State health officials in a webinar hosted by the Health Care Access and Information (HCAI) program said Certified Wellness Coaches (CWCs) can be reimbursed by Medi‑Cal managed care plans and commercial insurers under the Children and Youth Behavioral Health Initiative (CYBHI) fee schedule, and explained the certification, billing and documentation rules that local education agencies (LEAs) and institutions of higher education (IHEs) must follow. The webinar presenters were officials from the California Department of Health Care Services (DHCS) and HCAI.

Why it matters: The CYBHI fee schedule creates a standardized rate structure intended to expand school‑site behavioral health capacity by allowing qualified non‑licensed workers (CWCs) to deliver preclinical prevention, screening, care coordination and behavioral‑health coaching while being reimbursed through Medi‑Cal and other insurers when requirements are met.

What DHCS and HCAI said about the legal and program framework: DHCS presenters identified the statutory foundation as California Welfare and Institutions Code section 5961.4 and referenced the state plan amendment (SPA 20‑514) that defines the scope of covered school‑site behavioral health services. DHCS said participating providers must meet medical‑necessity criteria under California law for covered outpatient mental‑health and substance‑use disorder services when billing Medi‑Cal or private plans, and noted California Health and Safety and relevant insurance code language that defines medically necessary behavioral‑health care.

Who is eligible and who must pay: DHCS said the CYBHI fee schedule requires Medi‑Cal managed care plans, Medi‑Cal fee‑for‑service and applicable health care service plans and disability insurers to reimburse eligible school‑site services for students under age 26 who are covered by those insurance types. Webinar slides listed excluded payers such as federal plans, self‑funded employer plans, certain high‑deductible plans and (as presented on the slide) indicated that services provided pursuant to special‑education plans were treated separately; the presenters said LEAs must still provide medically necessary services even when a student is outside the fee‑schedule coverage.

Certification and workforce pathways: HCAI staff described two certification pathways for CWCs: an education pathway (associate or bachelor degree in specified majors plus minimum supervised hours) and a workforce/experience pathway (documented direct preclinical behavioral‑health hours). Ben Dimash, Policy Consultant, HCAI, explained that the workforce path allows experienced non‑licensed staff already doing school‑based supports to earn certification. CWCs must maintain active certification and recertify every two years.

Service codes, rates and retroactivity: DHCS staff listed three CWC procedure codes and state rates: “0591T is for individual initial assessment ... This service is reimbursed at $66.24,” (Corine Marshallek, DHCS); follow‑up individual sessions use 0592T ($41.08); and group sessions use 0593T ($12.45 per participant). DHCS said those CWC services can be billed retroactively to Jan. 1, 2025 where program participation and eligibility criteria are met.

Time, frequency and billing rules: Presenters explained the billing limits and time rules. Initial assessment (0591T) may not be billed on the same day as a follow‑up (0592T). DHCS said the initial assessment code has a maximum of two units per year per provider; follow‑up and group codes have a maximum of three units per day per provider. DHCS staff explained the midpoint rule for time‑based billing: to bill one 30‑minute unit the encounter must meet a minimum of 16 minutes of direct service. Kenna (DHCS) clarified in Q&A: “That should be selected first as the first time they see the student” when determining whether to use the initial code 0591T for an individual.

What is billable vs. not billable: DHCS and HCAI repeatedly said billable time is direct service time with the student (or a session where the student is present and the service benefits the student); documentation, administrative tasks and meetings without the student present are not billable by CWCs. Examples provided during the webinar: classroom presentations to insured students, screening encounters meeting the time minimum, care coordination that includes direct contact and follow‑up with evidence of time spent, and telehealth delivered by video were described as billable when the medical‑necessity and presence/authorization requirements are met. CWCs may not assess, diagnose, provide clinical treatment or operate independently; they must practice under appropriate supervision.

Supervision and ORP (ordering/referring/prescribing) requirements: DHCS said CWCs must work under the recommendation or direction of a licensed practitioner on a claim for Medi‑Cal students. Presenters described an ORP as a licensed practitioner who orders or refers the service and whose name and NPI must appear on Medi‑Cal claims for students; ORP role applies to Medi‑Cal claims only. DHCS guidance in the webinar stated supervision should be provided by a PPS credential holder or licensed clinician in school settings and by licensed clinicians outside schools; frequency and format of supervision were left to employers’ program models.

Documentation and recordkeeping: DHCS told participants LEAs and IHEs must maintain records necessary to meet medical‑records regulations and program participation, including billing records, service delivery reports, identification of the person who provided the service and, for non‑licensed practitioners, the supervising licensed clinician. The agency emphasized documentation must reflect direct service time for each billed unit; indirect time such as paperwork is not billable.

Claims and administrative notes: DHCS said claims for fee‑schedule services must be submitted within 180 days of the date of service unless a good‑cause exemption applies. Telehealth via video is allowable; audio‑only encounters are not billable under the described rules. The agency also said the program uses a third‑party administrator and an onboarding process for cohort participation and claims submission.

Data collection and LEA/IHE responsibilities: DHCS and HCAI told LEAs and IHEs that participating organizations must collect minimum necessary student health‑insurance data for billing (for students whose services are billed under CYBHI). Suggested data elements included student name, date of birth, insurance plan name, member name and member ID/group number; presenters reiterated LEAs are not expected to collect insurance data for all enrolled students, only for those for whom reimbursement will be pursued. DHCS said it is working on additional supports to help LEAs access commercial coverage information through the third‑party administrator and other data sources.

Outstanding questions and follow‑up: Presenters took numerous detailed operational questions about supervision, documentation templates, billing scenarios where the student is not present, how interns and field‑placement hours count toward certification, and interactions between CYBHI billing and LEA BOP/I‑EP billing. DHCS and HCAI said they will provide written follow‑ups and listed contact emails for program questions.

Bottom line: The webinar clarified that CWCs can be an instrument to expand school‑site behavioral health capacity and be reimbursed under the CYBHI fee schedule when certification, supervision, documentation, ORP authorization and billing rules are met. LEAs and IHEs must prepare systems to collect insurance data, ensure CWCs are certified and supervised, and follow the time, unit and claim‑submission rules described by DHCS.

Contacts and resources: Webinar presenters directed attendees to the DHCS CYBHI fee‑schedule page, the SPA referenced during the presentation, HCAI’s CWC certification resources and the Q&A follow‑up email addresses provided by the presenters for program and certification questions.