Tsev Kev Koom Tes Ua Haujlwm Saib Xyuas Kev Noj Qab Haus Huv​​ 

Behavioral Health Administration Integration​​ 

Cov lus nug nquag​​ 

Lub Sijhawm Ua Haujlwm​​ 

Txhua theem ntawm Tus Cwj Pwm Kev Noj Qab Haus Huv Kev Tswj Xyuas Kev Noj Qab Haus Huv cuam tshuam dab tsi?​​ 

Txhawm rau kom ua tiav thoob lub xeev Kev Tswj Xyuas Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv hauv xyoo 2027, DHCS yuav ua haujlwm nrog cov nroog uas siv peb-theem mus kom ze nyob rau hauv uas cov khoom sib txawv yuav muab sib xyaw rau ntau qib sib txawv ntawm lub sijhawm sib txawv. Txoj kev npaj ua ntu zus tau tsim los suav nrog qhov tseeb tias qee cov khoom tuaj yeem koom ua ke raws li cov tub ceev xwm thiab cov nroog uas twb muaj lawm yuav tau ua cov kauj ruam ua li ntawd, thaum lwm cov khoom siv yuav xav tau kev nqis tes ua ntawm DHCS, kev hloov pauv rau lub xeev cov tub ceev xwm, lossis tsoomfwv kev pom zoo.​​ 

  • Theem 1 yog tsom rau kev yeem koom ua ke ntawm lub nroog ua haujlwm raws li cov ntawv cog lus uas twb muaj lawm nyob rau xyoo 2023 thiab 2024.​​  
  • Theem 2 yuav tsom mus rau kev yeem daim ntawv cog lus sib koom ua ke nyob rau xyoo 2025 thiab 2026 rau cov nroog uas tuaj yeem tuaj yeem txais cov ntawv cog lus ua ke thaum ntxov, pib lub Ib Hlis 1, 2025.​​  
  • In Phase 3, all counties will be required to adopt integrated contracts effective January 1, 2027, as specified in CalAIM statute (AB 133).​​  

Yog xav paub ntxiv txog txhua theem ntawm kev siv, thov mus saib Daim Ntawv Qhia Txog Tus Cwj Pwm Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv.​​ 

DHCS puas tuaj yeem muab cov ncauj lus kom ntxaws ntxiv ntawm daim ntawv thov kom ua tiav DHCS-Lub Nroog daim ntawv cog lus nrog Xyoo Xyoo uas tsis yog Xyoo Nyiaj Txiag?​​ 

Currently, DHCS-County behavioral health contracts are aligned with the State Fiscal Year, which runs from July 1 to June 30. In AB 133, however, the Legislature directed DHCS and counties to execute integrated behavioral health contracts effective January 1, 2027. Having the integrated behavioral health contracts take effect at the beginning of the calendar year would align with the renewal of DHCS’ existing 1915(b) waiver and with Managed Care Plan (MCP) contract cycles, both of which already follow the calendar year. DHCS will work closely with counties and other key stakeholders to assess the implications of shifting the behavioral health contract cycle to the calendar year, and to ensure a successful transition to calendar year contract cycles.
​​ 

DHCS yuav txhawb cov nroog li cas kom ua tau raws li Kev Tswj Xyuas Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv los ntawm Lub Ib Hlis 1, 2027?​​ 

DHCS lees paub tias lub sijhawm cov neeg ua haujlwm hauv nroog tsuas muaj tsawg thiab cov nroog tab tom siv lwm txoj kev hloov kho CalAIM. DHCS tau tsim txoj hauv kev ua ntu zus rau Kev Tswj Xyuas Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv nrog rau cov kev txwv muaj peev xwm hauv siab, suav nrog kev sib koom tes nrog lwm yam kev hloov kho CalAIM. DHCS yuav txuas ntxiv ua kom muaj kev koom tes nrog ntau tus neeg koom tes thiab kev pab tswv yim los xyuas kom meej tias cov nroog muaj cov ntaub ntawv, cov peev txheej, thiab cov kev pab cuam uas lawv xav tau los ua kom tiav Kev Ua Haujlwm Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv. Kev koom tes yuav suav nrog pawg neeg koom tes ua haujlwm, cov ntaub ntawv xov xwm hauv webinars, cov phiaj xwm nthuav tawm, thiab tso tawm cov lus qhia meej thiab lwm yam kev pab, raws li qhov tsim nyog.​​ 

Kev Tswj Xyuas Kev Noj Qab Haus Huv Tus Cwj Pwm yuav zoo li cas rau cov nroog uas tsis tuaj yeem pab dawb rau kev sib cog lus ntxov?​​ 

Thaum Theem 2 (1/1/25-12/31/26: Voluntary Contract Integration), lub nroog uas tsis xaiv los ua kev sib cog lus thaum ntxov tuaj yeem txuas ntxiv kev sib koom ua ke uas tsis tas yuav muaj kev taw qhia ntxiv los ntawm DHCS, xws li cov txheej txheem cuam tshuam txog 24/7 txoj kab nkag, kev tshuaj ntsuam, kev soj ntsuam, thiab kev npaj kho mob, kev lag luam kev lag luam thiab kev sib koom ua lag luam. kev npaj rau kev siv tag nrho los ntawm Lub Ib Hlis 1, 2027. Cov nroog no yuav tsis koom nrog cov khoom uas yuav tsum muaj kev cog lus ua ke, (piv txwv li, Kev Ntsuam Xyuas Sab Nraud Zoo (EQRs), BH kev tshuaj xyuas, thiab daim ntawv pov thawj network txaus) txog xyoo 2027.​​ 

DMC Lub Nroog​​ 

Kev Tswj Xyuas Kev Noj Qab Haus Huv Tus Cwj Pwm yuav zoo li cas rau cov nroog Medi-Cal (DMC)?​​ 

DMC cov nroog yuav txuas ntxiv muab cov kev pabcuam tsis zoo rau kev siv tshuaj (SUD) sab nraum cov qauv kev saib xyuas kev tswjfwm thaum koom nrog txhua yam uas siv tau ntawm qhov kev pib no, suav nrog kev txais yuav ib qho kev sib koom ua ke ntawm Mental Health Plan (MHP) thiab DMC daim ntawv cog lus nrog Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) uas txhawb nqa cov hom phiaj kev koom ua ke.​​ 

DMC-ODS Regional Model​​ 

Kev Tswj Tus Cwj Pwm Kev Noj Qab Haus Huv yuav ua li cas rau cov nroog uas nyob rau hauv Cov Tshuaj Medi-Cal-Organized Delivery System (DMC-ODS) Regional Model?​​ 

DHCS lees paub tias muaj cov kev txiav txim siab tshwj xeeb rau kev siv rau DMC-ODS cov qauv hauv cheeb tsam hauv cheeb tsam. Hauv Theem 2 (1/1/25-12/31/26: Kev Sib Koom Tes Ua Haujlwm Sib Koom Tes), DHCS yuav ua cov neeg muaj feem cuam tshuam nrog cov nroog uas koom nrog DMC-ODS Regional Model los qhia txog kev ua raws li Kev Coj Tus Cwj Pwm Kev Noj Qab Haus Huv rau cov koom nrog hauv tus qauv no. Cov ntaub ntawv ntxiv yog yuav los tom ntej.​​ 

Kev sib koom nrog lwm cov kev hloov kho CalAIM​​ 

Kev Tswj Tus Cwj Pwm Kev Noj Qab Haus Huv puas yuav tsum muaj kev sib koom ua ke Memoranda of Understanding (MOU) ntawm MCPs thiab Behavioral Health Plans (BHPs)?​​ 

Behavioral Health Administrative Integration does not require a new MOU between MCPs and Behavioral Health Plans (BHPs). BHPs may submit one integrated MOU template inclusive of MHP and DMC-ODS or DMC requirements that fulfills all requirements outlined in Behavioral Health Information Notice (BHIN) 23-056, 23-057, and 24-016.​​ 

