Tsev Ceg Haujlwm Tshwj Xeeb Medi-Cal​​ 

Tuam Txhab Tshwj Xeeb Medi-Cal Projects​​ 

Lub Tuam Txhab Tshwj Xeeb Medi-Cal Projects (SMCPB) saib xyuas ntau yam kev coj tus cwj pwm kev noj qab haus huv ntawm California Advancing thiab Innovating Medi-Cal (CalAIM) tsim los pab txhawb txhua tus neeg, kev saib xyuas ua ke; txav txoj kev tswj hwm ntawm Medi-Cal tus cwj pwm kev noj qab haus huv mus rau ib qho kev sib raug zoo thiab tsis sib haum los ntawm kev txo qis thiab ua kom yooj yim dua; thiab txhim kho cov txiaj ntsig tau zoo, txo qis kev noj qab haus huv tsis sib xws, thiab txhawb nqa kev hloov pauv thiab kev tsim kho tshiab los ntawm kev txhim kho rau kev coj tus cwj pwm kev noj qab haus huv cov cai thiab pib ntawm kev hloov pauv tus cwj pwm kev noj qab haus huv. SCPB suav nrog cov kev pib hauv qab no:​​ 

  • California Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT)​​ 
  • Nkag mus rau Cov Txheej Txheem Tshwj Xeeb rau Kev Pabcuam Kev Puas Siab Puas Ntsws​​   
  • Drug Medi-Cal Organized Delivery Systems (DMC-ODS)​​ 
  • Cov Ntaub Ntawv Txog Tus Cwj Pwm Kev Noj Qab Haus Huv Rov Tsim Kho​​ 
  • Tsis Muaj Qhov Rooj Tsis Zoo rau Kev Pabcuam Kev Puas Siab Puas Ntsws thiab Kev Kho Mob tshwm sim​​ 
  • Standardized Screening and Transition of Care Tools (STT) rau Medi-Cal Mental Health Services​​ 
  • Kev Txhaum Txhaum Cai​​ 
  • SMHS/NSMHS Kev xa mus rau tus kws kho mob​​ 
  • Medi-Cal Peer Support Services​​ 

BH-CONNECT Ntu 1 & 2​​ 

BH-CONNECT Sections saib xyuas Cov Cwj Pwm Kev Noj Qab Haus Huv Hauv Zej Zog Kev Sib Koom Tes ntawm Equitable Care and Treatment (BH-CONNECT), uas yog tsim los txhawb kev nkag mus thiab ntxiv dag zog rau kev pabcuam kev noj qab haus huv hauv zej zog txuas ntxiv rau Medi-Cal cov tswvcuab uas nyob nrog kev xav tau kev noj qab haus huv tseem ceeb. BH-CONNECT yog suav nrog kev nthuav qhia tsib xyoos tshiab Medicaid tshooj 1115, Lub Xeev Txoj Kev Hloov Kho (SPAs) kom nthuav dav cov kev pab cuam ntawm Cov Ntawv Pov Thawj-Based Practices (EBPs) muaj nyob rau hauv Medi-Cal, thiab ntxiv cov lus qhia thiab cov cai los txhawb cov kev pabcuam kev noj qab haus huv thoob plaws lub xeev.​​ 

BH-CONNECT nthuav dav kev pabcuam Medi-Cal, txhawb kev txhim kho kev ua haujlwm, thiab txhawb nqa kev ua haujlwm ncaj ncees rau cov qauv kev coj ua pov thawj los txhim kho cov txiaj ntsig rau Medi-Cal cov tswvcuab ntsib qhov tsis ncaj ncees loj tshaj plaws. Yog li ntawd, cov tswv cuab tuaj yeem zam lub chaw saib xyuas xwm txheej ceev uas tsis tsim nyog, mus pw hauv tsev kho mob, thiab cov neeg mob hauv tsev kho mob lossis cov chaw nyob hauv tsev nyob, txo kev koom tes nrog kev ncaj ncees, thiab muaj kev noj qab haus huv.​​    

