To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Tina Rivera, 707-565-4774
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Drug Medi-Cal Organized Delivery System Waiver
End
Recommended Action:
Recommended action
A) Receive a report on the Drug Medi-Cal Organized Delivery System Waiver Draft Implementation Plan.
B) Authorize the Director of Health Services, or designee, to enter into the Drug Medi-Cal Organized Delivery System Plan by submitting an application to the California Department of Health Care Services and work with the California Department of Health Care Services to develop the necessary Drug Medi-Cal Organized Delivery System structures.
end
Executive Summary:
The Sonoma County Department of Health Services (hereinafter, “DHS”, or “the Department”) is proposing the implementation of the Drug Medi-Cal Organized Delivery System (DMC-ODS) program for the organized, expanded, and comprehensive delivery of substance use disorder (SUD) treatment and recovery services to Medi-Cal-eligible individuals with SUD or at risk for developing an SUD.
Critical elements of DMC-ODS include providing a continuum of care modeled after the American Society of Addiction Medicine Criteria for SUD treatment services, increased local control and accountability, greater administrative oversight, creation of utilization controls to improve care and efficient use of resources, evidence-based practices in substance use treatment, increased coordination with other systems of care, and expanded access to care. To receive services through the DMC-ODS, a beneficiary must be enrolled in Medi-Cal or be Medi-Cal eligible, reside in a participating county, and meet the criteria for DMC-ODS services.
Opting into the waiver - The first step in opting into DMC-ODS is developing and submitting an Implementation Plan. The Implementation Plan is meant to show DHCS that the Department has a good understanding of what they need to do to implement DMC-ODS and that the County has a plan for addressing any potential challenges that may arise. After initial submission, there will be collaborative communication between the County and DHCS to finalize the Implementation Plan for preliminary approval. Upon DHCS preliminary approval, DHCS will enter into an intergovernmental agreement with the DMC-ODS County to administer DMC-ODS through a Prepaid Inpatient health plan.
Discussion:
California’s DMC-ODS program was the nation’s first SUD treatment demonstration project under Medicaid Section 1115 authority, approved by the Centers for Medicare and Medicaid Services (CMS) in 2015. Since the DMC-ODS waiver began in 2015, all California counties have had the option to participate in the program to provide their resident Medi-Cal beneficiaries with a range of evidence-based SUD treatment and recovery services in addition to those available under the Medi-Cal State Plan. The introduction of California Advancing and Innovating Medi-Cal (CalAIM) brought about updates to Medi-Cal programs, including the DMC-ODS, with some of the reforms and updated regulations taking effect in January 2022 and majority of the additional reform is set to take effect in July of 2023. The California Department of Health Care Services (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. As of today, 37 counties have opted into the waiver, representing 96 percent of the Medi-Cal population statewide. The last county, Riverside County, went live on February 1, 2021.
This initial item requests authorization for DHS to submit an Implementation Plan to DHCS and work with DHCS to develop the necessary DMC-ODS structures. If, at the end of this process, Sonoma County determines it wishes to proceed and DHCS deems it ready, Sonoma County will have the opportunity to enter into an Intergovernmental Agreement with DHCS to become a Drug Medi-Cal Organized Delivery System for Substance Use Disorder (SUD) services. In general, DMC-ODS will expand the quantity and type of services DHS can offer within its DHS Behavioral Health Division SUD program.
The DMC-ODS Process:
● Phase 1 - Finalize Implementation Plan with DHCS - (est. 3 months)
○ Submit Implementation Plan
○ Receive and incorporate feedback from DHCS
○ Receive preliminary approval from DHCS
● Phase 2 - Readiness Review & Network Certification (est. 5-8 months from receipt of Implementation Plan submission) - DHS will develop program infrastructure in the following areas:
○ Administration
● Hiring Plan
● Building Readiness
● Member Services System Capacity
● Training Schedule
● Compliance
○ Beneficiary Services
● Beneficiary Handbook Development
● Provider Directory
○ Service Provision
● Practice Guidelines
○ Access
● Provider Outreach
● Provider Policies & Procedures
● Network Adequacy
● Single Case Agreement
○ Continuity & Coordination of Care
● Care Coordination Plans
● Staff Training
● MOU with Medi-Cal Managed Care Plan
● Care Coordination Procedures
○ Grievance, Appeal, and Fair Hearing Process
● Call Center Training
● Internal Tracking System
● State Specific Reporting
○ Quality
● Quality Management Plan
● Policies & Procedures
● Performance Improvement Projects
○ Program Integrity
● Systems Development
● Compliance
● Overpayment Processes
○ Finance
● Test claims
● Phase 3 - Intergovernmental Agreement (1-2 months prior to the “go-live” date)
○ DHCS will draft and finalize a county-specific Intergovernmental Agreement
○ Board of Supervisors reviews Intergovernmental Agreement and determines whether or not to join agreement.