Kev Cwj Pwm Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv ua li cas koom ua ke nrog lwm yam kev hloov kho CalAIM txoj cai xws li Tsis Muaj Qhov Rooj Tsis Zoo, Kev Tsim Cov Ntaub Ntawv, thiab Cov Txheej Txheem Kev Ntsuam Xyuas thiab Hloov Cov Cuab Yeej?​​ 

DHCS tau tsim lub Cev Tswjhwm Saib Xyuas Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv thiab cov txheej txheem ua ntu zus los ua kom haum thiab tsim kom muaj kev txhawb nqa thiab txhawb nqa kev siv CalAIM cov phiaj xwm uas twb muaj lawm, nthuav qhia cov kev xav tau uas twb muaj lawm, thiab txhawb nqa cov kev coj ua zoo tshaj plaws ntawm kev saib xyuas rau kev tshuaj xyuas, kev ntsuam xyuas, thiab kev npaj kho mob. Cov phiaj xwm CalAIM no twb suav nrog txoj cai hloov pauv uas ua raws cov kev cai tswjfwm rau Medi-Cal SMHS thiab Cov Kev Pabcuam Siv Tshuaj (SUD). Piv txwv li, CalAIM suav nrog cov tswvcuab kev nkag mus rau cov txheej txheem hloov tshiab uas qhia meej tias kev kuaj mob tsis yog qhov yuav tsum tau txais kev pabcuam kev coj tus cwj pwm hauv SMH lossis DMC/DMC-ODS cov txheej txheem xa khoom; Cov neeg uas muaj MH lossis SUD cov tsos mob tuaj yeem tau txais kev saib xyuas thaum kuaj pom. Ntau Cov Ntaub Ntawv Hloov Kho txoj cai hloov pauv kuj tseem siv tau thoob plaws BH cov txheej txheem xa khoom tshwj xeeb, suav nrog kev tshem tawm cov phiaj xwm kho mob zoo li qub thiab siv cov npe teeb meem.​​ 

Yuav ua li cas them nyiaj ua haujlwm nrog Behavioral Health Administration Integration?​​ 

Effective July 1, 2023 under the CalAIM Behavioral Health Payment Reform initiative, county Behavioral Health Plans transitioned from cost-based reimbursement funded via Certified Public Expenditures (CPEs) to fee-for-service reimbursement funded via Intergovernmental Transfers (IGTs), eliminating the need for reconciliation to actual costs.  As part of payment reform, both Specialty Mental Health (SMH) and SUD services transitioned from existing Healthcare Common Procedure Coding System (HCPCS) Level II coding to Level I coding, known as Current Procedural Terminology (CPT) coding, when possible. Behavioral Health Administrative Integration will not change covered Medi-Cal BH benefits or modify the components of payment reform for SMH, DMC, or DMC-ODS.  Behavioral Health Administrative Integration Initiative also does not change the way Medi-Cal SMHS and SUD services are financed in California; in other words, it will not change existing allocation methods or spending requirements for MH and SUD funding sources including 1991 and 2011 Realignment and MHSA. More information about Behavioral Health Payment Reform, including technical assistance materials, is available on the CalAIM BH Webpage. 
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Kev Paub Tswvcuab​​ 

Kev Tswj Tus Cwj Pwm Kev Noj Qab Haus Huv yuav ua li cas txhim kho cov tswv cuab kev paub?​​ 

Kev sib koom lossis kev sib koom ua ke cov kev cai tswj hwm thoob plaws kev noj qab haus huv thiab SUD cov kev pabcuam hauv Kev Coj Tus Cwj Pwm Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv yuav txo qhov nyuaj thiab kev tswj hwm lub luag haujlwm rau Cwj Pwm Kev Noj Qab Haus Huv thiab cov chaw muab kev pabcuam, yog li txhim kho kev saib xyuas zoo uas cov tswvcuab tau ntsib vim tias cov kev hloov pauv yuav ua rau cov kws kho mob tsom mus rau kev txhim kho kev noj qab haus huv, suav nrog kev saib xyuas kev noj qab haus huv thiab SUD. Txhim kho cov kev cai tswj xyuas thoob plaws SMHS thiab DMC/DMC-ODS kuj tseem yuav ua rau nws yooj yim dua rau cov kws kho mob koom nrog hauv ob qho tib si xa khoom, uas tuaj yeem pab txhawb kev saib xyuas ntau dua rau cov tib neeg uas xav tau ob qho kev pabcuam SMHS thiab DMC/DMC-ODS.​​  

Cov tswv cuab kuj tseem yuav tau nkag mus rau ib phau ntawv koom ua ke thiab yog li ntawd yuav muaj peev xwm tshawb nrhiav SMHS thiab SUD cov kev pabcuam hauv ib qho chaw tsis yog ob. Tsis tas li ntawd, yuav muaj ib qho kev sib koom ua ke rau kev thov rov hais dua / tsis txaus siab, rov muab cov tswv cuab ib qho chaw nkag mus rau kev ua tiav cov txheej txheem no, tsis yog ob txoj kev sib txawv rau SMHS thiab SUD cov kev pabcuam. Thaum kawg, Kev Txhim Kho Kev Ua Haujlwm Zoo (QAPI) thiab Kev Ntsuam Xyuas Sab Nraud Zoo (EQR) yuav muaj kev tsom mus rau kev saib xyuas zoo rau cov tswv cuab nrog kev sib koom ua ke ntawm kev xav tau kev noj qab haus huv, lees paub qhov sib tshooj ntawm ob qho xwm txheej ntawm cov tswv cuab.​​ 

DHCS-County Contracts​​ 

Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) yuav ua li cas txhawm rau txheeb xyuas qhov sib txawv ntawm cov cai thiab cov cai ntawm cov kev pabcuam tshwj xeeb rau kev puas siab puas ntsws (SMHS) thiab Tshuaj Medi-Cal (DMC)/Drug Medi-Cal Organized Delivery System (DMC-ODS) cov kev pab cuam hauv daim ntawv cog lus?​​ 

DHCS tau siv daim ntawv cog lus Mental Health Plan (MHP) uas twb muaj lawm los ua ib qho chaw pib rau kev tsim cov ntawv cog lus sib koom ua ke thiab tom qab ntawd hloov kho thiab ntxiv cov ntsiab lus raws li qhov tsim nyog los ntes tag nrho cov kev xav tau ntawm DMC-ODS lossis DMC. Txawm hais tias daim ntawv cog lus DMC-ODS/SMHS yuav raug teeb tsa raws li ib qho kev pab them nqi kho mob hauv tus neeg mob Prepaid Inpatient Health Plan (PIHP), DMC cov nroog yuav txuas ntxiv mus ua haujlwm SMHS PIHP thiab qhov kev zov me nyuam tsis muaj kev tswj xyuas DMC. Qee feem ntawm daim ntawv cog lus sib koom ua ke raug txheeb xyuas raws li cov kev qhia tshwj xeeb (piv txwv li, kev xav tau kev kho mob thiab cov ntsiab lus ntawm kev pabcuam) thiab cov ntu no feem ntau tau theej ncaj qha los ntawm cov ntawv cog lus tam sim no rau SMHS, DMC-ODS, thiab / lossis DMC.  Rau "kev koom ua ke" ntu ntawm daim ntawv cog lus uas siv sib npaug rau ob qho tib si SMHS thiab DMC-ODS lossis DMC cov kev pab cuam, DHCS tau hloov kho me me raws li qhov xav tau los ua kom haum cov qauv thoob plaws cov haujlwm. Rau DMC cov nroog, qee qhov SMHS tswj hwm kev saib xyuas tau raug kho kom xav tau kev saib xyuas tshwj xeeb rau cov tswv cuab uas muaj kev xav tau kev noj qab haus huv zoo sib xws.​​  

Puas yog Kev Coj Tus Cwj Pwm Kev Tswj Xyuas Kev Noj Qab Haus Huv txhais tau hais tias cov nroog yuav tsum tau kho dua tshiab kom cov kab mob kev puas siab puas ntsws thiab kev siv tshuaj yeeb dej caw tag nrho nyob rau hauv ib lub chaw saib xyuas kev noj qab haus huv hauv lub nroog?​​ 

