Intensive Care Coordination (ICC) and Intensive Home Based Services (IHBS)
Intensive Care Coordination (ICC) is an intensive form of Targeted Case Management (TCM) that facilitates assessment of, care planning for, and coordination of services for children and youth. ICC includes urgent services for beneficiaries with intensive needs. The difference between ICC and the more traditional TCM service functions is that ICC is intended for children and youth with more intensive needs, and/or whose treatment requires cross-agency collaboration. Intensive Home-Based Services (IHBS) are individualized, strength-based interventions designed to ameliorate mental health conditions that interfere with a child’s or youth’s functioning. These interventions are aimed at: helping the child/youth build skills for successful functioning in the home and community, as well as improving the family’s ability to help the child/youth successfully function in the home and in the community. ICC and IHBS are provided through the EPSDT benefit to all children and youth who:
• Are under the age of 21;
• Are eligible for the full scope of Medi-Cal services; and
• Meet medical necessity criteria for SMHS
ICC and IHBS must be provided to all children and youth who meet medical necessity criteria for those services. Membership in the Katie A. subclass is not a prerequisite to receiving ICC and IHBS. As of January 1, 2022, all SMHS providers are required to screen all eligible persons served age 21 years and under for ICC and IHBS services using the Fresno County ICC IHBS Consideration Tool at the time of initial mental health assessment, reassessessment, and at the time of discharge and maintain a copy of the screening in the person’s medical record.
As of January 1, 2021, all providers of the FCMHP that plan to provide new Intensive Home-Based Services (IHBS) to Medi-Cal Beneficiaries are required to submit an IHBS Authorization Request Form for each person served prior to providing any IHBS services. Once the IHBS authorization request is approved, the special population identifier either “ICC/IHBS” or “Katie A. ICC/IHBS” will be added to the County system as appropriate to allow for the provision and claiming of ICC and IHBS. Please note, since IHBS requires prior authorization from the FCMHP, per the Department of Health Care Services (DHCS) MHSUDS IN 22-016, for providers to claim for ICC, they will also need to submit a request to provide and claim for IHBS.
Therapeutic Behavioral Service (Tbs) Medi-cal Services
What are Therapeutic Behavioral Services (TBS)?
TBS is a type of mental health service available to you if you have serious emotional problems that put your placement at risk. You must be under 21 and have full-scope Medi-Cal to get TBS.
- If you are living at home, the TBS staff person can work one-to-one with you to reduce severe behavior problems to try to keep you from needing to go to a higher level of care, such as a group home for children and young people with very serious emotional problems.
- If you are living in a group home for children and young people with very serious emotional problems, a TBS staff person can work with you so you may be able to move to a lower level of care, such as a foster home or back home.
TBS will help you and your family, caregiver or guardian learn new ways of controlling problem behavior and ways of increasing the kinds of behavior that will allow you to be successful. You, the TBS staff person, and your family, caregiver or guardian will work together very intensively for a short period of time, until you no longer need TBS. You will have a TBS Plan that will say what you, your family, caregiver or guardian, and the TBS staff person will do during TBS, and when and where TBS will occur. The TBS staff person can work with you in most places where you are likely to need help with your problem behavior. This includes your home, foster home, group home, school, day treatment program and other areas in the community.
Who can get TBS?
You may be able to get TBS if you have full scope Medi-Cal, are under 21 years old AND
- Have serious emotional problems AND
- Live in a group home for children and young people with very serious emotional problems. [These group homes are sometimes called Rate Classification Level (RCL) 12,13 or 14 group homes]; OR
- Live in a state mental health hospital, a nursing facility that specializes in mental health treatment or Mental Health Rehabilitation Center (these places are also called institutions for mental diseases or IMDs); OR
- Are at risk of having to live in a group home (RCL 12,13 or 14), a mental health hospital or IMD; OR
- Have been hospitalized, within the last 2 years, for emergency mental health problems; OR
- Have previously received TBS
Are there other things that must happen for me to get TBS?
Yes. You must be getting other mental health services. TBS adds to other mental health services. It doesn't take the place of them. Since TBS is short term, other mental health services may be needed to keep problems from coming back or getting worse after TBS has ended.
TBS is not provided if the reason it is needed is:
- Only to help you follow a court order about probation.
- Only to protect your physical safety or the safety of other people.
- Only to make things easier for your family, caregiver, guardian or teachers.
- Only to help with behaviors that are not part of your mental health problems.
You cannot get TBS while you are in a mental health hospital, an IMD, or locked juvenile justice setting, such as a juvenile hall. If you are in a mental health hospital or an IMD, though, you may be able to leave the mental hospital or IMD sooner, because TBS can be added to other mental health services to help you stay in a lower level of care (home, a foster home or a group home).
How do l get TBS?
If you think you may need TBS, ask your Fresno County Mental Health Provider, if you already have one, to contact the county mental health department and request services. A family member, caregiver, guardian, doctor, psychologist, counselor or social worker may call and ask for information about TBS or other mental health services for you. You may also call the MHP at 1 800 654-3937 for more information about TBS. Who decides whether or not I need TBS and where and when I can get it?
The county mental health department decides if you need mental health services, including TBS. Usually your Mental Health Provider will send a TBS referral to the Mental Health Plan TBS advisors. The referral will be reviewed for TBS class criteria and, if appropriate, will be forwarded to our TBS Provider. A meeting will then be scheduled with the caregiver and the initial TBS Plan will be developed utilizing both the input from the information provided by the referring clinician and the caregiver.
