Mental Health Services

• Launched in 2021, the Children and Youth Behavioral Health Initiative (CYBHI) is an innovative, five-year, $4.7 billion investment by the State of California. It is part of a master plan to prioritize and to reimagine and transform how we support the mental health and well-being of children and youth. link. 
• The statewide multi-payer school-linked fee schedule (fee schedule) is part of the CYBHI initiative and a new way to fund school-based behavioral health services for children and youth in California.
• It is called a multi-payer school linked fee schedule because behavioral health services available to students are either connected to or coordinated by schools – aiming to provide mental health support in an environment where students already spend much of their time. It’s a multi-payer initiative because both Medi-Cal and private insurance companies are funding sources for this initiative.  A multi-payer approach ensures that behavioral health services are available to a broader group of students, regardless of their insurance status or ability to pay.
• The fee schedule establishes a specific set of behavioral health services and rates at which Medi-Cal and Commercial Insurance Plans are required to reimburse local education agencies, public institutions of higher education and other school-affiliated providers. 
• The new fee schedule aims to expand access to school-linked behavioral health services by ensuring that Medi-Cal and commercial health plans reimburse school-affiliated providers for services delivered to students, regardless of their network provider status.
• This is important because many schools and their partner organizations currently offer behavioral health services to students covered by Medi-Cal or commercial health plans but do not receive any reimbursement for these services.
• Add here about no co-pay and no explanation of benefits. 
• There are no co-pays or additional expenses to families or caregivers for students who receive services eligible for reimbursement under this initiative. And further, students who receive services will not reduce or impact students or their family’s ability to obtain care outside of school.

The goal of the CYBHI Fee Schedule is to expand access to school-based and school-linked behavioral health services for children and youth in California by establishing a sustainable and simplified reimbursement model for providers. Specifically, the Fee Schedule aims to:

1. Increase Access to Behavioral Health Services:
   • Ensure that all children and youth up to age 25 can receive behavioral health services regardless of insurance status (Medi-Cal, commercial insurance, or uninsured).
   • Provide a consistent and predictable funding mechanism for services delivered in schools, school-linked locations, and higher education institutions.
2. Simplify and Standardize Reimbursement:
   • Establish a uniform, statewide fee-for-service reimbursement model to remove financial and administrative barriers for providers, such as schools, mental health organizations, and healthcare providers.
   • Allow Local Educational Agencies (LEAs) and other providers to bill for behavioral health services in a way that ensures timely and sustainable payment.
3. Ensure No Out-of-Pocket Costs for Families:
   • Prevent families from incurring any copays, deductibles, or out-of-pocket expenses, ensuring that financial concerns do not limit access to care.
4. Support the Integration of Behavioral Health Services in Schools:
   • Promote a preventative and early intervention approach by embedding behavioral health services within school settings where children and youth spend most of their time.
   • Enhance collaboration between schools, healthcare providers, and community-based organizations to ensure students receive comprehensive mental health support.
5. Align with the Broader CYBHI Goals:
   • Support the transformation of California’s behavioral health system by increasing service availability, improving equity in mental health care, and reducing disparities in access.

In essence, the Fee Schedule’s primary goal is to remove financial and administrative barriers to providing mental health and substance use disorder services in schools, making behavioral health support more accessible and sustainable for California’s youth.

The Local Educational Agency Medi-Cal Billing Option Program (LEA BOP) and the Children and Youth Behavioral Health Initiative (CYBHI) Fee Schedule are two distinct reimbursement mechanisms in California designed to fund health-related services in educational settings.

Local Educational Agency Medi-Cal Billing Option Program (LEA BOP):

• Scope of Services: LEA BOP allows Local Educational Agencies (LEAs)—including school districts, county offices of education, charter schools, and certain higher education institutions—to receive federal reimbursement for approved health-related services provided to Medi-Cal eligible students. These services encompass a broad range of health services, such as medical, dental, vision, and mental health services, particularly those specified in a student’s Individualized Education Plan (IEP) or Individualized Family Services Plan (IFSP). 

Children and Youth Behavioral Health Initiative (CYBHI) Fee Schedule:

• Scope of Services: The Fee Schedule focuses specifically on outpatient mental health and substance use disorder services provided at school or school-linked sites to students up to 25 years old. The services covered include psychoeducation, screenings, assessments, therapy, and case management. 

It sets standardized reimbursement rates for services rendered to children and youth who are:

• Under the age of 26,
• Enrolled in public TK-12 schools or institutions of higher education, and
• Covered by Commercial health plan, Medi-Cal managed care plans, Medi-Cal Fee-for-Service, or disability insurers.

Notably, children, youth, and families will not incur out-of-pocket expenses, there is no co-pay and there will be no impact on their existing insurance plans or deductibles. Additionally parents will not receive an explanation of benefits

Key Differences:

• Service Focus:
  • LEA BOP: Encompasses a wide range of health-related services, including both physical and mental health services, primarily tied to IEP or IFSP requirements.
  • CYBHI Fee Schedule: Concentrates specifically on behavioral health services, such as mental health and substance use disorder treatments, provided in school or school-linked settings.
• Reimbursement Mechanism:
  • LEA BOP: Operates on a cost-reimbursement model, where LEAs submit claims and later reconcile costs through a detailed cost reporting process.
  • CYBHI Fee Schedule: Provides a fee-for-service reimbursement model with standardized rates, simplifying the billing process for specified behavioral health services.
• Eligibility and Coverage:
  • LEA BOP: Targets services for Medi-Cal eligible students, often linked to special education services outlined in IEPs or IFSPs.
  • CYBHI Fee Schedule: Aims to broaden access by covering services for all students under 26, regardless of Medi-Cal eligibility, including those with commercial insurance, thereby expanding the reach of behavioral health services in educational settings.

