24-1292m Expanded Definition of Psychiatric Emergency Medical Condition

Date: 12/16/24

Psychiatric emergency services are covered, regardless of whether the patient is voluntarily, or involuntarily detained

Assembly Bill (AB) 1316 revises the definition of “psychiatric emergency medical condition” to mean a mental health disorder that manifests itself by acute symptoms of sufficient severity that it renders the patient as being either of the following, regardless of whether the patient is voluntarily or involuntarily detained for assessment, evaluation, and crisis intervention, or placement for evaluation and treatment pursuant to the Lanterman-Petris-Short Act (Part 1 (commencing with Section 5000) of Division 5 of the Welfare and Institutions Code):

• (A) An immediate danger to themselves or to others.
• (B) Immediately unable to provide for, or utilize, food, shelter, or clothing, due to the mental health disorder.

The Plan covers emergency services necessary to relieve or eliminate a psychiatric emergency medical condition, regardless of whether the patient is voluntarily or involuntarily detained for evaluation and treatment.

Additional information

Behavioral health trainings available to support your work with CalAIM and other special populations! Medi-Cal physicians and providers can register for live behavioral health webinar trainings, including Motivational Interviewing, Social Determinants of Health, De-escalation Techniques, and more. Visit CalAIM Provider Training & Webinars > Behavioral Health Training Series to register today.

Please refer to the link, for additional details on AB 1316.

If you have questions regarding the information contained in this update, contact CalViva Health at 888-893-1569. Behavioral health providers can call 844-966-0298.

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, Enhanced Care Management (ECM) Providers, and Behavioral Health Providers.

This information applies to Medi-Cal in Fresno, Kings and Madera counties.