Statutes, codes, and regulations
California Code Of Regulations
Title 22 - Social SecurityDivision 3 - Health Care ServicesSubdivision 1 - California Medical Assistance ProgramChapter 3 - Health Care Services
Article 6 - Eligibility for Payment
Section 51490.1 - Claim Submission Requirements for Counties and Providers of Drug Medi-Cal Substance Use Disorder Services

Cal. Code Regs. tit. 22 § 51490.1

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Current through Register 2024 Notice Reg. No. 50, December 13, 2024
Section 51490.1 - Claim Submission Requirements for Counties and Providers of Drug Medi-Cal Substance Use Disorder Services
(a) Claims from counties and providers for reimbursement of outpatient drug free, day care habilitative, narcotic treatment program, Naltrexone treatment, and perinatal residential treatment services shall be presented to the Department no later than six (6) months from the date of service, unless the county or provider has good cause, as specified in Sections 51008 and 51008.5. The county or provider shall produce, upon request by the Department for audit or monitoring purposes, documentation to substantiate the good cause.
(b) An additional unit of service, or a multiple service billing, provided to a beneficiary on the same day may be claimed up to the maximum amount allowable if the beneficiary's return visit is to the same provider and the return visit service is not a duplicate to, or the same as, the service previously provided to the beneficiary on the same day.

"Multiple billing" means a claim is being made for a return, face-to-face visit, which is for an additional service to a previously provided service on that same day. The county and/or provider shall prepare and retain, in the beneficiary's patient record, a Multiple Billing Override Certification (Form DHCS MC 6700 (Revised 6/2014)), hereby incorporated by reference, certifying that a review of the client's record substantiated the multiple service. The form shall be signed by the person authorized to represent the county and/or provider.

(1) For outpatient drug free and Naltrexone treatment services:
(A) The return visit shall not create a hardship on the beneficiary; and
(B) The return visit shall be clearly documented in the beneficiary's progress notes with the time of day each visit was made. The progress notes shall clearly reflect that an effort was made to provide all necessary services during one visit and the return visit was unavoidable; or,
(C) The return visit shall be a crisis or collateral service. Collateral services shall be documented in the beneficiary's treatment plan in accordance with the beneficiary's short/long-term goals. The beneficiary's progress notes shall specifically reflect the steps taken to meet the goals defined in the beneficiary's treatment plan.
(2) For day care habilitative services, the return visit shall be a crisis service. Crisis services shall be documented in the progress notes.
(3) The county and/or provider shall prepare and keep on file a statement which documents the reason the beneficiary required a return visit. This statement shall be produced upon request by the Department for audit or monitoring purposes.

Cal. Code Regs. Tit. 22, § 51490.1

1. New section filed 12-14-95 as an emergency; operative 12-14-95 (Register 95, No. 50). A Certificate of Compliance must be transmitted to OAL by 4-12-96 or emergency language will be repealed by operation of law on the following day.
2. Repealed by operation of Government Code section 11346.1 (Register 96, No. 16).
3. New section filed 4-16-96 as an emergency; operative 4-16-96 (Register 96, No. 16). A Certificate of Compliance must be transmitted to OAL by 8-14-96 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 4-16-96 order, including amendment of subsection (a) and new subsections (a)(1)-(a)(2)(B), transmitted to OAL 8-13-96 and filed 9-25-96 (Register 96, No. 39).
5. Amendment of section heading and section filed 5-12-97 as an emergency; operative 5-12-97 (Register 97, No. 20). A Certificate of Compliance must be transmitted to OAL by 9-9-97 or emergency language will be repealed by operation of law on the following day.
6. Amendment of section heading, section and NOTE filed 6-30-97 as an emergency; operative 7-1-97 (Register 97, No. 27). A Certificate of Compliance must be transmitted to OAL by 10-29-97 or emergency language will be repealed by operation of law on the following day.
7. Certificate of Compliance as to 5-12-97 order transmitted to OAL 8-13-97 and filed 9-23-97 (Register 97, No. 39).
8. Amendment of section heading, section and NOTE refiled 10-6-97 as an emergency; operative 10-29-97 (Register 97, No. 41). A Certificate of Compliance must be transmitted to OAL by 2-26-98 or emergency language will be repealed by operation of law on the following day.
9. Amendment of section heading, section and NOTE refiled 1-14-98 as an emergency; operative 2-26-98 (Register 98, No. 3). A Certificate of Compliance must be transmitted to OAL by 6-26-98 or emergency language will be repealed by operation of law on the following day.
10. Certificate of Compliance as to 1-14-98 order, including further amendment of section heading, section and NOTE, transmitted to OAL 6-11-98 and filed 6-29-98 (Register 98, No. 27).
11. Change without regulatory effect relocating forms ADP 7700 and ADP 1584 from section 51516.1 to section 51490.1 filed 4-4-2000 pursuant to section 100, title 1, California Code of Regulations (Register 2000, No. 14).
12. Change without regulatory effect amending section heading, section and NOTE and removing and incorporating by reference forms ADP 7700 and ADP 1584 filed 12-16-2013 pursuant to section 100, title 1, California Code of Regulations (Register 2013, No. 51).
13. Change without regulatory effect amending subsection (b) and Form DHCS MC 6700 (formerly Form DHCS MC 7700) (incorporated by reference) filed 7-10-2017 pursuant to section 100, title 1, California Code of Regulations (Register 2017, No. 28).
14. Change without regulatory effect amending subsection (a) filed 9-4-2018 pursuant to section 100, title 1, California Code of Regulations (Register 2018, No. 36).

