Mental Health Services & Behavioral Health Treatment

CenCal HEALTH members have access to services addressing mental health and substance use.  Coverage and provision of these services are shared between CenCal Health, County Behavioral Health Services and State FFS.  CenCal Health Behavioral Health Department is responsible for Mental Health Benefits for those who are determined to be mild to moderate in impairment of functioning: additionally, The Behavioral Health Department reviews authorization requests for ABA treatment. 

Please use the Behavioral Health Care Coordination Request Form when requesting care coordination for mental health or substance use services. 

Outpatient Services

CenCal Health Primary Care Physicians (PCP) are responsible to provide alcohol screening, brief depression screenings, and referrals for treatment.  CenCal Health Mental Health Benefits includes; psychotherapy, psychological testing, monitoring of drug therapy, outpatient lab services and psychiatric consultation. Members can start mental health services (psychotherapy or medication management) by a contracted the Behavioral Health Department for assistance in locating a provider.  Members and Primary Care Physicians (PCP) can find a list of providers by location and specialty on the CenCal Health Provider Directory.

Please call the Behavioral Health Provider Line at (805) 562-1600 for questions related to outpatient mental health services or Behavioral Health Treatment (ABA) services.  CenCal Health Members can contact The Behavioral Health Department directly through Member Services at (877) 814-1861.

Services for Children diagnosed with Autism Spectrum Disorder

CenCal Health covers many services for the medical and behavioral health needs of children diagnosed with ASD. 

Applied Behavior Analysis (ABA) therapy is based on science and learning. The goal is to increase helpful and appropriate behaviors (such as greeting others and responding to directions).

ABA therapy can help to improve:

  • Language
  • Communication
  • Attention
  • Memory
  • Social skills

ABA services can be provided by:

  • Board-certified behavior analysts (BCBA)
  • Registered Behavior Technicians

ABA services offered through insurance do not replace ABA services your child may be receiving at school or a regional center.

Physical Therapy (PT) is provided by a licensed physical therapist. Physical therapy focuses on:

  • Developing gross motor skills
  • Improving balance and coordination
  • Improving confidence in social situations
  • Other specific goals (like increasing ankle mobility for those that walk on their toes).

Occupational Therapy (OT) is provided by a licensed occupational therapist. Occupational therapy focuses on improving skills to support independent learning, such as:

  • Independently dressing and eating
  • Fine motor skills
  • Using the restroom
  • Eating and swallowing

Speech Therapy is provided by a licensed speech therapist. Speech therapy focuses on:

  • Improving language
  • Improving verbal, nonverbal and social communication
  • Enunciation (making clearer sounds)
  • Strengthening muscles used to speak
  • Modulating tone of voice
  • Understanding nonverbal social cues (like body language and facial expressions)

Mental Health Services address co-occurring symptoms and conditions such as ADHD, anxiety, and mood disorders.  Mental Health services may include:

  • Medication management with a Psychiatrist or Psychiatric Nurse Practitioner 
  • Individual or family therapy

Please talk to your child’s pediatrician for to learn more about these services. 

Claims & Billing

Effective March 1, 2022, CenCal Health will be processing claims with 2021 and 2022 Dates of Service (DOS).  These claims should be submitted to CenCal Health, not The Holman Group.  Claims can be submitted on the portal, electronically or via paper.  If you need assistance with the portal, or have questions please feel free to contact our Claims Customer Service Representatives at (800) 421-2560 ext. 1083.  We are here to help! 

For additional resources please reference the Claims Section of the CenCal Health website.  Providers can use the procedure codes and modifiers outlined within the CenCal Health Provider Manual (Section E7 for Mental Health Providers & Section E6 Behavioral Health Providers).

Authorizations

Authorizations are required for all case managed CenCal Health members; however, there are a number of exceptions to this rule such as Psychotherapy and Medication Management as referrals (RAF) and TARs are not required for these services.  For authorization requirements, please reference Section E6 & E7 of the Provider Manual.

Authorization Resources:

For additional resources, please reference the Authorization Section of our website.