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Behavioral health treatment for Medi-Cal members under the age of 21

Blue Shield of California Promise Health Plan covers Behavioral Health Treatment (BHT), including Applied Behavior Analysis (ABA) therapy, for Medi-Cal beneficiaries under the age of 21. Blue Shield Promise manages this benefit directly.

Referrals for BHT or ABA treatment for a member should not be sent to the member's medical group or IPA. A primary care physician (PCP) or healthcare provider will follow the screening process below.

If a provider believes the member may have autism spectrum disorder (ASD), based on screening outcomes, the provider should submit a diagnostic evaluation referral for ASD to Blue Shield Promise. If a provider believes a member is likely to benefit from BHT or ABA services, the provider can submit a referral for treatment to Blue Shield Promise. 

A diagnosis of autism spectrum disorder is not required for the member to be eligible for BHT or ABA treatment. Please refer to All Plan Letter (APL) 19-014 from Department of Health Care Services (DHCS) for more information.

Steps for referral and evaluation:

Step 1 - Screening

The PCP or healthcare provider completes Early Periodic Screening, Diagnosis, and Treatment (EPSDT), which should include a validated screening tool. The provider then makes a referral to Blue Shield Promise, as appropriate.

Step 2 - Diagnostic evaluation for autism spectrum disorder OR referral for BHT or ABA treatment

  • If your screening leads you to believe that the member may have autism spectrum disorder, the Behavioral Health Treatment team at Blue Shield Promise will provide authorization for a diagnostic evaluation with a licensed clinical psychologist.  
  • If your screening leads you to believe the member is likely to benefit from behavioral health treatment such as ABA, please submit a referral form to the Behavioral Health Treatment team at Blue Shield Promise.  
     

The questions and answers below will help guide you through helping the member to use this benefit.

Alcohol and drug screening and services

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Behavioral Health Services

Blue Shield Promise behavioral health services cover mental health, substance use disorder, and autism spectrum disorder behavioral health treatment.

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Health education for Medi-Cal providers

Find information and health education materials for your Medi-Cal patients.

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Health assessment guidelines for Medi-Cal providers

Learn how to conduct health assessments, find age-appropriate patient questionnaires and forms, and related provider training materials.

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Provider Connection

Access network provider tools on Provider Connection website.

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Blue Shield of California Promise Health Plan has neither reviewed nor endorsed this information.

Blue Shield of California Promise Health Plan is an independent licensee of the Blue Shield Association. Blue Shield of California Promise Health Plan is a Medicare Advantage HMO plan with a Federal Government contract in California. Enrollment in Blue Shield of California Promise Health Plan depends on contract renewal.

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