACTOR will ensure that the clinical record for each client includes information as a whole indicating that client’s presentation and needs are aligned with the criteria applicable to their age at the time of service provision as specified below. 4.2. For enrolled clients under 21 years of age, CONTRACTOR shall provide all medically necessary SMHS required pursuant to Section 1396d(r) of Title 42 of the United States Code. Covered SMHS shall be provided to enrolled clients who meet either of the following criteria, (I) or (II) below. If a client under age 21 meets the criteria as described in (I) below, the beneficiary meets criteria to access SMHS; it is not necessary to establish that the beneficiary also meets the criteria in (II) below. 4.2.1. The client has a condition placing them at high risk for a mental health disorder due to experience of trauma evidenced by any of the following: scoring in the high-risk range under a trauma screening tool approved by DHCS, involvement in the child welfare system, juvenile justice involvement, or experiencing homelessness. 4.2.2. The client has at least one of the following: 4.2.2.1. A significant impairment 4.2.2.2. A reasonable probability of significant deterioration in an important area of life functioning 4.2.2.3. A reasonable probability of not progressing developmentally as appropriate. 4.2.2.4. A need for SMHS, regardless of presence of impairment, that are not included within the mental health benefits that a Medi-Cal Managed Care Plan (MCP) is required to provide. 4.2.2.5. A diagnosed mental health disorder, according to the criteria in the current editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases and Related Health Problems (ICD). 4.2.2.6. A suspected mental health disorder that has not yet been diagnosed. 4.2.2.7. Significant trauma placing the client at risk of a future mental health condition, based on the assessment of a licensed mental health professional. 4.3. For clients 21 years of age or older, CONTRACTOR shall provide covered SMHS for clients who meet both of the following criteria, (I) and (II) below: 4.3.1. The client has one or both of the following: 4.3.1.1. Significant impairment, where impairment is defined as distress, disability, or dysfunction in social, occupational, or other important activities. 4.3.1.2. A reasonable probability of significant deterioration in an important area of life functioning. 4.3.2. The client’s condition as described in paragraph (I) is due to either of the following: 4.3.2.1. A diagnosed mental health disorder, according to the criteria in the current editions of the DSM and ICD. 4.3.2.2. A suspected mental disorder that has not yet been diagnosed.

ACCESS TO SPECIALTY MENTAL HEALTH SERVICES. 4.1. In collaboration with the COUNTY, CONTRACTOR will work to ensure that individuals to whom the Contractor provides SMHS meet access criteria, as per DHCS guidance specified in BHIN 21-073. Specifically, the CONTRACTOR will ensure that the clinical record for each client includes information as a whole indicating that client’s presentation and needs are aligned with the criteria applicable to their age at the time of service provision as specified below. 4.2. For enrolled clients under 21 years of age, CONTRACTOR shall provide all medically necessary SMHS required pursuant to Section 1396d(r) of Title 42 of the United States Code. Covered SMHS shall be provided to enrolled clients who meet either of the following criteria, , (I) or (II) below. If a client under age 21 meets the criteria as described in (I) below, the beneficiary meets criteria to access SMHS; it is not necessary to establish that the beneficiary also meets the criteria in (II) below. 4.2.1. The client has a condition placing them at high risk for a mental health disorder due to experience of trauma evidenced by any of the following: scoring in the high-risk range under a trauma screening tool approved by DHCS, involvement in the child welfare system, juvenile justice involvement, or experiencing homelessness. 4.2.2. The client has at least one of the following: 4.2.2.1. A significant impairment 4.2.2.2. A reasonable probability of significant deterioration in an important area of life functioning 4.2.2.3. A reasonable probability of not progressing developmentally as appropriate. 4.2.2.4. A need for SMHS, regardless of presence of impairment, that are not included within the mental health benefits that a Medi-Cal Managed Care Plan (MCP) is required to provide. 4.2.2.5. A diagnosed mental health disorder, according to the criteria in the current editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases and Related Health Problems (ICD). 4.2.2.6. A suspected mental health disorder that has not yet been diagnosed. 4.2.2.7. Significant trauma placing the client at risk of a future mental health condition, based on the assessment of a licensed mental health professional. 4.3. For clients 21 years of age or older, CONTRACTOR shall provide covered SMHS for clients who meet both of the following criteria, (I) and (II) below: 4.3.1. The client has one or both of the following: 4.3.1.1. Significant impairment, where impairment is defined as distress, disability, or dysfunction in social, occupational, or other important activities. 4.3.1.2. A reasonable probability of significant deterioration in an important area of life functioning. 4.3.2. The client’s condition as described in paragraph (I) is due to either of the following: 4.3.2.1. A diagnosed mental health disorder, according to the criteria in the current editions of the DSM and ICD. 4.3.2.2. A suspected mental disorder that has not yet been diagnosed.

