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Fact Sheets, Frequently Asked Questions, & Information Notices

The following are resources for the Drug Medi-Cal Organized Delivery System (DMC-ODS): 

Fact Sheets and Frequently Asked Questions

Subject​

Last Updated​
DMC-ODS Frequently Asked Questions ​June 2019
​​How Medi-Cal is Improving Treatment for Substance Use Disorder in California December 2018​
Overview of the DMC-ODS December 2018​
  

DMC-ODS Related Information Notices

The purpose of this document is to outline key DMC‐ODS policy topics and provide a list of resources where counties and other stakeholders can seek additional information. In addition to the resources outlined below, additional information can be found in the Special Terms and Conditions and the Intergovernmental Agreement. Providers contracting with counties participating in DMC‐ODS may also be subject to additional Information Notices.

For a complete list of Mental Health and Substance Use Disorder Services (MHSUDS) Information Notices, please visit the MHSUDS Information Notices webpage.

For additional County Resources, please visit the County Resources webpage.

Billing and Fis​cal Considerations

​No Issued ​Subject
​Date
​19-034

​Overpayment Recovery and Reporting Procedures

​7/1/2019
19-032

​Drug Medi-Cal Organized Delivery System 837 Institutional (837I) Claims for American Society of Addiction Medicine (ASAM) Level of Care 3.7 and 4.0

 

​6/17/2019
​19-016 ​​Revisions to County-Specific Interim Rates under the Drug Medi-Cal Organized Delivery System ​3/18/2019
​19-013

​2019 International Classification of Diseases, Tenth Revision Included Code Sets and System Edit for Short Doyle Medi-Cal II Billing

Enclosure - ICD 10 Analysis Included Codes

​3/8/2019
​18-058 ​Supersedes IN 16-059. Substance Abuse Prevention and Treatment Block Grant Funded Room and Board for Transitional Housing, Recovery Residences and Residential Treatment Services ​12/17/2018
18-055​ ​​Amendment of California Code of Regulation (CCR), Title 22, Section 51490.1 11/2/2018​
18-052 ​Delay in Short-Doyle Claims Processing for Buprenorphine-Naloxone under the Drug Medi-Cal Organized Delivery System 10/25/2018​
18-037​
​​MHSUDS Drug Medi-Cal Reimbursement Rates for Fiscal Year 2018-19
8/3/2018​
​18-036
​Medication Assisted Treatment Reimbursement Rates for Fiscal Year 2018-19 Under the Drug Medi-Cal Organized Delivery System
​8/3/2018
18-​023 ​Drug Medi-Cal Organized Delivery System Cost Reporting Requirements for Narcotic Treatment Programs 5/25/2018​
​18-005 ​Drug Medi-Cal Organized Deliver System Case Management for Care Coordination Claiming 3/27/2018​
18-001 ​Drug Medi-Cal Organized Delivery System Residential Reimbursement 1/4/2018​
​17-047 ​Substance Abuse Prevention and Treatment Block Grant Coverage Gaps in Drug Medi-Cal and Drug Medi-Cal Organized Delivery System Waiver Substance Use Disorder Services 9/20/2017​
17-045 Supersedes IN 17-002. Drug Medi-Cal Organized Delivery System Healthcare Common Procedure Coding System Waiver Substance Use Disorder Services ​9/14/2017
17-039​ Supersedes IN 17-023: Changing Same Day Billing Requirements for Counties that Opt-In to the Drug Medi-Cal (DMC) Organized Delivery System (ODS) 1115 Demonstration Waiver 8/18/2017​
17-038
​Updated Drug Medi-Cal (DMC) Billing Manual
7/31/2017​
17-034 International Classification of Diseases, Tenth Revision (ICD-10) Substance Use Disorder (SUD) Remission Codes for the Drug Medi-Cal Organized Delivery System (DMC-ODS) 7/27/2017​
​17-030 ​State Health Information Guidance (SHIG) for Sharing Behavioral Health Information in California 6/26/2017​
17-029
​Medication Assisted Treatment Reimbursement Rates for Fiscal Year 2017-18 Under the Drug Medi-Cal Organized Delivery System
​6/26/2017
17-023
​Changing Same Day Billing Requirements for Counties That Opt-In To The Drug Medi-Cal Organized Delivery System (DMC-ODS) 115 Demonstration Waiver
​5/25/2017
17-020
​Short-Doyle Medi-Cal (SD/MC) Claim Adjustment Reason Code and Remittance Advice Remark Code for the Drug Medi-Cal Organized Delivery System
5/26/2017​
​17-011 Reimbursement for Drug Medi-Cal Organized Delivery System Quality Assurance and Utilization Review Expenses 4/14/2017​
17-002 ​Drug Medi-Cal Organized Delivery System Healthcare Common Procedure Coding System and Modifiers ​1/24/2017
​16-057 ​Drug Medi-Cal Organized Delivery Systems Healthcare Common Procedure Coding System (HCPCS) and Modifiers ​11/9/2016
​16-050
​Drug Medi-Cal Organized Delivery System Waiver County Implementation Fiscal Plan Guide
​10/4/2016
​16-035 ​Drug Medi-Cal Organized Delivery System Healthcare Common Procedure Coding System (HCPCS) and Modifiers ​7/20/2016
16-009 ​State General Fund Quarterly Claiming Process for Drug Medi-Cal Organized Delivery System Participating Counties ​3/17/2016
​15-034 ​Drug Medi-Cal Organized Delivery System Pilot Fiscal Provisions ​8/20/2015

