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HEARING - Health and Human Services Agency (HHSA) recommending the Board adopt and authorize the Chair to sign Resolution 192-2024, to implement an updated Behavioral Health Fee Schedule (Exhibit A) for Medi-Cal eligible services, effective on November 12, 2024, in accordance with the Department of Health Care Services (DHCS) updated fee schedule, thereby replacing Board adopted Resolution 168-2023.
FUNDING: Combination of Federal Medi-Cal, State, and local realignment, including State Mental Health Services Act (MHSA) funds, reimbursed to HHSA from DHCS for claims for client services, with the funding percentages dependent upon the beneficiary.
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DISCUSSION / BACKGROUND:
DHCS is responsible for developing and administering fiscal policies for the State’s Mental Health Programs, including Medi-Cal Specialty Mental Health Services (SMHS), and Drug Medi-Cal (DMC)/Drug Medi-Cal Organized Delivery System (DMC-ODS) programs (collectively referred to as the Medi-Cal programs). The SMHS program provides mental health services to Medi-Cal beneficiaries who meet medical necessity criteria; and the DMC/DMC-ODS programs provide Substance Use Disorder (SUD) treatment and expanded SUD treatment services to Medi-Cal beneficiaries who meet medical necessity criteria for those services.
The Mental Health Plan (MHP) in each county is responsible for providing or arranging for the provision of SMHS to local residents that are Medi-Cal beneficiaries. Mandated SMHS programs include outpatient mental health services such as medication therapeutic services, inpatient services such as acute psychiatric hospitalizations, and certain types of residential placements, including psychiatric health facility (PHF) placements. HHSA’s Behavioral Health Division (BHD) also contracts with DHCS under the County DMC-ODS Intergovernmental Agreement to provide SUD treatment to Medi-Cal eligible beneficiaries.
Beginning in early 2023, DHCS developed program and payment reform across th...
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