by Sara Jasper, J.D.
Staff Attorney

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In May of this year, the Center for Medicare and Medicaid Services approved a State Plan Amendment (SPA), SPA-14-012 adding Licensed Marriage and Family Therapists (LMFTs) and Registered Interns to the list of Medi-Cal providers. The Department of Health Care Services (DHCS) began accepting applications for enrollment of LMFTs on November 3rd. Instructions on about how to apply are available at www.medi-cal.ca.gov.

The following are Frequently Asked Questions about who should apply, how to apply, and how to contact the DHCS with questions about the enrollment process.

Q: Who is eligible to enroll as a Fee-For-Service Medi-Cal provider?

A: Licensed Marriage and Family Therapists who wish to see Medi-Cal clients in a private practice setting.

To be eligible for enrollment as a fee-for-service Medi-Cal provider, a person must be licensed. LMFTs who are currently offering Medi-Cal services through the County or through Medi-Cal Managed Care Plans, but who are not planning to treat Medi-Cal clients in a private practice setting (i.e. sole proprietorship, partnership, for-profit corporation) do not need to apply/enroll.

Although Registered Interns under supervision are also eligible under State Plan Amendment 14-012 to render services to Medi-Cal clients, pre-licensees do not need to enroll with Medi-Cal because those claims should be submitted by and through their supervisors. More information about how to fill out and submit claims for mental health services performed by interns will be available in a Medi-Cal provider manual to be published on the Department's Medi-Cal website (www.medi-cal.ca.gov) in November. Information about reimbursement rates for both LMFTs and Registered Interns will also be provided in the manual.

Q: How do I apply to become a Fee-For-Service Medi-Cal Provider?

A: LMFTs who wish to apply must complete and submit the following forms to the DHCS:

Forms Required for Those Applying as Individuals

• Medi-Cal Provider Application (DHCS 6204);
• Disclosure Statement (DHCS 6207);
• Medi-Cal Provider Agreement (DHCS 6208); and
• All supporting documents

Forms Required for Those Applying as a Group

• Medi-Cal Provider Group Application (DHCS 6203)
• Medi-Cal Disclosure Statement (DHCS 6207);
• Medi-Cal Provider Agreement (DHCS 6208); and
• All supporting documents

For those who may be interested in applying to become a provider group, the term provider group means two or more rendering providers doing business together under a provider number at the same business location. In order to enroll as a group there must be two or more individuals providing services who are appropriately licensed with the California Board of Behavioral Science. When applying as a group provider, in addition to the group provider application package, a complete rendering provider application package (DHCS 6216) must be submitted for each individual provider not enrolled in Medi-Cal who is rendering services for the group.

Q: Where can I find the forms I need to apply?

A: All of the aforementioned Medi-Cal provider application forms are available on the “Provider Enrollment” page of the Medi-Cal website at www.Medi-Cal.ca.gov.

Q: Who should I contact if I am having issues with my application?

A: A Provider Bulletin with instructions on how to apply can be found at www.medi-cal.ca.gov. The DHCS's Provider Enrollment Division can also be contacted by calling 916-323-1945 or by emailing PEDcoor@dhcs.ca.gov.

Q: How long will it take the DHCS to process my application?

A: The DHCS is required to take action on a submitted application within 180 days of receipt of the application.

Q: What is the rate of reimbursement for LMFTs and Registered Interns?

A: Information about reimbursement rates for both LMFTs and Registered Interns will also be provided in the manual.