○ If Sonoma County joins, it may begin offering DMC-ODS benefits to eligible Medi-Cal beneficiaries
Breakdown of the Implementation Plan:
● Part 1. Plan Questions: A series of eight (8) closed-ended questions that summarize the county’s DMC-ODS plan
○ Sample questions:
■ “Identify the county agencies and other entities involved in developing the county plan.”
■ “What services will be available to DMC-ODS clients upon year one implementation under this county plan?”
• Part 2. Plan Description: Narrative description of the County’s implementation policies, procedures, and activities divided into nineteen (19) sections
DHS program staff and management are currently working with the DHCS to evaluate staff resources required for implementation and will follow the County’s Budget and Program Change process, which includes presenting for Board approval staffing changes. Current resource demands being evaluated include:
1. DMC-ODS requires that the County have an integrated Behavioral Health Access Phone Line for mental health and SUD services to accommodate screenings, assessments, and referrals into the SUD system of care. Services must be provided in the County’s threshold language of Spanish.
2. DMC-ODS requires that regular utilization reviews occur at all SUD programs in the DMC-ODS network as well as a residential authorization process be in place for all residential treatment providers, and a grievance and appeals process similar to the County’s current Mental Health Plan. All of these requirements are new to the Department for the SUD section and will require resources identified to complete these required tasks.
3. With all of the new required SUD activities occurring within the County, additional administrative oversight will be needed to implement and monitor the implementation of the DMC-ODS waiver. DHS will present a board item at a later date asking for additional staff and appropriations to address program administration.
4. DMC-ODS requires that various levels of care be available within the County including outpatient services. With the closure of California Human Development’s outpatient treatment services in June 2022, the County proposes bringing some services in-house to ensure the delivery of outpatient and intensive outpatient services required under the waiver. Clinical supervision and counseling staff may be needed to deliver these required programs in the County.
References:
CalAIM 1115 Demonstration & 1915(b) Waiver - <https://www.dhcs.ca.gov/provgovpart/Pages/CalAIM-1115-and-1915b-Waiver-Renewals.aspx>
California Health Care Foundation - How Medi-Cal Expanded Substance Use Treatment and Access to Care - A Close Look at Drug Medi-Cal Organized Delivery System Pilots - <https://www.chcf.org/publication/how-medi-cal-expanded-substance-use-treatment-access-care/>
Strategic Plan:
This item directly supports the County’s Five-year Strategic Plan and is aligned with the following pillar, goal, and objective.
Pillar: Healthy and Safe Communities
Goal: Goal 1: Expand integrated system of care to address gaps in services to the County’s most vulnerable.
Objective: Objective 2: Identify gaps in the Safety Net system of services and identify areas where departments can address those gaps directly, and seek guidance from the Board when additional resources and/or policy direction is needed.
Prior Board Actions:
N/A
Fiscal Summary
|
Expenditures |
FY 22-23 Adopted |
FY 23-24 Projected |
FY 24-25 Projected |
|
Budgeted Expenses |
|
|
|
|
Additional Appropriation Requested |
|
|
|
|
Total Expenditures |
0 |
0 |
0 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
|
|
|
|
Fees/Other |
|
|
|
|
Use of Fund Balance |
|
|
|
|
Contingencies |
|
|
|
|
Total Sources |
0 |
0 |
0 |
Narrative Explanation of Fiscal Impacts:
There are no fiscal impacts directly associated with the Board authorizing the Implementation Plan submission. A follow-up Board item will be presented to request appropriations once collaboration with DHCS staff have identified additional resources required for the implementation of the DMC-ODS program along with the funding to finance increased costs.
|
Staffing Impacts: |
|
|
|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
Attachment 1 - Draft DMC-ODS Implementation Plan
Attachment 2 - Presentation
Related Items “On File” with the Clerk of the Board:
None