Section 6850 - Referral to Diagnosis and Treatment(a) The following shall apply to all persons for whom diagnosis and treatment is indicated as a result of initial or periodic health assessments received under the provisions of this subchapter: (1) All reasonable steps, including assistance in scheduling and completing appointments shall be taken to ensure that persons receive needed diagnosis and treatment services. This referral assistance shall include giving the family or person the names, address and telephone numbers of providers who have expressed a willingness to furnish, at little or no expense to the family, those treatment services which are not reimbursable by the Department.(2) Appointments for diagnostic and treatment services shall be completed in a reasonable period of time, normally not to exceed 60 days from the time of the health assessment.(3) The health assessment provider shall be responsible for assisting the person in completing diagnosis and treatment. Such assistance may be rendered directly by the provider or through the provider's agreements with the community child health and disability prevention program, appropriate agency or individual.(4) The first source of referral for diagnosis and treatment shall be the person's usual source of licensed or certified health care. If a referral is required and no regular source of licensed or certified health care can be identified, the provider shall provide a list of at least three appropriate sources of care, when available, without prejudice for or against any specific source or licensed profession. One of the referral sources may be the health assessment provider. State reimbursement for diagnostic and treatment services provided to Medi-Cal beneficiaries can be made only to providers who have been approved for participation in the Medi-Cal program.(5) The community child health and disability prevention program shall: (A) Identify those persons eligible for CHDP services who can obtain needed medical or remedial services through a grantee under Title V of the Social Security Act (Maternal and Child Health and Crippled Children's Services).(B) Ensure that persons eligible for Title V services are informed of available services, and referred, if they desire, to Title V grantees that offer services appropriate to the persons' needs.(6) The source of health care selected by the person shall be indicated on the CHDP assessment form. If that source is other than the assessment provider, a copy of the CHDP referral form or equivalent shall be provided, with the person's written permission, to the identified source of healthcare.(b) Additional to (a), above, the following shall apply to Medi-Cal beneficiaries for whom diagnosis and treatment is indicated as a result of initial or periodic health assessments: (1) Medi-Cal beneficiaries, who requested assistance with transportation or scheduling the appointment for the health assessment, shall be offered assistance with transportation and scheduling appointments for diagnosis and treatment. The response to this offer shall be recorded, and this assistance shall be provided if requested by the beneficiary.(2) Medi-Cal beneficiaries, who did not request assistance with transportation or scheduling the appointment for the health assessment, may request assistance with transportation and scheduling appointments for diagnosis and treatment. If the beneficiary requests such assistance, the request shall be documented and the assistance shall be provided.(3) Treatment needed as a result of an initial health assessment shall normally be initiated within 120 days from either the date the beneficiary requested the health assessment, or the date the beneficiary was certified eligible to receive Medi-Cal benefits, whichever occurs later. Treatment needed as a result of a periodic health assessment shall normally be initiated within 120 days from either the date the beneficiary requested the health assessment, or the last day of the month in which the beneficiary's age exceeds the oldest allowable age for the health assessment according to the periodicity schedule specified in Section 6847, whichever occurs earlier.(4) If diagnostic and treatment services are not provided to a Medi-Cal beneficiary who requests such services and who also requests assistance with transportation or scheduling appointments for such services, documentation must exist showing that the family or recipient declined the services, lost eligibility, could not be located despite a good faith effort to do so, or the recipient's failure to receive the services was due to an action or decision by the family or recipient, rather than a failure by the community child health and disability prevention program to meet requirements of this subchapter, including the requirement to offer and provide assistance with transportation and scheduling appointments for services.(c) Each community child health and disability prevention program shall be responsible for developing and maintaining a referral and follow-up system for diagnosis and treatment, and for ensuring that referral is carried out. The referral and follow-up system shall be specified in the community's child health and disability prevention program plan. Agreements between the community program and providers, and between the community program and other appropriate individuals and agencies participating in the community program, may be part of the referral and follow-up system.Cal. Code Regs. Tit. 17, § 6850
1. New section filed 4-16-79, correcting inadvertent omission of Section 6850 from 3-29-79 filing of Subchapter 3; effective 5-16-79 (Register 79, No. 15).
2. Repealer and new section filed 11-28-79 as an emergency; effective upon filing (Register 79, No. 48). A Certificate of Compliance must be filed within 120 days or emergency language will be repealed on 3-28-80.
3. Certificate of Compliance filed 3-27-80 (Register 80, No. 13).
4. Amendment of subsections (a)(4) and (6) filed 5-22-80; effective thirtieth day thereafter (Register 80, No. 21). Note: Authority cited: Sections 208 and 321, Health and Safety Code. Reference: Sections 321.2, 323.7 and 324, Health and Safety Code.
1. New section filed 4-16-79, correcting inadvertent omission of Section 6850 from 3-29-79 filing of Subchapter 3; effective 5-16-79 (Register 79, No. 15).
2. Repealer and new section filed 11-28-79 as an emergency; effective upon filing (Register 79, No. 48). A Certificate of Compliance must be filed within 120 days or emergency language will be repealed on 3-28-80.
3. Certificate of Compliance filed 3-27-80 (Register 80, No. 13).
4. Amendment of subsections (a)(4) and (6) filed 5-22-80; effective thirtieth day thereafter (Register 80, No. 21).