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.
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.
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 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).
