Adult Evidence-Based Practices

Overview:

In December 2024, the Centers for Medicare & Medicaid Services (CMS) approved SPAs 24-0042, 24-0051, and 24-0052, establishing ACT, FACT, CSC for FEP, Clubhouse Services, Enhanced Community Health Worker Services, and IPS Supported Employment as covered Medi-Cal services effective January 1, 2025. BH-CONNECT empowers Medi-Cal members with significant behavioral health needs to take advantage of a variety of new, evidence-based practices.
Effective January 1, 2025, county behavioral health plans (BHPs, inclusive of mental health plans and Drug Medi-Cal Organized Delivery System plans) and Drug Medi-Cal programs have the option to cover one or more of the following BH-CONNECT evidence-based practices (EBPs) within the Specialty Mental Health Services (SMHS), Drug Medi-Cal (DMC), and/or Drug Medi-Cal Organized Delivery System (DMC-ODS) delivery systems. These include:

ACT is a community-based, team-based service to help members cope with the symptoms of their mental health condition and develop or restore skills to function in the community.
ACT provides members with a multidisciplinary team that typically consists of a psychiatrist, nurse, case managers, peers, and other licensed mental health professionals.
ACT reduces the need for institutional care and support for individuals living with serious mental illness, which is why it is widely considered one of the most robust and cost-effective community-based treatment options.
ACT improves on other models, such as full-services partnerships, by incorporating robust support and monitoring processes.

FACT builds on the evidence-based ACT model to address the complex needs of members with serious mental illness who are also involved with the criminal justice system.
By addressing criminogenic risks and needs, FACT has been shown to improve functioning and reduce hospitalizations, homelessness, incarceration, and violations of probation and parole among enrolled participants. In opt-in counties, FACT can complement parallel initiatives designed to better meet the health care needs of the justice-involved population, such as the CalAIM Justice-Involved Reentry Initiative, the California Health & Human Services Agency (CalHHS) Incompetent to Stand Trial Workgroup, and Assembly Bill 1976.4 (Eggman, 2020).

CSC is a community-based service designed for members experiencing first-episode psychosis. By providing timely and integrated support during the critical initial stages of psychosis, CSC reduces the likelihood of psychiatric hospitalization, emergency room visits, residential treatment placements, criminal justice system involvement, substance use, and homelessness.
CSC is a comprehensive outpatient service, in which a multidisciplinary team consisting of behavioral health practitioners, including a psychiatrist or psychiatric prescriber, peer support specialist, and other licensed and credentialed practitioners provide a wide range of individualized supports to members exhibiting initial signs of psychosis.
CSC is a person-centered, team-based service that helps members cope with the symptoms of their mental health condition and to function and remain integrated in the community.

IPS Supported Employment helps support individuals living with behavioral health needs in obtaining and sustaining competitive employment in the community to support their recovery.
Supported Employment is a person-centered intervention that emphasizes a member's strengths, goals, and preferences. It also promotes self-esteem, independence, a sense of belonging, and overall well-being.
A core principle of Supported Employment is that services are available to anyone who wants to work.
This program is available to individuals who meet criteria for SMHS, DMC, and DMC-ODS.

Enhanced CHW are preventive services prevent disease, disability, and other health conditions or their progression; to prolong life; and promote physical and behavioral health. Enhanced CHW services includes all of the same components and requirements as CHW preventive services, which became a Medi-Cal benefit beginning July 1, 2022, but are tailored to Medi-Cal members who meet the access criteria for specialty mental health and/or substance use disorder services.
Enhanced CHW Services represent a broadened scope of preventative services provided by trusted community members, often including more intensive care coordination, deeper community engagement, and specialized support for individuals with complex behavioral health needs. In addition to basic outreach and education typically associated with a CHW role, an Enhanced CHW may help manage chronic conditions, navigate health care systems, provide social support, and advocate for members to access necessary resources.
Enhanced CHW Services are delivered through specialty mental health services (SMHS), Drug Medi-Cal (DMC), and the Drug Medi-Cal Organized Delivery System (DMC-ODS) to prevent disease, disability, and other health conditions, prolong life, and promote physical and mental health and efficiency.

The Clubhouse Model is an intentional, voluntary, and organized support system that uses a strengths-based approach to help members build emotional, cognitive, and social skills in an inclusive, community-based setting.
Clubhouses are physical settings that facilitate opportunities to build skills and relationships supportive of autonomous employment, education, and housing.
Members are involved in all major decisions related to the Clubhouse's operation. Through the Work-Ordered Day program, members and staff work together as colleagues to stock, clean, organize, and generally maintain the clubhouse. Clubhouses offer employment programs and provide structured opportunities for socialization and recreation on evenings, weekends, and holidays.
Clubhouse Services is a covered benefit under Medi-Cal through the SMHS delivery system, and Behavioral Health Plans (BHPs) will have the option to provide the service to eligible members.