Cov Cheebtsam tseem ceeb ntawm BH-CONNECT​​ 

  • Cov Kev Cai Raws Li Pov Thawj: BH-CONNECT nthuav dav thiab qhia meej txog Medi-Cal kev pab them nqi kho mob ntawm cov neeg laus thiab cov menyuam yaus thiab cov tub ntxhais hluas tsom mus rau kev coj ua pov thawj.​​ 
  • Qhov Kev Pab Cuam Tshuam: BH-CONNECT txhawb nqa $ 1.9 txhiab daus las kev txhawb nqa los muab nqi zog rau kev koom nrog kev coj cwj pwm kev noj qab haus huv rau kev nthuav qhia kev txhim kho hauv kev nkag mus rau cov kev pabcuam kev coj tus cwj pwm thiab cov txiaj ntsig ntawm Medi-Cal cov tswvcuab uas nyob nrog kev xav tau kev noj qab haus huv tseem ceeb.​​ 
  • Children and Youth Initiative: BH-CONNECT txhawb nqa cov kev pabcuam hauv tsev neeg thiab kev txhawb nqa rau cov menyuam yaus thiab cov hluas uas nyob nrog kev xav tau kev noj qab haus huv tseem ceeb.​​ 
  • Workforce Initiative: BH-CONNECT muab cov peev txheej los txhim kho kev pabcuam zoo ntawm cov neeg ua haujlwm noj qab haus huv.​​ 
  • Tsoom Fwv Teb Chaws Kev Koom Tes Nyiaj Txiag rau Cov Tsev Kawm Qib Siab Lub Sijhawm Rau Cov Mob Puas Hlwb Nyob​​ 

Yog xav paub ntxiv txog BH-CONNECT, thov mus saib hauv qhov program lub vev xaib no.​​ 

BH-CONNECT Sections tseem saib xyuas kev txhim kho thiab kev siv cov kev kho mob ib txwm muaj txiaj ntsig hauv DMC-ODS.​​ 

Thaum Lub Kaum Hli 16, 2024, Lub Chaw rau Medicare & Medicaid Services (CMS) tau pom zoo DHCS los them cov kev kho mob ib txwm muaj los ntawm Indian Health Care Providers (IHCPs) rau Medi-Cal cov tswv cuab hauv Drug Medi-Cal Organized Delivery System (DMC-ODS) counties txog lub Kaum Ob Hlis 31, 2026, unlessed.​​ 

Kev saib xyuas kev noj qab haus huv ib txwm muaj suav nrog ob hom kev pabcuam tshiab: Cov Kev Pabcuam Khomob thiab Kev Pabcuam Ntuj. DMC-ODS cov nroog yuav tsum muab kev pab them nqi kho mob ib txwm muaj uas tau txais los ntawm IHCPs rau Medi-Cal cov tswv cuab uas tau txais kev pab them nqi xa los ntawm lossis los ntawm cov chaw no thiab ua tau raws li DMC-ODS cov txheej txheem nkag. IHCPs suav nrog Indian Kev Pabcuam Kev Noj Qab Haus Huv (IHS) cov chaw, cov chaw ua haujlwm los ntawm Pawg Neeg lossis Pab Pawg Pabcuam (Cov Tsev Kawm Ntawv Qib Siab) raws li Txoj Cai Kev Txiav Txim Rau Tus Kheej thiab Kev Pabcuam Kev Kawm Indian, thiab cov chaw ua haujlwm los ntawm cov koom haum Indian hauv nroog (UIO cov chaw) raws li Title V ntawm 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.​​ 

Cov Txheej Txheem Tshwj Xeeb​​ 

Qhov Kev Pabcuam Tshwj Xeeb yog lub luag haujlwm rau kev txhim kho ntau yam ntawm CalAIM Initiative.  Tshooj lus no hloov kho cov ntaub ntawv txoj cai thiab pab txhim kho thiab pib ua raws li txoj cai lij choj.​​ 

Txoj Haujlwm Kev Ua Haujlwm Kev Ua Haujlwm muaj ob chav:​​ 

  •  Cov Txheej Txheem Tshwj Xeeb Ntu 1​​ 
  •  Cov Txheej Txheem Tshwj Xeeb Ntu 2​​ 

