THE SAN FRANCISCO MENTAL HEALTH PLAN
Community Behavioral Health Services (CBHS) within the Department of Public Health has developed the San Francisco Mental Health Plan (SFMHP) to serve the mental health needs of San Francisco Medi-Cal beneficiaries, uninsured, and indigent residents.
On April 1, 1998, the State transitioned financial responsibility for Fee-for-Service Medi-Cal payments to the counties.* The State plan for Medi-Cal Managed Care separated or "carved out" mental health services and gave counties the option to deliver Medi-Cal funded mental health services directly. By accepting this responsibility, Community Mental Health Services (CBHS) became responsible for ensuring access to mental health services for all San Francisco Medi-Cal and other eligible beneficiaries.
Previously, there were two mental health Medi-Cal programs: (1) private, fee- for-service, and (2) county-operated. Under the State's plan, the funding for both programs has been consolidated. Medi-Cal beneficiaries now receive their services through a single, County-administered plan, the San Francisco Mental Health Plan.
Currently, the San Francisco Mental Health Plan offers mental health benefits to approximately 104,000 San Francisco Medi-Cal beneficiaries and over 100,000 indigent and uninsured residents of San Francisco.
*On a future date, the State will transfer the responsibility and funding for Medi-Cal funded skilled nursing facility services in Institutes for Mental Disease (IMDs) for individuals over 65.
Eligibility For SFMHP Membership
All San Francisco Medi-Cal beneficiaries are eligible for membership in the San Francisco Mental Health Plan. A San Francisco Medi-Cal beneficiary is any person certified as eligible for services under the Medi-Cal Program according to Section 51001, Title 22, Code of California Regulations, whose beneficiary identification information includes San Francisco code number 38.
In addition, SFMHP recognizes the public mental health system's role as a safety net for San Francisco residents who do not possess insurance coverage or the personal means adequate to cover the cost of mental health care. San Francisco has opted to provide a single Mental Health Plan with comparable services for Medi-Cal beneficiaries and indigent San Francisco residents. For more specific information on eligibility for services, please refer to the Member Services section of this Manual.
Categories of SFMHP Participating Providers Contracted to Participate in the Provider Network
Services Covered By SFMHP
SFMHP Members have access to a comprehensive array of community-based services, including but not limited to the following:
Services covered by the SFMHP do not include all mental health services that have been reimbursed through the State's Fee-for-Service Medi-Cal program. Services that the State excluded from the SFMHP will continue to be provided and billed through the Fee-for-Service Medi-Cal program. These include substance abuse services; private psychologist and psychiatrist services for individuals who have both Medi-Cal and MediCare; and services for individuals with cognitive and organic brain disorders. Mental health services delivered by primary care providers will not be covered by SFMHP but may be covered either through the Fee-for-Service Medi-Cal program or one of the two health plans for those enrollees.
The State medical necessity criteria listed in Appendix 1 identifies included and excluded diagnoses. Appendix 2, the Standard Rate Schedule for Participating Providers, identifies included procedures and standard rates for providers delivering outpatient and professional services. Organizational providers, group practices, skilled nursing facilities, and hospitals should refer to their individual contracts to determine included procedures and rates for services.