Special Medi-Cal Projects Branch
The Special Medi-Cal Projects Branch (SMCPB) oversees multiple behavioral health components of California Advancing and Innovating Medi-Cal (CalAIM) 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. SMCPB encompasses the following initiatives:
- California Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT)
- Access Criteria for Specialty Mental Health Services
- Drug Medi-Cal Organized Delivery Systems (DMC-ODS)
- Behavioral Health Documentation Redesign
- No Wrong Door for Mental Health Services and Co-Occurring Treatment
- Standardized Screening and Transition of Care Tools (STT) for Medi-Cal Mental Health Services
- Trauma Screening Tool
- SMHS/NSMHS Provider Referrals
- Medi-Cal Peer Support Services
BH-CONNECT Sections 1 & 2
The BH-CONNECT Sections oversee the Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) initiative, which is designed to increase access to and strengthen the continuum of community-based behavioral health services for Medi-Cal members living with significant behavioral health needs. BH-CONNECT is comprised of a new five-year Medicaid section 1115 demonstration, State Plan Amendments (SPAs) to expand coverage of Evidence-Based Practices (EBPs) available under Medi-Cal, and complementary guidance and policies to strengthen behavioral health services statewide.
BH-CONNECT expands Medi-Cal service coverage, drives performance improvement, and supports fidelity implementation for evidence-based practice models to improve outcomes for Medi-Cal members experiencing the greatest inequities. As a result, members can avoid unnecessary emergency department visits, hospitalizations, and inpatient or residential facility stays, reduce involvement with the justice system, and feel healthier.
Key Components of BH-CONNECT
- Evidence-Based Practices: BH-CONNECT expands and clarifies Medi-Cal coverage of adult and children and youth focused evidence-based practices.
- Incentive Program: BH-CONNECT supports a $1.9 billion incentive program to reward participating behavioral health plans for demonstrating improvements in access to behavioral health services and outcomes among Medi-Cal members living with significant behavioral health needs.
- Children and Youth Initiatives: BH-CONNECT strengthens family-based services and supports for children and youth living with significant behavioral health needs.
- Workforce Initiative: BH-CONNECT provides resources to enhance service quality of behavioral health workforce.
- Federal Financial Participation for Short-Term Institutions for Mental Diseases Stays
For more information on BH-CONNECT, please visit the program website here.
The BH-CONNECT Sections also oversee the development and implementation of the traditional health care practices benefit within DMC-ODS.
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.
The Special Projects Section
The Special Projects Section is responsible for development of several components of the CalAIM Initiative. This section revises policy documents and assists with development and initial implementation of legislative requirements.
The Program Implementation Section consists of two Units:
- Special Projects Section Unit 1
- Special Projects Section Unit 2
The Special Projects Section implements several CalAIM Initiatives:
Drug Medi-Cal Organized Delivery System
The Drug Medi-Cal Organized Delivery System (DMC-ODS) is a program for the organized delivery of substance use disorder (SUD) treatment services to eligible Medi-Cal members with SUDs by providing a continuum of care modeled after the American Society of Addiction Medicine (ASAM) Criteria for SUD treatment services. As a county opt-in program, DMC-ODS also enables more local control and accountability, provides greater administrative oversight, creates utilization controls to improve care and efficient use of resources, implements evidenced based practices in SUD treatment, and coordinates with other systems of care.
This approach provides Medi-Cal members with access to the care and system interaction needed in order to achieve sustainable recovery.
In December 2021, DHCS received approval from CMS to reauthorize DMC-ODS, shifting the managed care authority to the consolidated CalAIM 1915(b) waiver and using the Medicaid State Plan to authorize the majority of DMC-ODS benefits. Authority to provide reimbursable Medi-Cal services for DMC-ODS members residing in institutions for mental disease (IMDs) remains in the 1115 demonstration through December 31, 2026. To learn more about DMC-ODS program and updates pursuant to CalAIM, please see BHIN 24-001 .
Additional resources for DMC-ODS counties, including free assessment tools, can be found on the County Resources page. Questions about the DMC-ODS program can be sent to CountySupport@dhcs.ca.gov.
Medi-Cal Peer Support Services
Senate Bill (SB) 803, chaptered in 2020, authorized DHCS to seek federal approvals to add Peer Support Specialists as a Medi-Cal provider type and Peer Support Services as a distinct service type under the Specialty Mental Health Services (SMHS), Drug Medi-Cal (DMC), and Drug Medi-Cal Organized Delivery System (DMC-ODS) delivery systems in counties opting to participate in this program. DHCS has acquired these federal approvals through the Medicaid waiver and State Plan Amendment processes. SB 803 also directed DHCS to develop state standards for Medi-Cal Peer Support Specialist Certification Programs that may be implemented by counties or agencies representing counties, who opt in to provide these programs.
The Medi-Cal Peer Support Services benefit went live on July 1, 2022, with the first Peer Support Services certification examinations taking place in September 2022.
No Wrong Door for Mental Health Services
As of July 1, 2022, DHCS implemented a “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, 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 (SUD) 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.
For more information on No Wrong Door, please visit CalAIM Behavioral Health Initiative.
CalAIM Behavioral Health Initiative
Currently, multiple behavioral health screening and transition of care tools are in use for Medi-Cal beneficiaries across the state, leading to inconsistencies for when beneficiaries are referred to mental health plan networks versus managed care networks. CalAIM seeks to streamline this process and improve patient care by creating standardized statewide tools. DHCS underwent a robust stakeholder process to develop statewide screening and transition of care tools for both adults and individuals under 21 years old (youth) for use by county mental health plans (MHPs) and Medi-Cal Managed Care Plans (MCPs). DHCS developed standardized screening tools to determine the most appropriate Medi-Cal behavioral health delivery system (MHP or MCP) for beneficiaries seeking an assessment of needs and services for the first time. In addition, DHCS developed a standardized transition of care tool to ensure that Medi-Cal beneficiaries receive timely and coordinated care when completing a transition of services to the other delivery system or when adding a service from the other delivery system to an existing care plan.
For more information on Screening & Transition of Care Tools, please visit CalAIM Behavioral Health Initiative.
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.
For more information on Documentation Redesign, please visit CalAIM Behavioral Health Initiative.
CalAIM Administrative Integration – Provider Integration Project
As part of DHCS' California Advancing and Innovating Medi-Cal (CalAIM) initiative, DHCS is implementing the Behavioral Health Administrative Integration project. This project allows for greater access to services, improve quality of services, and provide a more integrated care experience for beneficiaries. To further the goals of Administrative Integration, the Provider Integration Project is intended to achieve greater consistency and allow providers to participate equally across Medi-Cal behavioral health delivery systems. Through this effort, DHCS has made changes to the types of providers that can deliver Specialty Mental Health, Drug Medi-Cal, and Drug Medi-Cal-Organized Delivery System services and has removed certain limitations on service delivery in DMC Counties. In December 2023, DHCS received approval of State Plan Amendment (SPA) 23-0026. The SPA made changes to the types of providers that can provide specialty mental health and substance use disorder services and took effect retroactively to July 1, 2023. In addition, DHCS published Behavioral Health Information Notice (BHIN) 24-023 in June of 2024 to provide additional information that supports implementation of SPA 23-0026 which, similarly, took effect retroactively to July 1, 2023.
For more information on CalAIM Administrative Integration – Provider Integration Project, please visit CalAIM Behavioral Health Initiative.
Additional Resources
California Advancing and Innovation Medi-Cal (CalAIM):
Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) Initiative:
Medicaid and Medi-Cal General:
Contact Information
