In December 2024, the
Centers for Medicare & Medicaid Services (CMS) approved SPAs 24-0042,
24-0051,
and 24-0052,
establishing Assertive Community Treatment (ACT), Forensic ACT (FACT),
Coordinated Specialty Care (CSC) for First Episode Psychosis (FEP), Clubhouse
Services, Enhanced Community Health Worker (CHW) Services, and Individual
Placement and Support (IPS) Supported Employment as covered Medi-Cal services.
County behavioral health delivery systems have the option to cover one or more BH-CONNECT EBPs within the Specialty Mental Health Services (SMHS), Drug Medi-Cal (DMC), and/or Drug Medi-Cal Organized Delivery System (DMC-ODS) programs.
Visit Opt in to BH-CONNECT to learn more about how to participate in optional BH-CONNECT activities, including adult EBPs, and BH-CONNECT Resources for federal approvals and policy guidance related to BH-CONNECT EBPs.
Assertive Community Treatment (ACT):
- ACT supports members living
with complex and significant behavioral health needs and a treatment history
that may include psychiatric hospitalization and emergency room visits,
residential treatment, involvement with the criminal justice system,
homelessness, and/or lack of engagement with traditional outpatient services.
- ACT promotes recovery by helping members cope with the symptoms of their behavioral health conditions and acquire the skills they need to function and remain integrated in the community.
- ACT is provided by a multidisciplinary team that typically consists of a psychiatrist, nurse, peer support specialists, and other behavioral health practitioners.
- When delivered to fidelity,
ACT leads to improved health and social outcomes, including improved
psychiatric symptoms, fewer inpatient and emergency department admissions, and
increased integration with and participation in the community.
Forensic ACT (FACT):
- FACT adapts the ACT model to address the complex needs of members with significant behavioral health needs 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 members.
- FACT complements other DHCS initiatives designed to better meet the needs of members who are justice-involved, such as the CalAIM Justice-Involved Reentry Initiative.
Coordinated Specialty Care (CSC) for First Episode Psychosis (FEP)
- CSC supports members experiencing an initial episode of psychosis.
- CSC promotes recovery by
providing timely and integrated support during the critical initial stages of
psychosis to help members cope with the symptoms of their mental health
condition and to function and remain integrated in the community.
- CSC includes a wide range of
individualized supports that are provided by a multidisciplinary team of
licensed and non-licensed mental health practitioners.
- Participating in CSC has been shown to reduce
the likelihood of psychiatric hospitalization, emergency room visits,
residential treatment placements, criminal justice system involvement,
substance use, and homelessness, and result in improved psychopathology and overall
quality of life.
Individual Placement and Support (IPS) Supported Employment:
- IPS supports individuals living with behavioral health needs in obtaining and sustaining competitive employment to support their recovery.
- Members work with a team of
employment specialists in their initial job search and have access to ongoing
follow-along supports once employment is secured.
- IPS has been tied to
improved self-esteem, community inclusion, reductions in homelessness and
criminal justice system involvement, and improvements in overall quality of
life among individuals living with behavioral health conditions.
Enhanced Community Health Worker (CHW) Services:
- 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 include all of the same service activities and practitioner requirements as other Medi-Cal CHW Services, but are tailored to
Medi-Cal members who meet the access criteria for SMHS, DMC and/or DMC-ODS services.
Clubhouse Services:
- Clubhouses are inclusive, community-based
environments to help members living with behavioral health needs build
emotional, cognitive, and social skills. Clubhouses facilitate opportunities to build skills and relationships to support members in autonomous employment, education, and housing.
- Members work alongside Clubhouse
staff as equals to contribute to shared community needs. Clubhouses offer employment programs and provide structured opportunities for socialization and recreation on evenings, weekends, and holidays.
