Memorandum
Date: August 20, 2024
To: The Honorable Lake County Board of Supervisors
From: Elise Jones, Director of Behavioral Health Services
Subject: Consideration of Resolution Authorizing the Behavioral Health Director to Sign the Standard Agreement and Contractor Certification Clause Between the County of Lake and the California Department of Health Care Services for Provision of Substance Use Disorder Treatment Organized Delivery System Services Under the 1115 Medicaid Demonstration Waiver.
Executive Summary:
Lake County Behavioral Health Services entered the Organized Delivery System (ODS) of Drug Medi-Cal (DMC) under the 1115 Demonstration Waiver as authorized by the Federal Centers for Medicare and Medicaid on July 1, 2024. As a DMC-ODS County Plan, we can now offer expanded coverage to Medi-Cal beneficiaries for Substance Use Disorder Treatment Services. Notably, all Medi-Cal beneficiaries are entitled to residential SUD services if they meet criteria.
The following rates have been established for Lake County for outpatient services. These are fee-for-service rates that are paid by provider type. We have agreed to pass-through 65% of this rate to our contracted service providers.
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Hourly SUD Rates |
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|
SUD |
Provider Type |
Lake |
Pass-Through |
|
SUD |
Physicians Assistant |
$962.16 |
$625.41 |
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|
|
MD (typically in SUD system of care) |
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|
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Psychologist/Pre-licensed Psychologist |
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LPHA (MFT LCSW LPCC)/ Intern or Waivered LPHA (MFT LCSW LPCC) |
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|
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Alcohol and Drug Counselor |
|
|
|
SUD |
Peer Recovery Specialist |
$441.06 |
$286.69 |
Unfortunately, our rates for residential services are much lower. These has been raised as a global issue across California counties and both the California Behavioral Health Director’s Association and the California Department of Health Care Services are aware. There is advocacy to re-evaluate and raise the rates. However, because Lake’s outpatient fee-for-service rates are robust, it is estimated that the patient revenue from outpatient services may be enough to cover the difference between reimbursement and cost of service for residential treatment.
|
Lake |
Behavioral Health Long Term Residential 3.1 |
$ 223.09 |
|
Behavioral Health Long Term Residential 3.3 |
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Behavioral Health Long Term Residential 3.5 |
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Alcohol and Drug Services; (Residential Addiction Outpatient). Sub-Acute Detoxification 3.2 |
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Perinatal - Behavioral Health Short Term Residential |
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The approved DMC-ODS implementation plan identifies that several levels of service do not yet exist and we have committed to developing those services over a period of years. Notably, youth residential and Narcotic Treatment Program services must be developed. Additionally, inpatient withdrawal management must be provided in a hospital setting with a hospital. This will require collaboration with our local healthcare system.
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Recommended Action:
Approve Resolution Authorizing the Behavioral Health Director to Sign the Standard Agreement and Contractor Certification Clause Between the County of Lake and the California Department of Health Care Services for Provision of Substance Use Disorder Treatment Organized Delivery System Services Under the 1115 Medicaid Demonstration Waiver.