Final Rule Reference Page

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Final Rule Overview

On May 6, 2016, the Centers for Medicare & Medicaid Services (CMS) published the Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Final Rule. The new federal regulations modernize the rules governing the Medicaid (Medi-Cal) program and are set to be implemented over the next several years. The Fresno County Mental Health Plan is subject to the new Medicaid managed care regulations in 42 CFR Part 438, which affect Department of Behavioral Health (DBH) operations, DBH-operated providers, and providers contracted with DBH to provide services to Medi-Cal beneficiaries.

This page has been established as a resource for all interested parties to learn more about the Final Rule. There are multiple reference documents available that have been provided by the state Department of Health Care Services (DHCS) and the California Behavioral Health Directors Association (CBHDA) regarding the Final Rule.

Reference Documents

Provider Meeting PowerPoint Presentation - Final Rule (September 5, 2019) - NEW

Provider Meeting Network Adequacy Standards PowerPoint Presentation - Mental Health - Timely Access, Timely Access Reporting, Timely Access Monitoring & Support (September 5, 2019) - NEW

The CMS Medicaid Managed Care Final Rule - An Overview

DBH - Final Rule Checklist

CBHDA - Final Rule - Network Adequacy Summary

CBHDA - Final Rule - MHP Implementation Dates by Section

CBHDA - Final Rule - Grievance & Appeals System Summary

CBHDA - Final Rule - Beneficiary Protections: Informing and Authorization Requirements Summary

CBHDA & DHCS - Final Rule Implementation Webinar Slideshow (August 2017)

DHCS - QI Coordinators Annual Meeting Slides - Managed Care & Parity Final Rule (3/14/2018)

DHCS - Final Rule - Excerpts from Regional QIC Slideshow

DHCS - Final Rule - Network Adequacy Standards

DHCS Network Adequacy and Certification Webinar Presentation (February 2018)

DHCS - Final Rule - Implementation Priorities

CBHDA - Final Rule - Provisions Effective July 1, 2017

CBHDA - Comments on DHCS Network Adequacy Proposal

DHCS - 2013-2018 MHP Boilerplate Contract

Network Adequacy Certification Tool - 2017 Q3

Useful Links

Code of Federal Regulations Title 42, Section 438 (Final Rule Regulations)

Title 9, California Code of Regulations, Chapter 11, Medi-Cal Specialty Mental Health Services

CBHDA Final Rule Resource Page

CBHDA Handouts

California Welfare and Institutions Code (Commencing with 14700 et seq.)

California State Plan