CalAIM Behavioral Health Initiative
Return to the CalAIM Homepage
CalAIM is a multi-year DHCS initiative to improve the quality of life and health outcomes of our population by implementing broad delivery system, program, and payment reform across the Medi-Cal program. For more information about CalAIM more broadly, please go to the CalAIM Homepage.
The behavioral health components of CalAIM are designed to support whole-person, integrated care; move the administration of Medi-Cal behavioral health to a more consistent and seamless system by reducing complexity and increasing flexibility; and improve quality outcomes, reduce health disparities, and drive delivery system transformation and innovation through improvements to behavioral health policies and the launch of behavioral health payment reform. The majority of these policy changes launched in 2022, but implementation will continue through 2027. See below for more details on each initiative, including policy guidance, past webinars, and information on upcoming technical assistance opportunities.
The California Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) Waiver webpage provides information about the Medicaid Section 1115 Demonstration application, submitted in 2023, to increase access to and improve mental health services for Medi-Cal members statewide.
Download the factsheet about the CalAIM initiative to advance Behavioral Health.
CalAIM Behavioral Health Policy:
|
Launch Date:
|
Criteria for Specialty Mental Health Services (SMHS)
| January 2022 - LIVE!
|
Drug Medi-Cal Organized Delivery System (DMC-ODS) Policy Improvements
| January 2022 - LIVE!
|
| Drug Medi-Cal American Society of Addiction Medicine (ASAM)
Level of Care Determination | January 2022 - LIVE!
|
| Documentation Redesign for Substance Use Disorder & Specialty Mental Health Services | July 2022 - LIVE!
|
| No Wrong Door | July 2022 - LIVE!
|
Standardized Screening and Transition Tools
| January 2023 - LIVE!
|
| Behavioral Health Payment Reform | July 2023 - LIVE!
|
Traditional Health Care Practices
| March 2025 - LIVE!
|
Behavioral Health Administrative Integration
| January 2027
|
Resources
Criteria for Specialty Mental Health Services
As of January 1, 2022, DHCS updated and clarified the responsibilities of specialty Mental Health Plans (MHPs), including updates to the criteria for access to Specialty Mental Health Services (SMHS), both for adults and members under age 21 through
BHIN 21-073. These criteria were developed and improved based on significant feedback from stakeholders. The goal of these changes is to improve members' access to services and reduce provider administrative burdens.
Resources
Guidance
Webinars
- Informational webinar, November 18, 2021
As of January 1, 2024, DHCS made updates to DMC-ODS in BHIN 24-001, which superseded BHIN 23-001.BHIN 24-001 updates DMC-ODS program requirements to align with CalAIM behavioral health initiatives that went live in 2023.
Resources
Guidance
Webinars
- Technical Assistance Webinar, February 1, 2024
American Society of Addiction Medicine (ASAM) Level of Care Determination Requirements for Drug Medi-Cal (DMC) Treatment Services
As of January 1, 2022, to ensure access to Substance
Use Disorder (SUD) service delivery across the state, DHCS issued guidance
through BHIN 21-071, establishing
that the American Society of Addiction Medicine (ASAM) Criteria be used to
determine the appropriate level of care for covered SUD treatment services in
both Drug Medi-Cal Organized Delivery System (DMC-ODS) counties and Drug
Medi-Cal (DMC) State Plan counties.
Resources
Guidance
Behavioral Health Documentation Redesign
Effective July 1, 2022, DHCS implemented streamlined behavioral health documentation requirements for substance use disorder (SUD) and Specialty Mental Health Services (SMHS) to align more closely with national standards. In April 2022, DHCS published Behavioral Health Information Notice (BHIN) 22-019, which removed most client plan requirements from SMHS and most treatment plan requirements from Drug Medi-Cal (DMC) and Drug Medi-Cal Organized Delivery System (DMC-ODS) services, except for the continued requirements specifically noted in BHIN 22-019, BHIN 23-068, and/or subsequent guidance.
Following continued stakeholder feedback and clarifications from DHCS' federal partners, DHCS published BHIN 23-068 in November 2023, which superseded BHIN 22-019. BHIN 23-068 retained much of the guidance from BHIN 22-019 and allowed DHCS to clarify several documentation policies following extensive stakeholder feedback. BHIN 23-068 clarified care plan requirements for SMHS, DMC, and DMC-ODS, updated DMC and DMC-ODS assessment guidelines to align with SMHS, and clarified assessment requirements for crisis and group services, among other updates. The updated behavioral health documentation requirements also include the use of an active and ongoing problem list, progress notes, and other documentation within the clinical record reflecting the care given, and in alignment with the appropriate billing codes. Compliance with BHIN 23-068 is required beginning on January 1, 2024.
