Drug Medi-Cal (DMS) Organized Delivery System (ODS)

Transcription

1 Drug Medi-Cal (DMS) Organized Delivery System (ODS) Stanislaus County BHRS Substance Use Disorder (SUD) System of Care Stakeholder Meetings April 21 and May 4, 2017

2 Welcome and Introductions Rick DeGette, BHRS Director Dawn Vercelli, SUD System of Care, Sr. Leader Logistics Handouts In Attendance

3 Agenda Purpose & Vision What is DMC ODS?/Timeline Benefits, Eligibility & Services Break Program Requirements Managed Care Requirements - BHRS State Responsibilities - DHCS Stakeholder Involvement Q & A / Adjourn

4 Purpose & Vision Develop a continuum of care that effectively treats multiple dimensions of substance use disorders, continues to professionalize our field through the use of evidence based practices and aligns with state/federal regulations.

5 SUD Continuum of Care Vision Residential 3.5, 3.3, 3.1 Early Intervention SBIRT Outpatient IOT/OP Access, Assessment, Case Management, Care Coordination and Authorization Withdrawal Managment Narcotic Treatment Programs & other MAT Recovery Services

6 Integrated Health Care Vision SUD Delivery System Mental Health Physical Health

7 What the Heck is DMC ODS? Optional 5 Year Demonstration Project o Requires BOS approval Expansion of SUD Treatment Services Provides Delivery of Services in an Organized Way Demonstration Goals o Improves individual success o Decreases overall health care costs o Evaluation by UCLA

8 Timeline June 2017 Sept. 30, 2017 Pending Approval of IP/FP Pending BOS Approval Aug. 1, 2017 Sept. 15, 2017 Nov. 1, 2017 Jan Submit DMC ODS Implementation Plan (IP) Submit DMC ODS Fiscal Plan (FP) State - County Contract BOS Approval List of Providers to DHCS Beneficiary Rights Developed Grievance & Appeals Process Developed MOU's with Health Plans Begin DMC ODS Services in Stanislaus County

9 Benefit of DMC ODS for Medi-Cal Beneficiaries Timeliness of Services Evidence Based, High Quality Services Full Array of SUD Services Modeled from ASAM Beneficiary Rights Coordination of Care Continuity of Care

10 Benefit of DMC ODS for Community Reduce Emergency Rooms and Hospital Inpatient Visits Ensure Access to SUD Services Increase Program Oversight and Integrity Place Client in the Least Restrictive Level of Care Utilizing ASAM Criteria

11 Benefits of DMS ODS for Service Providers Expanding Local High Quality Providers through Selective Provider Contracting Rates Based on Actual Costs Part of an Organized Delivery System Improved Professional Practices o Evidence Based Practices o Comprehensive 6 dimension ASAM assessment

12 Eligibility Adults & Youth Enrolled in Medi-Cal Residing in Participating County Meeting Medical Necessity: o Adult One DSM Diagnosis of SUD; meets ASAM criteria definition of medical necessity o Youth Be assessed for risk for developing SUD, meet ASAM adolescent treatment criteria, honors EPSDT mandate Eligibility Verified Initial Medical Necessity Determination by LPHA

13 Standard DMC Services Existing Statewide Medi-Cal SUD Treatment Services Include: o Outpatient Drug Free Treatment (ODF) o Intensive Outpatient Treatment (IOT) o Naltrexone Treatment (with TAR) o Narcotic Treatment Program (NTP) o Perinatal Residential SUD Services (limited by IMD exclusion) o Detoxification in a Hospital (with TAR) These Benefits will Remain Available to all Medi-Cal Beneficiaries, Including those in Non-Pilot Counties

14 DMC ODS Services DMC-ODS Pilot Counties are Required to Provide: o Early Intervention o Outpatient Services o Residential o Narcotic Treatment Program o Withdrawal Management o Recovery Services o Case Management o Physician Consultation The Following Levels of Service are Optional for Pilot Counties: o Partial Hospitalization o Additional Medication Assisted Treatment

15 Break Begin to complete survey while on break

16 Program Requirements Provider Must be Drug Medi-Cal Certified Continuum of Care Modeled after American Society of Addiction Medicine (ASAM) Selective Provider Contracting Provide More Intensive Services for Hard to Treat Populations Requires Evidence-Based Practices(EBP)

17 County Oversite, Managing & Reporting (Managed Care Requirements) Quality Improvement o Timeliness and access to services o Access to after-hours care o Beneficiary access number (24/7 Call Center) o Requires coordination with mental health and physical health o Assessment of beneficiaries treatment experiences Quality Improvement Committee Utilization Management o Access o Medical Necessity Ensure Data Collection

18 State Oversite, Managing & Reporting Annual EQRO Timely Access Program Integrity o Site visits o ASAM designation of residential o Reporting of activity o Quarterly/annual progress reports Triennial Reviews

19 Stakeholder Involvement 2 Stakeholder Meetings Stakeholder Survey Strategic Partner Workgroups o ASAM o Coordination of care o MAT o Youth services continuum of care (Future) Training & Technical Assistance

20 Links to Website(s) Stakeholder Survey o DHCS Organized-Delivery-System.aspx Stanislaus County BHRS

21 Q & A What questions do you have?

22 Adjourn Complete the survey & feedback form before you leave today Let us know if you want to participate in the strategic partner workgroups Tell a friend about the DMC ODS process and survey monkey Thank you for your participation!