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) 23-010 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.

Providers should complete a valid screening using one of the suggested tools that indicates the member might need BHT or ABA services.

You can download, complete, and fax an Applied Behavioral Analysis Referral Form (PDF, 376 KB) for specialty referral to Blue Shield Promise at (844) 283-3298


 

After the diagnostic evaluation, if the licensed psychologist will include a recommendation for BHT or ABA in the evaluation, the member's referral will be for a functional assessment to determine which level of treatment would be therapeutic, as described in APL 23-010.

Blue Shield Promise will then make the appropriate referral and provide authorization to obtain those services.


 

You can call the Blue Shield Promise Behavioral Health Treatment Department:

Phone: (888) 297-1325, 8:30 a.m. to 5 p.m., Monday through Friday.

Reference materials

APL 23-010

DHCS' Behavioral Health Treatment website

Medi-Cal for Kids and Teens provider training

Autism spectrum disorder screening tools

Modified Checklist for Autism in Toddlers (M-CHAT)

CDC Development Screening Tools

Blue Shield Promise Referral Steps and Options (PDF, 117 KB)

Referral forms

Service Authorization Request form (PDF, 206 KB)

Applied Behavioral Analysis Referral form (PDF, 376 KB)


 

Alcohol and drug screening and services

Learn about the alcohol and drug screening, assessment, brief interventions and referral to treatment (SABIRT) program for Medi-Cal members 11 years of age and older, including pregnant women.

Behavioral Health Services

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

Health education for Medi-Cal providers

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

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.

Provider Connection

Access network provider tools on Provider Connection website.

Health Care Options: (844) 580-7272  {TTY: {800) 430-7077}, Monday through Friday from 8 a.m. — 6 p.m. 

For information on Blue Shield Promise plans for your health care, call the Department of Health Care Services at (800) 430-4263 {TTY: (800) 735-2922}, or visit https://www.healthcareoptions.dhcs.ca.gov/.

Blue Shield of California Promise Health Plan is a managed care organization, wholly owned by Blue Shield of California, offering Medi-Cal Plans.

© 2002-2024. California Physicians’ Service DBA Blue Shield of California Promise Health Plan. All rights reserved.

California Physicians’ Service DBA Blue Shield of California Promise Health Plan is an independent licensee of the Blue Shield Association.

The provider network may change at any time. You will receive notice when necessary.

Blue Shield of California Promise Health Plan complies with applicable state laws and federal civil rights laws, and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability.

Blue Shield of California Promise Health Plan cumple con las leyes estatales y las leyes federales de derechos civiles vigentes, y no discrimina por motivos de raza, color, país de origen, ascedencial, religión, sexo, estado civil, genero, identidad de genero, orientación sexual, edad ni discapacidad.

Blue Shield of California Promise Health Plan 遵循適用的州法律和聯邦公民權利法律,並且不以種族、膚色、原國籍、血統、宗教、性別、婚姻 狀況、性別認同、性取向、年齡或殘障為由而進行歧視。

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Blue Shield of California Promise Health Plan, 3840 Kilroy Airport Way, 
Long Beach, CA  90806

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