CYBHI Fee Schedule

The Department of Health Care Services (DHCS), in collaboration with the Department of Managed Health Care (DMHC), has developed a multi-payer, school-linked statewide fee schedule for outpatient mental health and substance use disorder services provided to students 25 years of age or younger at or near a school site.

The state statute (W&I Code section 5961.4) requires commercial health plans and the Medi-Cal delivery system, as applicable, to reimburse, at or above the published rates, these school-linked providers, regardless of network provider status, for services furnished to students pursuant to the fee schedule. Further, services provided as part of the fee schedule shall not be subject to copayment, coinsurance, deductible, or any other form of cost sharing.

To leverage the CYBHI fee schedule as a sustainable funding source for school-linked behavioral health services that:

• Increases access to school-linked behavioral health services for children and youth;
• Creates a more approachable billing model for schools and local educational agencies (LEAs);
• Eases burdens related to contracting, rate negotiation, and navigation across delivery systems; and,
• Reduces uncertainty around students’ coverage