The Statewide Multi-Payer Fee Schedule for School-Linked Behavioral Health Services establishes a set of school-based behavioral health services for which all health plans must reimburse.
The goal of the new fee schedule is to increase access to school-linked behavioral health services by requiring MediCal and commercial health plans to reimburse school-linked providers, regardless of network provider status, for services provided to students.
This is significant because many schools and school partner organizations already provide many behavioral health services to students that are enrolled in MediCal or a commercial health plan, but receive no reimbursement.
The fee schedule presents a huge opportunity to schools and partners to leverage ongoing, sustainable funding to support and expand behavioral health supports in schools.
This short video provides a good overview of the CYBHI Fee Schedule.
Introduction to the CYBHI Fee Schedule
In 2023, the Department of Health Care Services published the Fee Schedule Scope of Services, Codes, and Reimbursement Rates. While this document is still pending approval from CMS (Centers for Medicare & Medicaid Services), it provides detailed information about what services will be covered, specifies procedure codes, eligible practitioners, and reimbursement rates for services.
Services under the CYBHI Fee Schedule fall into four categories:
- Screening and Assessment
- Therapy Services
- Case Management
Given the scope of services that are billable under the Fee Schedule, schools and partners have the potential to receive reimbursement for services such as screenings, prevention, and case management that were previously not reimbursed.
In addition, practitioners that haven’t billed in the past—such as school social workers and counselors—will be eligible to bill under the Fee Schedule.
Eligible Practitioner Types
|PPS School Psychologist
|PPS School Social Worker
|PPS School Counselor
The Fee Schedule will be phased in through several cohorts, starting January 2024.
The first cohort of 47 LEAs across 25 counties were selected based on readiness to implement the fee schedule.
The selection of the second cohort will occur in Spring 2024, with a start of July 2024.
Interested districts should contact their County Office of Education to submit the Cohort 2 application. In January 2025, all districts will be eligible to begin participating in the Fee Schedule.
CYBHI Fee Schedule vs LEA BOP Billing
The CYBHI Fee Schedule differs from the Local Educational Agency Medi-Cal Billing Option Program (LEA BOP) in a few key ways.
The Fee Schedule covers both Medi-Cal enrolled and commercially insured students. The fee schedule reimburses both the federal and the state share, the LEA receives a straight fee-for-service rate rather than an interim payment with later cost settlement, and the Fee Schedule does not require a Random Moment in Time Study.
However, the CYBHI Fee Schedule only covers behavioral health related services, while LEA BOP allows for billing for a broad range of health-related services.
The state has selected Carelon Behavioral Health as the third party administrator (TPA) who will serve as a statewide clearinghouse for claims management and payment remittance.
The Department of Health Care Services will also be developing a state-wide school-linked provider network of school site behavioral health providers and practitioners.
To keep up-to-date on the Multi-Payer School-Linked Fee Schedule, please subscribe to the CYBHI newsletter here.
What You Can Do Now
- If your district is part of Cohort 1, participate in the trainings and convenings to learn how the Fee Schedule will work for both district and partner employees who are eligible providers
- If your district would like to be included in Cohort 2 (starting in July 2024), contact your local COE to complete application and prepare for operational readiness
- Contact your local COE to participate in the planning for CYBHI Fee Schedule readiness through the School-Linked Partnership and Capacity Grants.
- Start planning with your school and community partners for leveraging sustainable funding to maintain and increase behavioral health capacity
- Join us for future training webinars related to CYBHI!