COORDINATION WITH HEALTH PLAN, PRIMARY CARE PROVIDERS, AND OTHER SOCIAL SERVICES

• Coordination with Primary Care Provider
• Consultation/Liaison Services for Primary Care and Other Healthcare Providers
• Role and Responsibility of Primary Care Provider
• Coordination with Substance Abuse Treatment Services
• Coordination with Other Social Services
• Coordination with Specialized Child and Geriatric Services

Within the guidelines of SFMHP policies regarding confidentiality and release of information (#3.06-1) SFMHP providers are expected to coordinate with other providers serving their clients.

Coordination with Primary Care Provider

The SFMHP Access Team will provide SFMHP providers with the names of primary care providers for SFMHP members consistent with the SFMHP policy for confidentiality and release of information.

SFMHP members who have Medi-Cal may be enrolled in either the San Francisco Health Plan or Blue Cross CaliforniaCare for their health services and their pharmacy benefit (except those medications in Appendix 7). The SFMHP provides the mental health benefit for these members. If you are unable to identify your client's primary care provider in one of these plans and have a release to do so, you may contact the San Francisco Health Plan Provider Services Department at (415) 547-7805 or 547-7810 (automated) or California Care at (800) 407-4627.

The SFMHP has established a consult liaison service for primary care physicians and other health care providers to assist them in providing care for their patients. This is available through the Access Team at (415) 255-3737. Providers who have existing relationships with primary care providers should request authorization from the Access Team for services when a client is referred for an evaluation.

The primary care provider is responsible for assessing patients for the occurrence of mental disorders. The primary care provider may refer patients with mental health disorders who meet medical necessity criteria (see Appendix 1) to the SFMHP Access Team at (415) 255-3737.

The primary care provider is responsible for providing mental health treatment to his/her patients when the patients have uncomplicated mental health disorders.

Patients who are likely to need a spectrum of mental health services such as residential, case management, day treatment, etc., should be referred to the SFMHP Access Team. The primary care provider should consider requesting consultation from the Mental Health Access Team and/or treatment by a mental health provider in the following situations:

• The patient presents with a level of potential danger to self or other, or with an impairment of functioning which is beyond the clinical skill or experience of the referring primary care provider, or
• The mental health treatment provided by the referring primary care provider for the disorder has not produced adequate symptomatic improvement, or
• The existence, nature or proper treatment of the mental disorder is unclear to the referring primary care provider

The SFMHP Access Team may provide a consultation, in person or by telephone, or may authorize and refer the patient for specialty mental health treatment.

In cases where medical necessity is disputed, the primary care provider can use the Provider Problem Resolution Process described in Section IX for resolution.

The San Francisco Mental Health Plan has a collaborative relationship with Target Cities, the central access point operated by Community Substance Abuse Services for screening and referral to substance abuse services. In addition to responding to referrals from the SFMHP Access Team, Target Cities staff participate in the Mental Health Plan process for reviewing referrals to 24 hour care. Target Cities can be reached at (800) 750-2727.

Many people who receive Department of Human Services (DHS) benefits are also covered by the SFMHP. Some of our services are jointly supported. This is true of families and individuals who are enrolled in Foster Care, TANF, GA, Cal Works and Protective Services. Your client's DHS worker will be able to guide you as to the general benefits provided. The SFMHP Access Team can assist you to obtain the appropriate mental health benefits.

The SFMHP Access Team includes a special unit, the Foster Care Mental Health Program, that interfaces directly with the Department of Human Services (DHS) Child Welfare Section to coordinate mental health care for DHS dependents. The Foster Care Program may be reached directly at (415) 695-6975.

The SFMHP Access Team will link members to specialized child and geriatric services, and will refer problems as needed to the the SFMHP Administrators who oversee specialized child and geriatric services.