Tsis muaj. Txawm hais tias lub nroog (lossis cov pab pawg hauv cheeb tsam hauv cheeb tsam) yuav ua haujlwm ib qho kev pabcuam Medi-Cal kev noj qab haus huv kev coj noj coj ua los ntawm kev xav ntawm lub xeev thiab tsoomfwv txoj cai lij choj, cov nroog yuav txuas ntxiv txhim kho lawv cov haujlwm sab hauv raws li lawv pom zoo. Piv txwv li, qee lub nroog tau xaiv los sib sau ua ke lawv cov neeg ua haujlwm noj qab haus huv hauv ib lub nroog, thaum lwm lub nroog muaj cov chaw ua haujlwm sib cais (lossis kev faib ua haujlwm hauv ib chav haujlwm) tshwj xeeb rau kev noj qab haus huv thiab kev siv yeeb tshuaj.​​ 

Will there be an annual spending limit specified in the integrated contracts, similar to the current approach for counties’ DMC and DMC-ODS contracts? If not, will the removal of those annual limits affect State General Fund (SGF) contributions for, or any limits that may exist on, specific DMC or DMC-ODS services?​​ 

Currently, counties’ DMC and DMC-ODS contracts contain an annual spending limit, which must be amended if actual spending exceeds projections.  By contrast, MHP contracts are “zero dollar” contracts with no limit.​​ 

The integrated behavioral health contracts will be “zero dollar” contracts with no specified limit, similar to the current approach for MHP contracts.  All eligible county claims will be paid in accordance with the contract and applicable law.​​ 

A “zero dollar” approach means there is no need for a fiscal amendment if overall spending under the contract is higher than expected. Implementing “zero dollar” does not modify SGF contributions for specific services (e.g., intensive outpatient and residential DMC-ODS services) and populations (e.g., ACA Optional Expansion).​​ 

Yog xav paub ntxiv txog kev pab nyiaj rau ntau yam kev pabcuam kev noj qab haus huv tshwj xeeb thiab cov pej xeem, thov mus saib DMC, DMC-ODS, thiab Cov Lus Qhia Tshwj Xeeb Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv muaj nyob ntawm https://www.dhcs.ca.gov/services/MH/Pages/MedCCC-Library.aspx.  Tshooj 6 ntawm phau ntawv DMC/DMC-ODS tam sim no muaj cov ncauj lus kom ntxaws txog kev pab nyiaj txiag, suav nrog cov nyiaj pab SGF.
​​ 

Can the Department of Health Care Services (DHCS) provide additional clarification on the impact and operationalization of “zero dollar” contracts? Specifically, how will “zero dollar” contracts be operationalized between DHCS and counties, and how this could impact county contracts with community-based organizations (CBOs)?​​ 

A “zero dollar” approach means there is no need for a fiscal amendment if overall spending as part of the integrated contract is higher than expected. This approach avoids the administrative burden of contract amendments completed by counties and DHCS. The existing Mental Health Plan (MHP) contracts are already “zero dollar” with no issues. Therefore, DHCS does not anticipate any issues with the integrated contracts being zero-dollar. Furthermore, “zero dollar” financing should not have an impact on county contracts with CBOs. All eligible county and provider claims will continue to be paid in accordance with the contract and applicable law.​​ 

 Puas yuav muaj kev sib cog lus thaum ntxov ua rau muaj feem cuam tshuam rau State General Funding (SGF)?​​ 

 California txoj cai lij choj qhia txog cov peev nyiaj uas twb muaj lawm rau kev noj qab haus huv ntawm tus cwj pwm yuav raug siv los txhawb kev noj qab haus huv ntawm lub hlwb thiab/los yog kev siv tshuaj yeeb dej caw. Kev siv cov ntawv cog lus ua ke tsis hloov pauv SGF kev koom tes rau cov kev pabcuam tshwj xeeb thiab cov pejxeem.​​ 

 Puas yuav Block Grant kev faib tawm txawv rau cov nroog uas koom ua ke cov ntawv cog lus ntxov? Yog tias muaj, cov ntsiab lus tuaj yeem muab qhia txog yuav ua li cas qhov no yuav ua raws li daim ntawv cog lus ua ke?​​ 

 Funding allocations and restrictions will not be modified or adjusted through CalAIM Behavioral Health Administrative Integration and will continue to necessitate dual processes for certain fiscal and accounting functions at the county level.​​ 

 Raws li cov ntawv cog lus sib koom ua ke, cov nroog yuav thov li cas rau cov nuj nqis uas cuam tshuam nrog cov kev pabcuam Medi-Cal, kev pov hwm zoo & tshuaj xyuas kev siv (QA/UR), kev cog lus ntsig txog kev tswj hwm, thiab Mental Health Medi-Cal Kev Tswj Xyuas Kev Ua Haujlwm (MH MAA)?​​ 

  • Covered Medi-Cal Services for Members. Under the integrated contract, providers will continue to bill Medi-Cal behavioral health services to the appropriate program SMHS, DMC, or DMC-ODS), and counties will continue to use program-specific codes when they submit claims to DHCS for expenses related to those covered services. Adopting an integrated contract under Behavioral Health Administrative Integration does not require counties to make any changes to provider reimbursement rates, nor to the financing approach for the county’s share of Medi-Cal expenses.​​ 
  • QA/UR thiab Daim Ntawv Cog Lus Txog Kev Tswj Xyuas Kev Ua Haujlwm. DHCS yuav siv cov kev thov sib koom ua ke rau QA / UR thiab cov haujlwm tswj hwm. Hauv txhua pawg, cov nroog yuav tshaj tawm tag nrho cov nqi tsim nyog raws li daim ntawv cog lus sib koom ua ke (txawm tias lub nroog tseem tuaj yeem taug qab cov kev pabcuam tshwj xeeb rau lawv lub hom phiaj yog tias lawv xav tau). Lub nroog yuav tsum cais tawm cov kev siv nyiaj uas tsim nyog rau lub xeev cov nyiaj txiag raws li Txoj Cai 30.​​ 
  • MH MAS. Lub nroog tseem yuav thov nyiaj rov qab los ntawm MH MAA cov txheej txheem thov raws li lawv tam sim no thov nyiaj rov qab.​​     

24/7 Access Line​​ 

Rau txoj kab sib txuas 24/7, Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) puas xav kom cov nroog siv tus lej xov tooj hauv zos, lossis lawv puas tuaj yeem siv tus xov tooj hu dawb?​​ 

Raws li DHCS Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv Kev Sib Koom Tes, cov nroog nrog cov ntawv cog lus sib koom ua ke yuav ua kom muaj kev sib koom ua ke 24/7, uas txhais tau hais tias cov tswv cuab tuaj yeem hu rau ib tus lej txhawm rau nkag mus rau cov ntaub ntawv hais txog ob qho kev pabcuam tshwj xeeb rau kev puas hlwb (SMHS) thiab kev siv tshuaj tsis zoo (SUD). Rau kev yeem koom ua ke hauv xyoo 2025, DHCS tsis yog tam sim no tawm tswv yim lwm yam kev hloov pauv rau kev nkag mus rau cov kab uas yuav tsum tau ua. Cov nroog tuaj yeem txuas ntxiv siv tus lej xov tooj hauv zos lossis tus xov tooj hu dawb rau lawv cov kab sib txuas 24/7, ua raws li cov kev xav tau tam sim no, tsuav yog lawv muab ib tus xov tooj hu dawb rau SMHS thiab SUD cov kev pabcuam.​​ 

Puas yog kev sib koom ua ke 24/7 cov kab nkag yuav tsum tau ua los ntawm lub nroog, lossis cov nroog puas tuaj yeem siv cov neeg muag khoom / cov neeg ua haujlwm sub?​​ 