Resources
Guidance
Webinars
- Technical Assistance webinar, December 13, 2023
- Informational webinar, May 26, 2022
No Wrong Door for Mental Health Services and Co-Occurring Conditions
As of July 1, 2022, DHCS implemented the “no wrong door" policy to ensure members receive mental health services regardless of the delivery system where they seek care (via county behavioral health, Medi-Cal managed care plan (MCP), or the fee-for-service delivery system). This policy allows members who directly access a treatment provider to receive an assessment and mental health services, and to have that provider reimbursed for those services by their contracted plan, even if the member is ultimately transferred to the other delivery system due to their level of impairment and mental health needs. In certain situations, members may receive coordinated, non-duplicative services in multiple delivery systems, such as when a member has an ongoing therapeutic relationship with a therapist or psychiatrist in one delivery system while requiring medically necessary services in the other.
DHCS also clarified that patients with co-occurring mental health and substance use disorder conditions may be treated by providers in each of the behavioral health delivery systems, as long as the covered services are not duplicative and meet specified requirements for contracting and claiming.
Resources
Guidance
Materials
Webinars
- Drug Medi-Cal (DMC) State Plan Memoranda of Understanding with Medi-Cal Managed Care Plans: BHIN 24-016 Informational Webinar, May 16, 2024
- Mental Health Plan and Drug Medi-Cal Organized Delivery System Memoranda of Understanding with Managed Care Plans Informational Webinar, November 28, 2023
- Technical Assistance Webinar, June 9, 2022
-
Informational Webinar, April 28, 2022
Standardized Screening & Transition of Care Tools
The Screening and Transition of Care Tools for Medi-Cal Mental Health Services aim to ensure that Medi-Cal members receive timely and coordinated specialty and non-specialty mental health services (SMHS/NSMHS). The Screening and Transition of Care Tools for Medi-Cal Mental Health Services have distinct purposes:
- Adult and Youth Screening Tools: Determine the most appropriate Medi-Cal mental health delivery system (e.g., County Mental Health Plan (MHP) or Medi-Cal Managed Care Plan (MCP)) for members who are not currently receiving mental health services when they contact the MCP or MHP seeking mental health services.
- Transition of Care Tool: Supports timely and coordinated care for members who are currently receiving mental health services from either the MCP or MHP. This tool is used when completing a transition of services to the other delivery system or when adding a service from the other delivery system to their existing mental health treatment.
The Screening and Transition of Care Tools for Medi-Cal Mental Health Services were developed with robust stakeholder input, including beta and pilot testing with MCPs and MHPs in several counties across the state, including counties with large urban areas, small population sizes, and large rural regions.
Statewide implementation of the Screening and Transition of Care Tools for Medi-Cal Mental Health Services launched January 1, 2023. For more information, please visit the
Screening & Transition of Care Tools for Medi-Cal Mental Health Services webpage.
Behavioral Health Payment Reform
Through realignment efforts in 1991 and 2011, funding for the majority of the non-federal share of costs associated with the Specialty Mental Health Services (SMHS) and substance use disorder (SUD) services became the responsibility of the counties. Prior to the implementation of payment reform, counties were reimbursed for these programs via Medicaid Certified Public Expenditure (CPE) methodologies. Under the Certified Public Expenditure (CPE) structure, reimbursements to counties were limited to costs incurred by the counties and were subject to a lengthy and labor-intensive cost reconciliation process. The CalAIM Behavioral Health Payment Reform initiative moves counties away from cost-based reimbursement to enable value-based reimbursement structures that reward better care and quality of life for Medi-Cal beneficiaries.
Payment reform transitioned counties from cost-based reimbursement funded via CPEs to fee-for-service reimbursement funded via Intergovernmental Transfers (IGTs), eliminating the need for reconciliation to actual costs. As part of payment reform, SMHS and SUD services transitioned from Healthcare Common Procedure Coding System (HCPCS) Level II coding to Level I coding, known as Current Procedural Terminology (CPT) coding, when possible.
Timeline
|
Date: |
Policy Update: |
July 2023
| Payment reform effective July 1, 2023 |
Resources
Guidance
Materials
Traditional Health Care Practices
On October 16, 2024, the Centers for Medicare & Medicaid Services (CMS) approved DHCS to cover traditional health care practices provided by Indian Health Care Providers (IHCPs) for Medi-Cal members in Drug Medi-Cal Organized Delivery System (DMC-ODS) counties through December 31, 2026, unless extended or amended.
