​Drug Medi-Cal Organized Delivery System

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The Drug Medi-Cal Organized Delivery System (DMC-ODS) provides a continuum of care modeled after the American Society of Addiction Medicine Criteria for substance use disorder treatment services, 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 substance abuse treatment, and coordinates with other systems of care.
 
This approach provides the beneficiary with access to the care and system interaction needed in order to achieve sustainable recovery. 

 

DHCS initially received approval in August 2015 from the Centers for Medicare & Medicaid Services (CMS) to implement the DMC-ODS through the State’s prior Section 1115 demonstration. DHCS received approval from CMS on December 29, 2021 to reauthorize the DMC-ODS in the CalAIM Section 1915(b) waiver through December 31, 2026, alongside the State’s other Medi-Cal delivery systems: Medi-Cal managed care, dental managed care, and Specialty Mental Health Services (SMHS). For more information about the CalAIM initiatives and stakeholder engagement process, please visit the CalAIM homepage and CalAIM 1115 Demonstration & 1915(b) Waiver webpage.​

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In August 2018, the California Health Care Foundation (CHCF) published a paper titled “Medi-Cal Moves Addiction Treatment into the Mainstream: Early Lessons from the DMC-ODS Pilots.” This paper provides an overview of the DMC-ODS program and how it differs from the standard Drug Medi-Cal program. It also outlines the experiences and challenges encountered by four early adopter counties – Los Angeles, Marin, Riverside, and Santa Clara.

“How Medi-Cal Expanded Substance Use Treatment and Access to Care” is a follow up to the 2018 paper and includes perspectives from additional counties representing various population sizes and geographic areas throughout the state. 

California Advancing and Innovating Medi-Cal (CalAIM)

CalAIM is a multi-year initiative by DHCS 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. DHCS conducted broad stakeholder engagement to elicit county, provider, and beneficiary feedback on how to improve Medi-Cal programs, including DMC-ODS. As a result of that input, DHCS proposed CMS a set of updates to DMC-ODS, some of which CMS approved for the January – December 2021 extension period (see Information Notice 21-019, 21-020, 21-021, and 21-024​), and others which will be effective January 2022, pending CMS approval. The pending policy guidance updates and replaces the Special Terms and Conditions used to describe the program for the years 2015-2020.​

Evaluation​

The University of California, Los Angeles, Integrated Substance Abuse Programs (UCLA ISAP) is conducting the evaluation to measure and monitor outcomes of the DMC-ODS, using information gathered from existing state data sources, as well as new data collected specifically for the DMC-ODS evaluation. Quantitative methods will be used to analyze trends, while qualitative methods will be used to help interpret quantitative data.


Information about the DMC-ODS Evaluation is available on the UCLA ISAP webpage.​
Last modified date: 1/7/2022 1:18 PM