Cov nroog uas muaj cov ntawv cog lus sib koom ua ke yuav cia siab tias yuav ua haujlwm ib leeg, 24-teev kev nkag mus rau txhua tus tswvcuab Medi-Cal nrhiav kev pabcuam kev noj qab haus huv, kom lawv tuaj yeem raug sim thiab tshuaj xyuas kom zoo rau kev noj qab haus huv thiab kev noj qab haus huv xav tau, thiab teem sijhawm rau kev teem sijhawm tsim nyog raws li ib feem ntawm tib qho kev hu, tsis tas yuav hu xovtooj thiab hu xovtooj ntxiv. Cov nroog tuaj yeem txuas ntxiv siv cov neeg muag khoom / cov neeg ua haujlwm ua haujlwm rau cov neeg ua haujlwm thiab ua haujlwm lawv 24/7 tus xov tooj hu dawb.​​ 

Kev sib faib ntaub ntawv & Tsis pub twg paub​​ 

Raws li kev cog lus sib koom ua ke, 42 Txoj Cai Tswjfwm Ntiag Tug (CFR) Qhov 2 kev tiv thaiv kev siv tshuaj yeeb (SUD) cov ntaub ntawv puas siv tau rau tag nrho Cov Kev Npaj Noj Qab Haus Huv (BHP)?​​ 

  1. The integrated Behavioral Health Plan (BHP) contract does not require the county’s entire BHP to comply with 42 CFR Part 2 (“Part 2″) protections for SUD data. Counties have the ability to designate a “Part 2 Component” within their integrated BHP, just as counties currently designate Part 2 and non-Part-2 Components within the overall county government. Only the Part 2 Component must comply with Part 2 requirements for patient consent, over and above baseline requirements under the Health Insurance Portability and Accountability Act (HIPAA) privacy rule.​​ 
    • Under an integrated BHP contract, the Part 2 Component must include, at a minimum, county-operated and county-employed SUD providers, and any others who meet the federal definition of a “Part 2 Program” (e.g., people or entities that hold themselves out as providing, and provide, SUD diagnosis, treatment, or referral for treatment.) See below for the complete definition. If a large provider offers a mix of SUD and non-SUD services, it may be possible to designate specific individuals or units within that provider in the Part 2 Component, without making the entire provider subject to Part 2.​​ 
    • Hauv kev xaiv lub nroog, cov nroog tuaj yeem xaiv suav nrog lub nroog SMHS cov chaw muab kev pabcuam hauv lawv Tshooj 2. Lub nroog tuaj yeem xav ntsuas qhov xwm txheej xws li cov hauv qab no:​​ 
      • suav nrog SMHS cov chaw muab kev pabcuam hauv Tshooj 2 Cov Txheej Txheem yuav pab txhawb kev sib koom cov ntaub ntawv ntawm SMHS thiab SUD cov kev saib xyuas. Qhov no tuaj yeem tshem tawm qhov xav tau kev tso cai ntxiv rau tus neeg mob thiab cov foob pob hluav taws hauv Electronic Health Records (EHRs) vim tias Tshooj 2 qhov kev tso cai yuav tsis siv rau kev sib faib cov ntaub ntawv hauv Tshooj 2 Cov ntsiab lus rau kev kuaj mob, kev kho mob, lossis kev xa mus rau kev kho mob.​​ 
      • suav nrog SMHS cov chaw muab kev pabcuam hauv Tshooj 2 Cov Txheej Txheem muab lawv rau Tshooj 2 qhov yuav tsum tau ua thaum sib qhia cov ntaub ntawv nrog cov tib neeg lossis cov chaw sab nraud ntawm Tshooj 2 Cov Khoom.​​ 
    • The Part 2 Program definition does not include the administrative functions performed by health plans. Therefore, as counties decide which individuals, entities, and functions to include under their Part 2 Components, they are likely not required to include county staff activities that relate to administration of the Medi-Cal BHP (as opposed to activities performed by county-operated providers that relate to SUD diagnosis, treatment, or referral).​​ 
    • Part 2 governs the flow of information. Therefore, counties are not required to maintain physical separation between individuals and entities that are/aren’t subject to Part 2, as long as the county has implemented appropriate firewalls to ensure that individuals outside the Part 2 Component are not able to access protected Part 2 information without the necessary member consent.​​ 
    • California Health and Safety Code (H&S) section 11845.5 still applies to SUD services that are not provided through Medi-Cal. Welfare and Institutions Code section 14184.102(j) exempts CalAIM from H&S 11845.5. CalAIM captures substantially all of Medi-Cal.​​  

Definition of a “Part 2 Program”​​ 

Part 2 does not apply to all SUD information. Rather, Part 2 requirements apply to records that (1) reveal information about a patient’s SUD conditions or treatment, and (2) are held by a “Part 2 Program.” A Part 2 Program is defined as any of the following people/entities who receive federal funding (including Medicaid reimbursement):1​​ 

  1. An individual or entity (other than a general medical facility) who holds itself out as providing and provides SUD diagnosis, treatment, or referral for treatment; or​​ 
  2. Hauv ib lub chaw kho mob dav dav:​​ 
    • Ib lub subunit uas tau txheeb xyuas uas tuav nws tus kheej los muab thiab muab SUD kuaj mob, kho, lossis xa mus; los yog​​ 
    • Medical personnel or other staff in a general medical facility whose primary function is the provision of SUD diagnosis, treatment, or referral and who are identified as such providers. 

      According to Substance Abuse and Mental Health Services Administration (SAMHSA), a provider may “hold itself out” as providing SUD services if it, among other activities, obtains a state license specifically to provide SUD services, advertises SUD services, has a certification in addiction medicine, or posts statements on its website about the SUD services it provides.2 

      1 42 C.F.R. § 2.11

      2 SAMHSA, Substance Use and Confidentiality Regulations (October 27, 2023), https://www.samhsa.gov/about-us/who-we-are/laws-regulations/confidentiality-regulations-faqs​​ 

Under integrated contracts, will 42 Code of Federal Regulations (CFR) Part 2 data protections impact a county’s ability to co-locate specialty mental health services (SMHS) and substance use disorder (SUD) programs?​​ 

Part 2 compliance focuses on flows of information, not physical barriers. Therefore, Part 2 does not prevent co-location of providers as long as minimum Part 2 requirements are met (e.g., firewalls between staff or electronic health record (EHR) systems that are/aren’t part of the Part 2 Component).​​ 

Raws li cov nroog siv kev coj cwj pwm kev noj qab haus huv kev sib koom ua ke, DHCS tuaj yeem muab kev pab cuam dab tsi los txhawb cov nroog hauv kev tswj xyuas kev ua raws li 42 CFR Tshooj 2 cov cai nyob ib puag ncig cov ntaub ntawv tsis pub lwm tus paub txog kev siv yeeb tshuaj?​​ 

DHCS is committed to ensuring that behavioral health data are shared and stored as efficiently as possible while maintaining privacy protections for members, including the federal “Part 2″ confidentiality rules for substance use disorder-related information. To support county programs and behavioral health providers in maintaining compliance with 42 CFR Part 2 and other privacy laws as they advance data sharing capabilities and practices, DHCS is exploring opportunities for developing a template “universal release” form (the ASCMI form, see question below) that can be used to obtain individual authorizations for data sharing, including sharing with MCPs and other service providers. DHCS will also consider other opportunities for guidance, and potentially shared learning or other technical assistance, throughout the implementation period.​​ 

Qhov Kev Tso Cai Qhia Txog Cov Ntaub Ntawv Qhia Txog Medi-Cal (ASCMI) Pilot tam sim no ua tau zoo li cas nrog Kev Tswj Xyuas Kev Noj Qab Haus Huv?​​ 

The ASCMI Initiative seeks to promote coordinated, person-centered care for Medi-Cal members by providing tools that streamline consent to share health and social services information, including mental health and substance use disorder information. The ASCMI tools include the ASCMI Form (standardized release of information form) and the Consent Management Platform (electronic platform that will store and manage a member’s data sharing consent preferences). DHCS envisions Medi-Cal members and providers would be able to access the Consent Management Platform to view, submit, modify, or revoke consent enabling seamless data sharing under Behavioral Health Administrative Integration.​​ 

