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Non Specialty Behavioral Health

Provider news | Monday, December 23, 2013

Previously behavioral health was a "carve out" and all behavioral health services for Medi-Cal managed care members were provided by the Santa Clara County Mental Health Department (SCMHD). Effective January 1, 2014, Santa Clara Family Health Plan (SCFHP) is responsible for the non-specialty mental health benefits, excluding those benefits provided by the County under the Specialty Mental Health Waiver.

On January 1, 2014, the following outpatient behavioral health benefits will be available through SCFHP for Enrollees with mild to moderate impairment of mental, emotional, or behavioral functioning resulting from any mental health condition defined by the current Diagnostic and Statistical Manual that is also covered according to State regulations:

  1. Individual and group mental health evaluation and treatment (psychotherapy).
  2. Psychological testing, when clinically indicated to evaluate a mental health condition.
  3. Outpatient services for the purposes of monitoring therapy with medications.
  4. Psychiatric consultation.
  5. Outpatient laboratory, medications, supplies, and supplements (excluding medications as described in the All Plan Letter Medi-Cal Managed Care Plan Responsibilities for Outpatient Mental Health Services and Coordination with County Mental Health Plans).

How to refer the member:

  1. Member may self-refer to Santa Clara County Mental Health Department by calling 1-800-704-0900.
  2. Member can call the medical group/IPA and the IPA will contact SCFHP to coordinate the services.
  3. If you consider any member to be in a crisis or emergency situation, you may contact the Santa Clara Valley Health and Hospital System Emergency Psychiatric Services office at 1-408-885-6100 or refer the member to the nearest acute hospital emergency department.
  4. PCPs may also coordinate behavioral health services by contacting SCFHP at 1-408-874-1788.

Most asked questions:

Q: Are the Medical Groups/IPAs responsible for these services?

A: NO, SCFHP and SCMHD will take full risk for this new benefit.

Q: What about the current behavioral health carve out?

A: The current carve out does not change. All services currently carved out to Fee For Service Medi-Cal will remain carved out. The behavioral health benefit is expanded for services that were not previously covered.

If you have any questions, please feel free to call us at 1-408-874-1788 or email us at

Thank you for your continued support!