ACCESS TO SPECIALTY MENTAL HEALTH SERVICES. 4.1. In collaboration with the COUNTY, CONTRACTOR will work to ensure that individuals to whom the Contractor provides SMHS meet access criteria, as per DHCS guidance specified in BHIN 21-073. Specifically, the CONTRACTOR will ensure that the clinical record for each client includes information as a whole indicating that client’s presentation and needs are aligned with the criteria applicable to their age at the time of time-of-service provision as specified below. 4.2. For enrolled clients under 21 years of age, CONTRACTOR shall provide all medically necessary SMHS required pursuant to Section 1396d(r) of Title 42 of the United States Code. Covered SMHS shall be provided to enrolled clients who meet either of the following criteria, (I) or (II) below. If a client under age 21 meets the criteria as described in (I) below, the beneficiary meets criteria to access SMHS; it is not necessary to establish that the beneficiary also meets the criteria in (II) below. 4.2.1. The client has a condition placing them at high risk for a mental health disorder due to experience of trauma evidenced by any of the following: scoring in the high-risk range under a trauma screening tool approved by DHCS, involvement in the child welfare system, juvenile justice involvement, or experiencing homelessness. 4.2.2. The client has at least one of the following: 4.2.2.1. A significant impairment 4.2.2.2. A reasonable probability of significant deterioration in an important area of life functioning 4.2.2.3. A reasonable probability of not progressing developmentally as appropriate. 4.2.2.4. A need for SMHS, regardless of presence of impairment, that are not included within the mental health benefits that a Medi-Cal Managed Care Plan (MCP) is required to provide. 4.2.2.5. AND the client’s condition as described in subparagraph (II a-d) above is due to one of the following: 4.2.2.6. A diagnosed mental health disorder, according to the criteria in the current editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases and Related Health Problems (ICD). 4.2.2.64.2.2.7. A suspected mental health disorder that has not yet been diagnosed. 4.2.2.74.2.2.8. Significant trauma placing the client at risk of a future mental health condition, based on the assessment of a licensed mental health professional. 4.3. For clients 21 years of age or older, CONTRACTOR shall provide covered SMHS for clients who meet both of the following criteria, (I) and (II) below: 4.3.1. The client has one or both of the following: 4.3.1.1. Significant impairment, where impairment is defined as distress, disability, or dysfunction in social, occupational, or other important activities. 4.3.1.2. A reasonable probability of significant deterioration in an important area of life functioning. 4.3.2. The client’s condition as described in paragraph (I) is due to either of the following: 4.3.2.1. A diagnosed mental health disorder, according to the criteria in the current editions of the DSM and ICD. 4.3.2.2. A suspected mental disorder that has not yet been diagnosed.

ACCESS TO SPECIALTY MENTAL HEALTH SERVICES. 4.1. A. In collaboration with the COUNTYCounty, CONTRACTOR Contractor will work to ensure that individuals to whom the Contractor provides SMHS meet access criteria, as per DHCS guidance specified in BHIN 21-073. Specifically, the CONTRACTOR Contractor will ensure that the clinical record for each client includes information as a whole indicating that client’s presentation and needs are aligned with the criteria applicable to their age at the time of time-of-service provision as specified below. 4.2. B. For enrolled clients under 21 years of age, CONTRACTOR Contractor shall provide all medically necessary SMHS required pursuant to Section 1396d(r) of Title 42 of the United States Code. Covered SMHS shall be provided to enrolled clients who meet either of the following criteria, , (I) or (II) below. If a client under age 21 meets the criteria as described in (I) below, the beneficiary meets criteria to access SMHS; it is not necessary to establish that the beneficiary also meets the criteria in (II) below. 4.2.1. I. The client has a condition placing them at high risk for a mental health disorder due to experience of trauma evidenced by any of the following: scoring in the high-risk range under a trauma screening tool approved by DHCS, involvement in the child welfare system, juvenile justice involvement, or experiencing homelessness. 4.2.2II. The client has at least one of the following: 4.2.2.1. a. A significant impairment 4.2.2.2. b. A reasonable probability of significant deterioration in an important area of life functioning 4.2.2.3. c. A reasonable probability of not progressing developmentally as appropriate. 4.2.2.4. d. A need for SMHS, regardless of presence of impairment, that are not included within the mental health benefits that a Medi-Cal Managed Care Plan (MCP) is required to provide. 4.2.2.5. e. A diagnosed mental health disorder, according to the criteria in the current editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases and Related Health Problems (ICD). 4.2.2.6. f. A suspected mental health disorder that has not yet been diagnosed. 4.2.2.7. g. Significant trauma placing the client at risk of a future mental health condition, based on the assessment of a licensed mental health professional. 4.3. C. For clients 21 years of age or older, CONTRACTOR Contractor shall provide covered SMHS for clients who meet both of the following criteria, (I) and (II) below: 4.3.1. I. The client has one or both of the following: 4.3.1.1. a. Significant impairment, where impairment is defined as distress, disability, or dysfunction in social, occupational, or other important activities. 4.3.1.2. b. A reasonable probability of significant deterioration in an important area of life functioning. 4.3.2II. The client’s condition as described in paragraph (I) is due to either of the following: 4.3.2.1. a. A diagnosed mental health disorder, according to the criteria in the current editions of the DSM and ICD. 4.3.2.2. b. A suspected mental disorder that has not yet been diagnosed.