What is in my TBS Plan?
Your TBS Plan will spell out the problem behaviors that need to change and what the TBS staff person, you and sometimes your family, caregiver or guardian will do when TBS happens. The TBS Plan will say how many hours a day and the number of days a week the TBS staff person will work with you and your family, caregiver or guardian. The hours in the TBS Plan may be during the day, early morning, evening or night. The days in the TBS Plan may be on weekends as well as weekdays. The TBS plan will say how long you will receive TBS. The TBS Plan will be reviewed regularly. TBS may go on for a longer period of time, if the review shows you are making progress but need more time.
What if the county mental health department doesn't approve TBS, but you, your family or caregivers disagree?
You can file a grievance with the county mental health department if the county mental health department doesn't approve TBS, but you, your family, caregiver or guardian disagree. Call the MHP at 1 800 654-3937 for information and help. You may also call the county patient's rights advocate at (559) 492-1652 or the State Mental Health Ombudsman Office at 1 800 896-4042 or TTY 1 800 896-2512
You and your family or caregivers can ask for a State Hearing instead of filing a grievance or at the same time you file a grievance with the county mental health department. Call 1 800 952-5253, send a fax to 916-2294110, or write to the State Department of Social Services/State Hearings Division, P.O. Box 944243, Mail Station 19-37, Sacramento CA 94244-2430. You must ask for a State Hearing within 90 days after you learn that your request to the county mental health department for TBS was denied. Protection & Advocacy, Inc. is also available to assist with grievances and appeals at 1 800 776-5746.
Early & Periodic Screening, Diagnosis and Treatment Services (EPSDT)
Medi-Cal Services for Children and Young People
What are Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services?
EPSDT services are extra Medi-Cal services. You can get them in addition to other Medi-Cal services. You must be under age 21 and have full scope Medi-Cal to get these services. EPSDT services correct or improve medical problems that your doctor or other health care provider finds, even if the health problem will not go away entirely.
How can I get EPSDT services for my child or, if I am under age 21, for myself?
Ask your doctor or clinic about EPSDT services. You may get these services if you and your doctor, or other health care provider, clinic (such as Child Health and Disability Prevention Program [CHDP]) or county mental health department agree that you need them.
What are EPSDT mental health services?
EPSDT mental health services are Medi-Cal services that correct or improve mental health problems. These problems may be sadness, nervousness, or anger that makes your life difficult.
Some of the services you can get from your county mental health department are:
- Individual therapy
- Group therapy
- Family therapy
- Crisis counseling
- Case management
- Special day programs
- Medication for your mental health
- EPSDT mental health services to treat alcohol and drug problems you may have that affect your mental health.
You can also ask for counseling and therapy as often as once per week or more if you think you need it. You may be able to get these services in your home or in the community.
In most cases, your county mental health department, you, and your doctor or provider will decide if the services you ask for are medically necessary. County mental health departments must approve your EPSDT services. Every county mental health department has a toll-free phone number that you can call for more information and to ask for EPSDT mental health services.
What are EPSDT Therapeutic Behavioral Services (TBS)?
Therapeutic Behavioral Services (TBS) is a new EPSDT mental health service. TBS helps children and young people who:
- Have severe emotional problems
- Live in a mental health placement or are at risk of placement, or
- Have been hospitalized recently for mental health problems.
If you get other mental health services and still feel very sad, nervous, or angry, you may be able to have a trained mental health coach help you. This person could help you when you have problems that might cause you to get mad, upset or sad. This person would come to your home, group home or go with you on trips and activities in the community.
Your county mental health department can tell you how to ask for an assessment to see if you need mental health services including TBS.
Who can I talk to about EPSDT mental health services?
You can talk to your doctor, psychologist, counselor or social worker about EPSDT mental health services. For children and young people in a group home or residential facility, you can talk to the staff about getting additi6nal EPSDT services.
For children in foster care, you can also ask the child's court-appointed attorney. You can also call your county mental health department directly.
What if I don't get the services I want from my county mental health department?
You can file a grievance with the county mental health department if the county mental health department denies the EPSDT services requested by your doctor or provider. You may also file a grievance if you think you need mental health services and your provider or county mental health department does not agree. Call the MHP at 1 800 654-3937 for information and help. You may also call the county patient's rights advocate at (559) 492-1652 or the State Mental Health Ombudsman Office at 1 800 896-4042
You can ask for a State hearing at the same time. Call 1 800 952-5253, send a fax to 916-229-4110 or write to the Department of Social Services/State Hearings Division, P.O. Box 944243, Mail Station 19-37, Sacramento CA 94244-2430. You must ask for a hearing within 90 days after you learn that your request for services was denied. Protection & Advocacy, Inc. is also available to assist with complaints, appeals, and grievances.
Who can I call for more information?
For more information please contact the offices and telephone numbers below.
- Fresno County Toll-Free Access Line 1 800 654-3937
- Department of Health Care Services Mental Health Ombudsman's Office 1-800-896-4042
- Child Health and Disability Prevention (CHDP) Program Located in Your County or City Health Department Look in Your Local Phone Book.
Click Here to View the EPSDT Intensive Services (Pathways to Well-Being) Training 2017(PDF, 2MB)