Behavioral Health Delivery System Changes

1. Overview of the Affordable Care Act Implementation within theDHCS Behavioral Health Services Delivery SystemPresented at theAssociation for Criminal Justice Research (California)79th Semi-Annual MeetingMarch 21, 2014Brenda Grealish, ChiefMental Health Services Division

2. Behavioral Health Delivery System Changes There were two fundamental changes to the behavioral health delivery systems that occurred from 2012-2014: • Transfer/Merge of the former California Departments of Mental Health and Alcohol and Drug Programs to the Department of Health Care Services • January 1, 2014, Implementation of the Affordable Care Act (ACA)

3. DHCS Behavioral Health Merge • New capacity at DHCS came about as a result the Administration’s plans to reorganize for program and financial consolidation, effectiveness, efficiency and improved accountability • Often collectively referred to as … “Behavioral Health” • Recent re-organization divided major sections of 2 Departments (the former Dept. of Mental Health and Dept. of Alcohol and Drug Programs) • Divided the former DMH into 2 components • State hospital and specialty psychiatric programs in CDCR facilities • Community mental health programs moved to DHCS in 2012 • Integrated the former Dept. of Alcohol and Drug Programs into DHCS • Drug Medi-Cal (DMC) programs moved to DHCS in 2012 • Remaining ADP programs moved to DHCS in 2013

5. Medi-Cal Managed Care Effective January 1, 2014, eligible Medi-Cal beneficiaries may receive mental health benefits through Medi-Cal Managed Care Plans (MCPs). These services will continue to be offered as fee-for-service (FFS) benefits for eligible beneficiaries that are not enrolled in an MCP. • MCP/FFS Mental Health Services: • Individual and group mental health evaluation and treatment (psychotherapy) • Psychological testing when clinically indicated to evaluate a mental health condition • Outpatient services for the purposes of monitoring medication treatment • Outpatient laboratory, medications, supplies and supplements • Psychiatric consultation • Standard Briefing and Intervention (SBI)

6. Specialty Mental Health Services • Outpatient Services • Mental Health Services (assessment, plan development, therapy, rehabilitation and collateral) • Medication Support Services • Day Treatment Intensive • Day rehabilitation • Crisis Intervention • Crisis Stabilization • Targeted Case Management • Inpatient Services • Acute psychiatric inpatient hospital services • Psychiatric Inpatient Hospital Professional Services if the beneficiary is in a fee-for-service hospital (rather than a Short-Doyle/Medi-Cal acute psychiatric inpatient hospital).

7. Substance Use Disorder Benefits All eligible Medi-Cal beneficiaries may receive the following SUD services through county-administered [Drug Medi-Cal (DMC)] substance use disorder services: • Outpatient Drug Free Treatment • Narcotic Treatment Services • Intensive Outpatient Treatment (prior to ACA, this benefit was limited to pregnant and postpartum women, children, and youth under the age of 21; now available for the general population) • Residential Substance Use Disorder Services (prior to ACA, this benefit was limited to pregnant and postpartum women; now available for the general population) • Voluntary Inpatient Detoxification • Screening and Brief Intervention (this service is available to the general adult population for alcohol misuse, and if threshold levels indicate, a brief intervention is covered. This service would occur in primary care settings.)

8. Clear and concise communication and coordination between the County MH/SUD programs and the Medi-Cal Managed Care and FFS programs is key Screening  Assessments  Referrals  Care Coordination  Case Management County Mental Health Plan (MHP) Medi-Cal Managed Care Plans (MCP) County Alcohol and Other Drug Programs (AOD) Target Population: Children and adults who meet medical necessity or EPSDT criteria for Medi-Cal Specialty Mental health Services Target Population: Children and adults who meet medical necessity or EPSDT criteria for Drug Medi-Cal Substance Use Disorder Services Target Population: All beneficiaries in Managed Care Plans who meet medical necessity criteria • MCP services to be carved-in effective 1/1/14 • Individual/group mental health evaluation and treatment (psychotherapy) • Psychological testing when clinically indicated to evaluate a mental health condition • Outpatient services for the purposes of monitoring medication treatment (Current list of psychotropic medications will continue to be carved-out.) • Psychiatric consultation • Outpatient laboratory, medications, supplies and supplements • Substance Use Screening and Brief Intervention (target 2/1/14 effective date) • Outpatient Services • Mental Health Services (assessments plan development, therapy, rehabilitation and collateral) • Medication Support • Day Treatment Services and Day Rehabilitation • Crises Intervention and Crises Stabilization • Targeted Case Management • Therapeutic Behavior Services • Residential Services • Adult Residential Treatment Services • Crises Residential Treatment Services • Inpatient Services • Acute Psychiatric Inpatient Hospital Services • Psychiatric Inpatient Hospital Professional Services • Psychiatric Health Facility services • Outpatient Services • Outpatient Drug Free • Intensive Outpatient (newly expanded to additional populations) • Residential Services (newly expanded to additional populations) • Narcotic Treatment Program • Naltrexone • New Services • (Administrative linkage to County AOD still being discussed)

9. Medical Necessity Criteria • Out-patient specialty mental health (CCR-Title 9 Sec. 1830.205) • In-patient specialty mental health(CCR-Title 9 Sec. 1820.205) • Out-patient Drug Medi-Cal (CCR-Title 22, Sec. 51303) • Out-patient non-specialty mental health (CCR-Title 22, Sec. 51303)

10. Enrollment https://www.coveredca.com/

11. Contact Information Website: www.dhcs.ca.gov For Medi-Cal Managed Care Mental Health: Sarah.Brooks@dhcs.ca.gov For Specialty Mental Health: Brenda.Grealish@dhcs.ca.gov For Substance Use Disorder Services: Robert.Maus@dhcs.ca.govLaurie.Weaver@dhcs.ca.gov