Note: Authority cited: Section 20, Health and Safety Code; Sections 10725, 14021.5, 14021.30, 14021.33, 14124.26 and 14124.5, Welfare and Institutions Code. Reference: Sections 14021, 14021.5, 14021.6, 14021.51, 14043.7, 14053, 14107, 14124.1, 14124.2, 14124.20, 14124.21, 14124.24, 14124.25, 14131, 14132.21, 14132.905, 14133 and 14133.1, Welfare and Institutions Code; and Statutes of 2011, Chapter 32; and Statutes of 2012, Chapter 36.

1. New section filed 12-14-95 as an emergency; operative 12-14-95 (Register 95, No. 50). A Certificate of Compliance must be transmitted to OAL by 4-12-96 or emergency language will be repealed by operation of law on the following day.
2. Repealed by operation of Government Code section 11346.1 (Register 96, No. 16).
3. New section filed 4-16-96 as an emergency; operative 4-16-96 (Register 96, No. 16). A Certificate of Compliance must be transmitted to OAL by 8-14-96 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 4-16-96 order, including amendment of subsection (a) and new subsections (a)(1)-(a)(2)(B), transmitted to OAL 8-13-96 and filed 9-25-96 (Register 96, No. 39).
5. Amendment of section heading and section filed 5-12-97 as an emergency; operative 5-12-97 (Register 97, No. 20). A Certificate of Compliance must be transmitted to OAL by 9-9-97 or emergency language will be repealed by operation of law on the following day.
6. Amendment of section heading, section and Note filed 6-30-97 as an emergency; operative 7-1-97 (Register 97, No. 27). A Certificate of Compliance must be transmitted to OAL by 10-29-97 or emergency language will be repealed by operation of law on the following day.
7. Certificate of Compliance as to 5-12-97 order transmitted to OAL 8-13-97 and filed 9-23-97 (Register 97, No. 39).
8. Amendment of section heading, section and Note refiled 10-6-97 as an emergency; operative 10-29-97 (Register 97, No. 41). A Certificate of Compliance must be transmitted to OAL by 2-26-98 or emergency language will be repealed by operation of law on the following day.
9. Amendment of section heading, section and Note refiled 1-14-98 as an emergency; operative 2-26-98 (Register 98, No. 3). A Certificate of Compliance must be transmitted to OAL by 6-26-98 or emergency language will be repealed by operation of law on the following day.
10. Certificate of Compliance as to 1-14-98 order, including further amendment of section heading, section and Note, transmitted to OAL 6-11-98 and filed 6-29-98 (Register 98, No. 27).
11. Change without regulatory effect relocating forms ADP 7700 and ADP 1584 from section 51516.1 to section 51490.1 filed 4-4-2000 pursuant to section 100, title 1, California Code of Regulations (Register 2000, No. 14).
12. Change without regulatory effect amending section heading, section and Note and removing and incorporating by reference forms ADP 7700 and ADP 1584 filed 12-16-2013 pursuant to section 100, title 1, California Code of Regulations (Register 2013, No. 51).
13. Change without regulatory effect amending subsection (b) and Form DHCS MC 6700 (formerly Form DHCS MC 7700) (incorporated by reference) filed 7-10-2017 pursuant to section 100, title 1, California Code of Regulations (Register 2017, No. 28).
14. Change without regulatory effect amending subsection (a) filed 9-4-2018 pursuant to section 100, title 1, California Code of Regulations (Register 2018, No. 36).