FFS2 Provider Manual - Department of Mental Health

Local Mental Health Plan Medi-cal Specialty Mental Health Services Individual and Group Provider (Fee-For-Service 2) Manual, 10th Edition
Front Cover	08/25/26
Introduction	08/25/26
Important Phone Numbers	08/25/26
Table of Contents	08/25/26
Section I – Purpose, principles and goals	08/25/26
Section II – The Provider Network Attachment I – FFS2 Contract Workflow Attachment II – Notice of Psychotherapy Clients for Licensed or Registered Practitioners with the BBS Attachment III – Contract Address Attachment IV – Sample Beneficiary Notification Letter Figure A – County of Los Angeles Department of Mental Health Service Map	08/25/26
Section III – The Provider Relations Unit	08/25/26
Section IV – Access to Services	08/25/26
Section V – Confirmation of Medi-Cal Eligibility and Electronic Medi-Cal Beneficiary Enrollment	08/25/26
Section VI – The Beneficiary Services Program and Requirements for Providing Medi-Cal Beneficiary Material to Clients	08/25/26
Section VII – Consents and Authorization Standards for Client Access to Health Information and Use/Disclosure of Health Information Attachment I – Consent for Services (English) Attachment II – Consent for Services (Spanish) Attachment III – Medication Consent Attachment IV – Outpatient Medication Review Attachment V – Authorization for Use or Disclosure of Protected Health Information (PHI)	08/25/26
Section VIII – Documentation Standards, Treatment Standards and Medical Necessity Criteria Attachment I – Quality Assurance Bulletin 21-07 Attachment II – Quality Assurance Bulletin 21-08 Attachment III – Child/Adolescent Full Assessment Attachment IV – Adult/Full Assessment Attachment V – Child/Adolescent Assessment Addendum Attachment VI – Adult Addendum Attachment VII – Progress Note	08/25/26
Section IX – Procedure Codes, Diagnosis Codes and Rates Attachment I – CalAIM IGP/FFS II Fee Discipline List	08/25/26
Section X – Quality Improvement	08/25/26
Section XI – Financial Screening Attachment I – Payor Financial Screening	08/25/26
Section XII – Claiming Information	08/25/26
Section XIII – Provider Fiscal Problem Resolution Process Attachment I – Appeal Request	08/25/26
Section XIV – Care Coordination between Physical Health and Mental Health Providers Attachment I – Authorization for Use or Disclosure of Protected Health Information (PHI) Attachment II – HIPAA Compliant Fax Cover Sheet for Transmitting PHI	08/25/26
Section XV – Over-Threshold and Inpatient Professional Services	08/25/26
Section XVI – Psychological Testing Services Attachment I – Psychological Testing Request (PTR) Form Attachment II – Psychological Testing Request Response (PTR-Response) Form Attachment III – Quality Assurance: The Clinical Evaluation Form	08/25/26
Section XVII – Notice of Adverse Benefit Determination Attachment I – Notice of Adverse Benefit Determination – About Treatment Request and (3) Enclosures Attachment II – Notice of Adverse Benefit Determination – Acknowledgement of Receipt Attachment III – Notice of Appeal Resolution	08/25/26
Section XVIII – Medication, Pharmacy, Laboratory and Medicare Part D	08/25/26
Section XIX – Medical Transportation Services	08/25/26
Section XX – Out-of-County Services	08/25/26
Glossary of Terms	08/25/26
Acronyms & Abbreviations	08/25/26
Attachments, Policies and Figures	08/25/26