CurrentSan Francisco Health PlanPolicy N/A

Sensitive Services / Minors' Rights — Coverage Criteria

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Policy governing minors' consent to sensitive medical services (pregnancy-related care, family planning, STI-related care, and care for emancipated/financially independent minors) at San Francisco Health Plan-contracted sites; directed at clinical staff, site management, and PCP site reviewers to ensure compliance with California Family Code and DHCS requirements.

Policy Summary

PayerSan Francisco Health Plan

PolicySensitive Services / Minors' Rights — Coverage Criteria

Policy CodePolicy N/A

Change TypeMinor / informational update

Effective DateN/A

Next Review DateN/A

Key ActionEnsure site review and certification per DHCS Title 22 §53230 and protect minor communication privacy when delivering sensitive services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

12+minimum age referenced (years)

15independent-consent age (years)

Family Code 6920-6929statutory citation

APL 20-006DHCS guidance

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CurrentSan Francisco Health PlanPolicy N/A

Sensitive Services / Minors' Rights — Coverage Criteria

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Sign up for all sanfranciscohealthplan policy alerts

Know when sanfranciscohealthplan releases new policies or updates existing guidance.

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Policy Summary

PayerSan Francisco Health Plan

PolicySensitive Services / Minors' Rights — Coverage Criteria

Policy CodePolicy N/A

Change TypeMinor / informational update

Effective DateN/A

Next Review DateN/A

Key ActionEnsure site review and certification per DHCS Title 22 §53230 and protect minor communication privacy when delivering sensitive services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

12+minimum age referenced (years)

15independent-consent age (years)

Family Code 6920-6929statutory citation

APL 20-006DHCS guidance

When Minors May Consent to Sensitive Services

Covered Sensitive Services and Statutory Consent Criteria

Minors may consent to and receive covered sensitive services when the following statutory conditions apply:

Types of sensitive services allowed without parental consent: Pregnancy-related services and family planning; diagnosis or treatment of reportable infectious or communicable diseases (including related sexually transmitted diseases); and medical or dental care for minors meeting independent-living and financial-management criteria.

Based on California Family Code sections 6920-6929 and DHCS guidance.

Infectious disease / STI consent criteria: Minor is 12 years of age or older AND may have come into contact with an infectious, contagious, or communicable disease (including related STDs) that is required to be reported to the local health officer or as determined by the State Director of Health Services.age >= 12

Parents or guardian are not liable for payment for medical care provided under this section (Family Code §6925/6926).

Independent minor consent criteria: Minor is 15 years of age or older AND is living separate and apart from the minor's parents or guardian (with or without parental consent) AND is managing the minor's own financial affairs.age >= 15

Parents or guardian are not liable for medical or dental care provided under this section (Family Code §6922).

The policy does not enumerate broad clinical exclusions for sensitive-services consent. Instead, it clarifies that parental consent is not required for the categories of services identified by California law (for example, pregnancy-related services and family planning), and for the other statutory situations described in Family Code sections 6920–6929. Providers should apply the statutory consent rules to determine when a minor may receive sensitive services without parental permission and not assume unspecified services are excluded from those rules.

This document is provided as a knowledge-sharing and informational resource to support compliance with facility site review requirements and local practice. It does not itself make or record medical-necessity determinations; clinical judgment and applicable medical necessity processes must be used separately when determining coverage for an individual member.

Age Thresholds and Definitions

Age thresholds for consent — key ages

Infectious disease/STI consent age12 years — a minor 12 or older may consent to diagnosis and treatment for reportable infectious/communicable diseases or related STDs.

Independent-minor consent age15 years — a minor 15 or older may consent to medical or dental care if living separate and apart and managing own finances.

General minor consent capParental consent not required for members under 18 to access pregnancy-related services including family planning.

Definition of sensitive services

Pregnancy-related servicesPregnancy-related services and family planning may be provided without parental consent.

Reportable infectious/communicable diseasesDiagnosis or treatment of diseases required by law/regulation to be reported to the local health officer, and related sexually transmitted diseases, may be consented to by qualifying minors.

Operational Requirements for Providers and Sites

Prior Authorization

Prior authorization — Not required for sensitive services

This policy does not impose any prior authorization requirements for sensitive services. Instead, it references DHCS facility/site review and certification obligations under Title 22, CCR Section 53230 and related DHCS guidance.

Step Therapy

Step therapy — None specified

No step therapy requirements are specified in this document for covered sensitive services; clinical management and treatment sequencing are not restricted by a step-therapy mandate here.

Documentation Required

Site review and documentation — DHCS certification & readiness

Legal and Policy Background

Under California law, minors may consent to certain sensitive medical services without parental permission. Examples include pregnancy-related services and family planning, diagnosis and treatment for reportable infectious or communicable diseases (including related sexually transmitted diseases) when the minor is 12 years of age or older and may have been exposed, and medical or dental care for minors who are 15 years of age or older, living separate and apart from their parents or guardian, and managing their own financial affairs. The statute also provides that parents or guardians are not liable for payment for care provided under these provisions and requires special precautions to protect the minor’s communications and medical information.

Policy Summary

PayerSan Francisco Health Plan

PolicySensitive Services / Minors' Rights — Coverage Criteria

Policy CodePolicy N/A

Change TypeMinor / informational update

Effective DateN/A

Next Review DateN/A

Key ActionEnsure site review and certification per DHCS Title 22 §53230 and protect minor communication privacy when delivering sensitive services.

SourceLink

On This Page

Independent living medical/dental careMedical or dental care for minors 15+ who live separate and apart from parents/guardians and manage their own financial affairs.

Confidentiality protectionsCommunications about a minor's sensitive services must be protected (e.g., do not send letters or calls to the home without minor authorization).

Minor capable of consenting for infectious disease care

Minimum age12 years — a minor 12 or older may consent to medical care related to diagnosis or treatment of reportable infectious/communicable diseases or related STDs.

Scope of diseaseApplies when the disease/condition is required by law or regulation to be reported to the local health officer, or is a related sexually transmitted disease as determined by the State Director of Health Services.

Payment liabilityThe minor's parents or guardian are not liable for payment for medical care provided pursuant to this section.

Independent minor consent criteria

Age requirement15 years — the minor must be at least 15 years old to qualify for independent-minor consent.

Residence requirementMust be living separate and apart from the minor's parents or guardian, with or without their consent and regardless of duration.

Financial management requirementMust be managing the minor's own financial affairs, regardless of income source.

Parental liabilityParents or guardian are not liable for medical or dental care provided pursuant to this section.

Sites must comply with DHCS facility site review and certification requirements and be prepared for facility and medical record review; site-specific adaptations require site management approval.

Comply with California Department of Health Care Services Title 22, CCR Section 53230 (facility/site review and certification).
Be prepared for facility site review and medical record review per DHCS APL 20-006 and any superseding guidance.
Obtain site management review/approval before adopting or modifying the document content for local practices.

Denial Risk

Privacy breach risk — Protect minor communication privacy

Protect minor confidentiality when communicating about sensitive services; avoid sending letters or making calls to the minor's home without the minor's authorization to prevent privacy breaches.

Take special precautions to protect communications regarding a minor's sensitive medical information.
Do not direct letters or phone calls to the home without the minor's authorization.