| Clinical documentation completed within DMH shall minimally adhere to Medi-Cal standards regardless of the payer source.
DMH directly operated or legal entity providers and practitioners shall know, reference, and abide by the requirements and provisions within the following: - Organizational Provider’s Manual for Specialty Mental Health Services under the Rehabilitation Option and Targeted Case Management Services (Organizational Provider’s Manual);
- Guide to Procedure Codes for Specialty Mental Health Services (Guide to Procedure Codes);
- QA Bulletins; and
- Applicable DMH policies, including DMH Policy 401.02 and 312.02.
Fee-for-Service (FFS) providers and practitioners shall know, reference, and abide by the requirements and provisions within the following: - Medi-Cal Specialty Mental Health Services Fee-for-Service Network Provider Manual (FFS Network Provider Manual);
- Provider Bulletins; and
- Applicable DMH policies, including DMH Policy 401.02 and 312.02.
Providers shall have a quality assurance process in place to ensure documentation requirements of the Organizational Provider’s Manual or FFS Network Provider Manual, as applicable. - Directly operated providers:
- The quality assurance process must be in accordance with standards set forth within the Guide to Quality Assurance Chart Review Requirements for Directly Operated Programs (Guide to Quality Assurance).
- Exceptions made to the requirements set forth in the Guide to Quality Assurance, including the chart review tool, must be authorized by the Quality Assurance Unit.
- Legal entity providers:
- The quality assurance process must be written and on file with the Quality Assurance Unit.
- The quality assurance process must include annual chart reviews on at least 5% of open clinical records per quarter and incorporate a process for using review findings to inform and improve ongoing documentation practices.
- FFS providers:
- The quality assurance process must be in accordance with standards set forth in the FFS Network Provider Manual.
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