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DMC-ODS: A Comprehensive Approach to SUD Services

Learn about the DMC-ODS program, providing a full continuum of evidence-based substance use disorder services. Explore key benefits, county updates, and fiscal considerations.

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DMC-ODS: A Comprehensive Approach to SUD Services

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  1. DMC-ODS . . . and assorted topicsTom Renfree & Paula Wilhelm

  2. ODS refresher: ODS organized delivery system SUD Continuum of Care Community Health and Social Services (Prevention, Screening, and Brief Intervention Services) Intake, Assessment and Placement Withdrawal Management Residential Treatment Intensive Outpatient Services *Adapted from UCLA Integrated Substance Abuse Programs: 2015 Evaluation, Training, and Technical Assistance for Substance Use Disorder Services Integration (ETTA) Report (Appendix 2, 118). Outpatient Services Recovery Support Services

  3. ODS refresher: expanded benefits *Table from DHCS & Harbage Consulting, “Drug Medi-Cal Organized Delivery System Pilot Program: Informational Webinar for Providers & Community Partners,” September 22, 2016.

  4. New DMC-ODS Services Case Management Physician Consultation Withdrawal Management Medication Assisted Treatment Partial Hospitalization

  5. Services Comparison

  6. DMC-ODS Counties Provide access to a full continuum of evidence-based substance use disorder (SUD) services, modeled after the American Society of Addiction Medicine (ASAM) Criteria Act as Prepaid Inpatient Health Plans (PIHP) for SUD treatment with selective provider contracting, rate setting, and quality assurance and utilization controls Coordinate with primary care and mental health Have increased control and accountability, including compliance with federal Medicaid Managed Care Rule standards

  7. DMC-ODS Impact • 40 of CA’s 58 counties have indicated they wish to participate, reaching >97% of CA’s population • 19 counties have been approved to start implementing services, reaching almost 77% of CA’s population

  8. DMC-ODS County Update July 2018 * Denotes county participation in regional model.

  9. Other states implementing 1115 SUD waivers

  10. Key fiscal changes under ODS • County-specific interim rates • Resources: • ODS rate-setting workgroup calls: 2:00 p.m. on 2nd & 4th Thursdays • Fiscal plan guide: DHCS IN 16-050 • Fiscal considerations FAQs: http://www.dhcs.ca.gov/provgovpart/Pages/FAQs_Fact_Sheets.aspx • New CPE protocol • Resources: • CPE Protocol: http://www.dhcs.ca.gov/provgovpart/Documents/DMCAttachmentAA.pdf • Fiscal Provisions: DHCS IN 15-034 • Billing for expanded services • Resources: • DMC-ODS Billing Manual: http://www.dhcs.ca.gov/formsandpubs/Documents/DMC_Billing_Manual_2017-Final.pdf • Procedure Codes and Modifiers: DHCS IN 17-045 • Claiming webinar: http://www.dhcs.ca.gov/provgovpart/Pages/DMC_ODS_Webinars.aspx • Billing FAQs: http://www.dhcs.ca.gov/provgovpart/Documents/DMC-ODS_Waiver/DMC-ODS_Billing_FAQ.pdf • Different same-day billing rules • Resources: • DHCS IN 17-039 and same-day billing matrix