Txoj Haujlwm Tshwj Xeeb Seem siv ntau yam CalAIM Initiatives:​​ 

Tshuaj Medi-Cal Organized Delivery System​​ 

Lub Tsev Kho Mob Medi-Cal Organized Delivery System (DMC-ODS) yog ib qho kev pab cuam rau kev npaj xa cov khoom siv tsis zoo (SUD) kev kho mob rau cov tswv cuab Medi-Cal uas tsim nyog nrog SUDs los ntawm kev muab kev saib xyuas txuas ntxiv ua qauv tom qab American Society of Addiction Tshuaj (ASAM) Cov Cai rau Kev Pabcuam SUD. Raws li lub nroog xaiv qhov kev pab cuam, DMC-ODS tseem ua kom muaj kev tswj hwm hauv zos thiab kev lav phib xaub ntau dua, muab kev saib xyuas kev tswj hwm zoo dua, tsim kev siv cov kev tswj hwm los txhim kho kev saib xyuas thiab kev siv cov peev txheej zoo, ua pov thawj raws li kev coj ua hauv SUD kev kho mob, thiab koom tes nrog lwm cov txheej txheem ntawm saib xyuas.​​ 

Txoj hauv kev no muab Medi-Cal cov tswvcuab nkag mus rau kev saib xyuas thiab kev sib cuam tshuam hauv lub cev uas xav tau txhawm rau txhawm rau ua kom rov zoo dua qub.​​ 

Thaum Lub Kaum Ob Hlis 2021, DHCS tau txais kev pom zoo los ntawm CMS kom rov tso cai DMC-ODS, hloov txoj cai saib xyuas kev tswj hwm mus rau CalAIM 1915(b) kev zam thiab siv Medicaid State Plan tso cai rau feem ntau ntawm DMC-ODS cov txiaj ntsig. Txoj cai los muab cov kev pabcuam Medi-Cal them rov qab rau DMC-ODS cov tswvcuab uas nyob hauv cov tsev kho mob rau kev puas hlwb (IMDs) tseem nyob hauv 1115 ua qauv qhia txog lub Kaum Ob Hlis 31, 2026. Yog xav paub ntxiv txog DMC-ODS qhov kev pab cuam thiab hloov tshiab raws li CalAIM, thov mus saib BHIN 24-001 .​​ 

Cov peev txheej ntxiv rau DMC-ODS cov nroog, suav nrog cov cuab yeej ntsuas dawb, tuaj yeem nrhiav pom ntawm nplooj ntawv Lub Nroog Resources . Cov lus nug txog qhov kev pab cuam DMC-ODS tuaj yeem xa mus rau CountySupport@dhcs.ca.gov.
​​ 

Medi-Cal Peer Support Services​​ 

Senate Bill (SB) 803, tshooj nyob rau xyoo 2020, tau tso cai DHCS los nrhiav kev pom zoo los ntawm tsoomfwv los ntxiv Cov Kws Pabcuam Peer Kev Pabcuam raws li hom kev pabcuam Medi-Cal thiab Peer Support Services ua hom kev pabcuam sib txawv raws li Specialty Mental Health Services (SMHS), Drug Medi -Cal (DMC), thiab Drug Medi-Cal Organized Delivery System (DMC-ODS) cov kab ke xa hauv cov nroog xaiv los koom rau hauv txoj haujlwm no. DHCS tau txais cov kev pom zoo los ntawm tsoomfwv los ntawm Medicaid waiver thiab State Plan Amendment txheej txheem. SB 803 kuj tau qhia DHCS los tsim lub xeev cov qauv rau Medi-Cal Peer Support Specialist Certification Programs uas tej zaum yuav raug siv los ntawm cov nroog lossis cov koom haum sawv cev rau lub nroog, uas xaiv los muab cov kev pabcuam no.​​ 

Medi-Cal Peer Support Services tau txais txiaj ntsig tau tshwm sim thaum Lub Xya Hli 1, 2022, nrog rau thawj qhov kev xeem ntawv pov thawj ntawm Peer Support Services muaj nyob rau lub Cuaj Hli 2022.​​ 

Tsis Muaj Qhov Rooj Tsis Zoo rau Kev Pabcuam Kev Puas Hlwb​​ 

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.​​ 

Yog xav paub ntxiv txog No Wrong Door, thov mus saib CalAIM Behavioral Health Initiative.​​  