Traditional health care practices encompass two new service types: Traditional Healer and Natural Helper services. DMC-ODS counties shall provide coverage for traditional health care practices received through IHCPs to Medi-Cal members who receive covered services delivered by or through these facilities and meet DMC-ODS access criteria. IHCPs include Indian Health Service (IHS) facilities, facilities operated by Tribes or Tribal organizations (Tribal Facilities) under the Indian Self-Determination and Education Assistance Act, and facilities operated by urban Indian organizations (UIO facilities) under Title V of the Indian Health Care Improvement Act.
Traditional health care practices are expected to improve access to culturally responsive care; support these facilities’ ability to serve their patients; maintain and sustain health; improve health outcomes and the quality and experience of care; and reduce existing disparities in access to care. For more information including guidance and other resources, please visit the Traditional Health Care Practices webpage.
Behavioral Health Administrative Integration
Medi-Cal Specialty Mental Health (SMH) and substance use disorder (SUD) treatment services are currently administered through separate, unique structures at the county level, which creates many challenges for members, counties, and providers. DHCS is requiring counties to combine the administration of SMH and SUD services into one, integrated specialty behavioral health program by January 1, 2027. Administrative Integration is distinct from the CalAIM Full Integration Plan proposal that would integrate physical, behavioral, and oral health care into comprehensive managed care plans.
The primary goals of Behavioral Health Administrative Integration are to improve health care outcomes and the experience of care for Medi-Cal members—particularly those living with co-occurring mental health and SUD issues—by reducing administrative burden for members, counties, providers, and the state.
This initiative is a multi-year effort that began with the implementation of related CalAIM behavioral health policies, starting in 2022, including updated Criteria for Specialty Mental Health Services, Drug Medi-Cal Organized Delivery System (DMC-ODS) Policy Improvements, and Behavioral Health Payment Reform. By January 2027, DHCS will implement a single, integrated behavioral health plan in each county or region responsible for providing or arranging for the provision of SMH and SUD services. Behavioral Health Administrative Integration will include both Drug Medi-Cal (DMC) and Drug Medi-Cal Organized Delivery System (DMC-ODS) counties, and both state-level and county-level activities will be required to achieve this goal. The Behavioral Health Administrative Integration webpage is live and updated regularly to share initiative updates and Frequently Asked Questions.
Mobile Crisis Services
Mobile crisis services are a community-based intervention designed to provide de-escalation and relief to individuals experiencing a behavioral health crisis wherever they are, including at home, work, school, or in the community. Mobile crisis services are provided by a multidisciplinary team of trained behavioral health professionals. Mobile crisis services provide rapid response, individual assessment and community-based stabilization to Medi-Cal members who are experiencing a behavioral health crisis. Mobile crisis services are designed to provide relief to members experiencing a behavioral health crisis, including through de-escalation and stabilization techniques; reduce the immediate risk of danger and subsequent harm; and avoid unnecessary emergency department care, psychiatric inpatient hospitalizations and law enforcement involvement. The mobile crisis services benefit will ensure that Medi-Cal members have access to coordinated crisis care 24 hours a day, 7 days a week, 365 days per year..
DHCS submitted State Plan Amendment (SPA) 22-0043 to add qualifying community-based mobile crisis intervention services ("mobile crisis services") as a Medi-Cal benefit. DHCS received approval of its SPA, effective January 1, 2023.
Download the
CalAIM Mobile Crisis Services fact sheet
Training & Technical Assistance (TTA) for Moblie Crisis Team
DHCS' training partners – the Medi-Cal Mobile Crisis Training and Technical Assistance Center (M-TAC) – provides training, resources and ongoing technical assistance and consultation to counties and their mobile crisis teams to support the implementation of mobile crisis services across the state.
For more information on training and technical assistance offerings and curricula, please visit the M-TAC website.
Important Updates
DHCS released Behavioral Health Information Notice (BHIN) 22-064 to provide guidance on the implementation of mobile crisis services. Following the release of BHIN 22-064, DHCS released BHIN 23-025 (superseding BHIN 22-064), issuing revised guidance on this benefit.
DHCS released the CalAIM Behavioral Health Preliminary Implementation Report on the Medi-Cal Access Criteria for Specialty Mental Health Services, No Wrong Door for Mental Health Services, Screening and Transition of Care Tools for Medi-Cal Mental Health Services, and Medi-Cal Peer Support Services initiatives. The report includes feedback and findings solicited from implementation partners and behavioral health stakeholders on experiences with policy administration, and key implementation challenges and successes.
Additional Resources
