School-based fee schedule rollout slow; districts and vendors seek bridge funding

(Note: this article covers the CYBHI fee-schedule implementation, LEA onboarding, and requests for bridge funding to prevent service disruptions.)

DHCS officials said the technical infrastructure for the CYBHI fee schedule is operational and that claims have been paid to participating local education agencies (LEAs) since December 2024. Autumn Boylan, deputy director in DHCS’s Office of Strategic Partnerships, said 494 LEAs and institutions of higher education had signed up and that the department is working to address onboarding barriers, provide technical assistance, and increase the number of claims submitted and paid.

Why it matters: The CYBHI fee schedule is intended to create a sustainable funding stream that reimburses school-based behavioral health services under Medi‑Cal. Districts and community providers said long implementation delays could disrupt services created under prior bridge funding (the Student Behavioral Health Incentive Program, SBHIP) and urged a one-time reauthorization to preserve staff and services while the fee schedule matures.

Districts report onboarding and billing problems Trina Frazier of the Fresno County Superintendent of Schools described a multi-district arrangement that provides care across 300 schools and said Fresno hired clinicians and support staff to deliver services, but has had limited reimbursement to date. "To date, our county office has submitted 343 claims to our electronic health record. Of those, 40 have been sent on to Carillon. 21 have been denied, and only 2 have been paid for totaling $327," Frazier told the committee. She said Fresno had since submitted additional claims that were adjudicated and paid, with recent paid claims totaling more than $5,600.

Santa Clara County Office of Education reported a similar pattern: early test claims followed by a larger set of clean claims that were adjudicated and approved for payment. Amanda Dickey of Santa Clara said delays forced the county to pink‑slip 27 staff after districts assumed the fee schedule would be fully implemented.

Vendor and third‑party administrator experience Carillon Behavioral Health is the third-party administrator (TPA) that DHCS contracted to manage claims, onboarding, and payments for the new fee schedule. Several LEAs and vendors said Carillon had been responsive in many respects but that the pace of software access, training, and health-plan agreements slowed initial claiming. DHCS said Carillon and the department have expanded guidance, training modules and technical assistance, and that many claim denials reflect missing or incomplete data that federal clean-claims rules require.

Bridge funding request and policy suggestions Speakers representing LEAs and statewide school‑based telehealth providers asked the Legislature to consider one‑time bridge funding to avoid layoffs and protect newly built school‑based infrastructure. Commenters asked for $100 million as a one-time reauthorization of SBHIP funds to cover districts and community partners while onboarding completes. Vendors and district officials also urged legislative fixes to simplify certain statutory requirements that have constrained participation and to continue state support for billing and technical assistance.

DHCS status and next steps DHCS said the claims adjudication and payment process is operational and has paid a portion of submitted claims (the department reported 327 total claims submitted as of a recent update, 149 paid and more than $12,000 reimbursed across participating LEAs). DHCS pledged to continue intensive onboarding support, to work with LEAs and Carillon to reduce denials, and to help counties and vendors scale claiming before the next school year.

Sources: Testimony and public comment from Autumn Boylan (DHCS), Trina Frazier (Fresno County Superintendent of Schools), Amanda Dickey (Santa Clara County Office of Education), Erin Davis (Hazel Health), and multiple LEA & vendor public commenters.