A. Specialty Mental Health Services refers to mental health services (e.g. assessment, individual, group or family therapy, rehabilitation) medication support services; crisis intervention; targeted case management; psychiatrist services; and psychological services. Service delivery may occur in the office or field based on the needs of the client and/or family. B. Criteria for Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Supplemental Specialty Mental Health Services for full-scope Medi-Cal beneficiaries under twenty-one (21) years of age: 1. Must have a covered diagnosis or suspected mental health diagnosis not yet diagnosed 2. The intervention addresses symptoms associated with the diagnosis and will do one of the following: a. significantly diminish the impairment; b. prevent significant deterioration in an important area of life functioning; c. allow the beneficiary to progress developmentally as individually appropriate; d. correct or ameliorate the mental health condition or diagnosis C. Therapeutic Behavioral Services (TBS) are supplemental specialty mental health services covered under the EPSDT benefit as defined in CCR Title 9 Section 1810.215. These are services for children/youth who are full-scope Medi-Cal beneficiaries under twenty-one (21) years of age. TBS are intensive, one-to-one services designed to help beneficiaries and their parents/caregivers manage specific behaviors using short-term measurable goals based on the beneficiary’s needs. TBS are available to beneficiaries in accordance with the Department of Mental Health Information Notice 08-38, the TBS Coordination of Care Best Practices Manual, version 2 (October 2010) and the TBS Documentation Manual, version 2 (October 2009). TBS is to be provided in accordance with BHRS Policy 5.4.3. 1. TBS shall be considered for youth who are placed in or are being considered for placement in a Short-Term Residential Treatment Program (STRTP) or an RCL 12 or higher group home or have received hospitalization in the past twenty-four (24) months or are being considered for psychiatric hospitalization. 2. TBS is meant to be an intensive mental health service; while the frequency and intensity may vary depending on clinical needs, TBS sessions are typically a minimum of ninety (90) minutes or more, occurring multiple times per week, that are sufficient to observe and intervene with targeted behaviors. D. Intensified Services are services to beneficiaries at risk of hospitalization, placement change, incarceration or crisis. The goal is to reduce the level of impairment in their daily functioning and reduce the need for emergency services. These services are typically home-based. For adults, services are typically delivered with increased frequency utilizing community resources such as substance use treatment, employment and housing services. For children and adolescents, this includes assisting families with providing supportive services, increasing mental health and substance use services and providing TBS. Behavior shaping and redirection are two (2) essential components of service delivery. E. Intensive Care Coordination (ICC) is an entitlement service available to all full-scope Medi-Cal beneficiaries under twenty-one (21) years of age who meet the requirements. While ICC key service components are very similar to Targeted Case Management (TCM), ICC services must fully integrate a Child and Family Team (CFT) into the process and typically requires more frequent and active participation by an ICC coordinator to ensure the needs of the beneficiary are appropriately and effectively met.
