THE SAN FRANCISCO MENTAL HEALTH PLAN

• Introduction
• Eligibility For SFMHP Membership
• Categories of SFMHP Participating Providers
• Services Covered By SFMHP

Introduction

Community Behavioral Health Services (CBHS) within the Department of Public Health has developed the San Francisco Mental Health Plan (SFMHP) to serve the mental health needs of San Francisco Medi-Cal beneficiaries, uninsured, and indigent residents.

On April 1, 1998, the State transitioned financial responsibility for Fee-for-Service Medi-Cal payments to the counties.* The State plan for Medi-Cal Managed Care separated or "carved out" mental health services and gave counties the option to deliver Medi-Cal funded mental health services directly. By accepting this responsibility, Community Mental Health Services (CBHS) became responsible for ensuring access to mental health services for all San Francisco Medi-Cal and other eligible beneficiaries.

Previously, there were two mental health Medi-Cal programs: (1) private, fee- for-service, and (2) county-operated. Under the State's plan, the funding for both programs has been consolidated. Medi-Cal beneficiaries now receive their services through a single, County-administered plan, the San Francisco Mental Health Plan.

Currently, the San Francisco Mental Health Plan offers mental health benefits to approximately 104,000 San Francisco Medi-Cal beneficiaries and over 100,000 indigent and uninsured residents of San Francisco.

*On a future date, the State will transfer the responsibility and funding for Medi-Cal funded skilled nursing facility services in Institutes for Mental Disease (IMDs) for individuals over 65.

All San Francisco Medi-Cal beneficiaries are eligible for membership in the San Francisco Mental Health Plan. A San Francisco Medi-Cal beneficiary is any person certified as eligible for services under the Medi-Cal Program according to Section 51001, Title 22, Code of California Regulations, whose beneficiary identification information includes San Francisco code number 38.

In addition, SFMHP recognizes the public mental health system's role as a safety net for San Francisco residents who do not possess insurance coverage or the personal means adequate to cover the cost of mental health care. San Francisco has opted to provide a single Mental Health Plan with comparable services for Medi-Cal beneficiaries and indigent San Francisco residents. For more specific information on eligibility for services, please refer to the Member Services section of this Manual.

• Hospitals , skilled nursing facilities, institutes for mental disease (IMDs) and mental health rehabilitation facilities licensed by the State Department of Health Services and meeting national accreditation standards for staff qualifications.
• Organizational providers certified by SFMHP and the State to deliver mental health services through Short-Doyle Medi-Cal clinics staffed by licensed mental health professionals and interns under licensed supervision.
• Practitioner providers: psychiatrists, licensed psychologists, licensed clinical social workers, licensed marriage, family, child counselors, and masters prepared nurses licensed for independent practice are eligible to participate as both individual and group practice network providers.

SFMHP Members have access to a comprehensive array of community-based services, including but not limited to the following:

• information and referral services;
• prevention services
• a full range of voluntary mental health services for children, adults and older adults including outpatient, case management, medication support, social rehabilitation, vocational rehabilitation, day treatment, dual diagnosis treatment, supported housing, residential care, transitional residential treatment, sub-acute residential treatment, crisis residential treatment;
• mental health services for children who need them to meet educational goals (Special Education);
• 24 hour psychiatric emergency services, mobile crisis services, and a crisis hot line;
• involuntary assessment and inpatient and long term care services for individuals who are found to be a danger to themselves or others, or are gravely disabled because of a psychiatric problem;

Services covered by the SFMHP do not include all mental health services that have been reimbursed through the State's Fee-for-Service Medi-Cal program. Services that the State excluded from the SFMHP will continue to be provided and billed through the Fee-for-Service Medi-Cal program. These include substance abuse services; private psychologist and psychiatrist services for individuals who have both Medi-Cal and MediCare; and services for individuals with cognitive and organic brain disorders. Mental health services delivered by primary care providers will not be covered by SFMHP but may be covered either through the Fee-for-Service Medi-Cal program or one of the two health plans for those enrollees.

The State medical necessity criteria listed in Appendix 1 identifies included and excluded diagnoses. Appendix 2, the Standard Rate Schedule for Participating Providers, identifies included procedures and standard rates for providers delivering outpatient and professional services. Organizational providers, group practices, skilled nursing facilities, and hospitals should refer to their individual contracts to determine included procedures and rates for services.