Funded through a grant from the David and Lucile Packard Foundation, the California Institute for Behavioral Health Solutions (CIBHS) has established and operated the CIBHS Implementation of Healthy Families Project in recognition of the opportunity offered by the Healthy Families Program to serve children who have not previously had adequate access to mental health and alcohol and other drug services.Through this project, CIBHS, working with the County Mental Health Departments, Health Plans participating in the Healthy Families Program, the State Department of Mental Health, and staff from the Managed Risk Medical Insurance Board, has sought to identify and develop processes to address key obstacles to the availability and utilization of quality mental health and alcohol and other drug services benefits within the Healthy Families Program.
Through this project, CIBHS has sought to identify and develop processes to address key obstacles to the availability and utilization of quality mental health and alcohol and other drug services benefits within the Healthy Families Program.
These are responses to questions from the 7/18/01 Butte County Healthy Families Program Training:
Q: After the 30-day psychiatric inpatient benefit (provided by the basic benefit) is exhausted and counties are responsible for paying for psychiatric inpatient days, does the county get reimbursed as they do for Medi-Cal inpatient days?
A: Yes. When counties assume the responsibility for psychiatric inpatient benefits (after 30 days provided by the basic benefit), counties will bill via the SD/MC system using their HFP provider number (DMH notice 98-14). Counties, however, are reimbursed at 66% for HFP services whereas Medi-Cal services are reimbursed at approximately 50%.
Q: Are counties obligated to evaluate HFP kids who present directly to the county for SED, or can they refer kids back to their health plans (under the basic benefit) and have the health plan refer back to the county for an SED evaluation if they determine it necessary?
A: Counties are expected to provide the SED assessments for self-referrals without referring back to the health plan first. Although there are no clear guidelines that address this question, indicating that counties can or cannot refer back to health plans when they get a self-referral for a SED evaluation, clients, in general, are allowed to self-refer for SED evaluations.
Q: Is a Client Index Number (CIN) required and used to bill health plan companies as it is for counties?
A: No. Providers bill the HFP health plan (i.e., Blue Cross, Healthnet, Kaiser) based on the client number given by the plan, not the CIN. The client should have a card from the Health Plan indicating the client, or subscriber number.
Q: Does HFP cover kids to age 19 or through age 19?
A: Children are eligible for HFP up to age 19.
Q: If a parent is insured at no cost through their employer, and their kids are eligible for the employer-sponsored insurance, but at a cost, are the kids potentially eligible for HFP or do they have to seek the employer-sponsored health insurance that is available to them at a cost?
A: As long as the children are currently not covered by an employer-sponsored insurance and have not had the employer sponsored insurance within the last three months, they may qualify for Healthy Families.
CIBHS with the assistance of Riverside County has designed a report format to help identify potential HFP eligble youth using UMDAP data obtained at intake. Use of this format could result in recovery of a significant amount of money for services already delivered. There are two companion files to assist with this report.