PCP Referral to Behavioral Health Specialists Including Member with Special Needs
A specialist is any licensed provider providing specialty medical services to members. A PCP may refer a member to a specialist when medically necessary, including for behavioral health services (transition-aged youth, trauma, substance use in adolescents, opioid use disorder, supportive and rehabilitation services), Autism Spectrum Disorder, services for members birth to five, and social determinants of health needs . A PCP may communicate with a specialist directly to coordinate care, or a member may self-refer. If a PCP needs help finding a specialty provider for any area in the Molina network, they may contact MCC at (800) 424-5891 (TTY/TDD: 711) and request a care manager. Some services require a prior authorization. Specialists must obtain a prior authorization from MCC before performing specific procedures or when referring members to non-contracted providers.