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: Informational Only
Supervisorial District(s): Countywide
Title:
Title
California Advancing and Innovating Medi-Cal Update
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Recommended Action:
Recommended action
Receive an update on the California Advancing and Innovating Medi-Cal multi-year initiative.
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Executive Summary:
The Sonoma County Department of Health Services (hereinafter, “DHS”, or “the Department”) is presenting to the Board of Supervisors a briefing on critical developments to Medi-Cal, which is California's Medicaid health care program. This program pays for a variety of medical services for children and adults with limited income and resources. The state Department of Health Care Services (DHCS) has initiated a multi-year initiative, California Advancing and Innovating Medi-Cal (CalAIM), that will make significant changes to the Medi-Cal program. These changes are designed to leverage Medi-Cal to support challenges facing California’s vulnerable populations: homelessness, behavioral healthcare access, children with complex medical conditions, justice involved populations who have significant clinical needs, and the aging population.
CalAIM includes a series of far-reaching initiatives that together represent broad reforms of Medi-Cal’s programs and systems. DHCS is implementing CalAIM in partnership with Medi-Cal providers, managed care plans (MCPs), counties, community-based organizations and other stakeholders. These changes will span a multi-year period, with the first reforms already underway effective January 1, 2022, and subsequent reforms to be phased in through 2027.
The goal of this item is to provide an informational update to the Board of Supervisors, highlighting changes in the Behavioral Health delivery system currently underway in the Department.
Discussion:
Statewide, DHCS is transforming the Medi-Cal delivery system into CalAIM, which impacts many aspects of the work of local health departments and providers statewide. CalAIM is moving Medi-Cal towards a population health approach that prioritizes prevention and whole person care. Their goal is to extend supports and services beyond hospitals and health care settings directly into California communities.
This item will provide an informational update to the Board of Supervisors, highlighting changes in the Behavioral Health delivery system currently underway in DHS.
CalAIM Background
CalAIM’s transformation aligns all elements of Medi-Cal into a system that is standardized, simplified, and focused on helping enrollees live healthier lives. When CalAIM is fully implemented, Medi-Cal will better serve and benefit enrollees because it will be a seamless and streamlined health care system. CalAIM seeks to transform health care for Californians through the following areas:
Providing Access and Transforming Health
CalAIM will build up the capacity and infrastructure of on-the-ground partners, such as community-based organizations, public hospitals, county agencies, tribes, and others to successfully participate in the Medi-Cal delivery system as California widely implements Enhanced Care Management and Community Supports and Justice Involved Services.
Population Health Management
Managed care plans will be required to implement a whole-system, person-centered strategy that includes assessments of each enrollee’s health risks and health-related social needs, focuses on wellness and prevention, and provides care management and care transitions across delivery systems and settings.
Enhanced Care Management
Enhanced Care Management is person-centered care management provided to the highest-need Medi-Cal enrollees, primarily through in-person engagement where enrollees live, seek care, and choose to access services.
Community Supports (also known as “In Lieu of Services”)
Medi-Cal managed care plan partners will begin offering “Community Supports,” such as housing supports and medically tailored meals, which will play a fundamental role in meeting enrollees’ needs for heath and health-related services that address social drivers of health.
New Dental Benefits
CalAIM will expand key dental benefits statewide, including a tool to identify risk factors of dental decay, and silver diamine fluoride for children and certain high-risk populations. Statewide pay-for-performance initiatives will reward dental providers for focusing on preventive services and continuity of care.
Behavioral Health Delivery System Transformation
DHCS will strengthen the state’s behavioral health continuum of care for all Californians and promote better integration with physical health care. CalAIM will streamline policies to improve access to behavioral health services, simplify how these services are funded, and support administrative integration of mental illness and substance use disorders treatment.
Services and Supports for Justice-Involved Adults and Youth
These initiatives help California address poor health outcomes and disproportionate risk of illness and accidental death among justice-involved Medi-Cal eligible adults and youth as they re-enter their communities.
Statewide Managed Long-Term Care
CalAIM will transition institutional long-term care to managed care statewide to better coordinate care, simplify administration, and provide a more integrated experience.
Integrated Care for Dual Eligible Beneficiaries
Through CalAIM, DHCS is implementing policies that promote integrated and coordinated care for dual eligible beneficiaries, including the statewide expansion to Medicare Medi-Cal Plans (MMPs or Medi-Medi Plans) - a special kind of Medicare Advantage Plan that coordinates Medicare and Medi-Cal benefits for beneficiaries who are eligible for both programs.
Medi-Cal's Strategy to Support Health and Opportunity for Children and Families
DHCS launched Medi-Cal's Strategy to Support Health and Opportunity for Children and Families to integrate existing and new child and family health initiatives and strengthen DHCS' accountability and oversight of children's services.
Standard Enrollment with Consistent Managed Care Benefits
To improve each enrollee’s experience, CalAIM will expand the use of managed care plans and standardize benefits so that each enrollee will have access to a consistent set of services, no matter where they live.
Delivery System Transformation
CalAIM will explore other ways to improve care, including: developing a long-term plan of action for foster youth; seeking a federal waiver for short-term residential treatment for members with a Serious Mental Illness or Serious Emotional Disturbance; piloting full integration of physical health, behavioral health, and dental health in one managed care plan; and piloting a universal member release of information consent and process to facilitate the data exchange needed to successfully implement CalAIM.
