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Mental Health Service Provider Resources
Please use the Behavioral Health Care Coordination Request Form when requesting care coordination for mental health or substance use services.
Please use the Member Education Request Form when requesting outreach for missed appointments.
Covered Benefits:
Mental health services are a covered benefit for CenCal Health members when medically necessary and provided by a provider contracted with CenCal. CenCal Health is responsible for providing medically necessary non-specialty mental health services.
Types of Services Provided:
The following Mental Health services covered by CenCal Health include:
- Initial mental health assessment. Does not require a referral or preauthorization.
- Individual, family and group mental health evaluation and treatment. Does not require a referral or pre-authorization.
- Psychological testing, when clinically indicated to evaluate a mental health condition. Requires pre-authorization.
- Outpatient services for the purposes of monitoring drug therapy.
- Outpatient laboratory, drugs, supplies and supplements.
- Psychiatric consultation to a member to establish medical necessity for medication management of a psychiatric or behavioral disorder. No preservice authorization required. Treating physician must be the requesting provider. Note: psychiatric consultation in the Emergency Room is not a covered benefit.
- Preventative family therapy services for pediatric members under the age of 21 with elevated Adverse Childhood Experience (ACE) scores who are not presenting with a diagnosable mental health condition.
Carved Out Benefit:
The County Department of Behavioral Health provides Specialty Mental Health Services and treatment for Members with Substance Use Disorders.
Members can be referred to the Santa Barbara County ACCESS line 1 (888) 321-2843 or the San Luis Obispo County ACCESS line 1 (800) 838-1381 to be screened.
Screening Tools:
Transition of Care Form:
- CenCal Health Transition of Care Request Form: Mental Health providers should use this form when referring a Member for County level mental health services. Please include the Level of Care Screening Tool, which indicates that a member is scored at the “Severe Range”. Members who are scored as “Mild to Moderate” do not qualify for County Level mental health services.
Templates:
- Psychological/Neuropsychological Testing Pre-Service Authorization Request Form
- Psychological Evaluation Form
Resources:
Counties of Santa Barbara and San Luis Obispo
- County of Santa Barbara Department of Behavioral Wellness
- County of Santa Barbara Consent for Release of Client Information or Records
- County of San Luis Obispo Mental Health Services
- County of San Luis Obispo Multi-Agency Referral and Client Release of Information
For more details or to consult with the Behavioral Health Department, please call (805) 562-1600
A:No, please ensure that all members have the screening in their medical records.
Q: Are there limitations to how often I can see a member?
A: CenCal Health provides Mental Health Benefits to members with mild to moderate impairment of functioning. The frequency of services are required to be consistent with the treatment of a mild to moderate impairment
Q: My Patient needs a higher level of care, what do I do?
A: Mental Health providers recommending members for a higher level of care should discuss these recommendations with the member and fax the Level of Care Form showing member is “severe” with a Transition of Care Form to the Behavioral Health Department. You should continue to provide services to the member until they are engaged with a County level provider.