Responsibilities for behavioral health treatment (BHT) coverage for members under the age of 21

On May 4, 2023, the Department of Health Care Services (DHCS) released APL 23-010, responsibilities for behavioral health treatment (BHT) coverage for members under age 21. Within this policy, DHCS updated several requirements related to the services provided to members under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) and in accordance with mental health parity requirements. This APL stresses the importance of collaboration across the full treatment team, to ensure that the member's needs for medically necessary BHT services are met across environments, including on-site at school or during virtual school sessions. Documentation and authorization processes remain in place and providers shall continue to submit as required.

While it is essential that each provider reviews the related APL 23-010, some updates include:

• The behavioral treatment plan must identify the medically necessary services to be provided in each community setting in which treatment is medically indicated, including on-site at school or during remote school sessions, during school hours and effective coordination with the Local Educational Agency (LEA).
• If a member's (Individual Education Plan) IEP team concludes that Anthem Blue Cross (Anthem)-approved BHT services are necessary to the member's education, the IEP team must determine that Anthem-approved BHT services must be included in the member's IEP.
• A member's IEP must not be reduced or discontinued without formal amendment of the IEP.
• Anthem may coordinate with the LEA to contract directly with a school- based BHT services practitioner enrolled in Medi-Cal Managed Care to provide any medically necessary BHT services included in a member's IEP.
• Anthem must establish data and information sharing agreements as necessary to coordinate the provision of services with other entities that may have overlapping responsibility for the provision of BHT services including but not limited to Regional Centers (RCs), LEAs, and county mental health plans.

This applies to the following populations:

• Members who are individuals under 21 years of age
• This includes children diagnosed with autism spectrum disorder (ASD) and children for whom a licensed physician, surgeon, or psychologist determines that BHT services for the treatment of ASD are medically necessary, regardless of diagnosis

If you have any questions about this communication, please reach out to your assigned provider relationship management representative.