DHS Behavioral Health Highlights in CalAIM Transformation
Completed and published new CalAIM policies
• Criteria for Beneficiary Access to Specialty Mental Health Services
• No Wrong Door - ensuring beneficiaries receive services regardless of the delivery system where they seek care: County Behavioral Health, Managed Care Plan, or Fee-for-Service delivery system
• Documentation requirements for all Specialty Mental Health Services and Drug Medi-Cal Services (MHP/DMC)
• Medical Necessity Determination and Level of Care Determination Requirements for Drug Medi-Cal Treatment Programs
MHP/DMC Network has also trained on all CalAIM Policy Changes via CalMHSA’s System. Staff monitor on a weekly basis for completion of the following trainings:
• CalAIM Overview
• Access to Services
• Assessment
• Diagnosis and Problem List
• Progress Notes
• Care Coordination
• Screening
• Transition of Care Tool
• Discharge Planning
Promoting bi-directional data exchange between county Behavioral Health and Managed Care Plans by demonstrating
• Direct sharing of data with Managed Care Plan
• Onboarding to a Health Information Exchange
• Active Fast Healthcare Interoperability Resources application interface that will allow Mental Health Plan, Drug Medi-Cal, and Drug Medi-Cal Organized Delivery System to be compliant with CMS-mandated interoperability rules
• Mental Health Plan, Drug Medi-Cal, and Drug Medi-Cal Organized Delivery System have mapped data elements to the United States Core Data for Interoperability standard set
SmartCare, Semi-Statewide Electronic Health Record progress
• Board of Supervisors approval using Mental Health Services Act (MHSA) Innovation Funding
• Actively engaging stakeholders in demonstrations of SmartCare’s features
• Collaborating closely with CalMHSA Project Lead to meet milestones
• Currently working on data conversion
Preparations for Behavioral Health Payment Reform - July 1, 2023
• Counties will transition from cost-based reimbursement funded via Certified Public Expenditures to fee-for-service reimbursement funded via Intergovernmental Transfers, eliminating the need for reconciliation to actual costs
• Specialty Mental Health and Substance Use Disorder services will transition from existing Healthcare Common Procedure Coding System Level II coding to Level I coding, known as Current Procedural Terminology coding
• Behavioral Health Current Procedural Terminology Coding Transition - July 2023
• Transition to fee-for-service and Intergovernmental Transfers - July 2023
Administrative Integration of Specialty Mental Health and Substance Use Disorder Services
• Multi-year effort beginning with all previous initiatives starting in 2022
• Goal: submit a single, integrated behavioral health plan in each county providing for the provision of specialty mental health and Substance Use Disorder services under “one plan,” following the CalAIM Project Period, 2022-2026, the next 1915 B Waiver
Behavioral Health Quality Improvement Program (BHQIP)
• BHQIP Implementation Plan submitted on-time and approved by DHCS
• Received all available incentives thus far for meeting deliverable milestones
• Utilizing CalMHSA for BHQIP Project Management
Implemented CalAIM Initiatives
• Criteria for Specialty Mental Health Services
- January 2022
• Drug Medi-Cal Organized Delivery System Policy Improvements and ASAM Level of Care Determination
- January 2022
• Streamline documentation requirements for Substance Use Disorders and Specialty Mental Health Services (SMHS) and align with national standards
- July 2022
• Screening & Transition Tools for Youth and Adults for County Mental Health Plans and Medi-Cal Managed Care Plans
- January 2023
References:
Department Health Care Sservices - “What is Medi-Cal?” - <https://www.dhcs.ca.gov/services/medi-cal/pages/whatismedi-cal.aspx>
Strategic Plan:
N/A
Prior Board Actions:
On August 30, 2022 the Board A) Authorized the Director of Health Services, or designee, to execute a grant agreement with Partnership HealthPlan of California to receive $52,000 in revenue to support California Advancing and Innovating Medi-Cal implementation in Sonoma County through December 31, 2023, and B) Adopted a budget resolution authorizing budgetary adjustments to the fiscal year 2022-2023 adopted budget to reflect additional revenues and expenditures supporting the implementation of California Advancing and Innovating Medi-Cal in the amount of $52,000 within DHS.
On November 16, 2021 the Board A) received a report on the California Advancing and Innovating Medi-Cal multi-year initiative; B) approved the County’s participation as an Enhanced Care Management (ECM) provider and authorize the Health Services Interim Director, or designee, to enter into an agreement with Partnership HealthPlan of California (PHC) to provide ECM services to PHC referred members at the Per Enrollee Per Month (PEPM) contract rates; C) adopted a personnel resolution amending the Department of Health Services allocation list, adding a 1.00 time-limited full-time equivalent Program Planning and Evaluation Analyst position and a 1.00 time-limited full-time equivalent Department Analyst position, effective November 16, 2021; and D) adopted a resolution authorizing budgetary adjustments to the fiscal year 2021-2022 adopted budget by increasing revenues and expenditures in the Department of Health Services by $266,980 to support additional position allocations for the remainder of the fiscal year.
Fiscal Summary
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Narrative Explanation of Fiscal Impacts:
There is no fiscal impact associated with this item.
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Narrative Explanation of Staffing Impacts (If Required):
No impact at this time.
Attachments:
Attachment 1 - Presentation
Related Items “On File” with the Clerk of the Board:
None