Effective September 15, 2014, VHP is responsible for the treatment of MediCal patients with Autism treatment disorder. This may include Speech Therapy, Occupational Therapy and Behavioral Health Treatments such as Applied Behavioral Analysis (ABA).
VHP contracts exclusively with Santa Clara Family Health Plan (SCFHP) for Managed MediCal members. Managed MediCal members calling to inquire about these services should be directed to SCFHP Member Services at 1-800-260-2055 (toll-free). VHP does NOT provide member services support for SCFHP Plan Members. The members should NOT be referred to County Mental Health or San Andreas Regional Centers.
Providers calling to obtain referrals for these patients should be referred to the VHP UM Department at 408.885.4647. All services must be referred by their PCP, as for any other service. Patients may not self-refer. The UM Department will review for coverage criteria, network participation, and coordination of care as they would with any other service.
Primary Care Providers are responsible for coordinating Autism care the same as for any other diagnosis; referral for evaluation, review of the evaluation and treatment plan, and prescription of treatment services and duration. Per regulations, all treatment must be prescribed by a physician or psychologist. Primary Care Providers that see patients with autism should visit www.scfhp.com to familiarize themselves with the benefit, treatments available, and available resources.