In California

Facilities are not allowed to exclude someone from residential treatment solely due use of IV/infusion medications.  Individuals who meet the criteria for admission and are deemed appropriate for care would not be excluded from receiving external medical treatment for a coexisting condition. However, if the individual’s medical condition exceeds the facility’s licensed capacity or capabilities, or if a different setting is clinically indicated as more appropriate, the provider may refer the member accordingly. But, the county behavioral health plan and managed care plan remain responsible for ensuring that the individual receives timely and appropriate placement in a setting that can meet both their behavioral health and medical needs.

Source:

• Ivan Bhardwaj, Division Chief, Medi-Cal Behavioral Health – Policy Division, California Department of Health Care Services via email on July 9, 2025.

“As you may know, In May 2024, the U.S. Department of Health and Human Services (HHS), through its Office for Civil Rights (OCR), finalized a new rule under Section 504 of the Rehabilitation Act of 1973. The new rule, entitled “Discrimination on the Basis of Disability in Health and Human Service Programs or Activities,” clarifies that medical providers (including behavioral health facilities) that accept federal funding must conduct an individualized inquiry to determine whether the facility can meet the needs of a person with a disability, in this case, a person with a bleeding disorder. They cannot deny access based solely on the presence of a diagnosis, such as a bleeding disorder.”

“All medical providers that receive federal financial assistance, including mental health and substance use treatment providers, must follow this new rule”.

“As [insert patient’s name]’s bleeding disorder treatment provider, I would be happy to talk with you about [insert patient’s name]’s bleeding disorder. With a better understanding of the condition and how easily it is managed, I am certain that you will feel more confident admitting [insert patient’s name].”

“Also, just so you’re aware, per Medi-Cal program policies, facilities are not allowed to exclude someone from a residential treatment program solely on the basis of a medical condition, like a bleeding disorder. Anyone who meets the criteria for admission and is deemed appropriate for care should not be excluded from receiving external medical treatment for a co-occurring condition, like a well-managed bleeding disorder.”

Send the following to the facility:

• Request for Discussion Follow-up: Personalize this email template to follow up on the denial and provide regulatory information. For Medi-Cal members, add the following:

  “Also, just so you are aware, per Medi-Cal program policies, facilities are not allowed to exclude someone from a residential treatment program solely on the basis of a prescribed medication, such as infusion or injection medications, or a medical condition, like a bleeding disorder. Anyone who meets the criteria for admission and is deemed appropriate for care should not be excluded from receiving external medical treatment for a co-occurring condition, like a well-managed bleeding disorder.”

• Link to regulations: Section 504 – Discrimination on the Basis of Disability in Health and Human Service Programs or Activities.