Members can access services by self-referral 24 hours a day, seven days a week, by a family referral, or referral from the PCP or other appropriate provider.
Serra Medical Group covers all Medically Necessary Covered Services for the Member, including the following services (Medi-Cal Only):
1. Emergency room professional services as described in Title 22, CCR, Section 53855, except services provided by psychiatrists, psychologists, licensed clinical social workers, marriage, family and child counselors, or other Specialty Mental Health Providers.
2.All laboratory and radiology services when these services are necessary for the diagnosis, monitoring, or treatment of a Member’s mental health condition.
3.Medically Necessary covered services after SCMC has been notified by a specialty mental health provider that a Member has been admitted to a psychiatric inpatient hospital, including the initial health history and physical examination required upon admission and any consultations related to Medically Necessary covered Services. However, notwithstanding this requirement, SCMC shall not be responsible for nursing facility services including room and board charges for psychiatric inpatient hospital stays by Members unless the services are classified an IMD services and are provided to members are less that age 22 or greater than age 64. MCPs are not required to pay for duplicate test or procedures that are not medically necessary.
Medi-Cal children and youth must have a covered diagnosis and meet the following criteria:
1. Have a condition what would not be responsive to physical health care-based treatment; and
2. The service are necessary to correct or ameliorate a mental illness and condition discovered by a screening conducted by the MCP, the Child Health and Disability Prevention Program, or any qualified provider operating within the scope of his or her practice, as defined by state law regardless of whether or not that provider is a Medi-Cal provider.
Behavioral Health for Medi-Cal is a carve-out and will be coordinated through Community Mental Health Services organizations (e.g., health plan, County Department of Mental Health, etc.) For Healthy Families, which is not a carve-out, procedures may be different but must be in accordance with the Healthy Families and regulatory requirements. For more information, please Serra Medical Group at 818-504-4569.