​ 

 Quality Management

​No Issued​
​Subject
​Date
19-024​
​Federal Out of Network Requirements for Drug Medi-Cal Organized Delivery System (DMC-ODS) Pilot Counties
5/8/2019​
19-022​
Certification of Document and Data Submissions for Drug Medi-Cal Organized Delivery System (DMC-ODS) System Pilot Counties
Enclosure - DMC-ODS County Certification Template
4/30/2019​
​19-018 Supersedes IN 17-060. Department of Health Care Services (DHCS) Organized Delivery System (DMC-ODS) Provider Selection Review Process 3/20/2019​
18-051 ​Drug Medi-Cal Organized Delivery System Transition of Care Policy 10/25/2018​
18-032​
​Drug Medi-Cal Organized Delivery System Treatment Perceptions Survey for Youth
7/25/2018​
​18-020 ​Federal Provider Directory Requirements for Mental Health Plans (MHPs) and Drug Medi-Cal Organized Delivery System (DMC-ODS) Pilot Counties ​4/24/2018
​18-019 ​Provider Credentialing and Re-Credentialing for Mental Health Plans (MHPs) and Drug Medi-Cal Organized Delivery System (DMC-ODS) Pilot Counties ​4/24/2018
18-011
Federal Network Adequacy Standards for Mental Health Plans (MHPs) and Drug Medi-Cal Organized Delivery System (DMC-ODS) Pilot Counties
Enclosure 1 - contact DHCS MHSD Final Rule for a copy
Enclosure 2
Enclosure 3
2/13/2018​​
​18-010E
​Federal Grievance and Appeal System Requirements with Revised Beneficiary Notice Templates
Enclosure 1 Notice of Grievance Resolution (NGR)
Enclosure 2 Denial Notice (NOABD)
Enclosure 3 Payment Denial Notice (NOABD)
Enclosure 4 Delivery System Notice (NOABD)
Enclosure 5 Modification Notice (NOABD)
Enclosure 6 Termination Notice (NOABD)
Enclosure 7 Timely Access Notice (NOABD)
Enclosure 8 Financial Liability Notice (NOABD)
Enclosure 9 NOABD Your Rights Attachment
Enclosure 10 Adverse Benefit Determination Upheld (NAR)
Enclosure 11 NAR Your Rights Attachment
Enclosure 12 Adverse Benefit Determination Overturned (NAR)
Enclosure 13 Beneficiary Non-Discrimination Notice
Enclosure 14 Language Assistance Taglines
Enclosure 15 Authorization Delay Notice
Enclosure 16 NOABD Grievance and Appeal Timely Resolution Notice
3/27/2018
​17-046
​​Reporting Requirements Related to Provider Preventable Conditions in DMC-ODS Pilot Counties
9/20/2017​
17-036 ​Drug Medi-Cal County of Responsibility Transition 7/28/2017​
​17-030 ​State Health Information Guidance (SHIG) for Sharing Behavioral Health Information in California 6/26/2017​
17-026​
​Drug Medi-Cal Organized Delivery System (DMC-ODS) Treatment Perceptions Survey
6/9/2017​
​17-011 Reimbursement for Drug Medi-Cal Organized Delivery System Quality Assurance and Utilization Review Expenses 4/14/2017​
17-008​
​Peer Support Services in the Drug Medi-Cal Organized Delivery System (DMC-ODS) Waiver
​2/14/2017

