​​​​​​​​​CalAIM Behavioral Health Quality Improvement Program​

The CalAIM Behavioral Health Quality Improvement Program (BHQIP) is an incentive payment program to support Mental Health Plans (MHP), Drug Medi-Cal State Plans (DMC) and Drug Medi-Cal Organized Delivery Systems (DMC-ODS) (also referred to as County Behavioral Health Plans) as they prepare for changes in the California Advancing and Innovating Medi-Cal (CalAIM) initiative and other approved administration priorities.

Each County Behavioral Health Plan can earn incentive payments in the CalAIM BHQIP by completing deliverables tied to program milestones. Funds may be used at each county's discretion to accomplish CalAIM requirements including but not limited to: staffing, technology and infrastructure, contracting, training and/or technical assistance.

Incentives are available from FY 2021-2022 to FY 2023-2024.

Program Goals & Milestones

​Every County Behavioral Health Plan is intended to reach the following milestones by July 2023.

Goal 1: Payment Reform

 Milestones:

• Milestone 1a: ​​​​​​​​Implement new Current Procedural Technology/Healthcare Common Procedure Coding System (CPT/HCPCS) procedure codes, modifiers, place of service codes, and taxonomy codes.
• Milestone 1b: Update county claiming systems to successfully submit 837 transactions to the Short-Doyle Medi-Cal claiming system.
• Milestone 1c: Implement new Intergovernmental Transfer (IGT) agreement protocol.​​

​Goal 2: Implementation of CalAIM Behavioral Health Policy Changes

 Milestones:

• Milestone 2a: Implement standardized screening tools in compliance with DHCS guidance.
• Milestone 2b: Implement standardized transition of care tools in compliance with DHCS guidance​.
• Milestone 2c: For DMC State Plan Only: Assist providers to implement ASAM Criteria to determine level of care in compliance with DHCS guidance.
• Milestone 2d: Implement revised documentation standards, including but not limited to, assessment domains, problem lists, progress notes, and applicable timeliness standards.
• Milestone 2e: Provide guidance and training to county-operated and county-contracted providers on all new behavioral health policies, as outlined by DHCS in Behavioral Health Information Notices.
• ​​​​​​Criteria for DMC and DMC-ODS services, including use of criteria in DMC counties, changes to diagnostic, eligibility, and medical necessity requirements, and new processes to claim Medi-Cal reimbursement for early intervention services for youth and for specified EPSDT SUD services in DMC counties.
• Criteria to access Specialty Mental Health Services (SMHS) for adults and for children (including criteria related to trauma, child welfare involvement, and homelessness)
• Mandatory screening and transition tools for specialty (SMHS) and non-specialty mental health (NSMHS)
• Documentation requirements and assessment standards (SMHS and DMC, DMC-ODS)
• No Wrong Door (SMHS)
• Co-occurring diagnoses (SMHS and DMC, DMC-ODS)
• Treatment during assessment period, prior to diagnosis (SMHS and DMC, DMC-ODS)

Goal 3: Data Exchange

 Milestones:

• Milestone 3a: Demonstrate improved data exchange capabilities.
• ​​​​​​Option 1: ​Demonstrate direct sharing of data with Medi-Cal Managed Care Plan
• ​​​​Option 2: ​Demonstrate onboarding to a Health Information Exchange.
• Milestone 3b: ​​Demonstrate an active Fast Healthcare Interoperability Resources (FHIR) application programming interface (API) that will allow the MHP, DMC, and DMC-ODS to be compliant with CMS-mandated interoperability rules.
• Milestone 3c: Demonstrate that the MHP, DMC, and DMC-ODS have mapped data elements to the United States Core Data for Interoperability (USCDI) standard set.
  
• Milestone 3d:​Leverage improved data exchange capabilities to improve quality and coordination of care.
  

​​Reporting Schedule