MedicaidCoverageMedium impact
24-24-1293m Expanded Definition of Psychiatric Emergency Medical Condition
Health Net·CA · Emergency Medicine, Psychiatry·Provider News
We identified it
Jun 20, 2026
Summary
Assembly Bill 1316 expands the definition of 'psychiatric emergency medical condition' to include situations where patients are voluntarily or involuntarily detained, covering two key scenarios: patients who are immediate dangers to themselves/others, or immediately unable to provide for basic needs due to mental health disorders. Emergency services for these expanded psychiatric conditions are now covered regardless of detention status.
Action Required
Immediately: Billing team should review current psychiatric emergency claims to ensure coverage includes patients who are voluntarily detained (not just involuntary). Update billing guidelines to reflect expanded coverage for psychiatric emergencies meeting the new AB 1316 criteria. Contact Community Health Plan at 833-236-4141 for questions or behavioral health providers at 844-966-0298 for clarification on specific cases.