Memorandum
Date: January 7th, 2024
To: The Honorable Lake County Board of Supervisors
From: Elise Jones, Director of Behavioral Health
Subject: Adopt Resolution Authorizing the Integrated Behavioral Health Standard Agreement between the County of Lake and the Department of Health Care Services for Drug Medi-Cal Organized Delivery System and Specialty Mental Health Services for the Period of January 1,2025 to December 31, 2026 and Authorizing the Behavioral Health Director to Sign the Standard Agreement and the Contractor Certification Clause.
Executive Summary:
California Advancing and Innovating Medi-Cal (CalAIM) is a long-term commitment to transform and strengthen Medi-Cal by reducing complexity across the Medi-Cal delivery systems for behavioral health services, among other reforms. Consistent with that goal, CalAIM proposed the Behavioral Health Administrative Integration initiative to consolidate specialty mental health services (SMHS) and substance use disorder (SUD) services-covered either by county Drug Medi-Cal (DMC) or Drug Medi-Cal Organized Delivery System (DMC-ODS) programs-into a single county-based behavioral health program. This program will be operated under a single, integrated contract between counties and the state. The Department of Health Care Services (DHCS) and counties will partner on a phased implementation approach that achieves statewide administrative integration of SMHS and SUD by State Fiscal Year (SFY) 2027-2028.
The primary goals of Behavioral Health Administrative Integration are to improve health care outcomes and the experience of care for Medi-Cal beneficiaries, particularly those living with co-occurring mental health and SUD issues, and to reduce administrative burden for beneficiaries, counties, providers, and the state. Historically, counties have administered two separate programs for the delivery of Medi-Cal SMHS and SUD services, each with its own state contract and funding streams. Individuals with serious mental health needs access inpatient and outpatient SMHS through their county’s Mental Health Plan (MHP). For SUD treatment, counties operate either a DMC program or, at county election, the DMC-ODS managed care SUD program. The state-county contracts for these programs include certain similar or identical requirements, as well as program-specific requirements for clinical documentation, health plan and provider compliance reviews, billing and claiming, licensing and certification, and more. This administrative complexity has created unintended barriers for clients that seek care for co-occurring mental health and substance use conditions, in addition to adding to the administrative burdens faced by behavioral health providers and officials at the state and county levels.
The Behavioral Health Administrative Integration initiative seeks to reduce those barriers and burdens by aligning and integrating SMHS and DMC/DMC-ODS program requirements to the greatest extent possible. This may, in turn, facilitate behavioral health providers offering more seamless and integrated treatment to beneficiaries who need both mental health and SUD services. This initiative will not mandate changes in care models at the provider level. There will continue to be value in highly specialized programs that focus on addressing more specific mental health or SUD needs. With the policy changes outlined in this concept paper, DHCS aims to support and encourage development of a behavioral health workforce-including licensed and unlicensed providers-that can competently identify and address co-occurring mental health and SUD needs across all settings and delivery systems. Behavioral Health Administrative Integration provides an opportunity to facilitate access, improve quality, and provide a more integrated care experience for beneficiaries, potentially including adjustments to policies that currently hinder the expansion of integrated care models. Through this initiative, DHCS and counties will collaborate to streamline and strengthen three domains:
• Beneficiary experience with county and provider interactions when seeking behavioral health services
• Internal county structures and processes regarding program administration and data management
• DHCS oversight of county and provider operations Whereas counties currently execute two separate contracts with DHCS for the provision of SMHS and SUD services, this CalAIM initiative will result in counties adopting a single integrated contract for the delivery of Medi-Cal behavioral health services.
Counties that participate in DMC-ODS will consolidate their behavioral health programming into a single prepaid inpatient health plan (PIHP) managed care structure rather than operating separate managed care programs for SMHS and SUD services. Counties that have not opted into DMC-ODS may continue offering DMC services outside of managed care while participating in all other applicable aspects of this initiative, including by adopting updated MHP and DMC contracts with DHCS that promote integration goals. The Behavioral Health Administrative Integration initiative will proceed in three phases, described below, thereby allowing DHCS and counties to spread their efforts across multiple years ahead of the full statewide implementation in 2027. Certain aspects of this proposed timeline and other elements described in this concept paper may be contingent on receiving all necessary federal approvals from the Centers for Medicare & Medicaid Services (CMS) and/or revisions to current DHCS regulations or state legislation.
Lake County is proud to be an early adopter of the Integrated Agreement.
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Recommended Action: Adopt Resolution Authorizing the Integrated behavioral Health Standard Agreement between the County of Lake and the Department of Health Care Services for Drug Medi-Cal Organized Delivery System and Specialty Mental Health Services for the Period of January 1,2025 to December 31, 2026 and Authorizing the Behavioral Health Director to Sign the Standard Agreement and the Contractor Certification Clause.