Behavioral Health Treatment Authorization Requests – New Template
| Date: | February 25, 2026 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) |
| To: | Health Plan Behavioral Health Treatment/Applied Behavioral Health Providers |
| Type: | Procedural |
| Subject: | Behavioral Health Treatment Authorization Requests – New Template |
| Business: | Medi-Cal Managed Care |
Health Plan requires that Behavioral Health Treatment (BHT) services must be provided, observed, and directed under a Managed Care Plan (MCP) approved behavioral treatment plan. BHT authorization requests, behavioral treatment plans, functional behavior assessments (FBAs), and/or progress reports (PRs) must meet all criteria detailed in the Department of Health Care Services (DHCS) All Plan Letter (APL) 23-010- Responsibilities for Behavioral Health Treatment Coverage for Members Under the Age of 21.
To make the process easier for Applied Behavioral Analysis (ABA) Providers, Health Plan’s BHT Team developed a template for behavioral treatment plans, FBAs and/or PRs that covers the requirement of submitting an MCP-approved behavioral treatment plan, and meets all criteria noted in DHCS APL 23-010.
If you choose to use your own template for behavioral treatment plans, FBAs and/or PRs, please ensure that all criteria in DHCS APL 23-010 are captured.
Reminders:
- The BHT Report Template can be found online at:
Forms & Documents for HPSJ/MVHP Providers
- Please continue to send all authorization requests through the Behavioral Health Treatment (BHT) team’s fax at 209-762-4760 or the Provider Portal.
- Behavioral treatment plans must be reviewed, revised, and/or modified no less than once every six months by ABA Providers.
- To request authorization to start services or for continued services, Behavioral Treatment Plans including Functional Behavior Assessments and/or Progress Reports can be submitted as early as 30 days from the start date of service, and as late as two weeks prior to start date.
For more information on Health Plan’s Behavioral Health Services, please visit: https://www.hpsj.com/providers/behavioral-health-services/
To learn more about APL 23-010: Responsibilities for Behavioral Health Treatment Coverage for Members Under the Age of 21, please visit: https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2023/APL23-010.pdf.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org