DHCS tau ua cov kws tsav dav hlau hauv peb lub tebchaws hauv 2023 los ntsuas kev txaus siab thiab kev txais tos rau ASCMI cov cuab yeej. Saib ASCMI Pilot Evaluation Report kom paub ntau ntxiv. Siv cov lus tawm tswv yim thiab cov lus qhia uas tau kawm los ntawm tus tsav, DHCS tab tom kho daim ntawv ASCMI thiab tsim cov qauv tsim, kev pab nyiaj txiag, kev npaj ua tiav rau lub Xeev Kev Pom Zoo Kev Tswj Xyuas Platform. Daim ntawv ASCMI tau ua kom zoo thiab cov ntsiab lus ntxiv txog Kev Pom Zoo Kev Tswj Xyuas Platform yuav raug tso tawm xyoo 2025.
​​ 

Yuav Ua Li Cas Kom Paub Txog Tus Cwj Pwm Saib Xyuas Kev Noj Qab Haus Huv Cov Ntaub Ntawv Txoj Haujlwm ua raws li Kev Coj Tus Cwj Pwm Kev Tswj Xyuas Kev Noj Qab Haus Huv?​​ 

Txoj Haujlwm Kev Cuam Tshuam Txog Tus Cwj Pwm Kev Noj Qab Haus Huv yog npaj los txheeb xyuas cov kev daws teeb meem thev naus laus zis los hloov kho tshiab thiab hloov kho cov ntaub ntawv sau thiab tshaj tawm, tshuaj xyuas, thiab lwm yam haujlwm ntsig txog cov ntaub ntawv, thiab tsim kom muaj kev tshaj tawm thiab tshuaj xyuas platform uas sib xyaw cov ntaub ntawv los ntawm 12 cov ntaub ntawv kev noj qab haus huv uas twb muaj lawm. DHCS yuav koom tes sab hauv thiab nrog cov neeg muaj feem cuam tshuam los xyuas kom muaj kev sib koom ua ke ntawm kev ua kom tiav Cov Ntaub Ntawv Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv thiab Kev Coj Tus Cwj Pwm Kev Noj Qab Haus Huv.​​ 

Cultural Competence Plans​​ 

Cov nroog puas yuav tau txais cov qauv lossis cov lus qhia los pab tsim cov phiaj xwm kev coj noj coj ua zoo ib yam thiab muaj txiaj ntsig?​​ 

Yog lawm. DHCS tab tom tab tom tsim cov qauv kev coj ua kev cai lij choj ua ke rau kev siv hauv nroog.​​ 

Kev Ntsuam Xyuas Sab Nraud Zoo (EQR)​​ 

Cov Kev Ntsuam Xyuas Sab Nraud Zoo (EQRs) yuav ua haujlwm li cas hauv kev sib cog lus?​​ 

Raws li kev cog lus sib koom ua ke, Lub Nroog Lub Tsev Muag Tshuaj Medi-Cal Organized Delivery System (DMC-ODS) yuav dhau los ua ib qho kev sib koom ua ke EQR uas hais txog ob qhov Kev Pabcuam Kev Mob Siab Tshwj Xeeb (SMHS) thiab DMC-ODS. Lub nroog Medi-Cal (DMC) yuav tau txais EQR txuas ntxiv rau lawv cov haujlwm SMHS nkaus xwb.​​ 

How will DHCS ensure that the integrated EQR process includes adequate focus on both mental health and substance use disorder priorities aren’t lost in the aim to have an integrated EQR?​​ 

DHCS designs its EQR approach across all programs (SMHS, SUD, Managed Care and Dental) in compliance with federal regulations at Title 42, Part 437, Subpart E of the Code of Federal Regulations.
With respect to the integrated behavioral health EQR under Behavioral Health Administrative Integration, DHCS will work with stakeholders to ensure that EQR—and other oversight mechanisms—include appropriate measures regarding the provision of high-quality mental health and substance use disorder treatment services, including services to treat co-occurring conditions.​​ 

Raws li cov phiaj xwm Kev Puas Siab Puas Ntsws (MHPs) thiab Cov Tshuaj Kho Mob Medi-Cal Cov Txheej Txheem Kev Xa Khoom (DMC-ODS) cov ntawv cog lus, cov nroog yuav tsum ua kom tiav ib txoj haujlwm kho mob txhim kho (PIP) thiab ib qho PIP uas tsis yog chaw kho mob rau txhua qhov haujlwm, tag nrho plaub PIPs. Raws li kev cog lus sib koom ua ke, cov nroog puas tseem yuav tsum ua kom tiav plaub PIPs?​​ 

Txhua lub nroog uas muaj cov ntawv cog lus sib koom ua ke yuav tsum tau siv tsawg kawg ob PIPs: ib qho chaw kho mob PIP thiab ib qho PIP uas tsis yog chaw kho mob, raws li tsoomfwv txoj cai lij choj.​​ 


  • Rau cov nroog DMC-ODS kev koom ua ke, PIPs yuav muaj feem xyuam rau cov kev pabcuam tshwj xeeb rau kev puas hlwb (SMHS), DMC-ODS, lossis ob qho tib si.​​ 



  • Rau cov nroog koom ua ke Cov Tshuaj Medi-Cal (DMC), ob qho tib si PIPs yuav tsum muaj feem xyuam rau SMHS, uas muaj peev xwm suav nrog kev saib xyuas tshwj xeeb rau cov tswv cuab uas muaj kev xav tau ntawm kev siv tshuaj yeeb (SUD).​​ 


Raws li cov ntawv cog lus uas twb muaj lawm, DHCS yuav xav kom cov nroog koom ua ke kom ua tiav cov PIPs tshwj xeeb thiab / lossis PIPs ntxiv.​​ 

Compliance Reviews (or “BH Audits”)​​ 

What will counties’ compliance reviews look like under Behavioral Health Administrative Integration?​​ 

As part of Behavioral Health Administrative Integration, DHCS will develop a streamlined compliance review for both SMHS and SUD. Adopting integrated reviews will be one of several policy changes that DHCS will implement to restructure and refocus SMHS and DMC/DMC-ODS compliance reviews (or “BH audits”) to support CalAIM goals. DHCS will continue to release guidance on these policy updates and will seek feedback on options for streamlining or integrating compliance monitoring during stakeholder engagement for BH Administrative Integration.​​ 

Yuav ua li cas kev soj ntsuam Kev Noj Qab Haus Huv (BH) ua haujlwm raws li kev cog lus sib koom ua ke ntawm cov qauv thiab zaus?​​ 

Cov nroog uas muaj cov ntawv cog lus sib koom ua ke yuav tau txais kev soj ntsuam txhua xyoo BH uas ntsuas kev ua raws li daim ntawv cog lus sib koom ua ke, suav nrog cov ntsiab lus tshwj xeeb rau cov kev pabcuam tshwj xeeb rau kev puas hlwb (SMHS) thiab cov kev pabcuam tshuaj siv tshuaj (SUD). Cov txheej txheem kev sib koom ua ke no yuav siv tau rau ob qho tib si Drug Medi-Cal Organized Delivery System (DMC-ODS) thiab Drug Medi-Cal (DMC) counties thiab yuav txuas ntxiv ua raws li lub xeev lub xyoo nyiaj txiag (SFY) raws li lub sijhawm teem sijhawm thiab tshuaj xyuas. Kev sib koom ua ke BH kev tshuaj xyuas yuav ua raws li txoj hauv kev uas yog lub nroog tshwj xeeb raws li tau piav qhia hauv BHIN 23-044.​​ 

Puas yog Kev Tshawb Fawb Txog Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv (BH) puas suav nrog kev tshuaj xyuas txog Kev Tiv Thaiv Kev Siv Tshuaj, Kev Kho Mob thiab Kev Pabcuam Rov Qab Block Grant (SUBG) ntxiv rau Cov Kev Pabcuam Tshwj Xeeb Mental Health (SMHS) thiab Tshuaj Medi-Cal (DMC)/Drug Medi-Cal Organized Delivery System (DMC-ODS) cov kev pabcuam?​​ 

