» Statewide Multi-Payer Fee Schedule for School-Linked Behavioral Health Services

Workstream

Statewide Multi-Payer Fee Schedule for School-Linked Behavioral Health Services

About this Workstream

The Statewide Multi-Payer Fee Schedule for School-Linked Behavioral Health Services unites healthcare and education, ensuring sustainable reimbursements for specific services in school settings. It mandates Medi-Cal and commercial plans to adhere to set rates for local education agencies and school-affiliated providers. This initiative also aims to develop and maintain a statewide network of school-linked behavioral health counselors, serving all children regardless of payer status. Simplifying cost structures and facilitating easier access, the fee schedule broadens the reach of school-linked services, enhances reimbursement processes, eases administrative challenges and promotes a more inclusive, supportive environment for students’ mental well-being.

Managed by

  • DHCS
  • DMHC

Strategic Area

Coverage

Funding

Payment for covered services will be provided by managed care plans.

Timeline

2021-2025

Workstream Goals

Reduce uncertainty around students’ coverage; thereby eliminating barriers to care.

Increase access to school-linked behavioral health services for children and youth.

Apply to multiple payers, including Medi-Cal Managed Care Plans (MCPs), health care service plans, commercial health plans, and disability insurers. 

Expand the types of practitioners eligible for reimbursement for school-based behavioral health services to include Pupil Personnel Services (PPS) credentialed providers and Certified Wellness Coaches.

Create a more approachable reimbursement model for schools, given the shift to fee-for-service reimbursement.

Ease burdens for educational entities around contracting, rate negotiation and navigation of delivery systems with state-established rates for all included services.

Key Achievements

  • Approved readiness reviews and go-live for 47 LEAs across 25 counties (cohort 1).

  • Selected Carelon Behavioral Health as the third-party administrator (TPA) for the fee schedule.

  • Published guidance document (including finalized codes, set of eligible providers, and rates).

  • DHCS and DMHC established a Fee Schedule Working Group composed of more than 60 members supporting the design of an all-payer, statewide, and school-linked fee schedule for behavioral health services.

  • Convened statewide listening sessions with LEA partners and institutions of higher education (Universities, California State Universities, and California Community Colleges).

Milestones

January 2025

Rolling Opt-In: Cohort participants will expand to include all California institutions of higher education campuses, local educational agencies, charter schools, California Schools for the Deaf, and California Schools for the Blind.

November 2024

Nevada Joint Union High School District submitted the first successful claim for reimbursement.

September 2024

159 LEAs and 3 IHEs joined Cohort 3; anticipate submitting claims in 2025.

July 2024

92 LEAs and 4 IHEs join Cohort 2; anticipate submitting claims in early 2025.

January - July 2024

Program onboarding complete for all 46 LEAs in Cohort 1.

January 2024

Issued initial guidance and onboard first cohort of participating LEAs. Learn More.

January 2024

Carelon Behavioral Health awarded $10 million from DHCS to serve as the state’s third-party administrator for implementation of the CYBHI Fee Schedule program in January 2024.

December 2023

Published fee schedule. Learn More.

December 2023

First Cohort of 46 LEAs begin development of workflows and service models.