 

Levels of Care

​No Issued ​Subject ​Date
19-022​

Certification of Document and Data Submissions for Drug Medi-Cal Organized Delivery System (DMC-ODS) System Pilot Counties

Enclosure - DMC-ODS County Certification Template

4/30/2019​
​18-058 ​Supersedes IN 16-059. Substance Abuse Prevention and Treatment Block Grant Funded Room and Board for Transitional Housing, Recovery Residences and Residential Treatment Services ​12/17/2018
18-046​ ​Supersedes IN 17-035. American Society of Addiction Medicine (ASAM) Level Of Care (LOC) Data Collection for Drug Medi-Cal Organized Delivery System (DMC-ODS) Waiver ​10/1/2018
​18-042 ​Perinatal Practice Guidelines ​9/20/2018
18-​023 ​Drug Medi-Cal Organized Delivery System Cost Reporting Requirements for Narcotic Treatment Programs 5/25/2018​
​18-021 ​Women and Perinatal Community Substance Use Disorder Provider Directory ​4/24/2018
18-001 ​Drug Medi-Cal Organized Delivery System Residential Reimbursement 1/4/2018​
17-034 International Classification of Diseases, Tenth Revision (ICD-10) Substance Use Disorder (SUD) Remission Codes for the Drug Medi-Cal Organized Delivery System (DMC-ODS) 7/27/2017​
​16-063 ​​Substance Use Disorder (SUD) Treatment Services for Youth in California 12/21/2016​
16-059 ​Substance Abuse Prevention and Treatment Block Grant Funded Room and Board For Transitional Housing, Recovery Residences and Residential Treatment Services ​11/15/2016​
​16-048

​Medication Assisted Treatment in Narcotic Treatment Programs Under the Drug Medi-Cal Organized Delivery System Pilot Program

​9/27/2016
​16-044 ​Clarifying the Meaning of "Face-to-Face Review" from Standard Terms of Conditions for the Drug Medi-Cal Organized Delivery Systems (DMC-ODS) ​9/14/2016
16-042 ​Residential Treatment Services and Residential Authorizations in the Drug Medi-Cal Organized Delivery System (DMC-ODS) Pilot Program ​8/11/2016
​16-037 ​Medically Monitored and Medically Managed Detoxification/Withdrawal Management and Residential Treatment Services in the DMC-ODS Pilot Program ​7/20/2016
​15-048 ​Addition of Withdrawal Management (Detox) Services ​10/12/2015
​15-035 ​American Society of Addiction Medicine (ASAM) Designation for Residential Facilities ​8/26/2015
15-033 ​Medications Used in Treatment of Substance Use Disorders in an Outpatient Setting ​8/14/2015​

 
Last modified date: 12/18/2019 9:20 AM