: Medi-Cal 11/28/01; 01/15/03; 10/20/04; 10/19/05; 10/18/06, 08/20/08; 08/18/10; 10/01/10; 05/16/12; 01/20/16; 08/17/16; 02/15/17; *03/14/18; 08/08/18 *Through 2017, Approval Date reflective of the Quality/Utilization Advisory Committee meeting date. Effective January 2018, Approval Date reflects that of the Physician Advisory Committee’s meeting date. : Healthy Kids MPUP3026 (Healthy Kids program ended 12/01/2016) 10/18/06; 08/20/08; 08/18/10; 10/01/10; 05/16/12; 01/20/16; 08/17/16 to 12/01/2016 ********************************* In accordance with the California Health and Safety Code, Section 1363.5, this policy was developed with involvement from actively practicing health care providers and meets these provisions: Consistent with clinical principles and processes Evaluated and updated at least annually If used as the basis of a decision to modify, delay or deny services in a specific case, the criteria will be disclosed to the provider and/or enrollee upon request The materials provided are guidelines used by PHC to authorize, modify or deny services for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and the benefits covered under PHC. PHC’s authorization requirements comply with the requirements for parity in mental health and substance use disorder benefits in 42 CFR 438.910.
: Medi-Cal 11/28/01; 01/15/03; 10/20/04; 10/19/05; 10/18/06, 08/20/08; 08/18/10; 10/01/10; 05/16/12; 01/20/16; 08/17/16; 02/15/17; *03/14/18; 08/08/18 *Through 2017, Approval Date reflective of the Quality/Utilization Advisory Committee meeting date. Effective January 2018, Approval Date reflects that of the Physician Advisory Committee’s meeting date. : Healthy Kids MPUP3026 (Healthy Kids program ended 12/01/2016) 10/18/06; 08/20/08; 08/18/10; 10/01/10; 05/16/12; 01/20/16; 08/17/16 to 12/01/2016 ********************************* In accordance with the California Health and Safety Code, Section 1363.5, this policy was developed with involvement from actively practicing health care providers and meets these provisions: Consistent with clinical principles and processes Evaluated and updated at least annually If used as the basis of a decision to modify, delay or deny services in a specific case, the criteria will be disclosed to the provider and/or enrollee upon request The materials provided are guidelines used by PHC to authorize, modify or deny services for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and the benefits covered under PHC. PHC’s authorization requirements comply with the requirements for parity in mental health and substance use disorder benefits in 42 CFR 438.910.
MPUP3026.docx