  11. DHCS same-day billing matrix Same Day Billing Allowed Same Day Billing NotAllowed Recovery Services - Support Residential Withdrawal Ambulatory Withdrawal Withdrawal Recovery Services - Case Management Methadone Dosing MAT-Dosing MAT- Case Physician NTP and Non-NTP Non-NTP Management Consultation Ambulatory Residential Partial IntensiveIndividual GroupIndividual Group Recovery Recovery Hospital Outpatient Counseling Counseling Counseling Counseling Services - Services- NTP NTP Individual Group Management Management Management 3.2 2 1 H0012 H0014 H0014 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y H0019 S0201 H0015 H0004 H0005 H0004 H0005 H0004 H0005 H0006 T1012 H0020 S5000/S5001 H2010 H0006 G9008 Physician Consultation Y Y Y Y Y Y Y Y Y Y Y Y N N N N CaseManagement Y Y Y Y Y Y Y Y Y Y Y N N N N MAT - Dosing NTP andNon-NTP Y Y Y Y Y Y Y Y Y Y N N N N MAT -NTP Y Y Y Y Y Y Y Y Y N N N N MethadoneDosing Y Y Y Y Y Y Y N N N N N Recovery Services - Support Y Y Y Y N N N N N N N N N N Recovery Services- CaseManagement Y Y Y N N N N N N N N N N Recovery Services - Group Y Y N N N N N N N N N N Recovery Services- Individual Y N N N N N N N N N N Individual CounselingNTP Y Y Y Y Y Y Y Y Y Y GroupCounseling NTP Y Y Y Y Y Y Y Y Y Individual Counseling Y Y N N N N N N GroupCounseling Y N N N N N N Intensive Outpatient Y N N N N N PartialHospital N N N N N Residential N N N N Ambulatory Withdrawal Management1 N N N Ambulatory Withdrawal Management2 N N Residential Withdrawal Management3.2 N

  12. Billing & services comparison *Source: DHCS & Harbage Consulting, “Drug Medi-Cal Organized Delivery System Claiming,” February 2, 2017.

  13. ASAM Criteria: Evidence-Based SUD Treatment First developed in 1991 by American Society of Addiction Medicine Used to create comprehensive, individualized patient treatment plans Treatment levels range from outpatient services to residential or inpatient services, matched to patient need Source: https://www.asam.org/resources/the-asam-criteria/about

  14. UCLA Evaluation UCLA will release a 3rd evaluation report in the Fall, focusing on: Access, Quality, Cost, and Integration and Coordination of Care. Claims and CalOMS Treatment (CalOMS-Tx) data analysis is underway. Preliminary analysis shows overall, counties that have “gone live” increased the number of individuals receiving Drug Medi-Cal-funded treatment. Implementation has varied substantially by county. Level of Care (LOC) data is being reported for the first time. Evaluation, Survey website: http://www.uclaisap.org/ca-policy/html/evaluation.html

  15. UCLA Evaluation – County Administrator Survey • Counties overwhelmingly report the waiver has positively influenced: • Establishment of beneficiary access lines • Quality improvement activities • Communication between SUD and health services • Communication between SUD and mental health services • Delivery of case management services

  16. Treatment Perception Surveys (TPS) First round of TPS conducted with Marin, Riverside, San Mateo, Santa Clara, Contra Costa, San Francisco and Los Angeles. Next TPS will be conducted in October 2018. Over 9,000 surveys were returned with positive average scores for each county. Counties will utilize feedback for quality improvement. TPS website: http://www.uclaisap.org/ca-policy/html/client-treatment-perceptions-survey.html

  17. Average Score of 14 Survey Questions Average score is based on a 5-point scale

  18. Examples of County Use of TPS for Quality Improvement Reviewed TPS reports with the Quality Improvement Committee. Reviewed/analyzed comments; if negative, visit programs to discuss. Considering including client satisfaction as one metric in individual provider report cards relative to peers. Shared report with DMC-ODS providers during onsite reviews.

  19. DMC-ODS Health Care Procedure Coding System

  20. DMC-ODS Health Care Procedure Coding System (HCPCS) - Codes New procedure codes will be added for the DMC-ODS services: Non-perinatal Residential Partial Hospitalization Withdrawal Management Case Management Physician Consultation Recovery Services Additional Medication Assisted Treatment

  21. DMC-ODS Health Care Procedure Coding System (HCPCS) - Codes

  22. DMC-ODS Health Care Procedure Coding System (HCPCS) - Codes

  23. DMC-ODS Health Care Procedure Coding System (HCPCS) - Modifiers • New Modifiers. New modifiers will be needed to differentiate between: • The new services as they are delivered in the various modalities • The different ASAM Levels of Care • Adult and youth services • NDC. The National Drug Code will be needed to differentiate between the various additional medications that will be offered

  24. DMC-ODS Health Care Procedure Coding System (HCPCS) - Modifiers

  25. Resources & Contact Information

  26. FAQs and Information Notices DMC-ODS Fiscal Considerations FAQ: http://www.dhcs.ca.gov/provgovpart/Pages/FAQs_Fact_Sheets.aspx DMC-ODS Information Notices: http://www.dhcs.ca.gov/provgovpart/Pages/Waiver_Information_Notices.aspx

  27. Recovery Services • Recovery Services have some unique characteristics. • Recovery Services are available for each DMC-ODS level of care. • Recovery Services are available to beneficiaries that have completed treatment. • Recovery Services cannot be claimed in combination with any other treatment service.

