Referral to Non-Specialty Mental Health Services and Behavioral Health Treatment/Applied Behavioral Analysis
| Date: | October 1, 2025 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) |
| To: | Health Plan All Primary Care Providers |
| Type: | Procedural Update |
| Subject: | Referral to Non-Specialty Mental Health Services and Behavioral Health Treatment/Applied Behavioral Analysis |
| Business: | Medi-Cal Managed Care |
Health Plan manages Medi-Cal Behavioral Health Services/Non-Specialty Mental Health Services (NSMHS) and Behavioral Health Treatment (BHT) Services coverage for all eligible members.
Services are available in all servicing counties:
- San Joaquin, Stanislaus, El Dorado, and Alpine
- Members can self-refer
- Outpatient Treatment such as individual, family, and group therapy, psychological/neuropsychological testing, and medication management for all ages does not require prior authorization for In-Network Providers
- Any services that are a higher level of care or specialty mental health services can be coordinated by the Behavioral Health Case Management team
- Behavioral Health Treatment (also known as Applied Behavioral Analysis (BHT/ABA)) for members under 21 years of age requires a medical necessity recommendation for BHT or ABA services by a Physician (MD/DO) or Licensed Psychologist (LP)
We are here to help
Non-Specialty Mental Health Services
- For members in need of case management or care coordination for Behavioral Health Care Services:
- Providers can complete the Behavioral Health Services Form –https://www.hpsj.com/wp-content/uploads/2024/10/HPSJ-MVHP-BHS-Referral-Form.pdf
- Send to the Health Plan via:
- Fax at 209-762-4760, or
- Email at BHCM@hpsj.com
Behavioral Health Treatment (BHT)/Applied Behavioral Analysis (ABA) Services for members under 21 years of age
- Services include ABA, diagnostic evaluation, and psychological assessment
- To request BHT/ABA services for a member, a Physician or Licensed Psychologist medical necessity recommendation for BHT/ABA services is required
- For members in need of case management or care coordination for BHT/ABA services:
- Providers can complete the Behavioral Health Services Referral Form – https://www.hpsj.com/wp-content/uploads/2024/10/HPSJ-MVHP-BHS-Referral-Form.pdf
- Send to the Health Plan via:
- Fax at 209-762-4760, or
- Email at bhtreferral@hpsj.com
- When sending a prior authorization request, a Physician or Licensed Psychologist medical necessity recommendation for BHT/ABA services is needed
- The BHT/ABA Recommendation Form is an option in lieu of a physician order or prescription letterhead
- Providers can complete the BHT/ABA Recommendation Form – https://www.hpsj.com/wp-content/uploads/2025/09/9.8.25-HPSJ-MVHP_BHT-ABA-REC-FORM_09082025E_Final.pdf
- Send to the Health Plan via:
- Fax at 209-762-4760, or
- Email at bhtreferral@hpsj.com
References
- For more information on Health Plan’s Behavioral Health Services, please visit: https://www.hpsj.com/providers/behavioral-health-services/
- To learn more about DHCS All Plan Letter 22-005: No Wrong Door for Mental Health Services Policy, please visit: https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2022/APL22-005.pdf
- To learn more about DHCS All Plan Letter 23-010: Responsibilities for Behavioral Health Treatment Coverage for Members Under The Age of Twenty One, 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
