Mental Health

Provider Type

  • Physicians
  • Participating Physician Groups (PPG)
  • Hospitals
  • Ancillary

Health Net Medi-Cal members obtain the following mental health services through Health Net:

  • Individual and group mental health evaluation and treatment (psychotherapy)
  • Psychological testing to evaluate a mental health condition
  • Outpatient services that include laboratory work, medications and supplies
  • Outpatient services for the purposes of monitoring medication therapy
  • Psychiatric consultations

Members do not need to contact their primary care physician (PCP), participating physician group (PPG) or attending physician to request a referral for mental health care services. Health Net members may obtain these services directly through Health Net's extensive behavioral health network by calling the member services telephone number listed on their identification card (ID). Participating providers may also contact Behavioral Health Provider Services for assistance with mental health services referrals.

Prior authorization is not required for initial assessment for outpatient behavioral health services.

PCPs may refer members to marriage and family therapists, social workers, professional counselors, psychologists, and psychiatrists for services, as follows:

  • Marriage and family therapists, social workers, professional counselors, and psychologists can:
    • Diagnose, treat and consult for the management of mild to moderate emotional problems for which the PCP or member feels the need for consultation.
    • Evaluate cases for which a member would benefit from psychotherapy in addition to psychotherapeutic medication.
    • Conduct psychological testing for clarification of diagnosis to establish a treatment plan (psychologists).
  • Psychiatrists can:
    • Diagnose, treat and recommend a medication regimen in difficult or complex cases, including cases of depression that do not respond to a 60-day trial of selective serotonin re-uptake inhibitor (SSRI) medications or other antidepressants.
    • Evaluate cases in which members report feeling suicidal or homicidal, severe anxiety states, clear somatoform disorders, schizophrenic disorders where Clozaril® or risperidone is being considered, and bipolar disorder where lithium, carbamazepine or valproic acid may be needed.

    PCPs are responsible for coordinating referrals for members requiring specialty or inpatient mental health services to county mental health plans (CMHPs). PCPs retain responsibility for coordination of ongoing care for co-existing medical and mental health needs and provision of medically necessary medications.

The Mental Health Services Division (MHSD) oversees CMHPs and each county is required to provide access to specialty mental health services for Medi-Cal members. Refer to the MHSD Medical Necessity Criteria document for additional information about criteria for specialty mental health services.