Memorandum
Date: April 25, 2023
To: The Honorable Lake County Board of Supervisors
From: Stephen Carter, Jr., Interim Behavioral Health Director
Subject: Consideration of Presentation by Behavioral Health Services regarding State-wide payment reform for Drug Medi-Cal plans and updated recommendations regarding the Organized Delivery System.
Executive Summary:
All County Mental Health Plans and Drug Medi-Cal (DMC) Plans will go live with payment reform on July 1, 2023. Please see attached FAQ regarding the general outline of payment reform. Significantly, plans move from a cost-based reimbursement to fee-for-service reimbursement. Because of this, there is significant opportunity for patient revenue generation. This revenue must be used to expand and/or enhance DMC services in the County.
The Organized Delivery System (ODS) allows the County to operate under a waiver that enables reimbursement for non-covered DMC services, significantly residential treatment services. Here is a comparison of covered services under DMC and ODS:
Drug Medi-Cal (status quo)
Organized Delivery System
(either Regional Model or Direct contract)
Early Periodic Screening, Diagnosis and Treatment (EPSDT)
ALL DMC SERVICES
Intensive Outpatient Treatment
Withdrawal Management Services
Outpatient Drug-Free Treatment
*Non-Perinatal Residential Treatment Services
*Perinatal Residential Treatment Services
Recovery Services
Narcotic Treatment Program (NTP)
Case Management
Naltrexone Treatment
Physician Consultation
*Does not include Room and Board costs
From a service network perspective, which is one of the most significant considerations with regard to joining the Regional Model with Partnership Healthplan, Lake is only missing one required service: youth residential. Presently, we are in the community discovery process to explore provision of this service.
Moving forward into FY 2023-24 and CalAIM payment reform, Lake DMC Plan stands to generate millions in revenue after costs. Th...
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