About this service
Marin Behavioral Health and Recovery Services (BHRS) provides the Policy and Criteria for Member Access to Specialty Mental Health Services to explain how individuals qualify for and access specialty mental health services. This policy describes medical necessity criteria, service eligibility standards, and access requirements used to determine whether specialty mental health services are appropriate.
The policy helps member, families, providers, and referral partners understand how access decisions are made and what standards apply for services delivered through the county behavioral health system.
Who this service is for
This information is for:
- Medi-Cal members seeking specialty mental health services
- Clients, families, and caregivers who want to understand access and eligibility criteria
- Providers, clinicians, and referral partners making or supporting referrals
- Community organizations and advocates assisting individuals with behavioral health service navigation
- County staff and contract providers applying specialty mental health access standards
Details
Marin BHRS - 89 - Policy and Procedure for Criteria for Member Access to Specialty Mental Health Services
What the policy covers
This policy describes the criteria used to determine member access to specialty mental health services and outlines how access decisions are made within the Marin BHRS system of care.
Key areas addressed
- Medical necessity criteria for specialty mental health services
- Clinical and functional factors considered in determining access
- Requirements related to assessment, referral, and authorization
- Standards used to guide beneficiary entry into the specialty mental health delivery system
- Related beneficiary protections and procedural requirements
Why this information matters
The policy supports consistent and transparent decision-making about access to care. It helps beneficiaries and providers understand when specialty mental health services may be available and what standards must be met for services to be approved and delivered.
Where to find related information
Additional policies and procedures may be available through the Marin BHRS policies and procedures section for clients and caregivers. These materials may include related guidance on beneficiary rights, notices, grievance and appeal processes, and service access procedures.
Getting help
People who need help understanding behavioral health service options or accessing care can contact Marin BHRS through the Access Line at 888-818-1115.