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Health and Human Services Agency, recommending the Board:
1) Approve and authorize the Health and Human Services Agency (HHSA) Director to “opt in” to the Federal 1115 Waiver for a Drug Medi-Cal Organized Delivery System (DMC Waiver), thereby allowing HHSA to continue evaluation of the feasibility of participating in this pilot project;
2) Authorize the HHSA Director to begin the negotiation process with the State Department of Health Care Services for a DMC Waiver agreement;
3) Authorize the HHSA Director to continue development of opportunities for expanding the local continuum of care for substance use treatment; and
4) Authorize the HHSA Director to assess the viability of this pilot project for the County of El Dorado and return to the Board with a recommendation.
FUNDING: Federal Medi-Cal, with match funding from 2011 Behavioral Health Realignment.
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DEPARTMENT RECOMMENDATION:
Health and Human Services Agency (HHSA) recommending the Board authorize the Agency to “opt in” to participation in the Drug Medi-Cal Organized Delivery System (DMC-ODS) pilot program, thereby allowing HHSA to continue evaluation of this program. Following evaluation and possible negotiation with the State Department of Health Care Services (DHCS) for rates, HHSA would return to the Board with a recommendation to either pursue implementation of the pilot program, or “opt out” of the program.
DISCUSSION / BACKGROUND:
The DMC-ODS is a voluntary pilot program that offers California counties the opportunity to expand access to quality care for Medi-Cal enrollees with Substance Use Disorders (SUD). The goal of the DMC-ODS is to demonstrate how organized SUD care improves beneficiary health outcomes, while decreasing system-wide health care costs. Counties that choose to participate in the DMC-ODS are required to provide access to a full continuum of SUD benefits utilizing the American Society of Addiction Medicine (ASAM) Criteria. This approach is expected to provide eligible enrollees with access to the care and services they need for a sustainable and successful recovery.
The ASAM Criteria is a proven model for outcome-oriented and results-based care in the treatment of addiction. The ASAM Criteria is the most widely used and comprehensive set of guidelines for assessing patient needs and optimizing placement into SUD treatment. Counties that implement the DMC-ODS are required to use the ASAM Criteria to ensure that eligible beneficiaries have access to the SUD services that best align with their treatment needs.
To receive services through the DMC-ODS project, the beneficiary must be enrolled in Medi-Cal, live in a county that is participating in the DMC-ODS, have a diagnosis of a substance related and addictive disorder, and must meet medical necessity criteria as defined by the ASAM.
The following information shows a side-by-side comparison of the Drug Medi-Cal benefits under the DMC-ODS waiver and what currently exists under standard Drug Medi-Cal benefits.
Benefits available from both the New DMC-ODS Waiver Benefits as well as (current) standard Drug Medi-Cal Benefits:
1) Outpatient Services
2) Intensive Outpatient Services
3) Narcotic Treatment Program Services
Benefits available from the New DMC-ODS Waiver that are different from those available through (current) standard Drug Medi-Cal Benefits:
1) Residential Treatment services through DMC-ODS have no bed limitation and multiple levels of care; however, standard DMC Benefits are limited to Perinatal clients in facilities with less than 16 beds.
2) Withdrawal Management services through DMC-ODS is a continuum of care; however, standard DMC Benefits are limited to Inpatient Hospital Detoxification.
3) Recovery Services, Case Management, Physician Consultation, Additional Medication-Assisted Treatment, and Partial Hospitalization benefits are provided through DMC-ODS; however, none of these services are provided by standard DMC Benefits.
In order to continue assessing the viability of the program for implementation in El Dorado County, the county must “opt-in” by June 1, 2017. However, the county does have the option of “opting-out” at any point in time if it is determined that the program will not be feasible. At this point in time, counties that have opted in are the larger counties including Alameda, Contra Costa, Kern, Los Angeles, Marin, Monterey, Napa, Orange, Riverside, San Bernardino, San Francisco, San Luis Obispo, San Mateo, Santa Clara, Santa Cruz, Sonoma, and Ventura. Other smaller northern counties are expected to opt in; however, many are still doing their feasibility analysis.
Services provided under the DMC-ODS Waiver will be funded by Federal Financial Participation (FFP) funds that will be matched with 2011 Realignment funds. Since many of the individuals in need of these services are in the expanded population enrolled in Medi-Cal, the FFP portion will cover between 90% - 95% of the cost for those individuals. The county will negotiate actual rates with the State Department of Health Care Services.
2011 Realignment funds would provide the match from the Behavioral Health Subaccount. It should be noted that 2011 Realignment is funded by a dedicated portion of statewide sales tax. As long as statewide sales tax continues to grow, “Growth” dollars are available to be allocated to counties to ensure that the cost of Federal entitlements are covered first before the remainder of the growth funds is allocated to all counties. Drug Medi-Cal is an entitlement program.
ALTERNATIVES:
The Board could decline to authorize further investigation of the Drug Medi-Cal Organized Delivery System pilot program, in which case there would be no increase in the current level of services provided by the Alcohol and Drug Program.
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
N/A
CAO RECOMMENDATION:
It is recommended that the Board approve this item.
FINANCIAL IMPACT:
There is no Net County Cost associated with this Agenda item.
CLERK OF THE BOARD FOLLOW UP ACTIONS
Clerk of the Board to provide one (1) Certified Minute Order to the HHSA Contracts Unit at 3057 Briw Road.
STRATEGIC PLAN COMPONENT:
County Strategic Plan: Goal #1 - “Public Safety: Protects the community, prevents crime, enforces the law, administers justice, provides rehabilitative services, and promptly responds to emergency and calls for service.” Goal #5 - “Healthy Communities: Improved health, well-being and self-sufficiency of El Dorado County communities, residents and visitors.”
CONTACT
Patricia Charles-Heathers, Ph.D., Director