Tam sim no, DHCS ua kev tshuaj xyuas kev ua raws cai txhua xyoo rau SUBG tib lub sijhawm rau DMC/DMC-ODS. Nyob rau lub sijhawm no, DHCS cia siab tias SUBG cov kev tshuaj xyuas yuav raug muab ua ke nrog kev sib koom ua ke ntawm BH kev tshuaj xyuas, suav nrog kev tshuaj xyuas kev ua raws cai txhua xyoo nrog tsawg kawg ib qho kev tshuaj xyuas ntawm qhov chaw txhua peb xyoos. DHCS yuav tshaj tawm cov lus qhia ntxiv txog kev ua kom zoo thiab ua kom muaj kev saib xyuas thoob plaws cov kev pabcuam kev noj qab haus huv.​​ 

DHCS npaj siab ua haujlwm li cas rau Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv (BH) tshawb xyuas nyob rau lub sijhawm thiab qhov twg / yuav ua li cas qee qhov kev tshuaj xyuas yuav raug muab ua ke los ua kom cov lus teb zoo dua? rau cov nroog uas koom ua ke cov ntawv cog lus ntxov? ? Kev qhia meej tuaj yeem muab rau ntawm lub sijhawm thiab qhov twg / yuav ua li cas cov kev tshuaj xyuas yuav raug muab sib xyaw ua kom cov lus teb zoo dua?​​ 

 Counties with integrated contracts will receive annual, integrated BH audits effective January 1, 2026 (after the integrated contracts have been in effect for a full year). Following the effective date, these counties will be audited according to the requirements outlined in the integrated contract and will receive a single, integrated findings report. Integrated BH audits will continue to follow the state fiscal year in terms of scheduling and review periods. BH audits will follow the systemic county-specific approach, as described in BHIN 23-044.​​ 

Network txaus​​ 

Yuav ua li cas kev koom ua ke cov ntawv pov thawj txaus txaus ua haujlwm?  Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) puas xav kom cov nroog xa tawm ob qho tib si txhua xyoo Network Adequacy Certification Tool (NACT) thiab cov ntaub ntawv nkag mus raws sijhawm ntxiv rau txhua hli 274 Electronic Data Interchange (274 tus qauv) cov ntaub ntawv network?​​ 


  • Rau cov nroog uas muaj cov ntawv cog lus sib koom ua ke, DHCS yuav ua daim ntawv pov thawj kev tsim nyog hauv lub network txhua xyoo los ntawm ib qho txheej txheem qhia kev sib koom ua ke. Cov nroog yuav ua kom tiav ib qho kev sib koom ua ke rau kev sib txuas lus txaus (siv 274 tus qauv piav qhia hauv BHIN 23-042) thiab kev qhia txog kev nkag mus raws sijhawm. Cov ntawv xa tuaj no yuav ua raws li lub xeev lub xyoo nyiaj txiag (SFY). Rau kev yeem koom ua ke hauv 2025, DHCS tsis tam sim no tab tom thov kev hloov pauv tseem ceeb rau cov qauv rau kev sib txuas lus txaus lossis kev nkag tau raws sijhawm.​​  



    • Drug Medi-Cal Organized Delivery System (DMC-ODS) counties thiab Mental Health Plans (MHPs) yuav tsum xa cov ntaub ntawv pov thawj Network Adequacy rau ob qho kev pabcuam tshwj xeeb rau kev puas siab puas ntsws (SMHS) thiab kev siv tshuaj tsis zoo (SUD) txhua xyoo raws li tau piav qhia hauv BHIN 25-013. DHCS yuav ua daim ntawv pov thawj network txhua xyoo los ntawm ib qho kev qhia ua ke, suav nrog kev sib sau ua ke ntawm 274 Electronic Data Interchange (274 tus qauv) tus neeg muab kev pabcuam network cov ntaub ntawv.​​ 

      • DMC-ODS cov nroog kuj tseem yuav raug xa mus rau cov chaw muab kev pabcuam network rau DHCS siv 274 tus qauv txhua hli raws li tau piav qhia hauv BHIN 25-013. Thaum DHCS yuav siv 274 tus qauv cov ntaub ntawv los ntsuas kev ua raws li kev sib txuas lus tsim nyog rau DMC-ODS cov nroog nrog cov ntawv cog lus sib koom ua ke, 274 tus qauv yuav tsis raug hloov NACT ua qhov tseem ceeb rau kev tshuaj xyuas rau cov nroog uas tsis koom nrog DMC-ODS kom txog rau thaum DHCS teeb tsa BHIN lossis lwm yam kev taw qhia txog kev hloov pauv ntawm lub nroog. Tom qab lub sijhawm xa ntawv, DHCS yuav muab txhua lub nroog nrog cov ntaub ntawv tshawb pom sib xyaw uas piav qhia seb puas muaj cov qauv kev tsim nyog hauv lub network tau ua tiav rau txhua qhov yuav tsum tau ua.​​ 




    Rau Lub Nroog Medi-Cal (DMC), DHCS tsuas yog yuav tsum xa cov ntaub ntawv nkag mus rau Sijhawm Sijhawm (TADT), uas yuav suav nrog cov ntaub ntawv nkag mus rau SUD thiab SMHS raws sijhawm. DHCS tseem yuav xav kom cov ntaub ntawv txuas ntxiv txaus thiab cov ntaub ntawv xa mus rau SMHS. Integrated reports detailing network certification nrhiav tau yuav raug xa mus rau DMC counties nrog integrated daim ntawv cog lus, tab sis tsuas yog lub sij hawm nkag mus rau cov qauv kev soj ntsuam yuav siv tau rau SUD cov kev pab cuam. Cov txiaj ntsig ntxiv yuav siv rau SMHS nkaus xwb.
    ​​ 


Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) puas yuav kho lossis hloov cov txheej txheem uas siv los ntsuas kev tsim nyog hauv lub network raws li kev cog lus ua ke?​​ 

DHCS yuav tsis hloov cov txheej txheem uas siv los txiav txim siab txog kev ua raws li kev sib txuas lus txaus rau Kev Siv Tshuaj Medi-Cal Organized Delivery System (DMC-ODS) cov nroog uas yeem xaiv los siv cov ntawv cog lus sib koom ua ke pib txij lub Ib Hlis Ntuj 1, 2025. DHCS yog qhib rau cov lus tawm tswv yim los ntawm cov nroog thiab lwm tus neeg muaj feem cuam tshuam txog qhov tsim nyog ntawm cov kev hloov kho tseem ceeb rau cov qauv tsim nyog hauv lub network tam sim no tau teev tseg hauv BHIN 23-041, xws li kev ua kom cov txheej txheem muaj peev xwm hla cov kev pabcuam tshwj xeeb rau kev puas siab puas ntsws (SMHS) thiab cov kev pabcuam tshuaj siv tshuaj tsis zoo (SUD), nrog rau kev tswj hwm kev tswj xyuas kev sib txuas lus ntxiv.
​​ 

Yog hais tias lub nroog tsis ua raws li qhov yuav tsum tau muaj nyob hauv lub network, Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) puas yuav teeb tsa Cov Kev Npaj Ua Haujlwm Kho Kho (CAPs)? Puas yuav tshaj tawm thiab cov CAP uas muaj peev xwm ua tau ib qho, lossis puas yuav xav tau rau ob qho tib si Mental Health Plan (MHP) thiab Drug Medi-Cal Organized Delivery System (DMC-ODS) cais?​​ 

Rau cov nroog uas muaj cov ntawv cog lus sib koom ua ke uas tsis ua raws li ib lossis ntau qhov kev xav tau ntawm lub network txaus, DHCS yuav pom zoo ib leeg, koom ua ke CAP uas hais txog qhov tsis txaus rau ob qho kev pabcuam tshwj xeeb rau kev puas hlwb (SMHS) thiab kev siv tshuaj tsis zoo (SUD), raws li muaj. Nyob ntawm CAP tau pom zoo, DHCS yuav xav tau cov ntaub ntawv xa mus ntxiv los ua kom pom tias ua raws. Lub nroog yuav nyob twj ywm rau ntawm CAP kom txog thaum txhua qhov kev tsis txaus yuav raug tshem tawm.​​  