While both programs aim to enhance student health services within educational institutions, LEA BOP offers a comprehensive approach to various health services with a focus on special education, whereas the CYBHI Fee Schedule specifically targets the expansion and simplification of funding for behavioral health services across a broader student population.

• The Fee Schedule will exist alongside the LEA Bop with the goal of increasing student access by expanding the program to Medi-Cal enrolled and commercially insured students and streamlining the billing and reimbursement processes while removing the ‘Random Moment in Time Study’ requirement. 
• Services that are rendered under the Fee Schedule will not be subject to any cost-sharing (e.g., co-pays and deductibles). It utilizes a flat fee for service methodology (100% reimbursement). There is no cost settlement required and no obligation for LEAs to pay for non-federal services. Table below illustrates which services are eligible for reimbursement under LEA Bop and the Fee Schedule. 

• Under the Fee Schedule, schools and partners have the potential to receive reimbursement for services such as screening, prevention and case management Reimbursable services fall into four categories: 
  • Psychoeducation services (see example below)
  • Screening and Assessment 
  • Therapy Services 
  • Case Management 

• Psychoeducation | The objective of psychoeducation services as defined by the Fee Schedule is to empower students and families with knowledge about their condition, identify strategies and treatment options and provide wellness education and skill-building services to manage it effectively. Services provided to students could include individual sessions, group workshops and even online training. 
• Screening and Assessments | The Fee Schedule allows for a range of behavioral health screenings to help identify students at risk for mental illness and/or substance use disorder, ensure that appropriate supports are provided across risk levels and inform prevention and early intervention strategies. Therapy Services | The Fee Schedule has identified a variety of therapy services as eligible for reimbursement including, crisis intervention, individual therapy (counseling), group therapy (counseling) and dyadic (parent and child) family counseling. 
• Case management | Coordinating the care of students is considered a reimbursable service by the Fee Schedule and is intended to support and guide students and families through the process. This may involve, identifying students who many be a risk for mental illness or substance use disorders, developing a plan for student’s care, ensuring that students receive the appropriate supports and services, advocating for the student and providing wellness education,skill building services such as mindfulness, de-escalation and emotional regulation, and making referrals to and linking to service providers outside of school.

• More information can be found here

A variety of professionals are eligible to provide behavioral health services under CYBHI. See a list of eligible providers below.  However, not all of these providers are based in schools. Schools can coordinate and partner with practitioners to offer services outside of the school setting, which are considered school-linked services.

Eligible Practitioner Types

• The state sets an amount that each school receives for services it provides to students. When a school provides a service and submits a claim, they receive the amount shown on the fee schedule. 
• A district provides and documents services. The district then sends that data to the Santa Cruz County Office of Education (SCCOE). The SCCOE will code the claim and submit it to the proper parties. The state reimbursement rate will go back to the district. 
• The Fee Schedule supports students ages 0 to 25. Districts don’t have to worry about interim payments. They receive unrestricted funds for a variety of school-based needs and the ability to sustain and expand services for youth which could lead to less chronic absenteeism, suspension, and increased behavioral health outcomes for students. 
• LEAs that have opted into the Fee Schedule Billing Consortium have agreed that the SCCOE will take care of claims submissions on behalf of districts. This is intended to help ease the administrative burden on districts who implement the fee schedule by handling claim submissions and getting you the reimbursements. This will free up time so that districts can focus on students. 

The School-Linked Partnerships and Capacity Grants are a one-time investment enabling COEs and LEAs to build necessary infrastructure and partnerships to achieve a long-term and sustainable funding model for student behavioral health services. This funding aims to increase the number of LEAs who meet the fee schedule’s operational requirements and expand access by increasing the availability, equity, and range of behavioral health services and growing service capacity and infrastructure. Additional information about the Capacity Grant is available here. 

All medical records under the CYBHI are confidential; the release of information must continue to follow state law, FERPA, HIPAA, and Medi-Cal laws and regulations. Schools will be responsible for finding other funding sources (e.g., LCFF) to reimburse the fee schedule services if the student, parents or legal guardian do not consent to release insurance information. Schools should provide parents/ guardians with information about the CYBHI fee schedule and encourage the consent to release insurance information.  

• The CYBHI has developed an Equity Framework designed to embed equity into all aspects of the initiative, including processes, design, planning, implementation, and accountability efforts. LEAs are expected to align their programs with this framework to ensure that services are accessible and effective for all students, particularly those from underserved communities.
• LEAs are required to collect and report data on behavioral health services provided to students. This data is used to assess progress in enhancing health outcomes for children and youth and to ensure that services are delivered equitably across different student populations
• LEAs develop Local Control Accountability Plans to set goals, plan actions, and leverage resources to meet those goals. Incorporating behavioral health objectives into LCAPs ensures that LEAs are accountable for addressing the mental health needs of their students and for implementing strategies that promote equitable outcomes.