Medical Necessity
This mandate requires Medi-Cal to expand to include medically necessary BHT services.
What is EPSDT?
Assessment is in this service category.
What is category 2?
The treatment plan will be developed by this.
What is service provider?
What is the treatment goals are achieved, are not able to be met, are determined to be no longer medical necessary, or when insurmountable barriers are present making continued treatment unfeasible?
BHT Services are available to this age group.
What is 0 to 20 years of age or under 21 years of age?
What is Pre-to-Five or Pre-to-Three?
The treatment plan includes these.
What is specific treatment goals with expected timelines for duration of treatment and timing of the reassessment?
This is when a reassessment occurs.
What is every 6 months?
This is the start date of the BHT benefit at BHRS.
What is July 1, 2018?
These disciplines can determine medical necessity?
Who is a physician and surgeon or licensed clinical psychologist?
What is 0-5 years of age and greater than 5 years of age?
These are individualized in the treatment plan.
What is specific treatments and duration?
These are examples of barriers.
What is level of engagement by member or family; and when services are ineffective.
These are examples of BHT.
What is Applied behavioral analysis (ABA), Individual or family training, Client/parent support behavior intervention training, or Adaptive skills training?
These are examples of aberrant behaviors.
What are self-injury, aggression, language skills, daily living, or social skills?
This is the purpose of the first assessment.
What is to match with the appropriate provider?
Treatments will vary depending on this.
What are the behaviors being treated as well as any associated conditions or comorbidities the client may have?
This can happen when treatment is discontinued.
What is ask for services again?
This is the full title of EPSDT.
What is Early and Periodic Screening, Diagnostic and Treatment?
This determines medical necessity.
What is persistent and developmentally inappropriate behavior that may be corrected or ameliorated?
This is identified by an assessment.
What is persistent developmentally inappropriate behavior and/or diagnosis that may be able to be corrected or ameliorated with BHT services?
This may or may not be included in the treatment plan.
What is ABA?
This is the service code for reassessment.
What is H0031?
This all plan letter describes covered services.
What is APL 18-006?