DHCS yuav ua li cas kom ntseeg tau tias cov txheej txheem tshiab Network Adequacy tseem ua kom pom tseeb txaus rau ob qho tib si kev siv yeeb tshuaj thiab qhov tseem ceeb ntawm kev noj qab haus huv?​​ 

Thaum cov nroog tau txais kev cog lus sib koom ua ke raws li Kev Tswj Xyuas Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv, lawv yuav ua raws li cov qauv kev tsim nyog hauv lub network uas tswj hwm cov phiaj xwm Kev Puas Siab Puas Ntsws thiab DMC-ODS cov kev pab cuam, uas xav kom cov phiaj xwm muaj kev sib txuas txaus thiab muaj zog, raws li kev noj qab haus huv lossis kev siv tshuaj yeeb. Cov txheej txheem kev tsim nyog hauv lub network uas twb muaj lawm suav nrog kev kwv yees kev noj qab haus huv ntawm lub hlwb thiab kev siv tshuaj yeeb dej caw hauv lawv qhov kev ntsuam xyuas ntawm lub peev xwm network. DHCS yuav ua haujlwm nrog cov neeg muaj feem los saib xyuas cov kev txhawj xeeb kom paub meej txog kev noj qab haus huv ntawm lub hlwb thiab kev siv tshuaj yeeb dej caw kom muaj kev sib koom tes txaus thaum tseem ua rau muaj kev kho mob rau cov xwm txheej tshwm sim.​​ 

Kev saib xyuas tus kws kho mob​​ 

Cov Kev Pabcuam Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv yuav cuam tshuam li cas?​​ 

Qhov kev pib no yuav tsis tso cai hloov pauv cov qauv kev saib xyuas ntawm qib kws kho mob, thiab cov kws kho mob tseem tuaj yeem xaiv seb puas yuav muab kev pabcuam SMHS, DMC/DMC-ODS, lossis ob qho tib si. DHCS cia siab tias cov kev tswj xyuas yooj yim tau ua raws li ib feem ntawm qhov kev pib no yuav tsim kom muaj txiaj ntsig zoo rau cov neeg muab kev pabcuam uas tuaj yeem ua kom yooj yim rau kev koom nrog hauv ob qho tib si SMH thiab DMC/DMC-ODS cov kev pabcuam thiab muab kev pabcuam tshwjxeeb rau kev coj tus cwj pwm yog tias tus kws khomob xaiv ua li ntawd.​​ 

Kev Tswj Xyuas Kev Noj Qab Haus Huv Tus Cwj Pwm yuav cuam tshuam li cas rau kev tshuaj xyuas lossis kev saib xyuas rau Medi-Cal cov kev pabcuam uas tau cog lus nrog cov kev pabcuam tshwj xeeb rau kev puas hlwb (SMHS) thiab cov kev pabcuam tshuaj siv tshuaj (SUD)?​​ 

Raws li cov ntawv cog lus uas twb muaj lawm, Cov Kev Pab Cuam Medi-Cal Organized Delivery System (DMC-ODS) thiab Drug Medi-Cal (DMC) cov kev pab cuam - tab sis tsis yog Mental Health Plans (MHPs) - yuav tsum tau ua txhua xyoo nyob rau ntawm qhov chaw tshuaj xyuas ntawm lawv cov chaw muab kev cog lus. Raws li cov ntawv cog lus sib koom ua ke, cov nroog yuav tsum ua cov hauv qab no rau txhua tus neeg muab kev cog lus thoob plaws txhua qhov kev xa khoom (tshwj tsis yog cov chaw muab kev pabcuam sab nraud uas pabcuam tshwjxeeb kev pabcuam kev puas hlwb (SMHS) lossis DMC-ODS cov tswvcuab):​​ 

  • Ua raws li kev tshuaj xyuas txhua xyoo (lub rooj lossis ntawm qhov chaw)​​ 
  • Ua raws li kev soj ntsuam ntawm qhov chaw tsawg kawg ib zaug txhua 3 xyoos rau cov koom haum muab kev pabcuam (tab sis tsis yog rau ib tus neeg SMHS cov kws kho mob uas cog lus ncaj qha nrog lub nroog)​​ 
  • Xa ib daim qauv ntawm kev saib xyuas thiab soj ntsuam cov ntawv ceeb toom rau DHCS nyob rau hauv ob lub lis piam ntawm kev tshaj tawm​​ 
  • Ua raws li cov txheej txheem txheej txheem rau:​​ 
    • Counties Corrective Action Plan (CAP) cov txheej txheem rau cov kws kho mob tsis txaus (raws li cov txheej txheem DMC-ODS/DMC tam sim no)​​ 
    • Rau SUD cov chaw muab kev pab, California Outcomes Measurement System (CalOMS) thiab Drug and Alcohol Treatment Access Report (DATAR) cov cai (tam sim no ua qauv thoob plaws DMC thiab DMC-ODS cov kev pab cuam).​​ 

Txhawm rau ua kom tau raws li tus kws kho mob saib xyuas cov cai, cov nroog puas tuaj yeem lees txais Cov Kev Pabcuam Kev Puas Siab Puas Hlwb Tshwj Xeeb (SMHS) kev soj ntsuam ua tiav los ntawm lwm lub nroog?​​ 

Yes. Under the integrated contract, counties must conduct annual compliance reviews and triennial on-site reviews for most network providers. Currently, for Drug Medi-Cal (DMC) providers, counties are able to accept a compliance review conducted by another county. This avoids duplicative reviews for providers that participate in multiple counties’ Medi-Cal programs. DHCS is extending this same flexibility to SMHS provider reviews: a county may accept a compliance review completed by another county for a SMHS provider contracted with both counties. DHCS will clarify this policy in a future amendment to the integrated contract.​​ 

How will the transition from fiscal year (FY) to calendar year (CY) contracts impact counties’ provider contracts, provider monitoring, and Corrective Action Plans (CAPs) for providers?​​ 

The transition from fiscal year (FY) to calendar year (CY) contracts does not require any changes to the timing of counties’ provider contracts, provider monitoring, or provider Corrective Action Plans (CAPs). Counties determine the timing of a provider’s review based on when that provider’s last review occurred. The provider review timing is not reset under the integrated contract.​​ 

Puas muaj kev cia siab tias yuav hloov pauv rau Medi-Cal cov cuab yeej ntawv pov thawj qhov chaw uas twb muaj lawm? Cov nroog puas yuav muaj lub luag haujlwm rau kev lees paub Cov Kev Pabcuam Kev Noj Qab Haus Huv Medi-Cal Organized Delivery System (DMC-ODS) zoo ib yam li cov kev pabcuam tshwj xeeb rau kev puas hlwb tam sim no (SMHS)?​​ 

Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) yuav txuas ntxiv ua pov thawj rau cov chaw kho mob uas tau cog lus Medi-Cal (DMC) thaum lub nroog yuav lees paub cov chaw kho mob tshwj xeeb uas muaj kev puas siab puas ntsws (SMHS). DHCS tsis cia siab tias yuav muaj kev hloov pauv rau qhov chaw muab ntawv pov thawj cov cuab yeej.​​ 

Cov qauv rau Cov Kev Pabcuam Kev Noj Qab Haus Huv Tshwj Xeeb thiab Kev Pabcuam​​ 

Clinical Trainee yog dab tsi?​​ 

Supplements 3 and 7 to Attachment 3.1-A of the Medicaid State Plan defines Clinical Trainee as an unlicensed individual who is enrolled in a post-secondary educational program that is required for the individual to obtain licensure as a Licensed Mental Health Professional or Licensed Practitioner of the Healing Arts; is participating in a practicum, clerkship, or internship approved by the individual’s program; and meets all relevant requirements of the program and/or applicable licensing board to participate in the practicum, clerkship or internship and provides rehabilitative mental health services or substance use disorder treatment services, including, but not limited to, all coursework and supervised practice requirements.​​  