  28. Recovery Services (cont.) • The components of Recovery Services include: • Individual counseling – H0004/U6 • Group counseling – H0005/U6 • Case management – H0006/U6 • Recovery monitoring/substance abuse assistance – T1012/U6

  29. Same Day Billing • DMC-ODS Same Day Billing rules (Information Notice 16-007) have eliminated the need for the Multiple Billing Override code. • Note: Same Day Billing in more than one level of care will be restricted to combinations with OTP/NTP to allow for cases where methadone dosing is part of the necessary treatment for any beneficiary in any other level of care.

  30. Short Doyle Medi-Cal Claiming In order to submit correctly coded claims for the DMC-ODS services beginning on the “Go Live” date and forward, each DMC-ODS county will need to use the new HCPCS code and modifier combinations that have been identified in IN 17-002.

  31. DMC Billing Manual & New DMC-ODS Waiver Chapter

  32. Overview • The purpose of the DMC Billing Manual is to provide counties and direct providers with information on how to submit a claim for reimbursement for DMC services rendered. • The DMC-ODS waiver chapter provides direction to counties that have an executed Intergovernmental Agreement with DHCS to administer waiver­­ services. • Updated DMC Billing Manual posted on the DHCS website: • http://www.dhcs.ca.gov/formsandpubs/Documents/DMC_Billing_Manual_2017.pdf

  33. Overview (cont.) Most federal and state regulations that pertain to DMC billing for regular state plan services are still applicable in the DMC-ODS. Only counties can opt-in to the waiver. Detailed guidance for DMC-ODS billing is outlined in Chapter 6 and related Information Notices.

  34. DMC-ODS Training DHCS holds a contract with California Institute for Behavioral Health Solutions (CIBHS) to conduct DMC-ODS related trainings. Trainings are available related to: Modality of Services, ASAM, Selective Contracting, Quality Assurance, MAT and the Continuum of Care. Approximately 230 DMC-ODS trainings have been provided thus far, representing approximately 9,000 participants. UCLA provides trainings as a sub-contractor to CIBHS. To contact CIBHS and/or learn more about their training opportunities: https://www.cibhs.org/dmc-ods-waiver-trainings

  35. DMC-ODS Challenges Existing data systems are still catching up to system redesign. Counties have faced technical difficulties in submitting claims and reporting ASAM LOC data. Implementation of the Medi-Cal Managed Care Final Rule in the midst of DMC-ODS Waiver implementation. Adjustments to high demand of services. Integration has improved significantly with mental and physical health, but there continue to be more challenges with implementation. Stigma from community and family members for those receiving MAT services. Some counties have not fully transitioned services into Drug Medi-Cal and are currently paying for services through other avenues.

  36. DMC-ODS Successes Tremendous redesign of county SUD delivery systems. Increase in SUD access statewide. Expanded service capacity and the range of services for Drug Medi-Cal beneficiaries. Innovations developed by the counties in addition to the required SUD services. Improved DMC certification process. Communication has improved with managed care plans and health care referrals to treatment increased. Initial TPS resulted in overall positive feedback from clients regarding services provided. California has become a leader with other States that are implementing 1115 demonstration waivers for SUD system changes.

  37. DMC-ODS Resources • For additional information, please see the DMC-ODS Frequently Asked Questions posted the DHCS website: http://www.dhcs.ca.gov/provgovpart/Pages/Fact-Sheets-and-FAQs.aspx? • For questions, please contact dmcodswaiver@dhcs.ca.gov

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