CalAIM Behavioral Health Initiative​​ 

Tam sim no, ntau yam kev tshuaj xyuas tus cwj pwm kev noj qab haus huv thiab hloov pauv cov cuab yeej saib xyuas tau siv rau cov neeg tau txais txiaj ntsig Medi-Cal thoob plaws lub xeev, ua rau muaj kev tsis sib haum xeeb rau thaum cov neeg tau txais txiaj ntsig raug xa mus rau cov phiaj xwm kev noj qab haus huv ntawm lub hlwb piv rau cov koom haum saib xyuas. CalAIM nrhiav kev txhim kho cov txheej txheem no thiab txhim kho kev saib xyuas tus neeg mob los ntawm kev tsim cov txheej txheem thoob plaws lub xeev. DHCS tau ua tiav cov txheej txheem muaj feem cuam tshuam los tsim kev tshuaj xyuas thoob plaws lub xeev thiab hloov pauv cov cuab yeej saib xyuas rau cov neeg laus thiab cov tib neeg hnub nyoog qis dua 21 xyoos (cov hluas) rau kev siv los ntawm lub nroog cov phiaj xwm kev puas siab puas ntsws (MHPs) thiab Medi-Cal Managed Care Plans (MCPs). DHCS tau tsim cov cuab yeej tshuaj ntsuam xyuas tus qauv los txiav txim siab qhov tsim nyog tshaj plaws ntawm Medi-Cal kev coj tus cwj pwm kev noj qab haus huv (MHP lossis MCP) rau cov neeg tau txais txiaj ntsig nrhiav kev ntsuas kev xav tau thiab kev pabcuam thawj zaug. Tsis tas li ntawd, DHCS tau tsim cov txheej txheem hloov pauv ntawm cov cuab yeej saib xyuas kom ntseeg tau tias cov neeg tau txais txiaj ntsig Medi-Cal tau txais kev saib xyuas raws sijhawm thiab sib koom tes thaum ua tiav cov kev hloov pauv mus rau lwm qhov kev xa khoom lossis thaum ntxiv kev pabcuam los ntawm lwm qhov kev xa mus rau cov phiaj xwm saib xyuas uas twb muaj lawm.​​ 

Yog xav paub ntxiv txog Kev Ntsuam Xyuas & Hloov Cov Cuab Yeej Kho Mob, thov mus saib CalAIM Behavioral Health Initiative.
​​ 

Cov ntaub ntawv rov tsim dua​​ 

Pib txij Lub Xya Hli 1, 2022, DHCS tau siv cov ntaub ntawv qhia txog kev coj tus cwj pwm kev noj qab haus huv rau kev siv tshuaj yeeb dawb (SUD) thiab Cov Kev Pabcuam Kev Mob Siab Tshwj Xeeb (SMHS) kom ua raws li cov qauv hauv lub tebchaws. Thaum Lub Plaub Hlis 2022, DHCS tau tshaj tawm Daim Ntawv Ceeb Toom Txog Tus Cwj Pwm Kev Noj Qab Haus Huv (BHIN) 22-019, uas tshem tawm feem ntau cov kev xav tau ntawm cov neeg thov kev pab los ntawm SMHS thiab feem ntau cov kev xav tau npaj kho mob los ntawm Drug Medi-Cal (DMC) thiab Tshuaj Medi-Cal Organized Delivery System (DMC-ODS. ) cov kev pabcuam, tshwj tsis yog cov kev xav tau txuas ntxiv tshwj xeeb tau teev tseg hauv BHIN 22-019, BHIN 23-068, thiab / lossis cov lus qhia tom ntej.​​ 

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.​​ 

Yog xav paub ntxiv txog Kev Tsim Kho Cov Ntaub Ntawv, thov mus saib CalAIM Behavioral Health Initiative. 
​​ 

CalAIM Kev Tswj Xyuas Kev Sib Koom Tes – Qhov Kev Pabcuam Kev Sib Koom Tes​​ 

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.​​ 

Yog xav paub ntxiv txog CalAIM Kev Tswj Xyuas Kev Sib Koom Tes - Kev Pabcuam Kev Sib Koom Tes, thov mus saib CalAIM Behavioral Health Initiative.
​​ 

Cov peev txheej ntxiv​​ 

California Advancing and Innovation Medi-Cal (CalAIM):​​ 

Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) Initiative:​​ 

Medicaid thiab Medi-Cal General:​​ 

Cov ntaub ntawv tiv tauj​​ 

General Division​​          MCBHPD@dhcs.ca.gov​​ 
County Support:​​ 
 CountySupport@dhcs.ca.gov​​