Court: State can limit Medi-Cal’s psychological treatment

SACRAMENTO

May 3, 2013
11:40am

•  Says two visits per month is permissible

•  “We will not impute to Congress an intent to have the states pay for unlimited psychology services”

California is within its rights to restrict the number of psychological treatments to no more than two per month for those covered by Medi-Cal, the state’s health plan for low-income residents, the California Third District Court of Appeal says.

“Federal law does not prohibit a state’s application of utilization controls to psychology services rendered at an FQHC [federally-qualified health centers], and state law provides for those utilization controls,” says the ruling by the Sacramento-based appellate court.

It ruled against the Mendocino Community Health Clinic and other related clinics that had gone to court and gotten an order allowing them to offer their Medi-Cal patients psychological treatments more than twice a month.

“The norm is that states can impose utilization controls to manage Medicaid funds, so we will not impute to Congress an intent to have the states pay for unlimited psychology services rendered to Medicaid patients by FQHC‟s without evidence that Congress so intended” the appeals court says. “Accordingly, we conclude that federal law does not prohibit California’s adoption of utilization controls to insure efficient use of Medicaid funds by FQHCs.”