Partnership HealthPlan of California is the County Organized Health System for 24 northern counties — from Del Norte and Humboldt down through Marin, Sonoma, Napa, Solano and Yolo, and since 2024 Butte, Placer, Nevada, Sutter, Yuba and the rest of the northern valley — with about 847,000 Medi-Cal members in August 2026. In a COHS county there is no other Medi-Cal plan to choose, so every managed-care child there is a Partnership member. Mental health is delegated to Carelon Behavioral Health, but BHT is not: Partnership’s own Health Services Department reviews every BHT Treatment Authorization Request.
Policy MCUP3126 (reviewed April 8, 2026) requires a TAR for all BHT. The TAR must include the "Medical or mental health diagnosis," the "Length and severity of the condition," a history and physical "including mental status, development status and/or any form of comprehensive diagnostic testing," and "The Functional Behavioral assessment conducted by a Board Certified Behavior Analyst." A signed release of information must accompany "any BHT related clinical documentation or TAR"; it is "valid for one calendar year from the date of signature," and "Failure to do so may result in a delay of service." If the documentation is missing "OR the information is beyond twelve months, Partnership may make a one-time allowance to approve a single visit in order to fulfill TAR requirements." The BHT fax cover has three boxes — Assessment TAR (with a CDE and the ROI), Initial BHT services TAR (treatment plan), Reauthorization TAR (treatment plan with goal progress).[1][2][4]
Submission: "Electronic submission will allow for more expedient processing. If online submission is not possible, the TAR may be submitted via fax (707) 863 - 4118." Retro TARs must arrive "within fifteen (15) business days of the date of service," or within 60 calendar days of a primary insurer’s denial.[1][2][4]
Partnership states it "is the primary Provider of medically necessary BHT services" and must fill gaps the school district leaves; it "must not assume that BHT services included in a Member’s IEP/IHSP/IFSP are actively being provided by the LEA." A child moving from a Regional Center automatically generates a continuity-of-care request, and continuity with an out-of-network BHT provider can run up to 12 months when the member saw that provider in the prior six months — paid at no less than "the established Medi-Cal Fee for Service (FFS) rate for the applicable BHT service." Members turning 21 get a transition plan toward community agencies or the Regional Center.[1]
The questions that decide whether a family can start with Partnership HealthPlan of California (Medi-Cal), and what they have to bring. Each maps onto something intake should ask on the first call.
"Be under 21 years of age" (MCUP3126); members approaching 21 get a transition plan toward providers, community agencies or the Regional Center.[1]
A soft 12-month rule: "If the above documentation is not available OR the information is beyond twelve months, Partnership may make a one-time allowance to approve a single visit in order to fulfill TAR requirements."[1]
The recommendation must come from "a licensed physician, surgeon or psychologist" stating BHT is medically necessary "regardless of diagnosis"; the functional behavior assessment must be "conducted by a Board Certified Behavior Analyst."[1]
None named — the TAR needs "any form of comprehensive diagnostic testing." UM uses the policy’s own criteria, "current clinical criteria and guidelines," and (generally) InterQual.[1][2]
No PCP referral form is required for BHT: the TAR is "to be submitted by the provider performing these services," and the fax cover also accepts a "Referral for BHT services for review." What is required is the physician/surgeon/psychologist recommendation and the signed ROI.[3][4][1]
MCUP3041: non-urgent pre-service decisions "within seven (7) calendar days from the receipt of the request, but no later than 14 calendar days"; urgent pre-service "within 72 hours"; a TAR lacking clinical information "may be deferred/pended up to 14 calendar days." Retro TARs within 15 business days of service. Reauthorization: the treatment plan is reviewed "no less than once every six months," and the ROI must be renewed yearly.[2][1]
"The primary carrier must be billed first … A copy of the EOB or RA from the primary carrier should be attached … Partnership /Medi-Cal is always the payer of the last resort." Partnership accepts retro TARs "within 60 calendar days of a denial from the primary insurance carrier" — which means it still expects its own authorization when it ends up paying behind another plan.[6][2]
Partnership’s telehealth policy lets covered CPT/HCPCS services, "subject to any existing treatment authorization requirements," be delivered by telehealth when clinically appropriate, with documented consent, POS 02/10 and modifier 95 (video) or 93 (audio-only); MCUP3126 contemplates BHT "on-site at school or during remote school sessions." No BHT-specific restriction (e.g. on technician-delivered 97153) is published.[5][1]
Ask the plan: Partnership Health Services (BHT TAR review) — ask on the TAR whether remote 97153 is approved for this member.
Coverage decides whether Partnership HealthPlan of California (Medi-Cal) pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
"Partnership only credentials Licensed Medical Professionals or BACB® certified providers … Providers who are not licensed or BACB® certified may only provide ABA services while under the supervision of a Partnership credentialed provider," and "BCaBA providers must work under the supervision of a Partnership credentialed BCBA." No numeric supervision ratio is published.[8]
No caps: "Blanket limitations or restrictions on benefits and services, such as caps on number of hours, are prohibited" (MCUP3126).[1]
MCUP3126: the provider "Delivers BHT services in a home or community-based setting, including clinics," with any school-based hours "proportionate to the Member’s medical need," including on-site at school or during remote school sessions.[1]
BHT must be delivered by a QAS Provider, Professional or Paraprofessional meeting the State Plan; Partnership credentials BCBA, BCBA-D and BCaBA (re-credentialing every 36 months), and "Individual unlicensed ABA therapists must submit to a criminal background check by Partnership" (group-employed unlicensed staff need a background check too). Contracted rates sit in each provider’s Partnership contract; non-contracted providers are paid "the State of California Medi-Cal fee-for-service rates."[1][8][7]
Not addressed in MCUP3126 or MCUP3041. Partnership’s claims manual says it "follows State of California Medi-Cal Provider Manual unless otherwise stated" — and the state BHT manual is itself silent on 97153 with 97155 in the same clock time.[12][13]
Ask the plan: Partnership Claims Department or provider relations — ask whether 97153 and 97155 may be billed for the same minutes.
Not addressed in the BHT policy.[1]
Blocked on: Partnership’s medical-record standards policy (not read this cycle) on partnershiphp.org / PowerDMS.
Yes — as Behavioral Health Treatment for Medi-Cal members under 21 in its 24 northern counties, reviewed by Partnership itself (not Carelon) through Treatment Authorization Requests.
A signed release of information (valid one year), a physician/surgeon/psychologist recommendation, a diagnosis, the H&P and diagnostic testing, and a BCBA’s functional behavior assessment — records older than 12 months only earn a one-time single visit.
Within 7 calendar days of receipt (up to 14 if information is missing), and within 72 hours for urgent requests.
State rule: APL 23-010 requires every Medi-Cal plan to offer continued access to out-of-network BHT providers (continuity of care) for up to 12 months under APL 23-022, so ask Partnership HealthPlan for a continuity-of-care arrangement before treatment stops. No state document says whether an existing authorization follows the child to a new agency within the plan; ask the plan before switching.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
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