Cov kws kho mob puas tuaj yeem tawm ntawm lawv qhov kev zov me nyuam tuaj yeem muab kev pabcuam tshwj xeeb rau kev coj tus cwj pwm?​​    

Clinical Trainees who are on leave of absence from their program may be reimbursed for providing Medi-Cal specialty behavioral health services if the following conditions are met:​​  

  • They are still enrolled in a post-secondary educational program, such as those offered by a university, community college, or vocational school, that is required for the individual to obtain licensure as a Licensed Mental Health Professional (LMHP) or Licensed Practitioner of the Healing Arts (LPHA)​​  
  • They are providing services as part of a practicum, clerkship, or internship approved by the individual’s program; and​​   
  • They meet all relevant program requirements and/or applicable licensing board requirements to participate in the practicum, clerkship, or internship, including all coursework and supervised practice requirements.​​  

Please refer to Supplements 3 and 7 to Attachment 3.1-A of the Medicaid State Plan and Behavioral Health Information Notice (BHIN) 24-023 for additional information on Clinical Trainees.​​  

Cov tib neeg uas tab tom ua haujlwm rau Clinical Social Worker (CSW), Kev Sib Yuav thiab Tsev Neeg Therapist (MFT), lossis Cov Kws Pab Tswv Yim Kho Mob (PCC) daim ntawv tso cai tuaj yeem muab kev pabcuam tshwj xeeb rau kev coj tus cwj pwm thaum lawv daim ntawv thov koom nrog tseem tos?​​   

Yes. Behavioral Health Information Notice (BHIN) 24-023 clarifies that behavioral health plans may allow CSW, MFT, and PCC candidates who have graduated from a master’s program to provide and bill for specialty behavioral health services as an Associate CSW, Associate MFT, or Associate PCC if they have submitted their application for associate registration to the California Board of Behavioral Sciences (BBS) within 90-days of their degree award date and are completing supervised experience toward licensure. Department of Health Care Services (DHCS) will reimburse for services rendered while their BBS application is pending, regardless of the number of days it takes for BBS to approve the application.​​  

Please refer to Business and Professions Code (BPC) for CSWs (BPC 4996.23), MFTs (BPC 4980.43), and PCCs (BPC 4999.46), as well as guidance published by BBS for additional information regarding requirements of the “90 Day Rule.”​​  

Puas yog lub nroog cov phiaj xwm kev noj qab haus huv hauv nroog (BHPs) yuav tsum tso cai rau Cov Kws Kho Mob lossis Cov Neeg Ua Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (CSW), Kev Sib Yuav thiab Tsev Neeg Therapist (MFT), lossis Tus Kws Pab Tswv Yim Kho Mob (PCC) cov neeg sib tw los muab cov kev pabcuam tshwj xeeb rau kev coj tus cwj pwm?​​  

Department of Health Care Services (DHCS) encourages county behavioral health plans (BHPs) to utilize provider types that meet the needs of their Medi-Cal members. DHCS allows counties to use Clinical Trainees and individuals who have submitted their application for associate registration to the Board of Behavioral Sciences (BBS) within 90-days of their degree award date to provide certain Specialty Mental Health Services (SMHS) and Drug Medi-Cal-Organized Delivery System (DMC-ODS) services as outlined in Behavioral Health Information Notice (BHIN) 24-023. DHCS does not require counties to use Clinical Trainees or individuals who are in the process of registration but have not yet received confirmation of associate registration from BBS. BHPs have discretion to determine their provider networks and specify contract terms.​​   

Please refer to Supplements 3 and 7 to Attachment 3.1-A of the Medicaid State Plan and BHIN 24-023 for additional information on Clinical Trainees and individuals who are in the process of obtaining their associate registration through BBS. 
​​ 

Dab tsi yog qhov sib txawv ntawm Daim Ntawv Tso Cai Kev Kho Mob Mob Siab (LMHP) thiab Tus Kws Kho Mob Kho Mob (LPHA)?​​  

Use of Licensed Mental Health Professional (LMHP) and Licensed Practitioner of the Healing Arts (LPHA) varies by behavioral health delivery system.​​   

LMHP is a term used in the Specialty Mental Health (SMH) delivery system to identify a select group of provider types that provide rehabilitative mental health services. An LMHP includes the following providers:​​   

  • Licensed Physicians​​ 
  • Licensed Psychologists (includes Waivered Psychologists),​​   
  • Licensed Clinical Social Workers (includes Waivered or Registered Clinical Social Workers),​​   
  • Licensed Professional Clinical Counselors (includes Waivered or Registered Professional Clinical Counselors),​​   
  • Licensed Marriage and Family Therapists (includes Waivered or Registered Marriage and Family Therapists),​​  
  • Registered Nurses (includes Certified Nurse Specialists and Nurse Practitioners),​​  
  • Licensed Vocational Nurses,​​    
  • Licensed Psychiatric Technicians, and​​   
  • Licensed Occupational Therapists.​​  

LPHA is a term used in the Drug Medi-Cal (DMC) and Drug Medi-Cal Organized Delivery System (DMC-ODS) to identify a select group of provider types that provide substance use disorder (SUD) and expanded SUD treatment services, respectively. An LPHA includes the following providers:​​  

  • Physician,​​  
  • Nurse Practitioner,​​ 
  • Physician Assistant,​​ 
  • Registered Nurse,​​   
  • Registered Pharmacist,​​ 
  • Licensed Clinical Psychologist,​​   
  • Licensed or Registered Clinical Social Worker,​​  
  • Licensed or Registered Professional Clinical Counselor,​​  
  • Licensed or Registered Marriage and Family Therapist,​​ 
  • Daim Ntawv Tso Cai Ua Haujlwm Ua Haujlwm,​​  
  • Daim Ntawv Tso Cai Ua Haujlwm Kho Mob, thiab​​   
  • Daim ntawv tso cai Psychiatric Technician.​​  

Please refer to Supplements 3 and 7 to Attachment 3.1-A of the Medicaid State Plan for additional information on LMHPs and LPHAs.​​   

Thaum twg "90 Hnub Txoj Cai" pib rau Clinical Social Worker (CSW), Kev Sib Yuav thiab Tsev Neeg Therapist (MFT), thiab Cov Kws Pab Tswv Yim Kho Mob (PCC) cov neeg sib tw?​​   

The “90 Day Rule” set by the California Board of Behavioral Sciences (BBS) allows candidates to count supervised experience toward licensure when gained during the window of time between the degree award date and the issue date of the associate registration number. To be eligible for the 90 Day Rule, a Clinical Social Worker (CSW), Marriage Family Therapist (MFT), or Professional Clinical Counselor (PCC) candidate must submit their application for associate registration to the BBS within 90-days of their degree award date. Degree award date may vary by educational program but is typically defined as the final day of the term in which the student completes all requirements to graduate from their program.​​   

Please refer to Business and Professions Code (BPC) for CSWs (BPC 4996.23), MFTs (BPC 4980.43), and PCCs (BPC 4999.46), as well as guidance published by BBS for additional information regarding requirements of the “90 Day Rule.”​​  

Cov nroog puas yuav suav cov kws muag tshuaj tom qab kawm tiav raws li Cov Kws Kho Mob rau cov hom phiaj ntawm Medi-Cal thov lossis muab kev pabcuam?​​ 

Tsis tau. Lub nroog yuav tsum xyuas kom meej tias txhua tus kws kho mob (CTs) raug xaiv ua tau raws li tag nrho cov kev tsim nyog tau txais CT, suav nrog kev nkag mus rau hauv ib qho kev kawm, raws li BHIN 24-043, SPA 23-0026, thiab SPA 24-0041. Piv txwv li, cov kws muag tshuaj intern uas tau kawm tiav thiab tab tom tos daim ntawv tso cai tag nrho tab sis tam sim no tsis tau cuv npe lossis koom nrog hauv kev kawm txuj ci yuav tsum tsis txhob muab cais ua CTs.​​