What’s happening: As of Jan. 1, hospital emergency departments (EDs) have a clear pathway for Medi-Cal reimbursement for behavioral health visits under CHA-sponsored Assembly Bill (AB) 1316 (2024). In a memo to members, CHA provides guidance to hospitals on the new requirements and their obligations for stabilizing or transferring individuals in EDs experiencing a mental health crisis.
What else to know: The new law ensures hospitals get reimbursed by Medi-Cal for the ED services they provide to patients with behavioral health conditions. It also empowers hospitals to promptly transfer patients to inpatient psychiatric care — without delays by counties and health plans.
Following decades of confusion about payer responsibility, AB 1316 clarifies that Medi-Cal managed care plans (not counties) are required to cover all ED services that hospitals provide to patients with behavioral health needs. AB 1316 also clarifies that regardless of whether an individual is on an involuntary “5150” hold, hospitals must handle psychiatric emergencies the same way the Emergency Medical Treatment and Active Labor Act requires them to handle other medical emergencies. Counties and other payers are prohibited from restricting, limiting, or directing the transfer of these patients.
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