CalAIM Behavioral Health Workgroup
To fulfill the objectives of the CalAIM initiative, DHCS is considering several independent but complimentary proposals to invest in and improve access to mental health (MH) and substance use disorder (SUD) services for Medi-Cal beneficiaries. These proposals are transformative, but all conceptualized with beneficiaries in mind to improve health outcomes and improve coordination across delivery systems. DHCS is exploring the following proposals to improve the way MH and SUD services are delivered to beneficiaries:
- MH and SUD Payment Reform;
- Revisions to Medical Necessity Criteria for Specialty Mental Health Services;
- County-Level MH and SUD Integration; and
- MH Institutions for Mental Disease (IMD) 1115 Waiver Opportunity.
MH and SUD payment reform is the foundation for the proposals listed above. DHCS is proposing to transition counties from a cost-based reimbursement methodology to a structure more consistent with incentivizing outcomes and quality over volume and cost. This shift will enable counties to participate in broader delivery system transformation, engage in value-based payment arrangements with other delivery system partners, and make long-term investments in the MH and SUD delivery systems at the local level.
Another significant proposal is county-level MH and SUD integration. Currently, DHCS provides Medi-Cal covered MH and SUD services through two separate county-operated delivery systems. This results in administrative inefficiencies and makes it difficult for counties to provide integrated care for beneficiaries with both MH and SUD needs. The goal of this proposal is to make necessary state and county changes to enable MH and SUD services through a single contract.
DHCS is also proposing to make changes to the medical necessity criteria for specialty mental health services to clarify beneficiary eligibility, service intervention requirements, and to streamline treatment planning and documentation. Finally, DHCS is interested in assessing county and stakeholder interest in pursuing the MH IMD 1115 waiver opportunity which would allow the state to receive federal funding for services rendered in an IMD.
While advisory group participation is limited to a select group of key stakeholders, members of the public are welcome to listen to the discussion via the webinar link once the meeting starts.
- Monday, September 12, 2022
CalAIM BH Workgroup Meetings 2019-2022
For any questions or concerns about this workgroup, please contact firstname.lastname@example.org
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