Leveraging FQHCs in California s Behavioral Health Care Continuum Allie Budenz Associate Director of Quality Improvement California Primary Care Association abudenz@cpca.org
Agenda About CPCA and FQHCs FQHCs in SUD/SMH Models of Partnership to Improve Consumer Access Yolo County and CommuniCare Collaboration MAT in Los Angeles County
About CPCA Mission The mission of CPCA is to lead and position community clinics, health centers, and networks through advocacy, education and services as key players in the health care delivery system to improve the health status of their communities. CPCA was founded to create a unified, statewide voice for community clinics and health centers. 1,237 Community Clinics and Health Centers (CCHC) in CA Members are comprised of: Community Clinics Free Clinics Federally Qualified Health Centers (FQHCs) FQHC Look-Alikes Rural Health Clinics Migrant Health Centers Indian Health Service Clinics Planned Parenthood Affiliates of California
Health Center Demographics 1 in 7 Californians served at Community Clinics and Health Centers (CCHCs) 38% of patients served in a language other than English 76% of patients live below or near poverty
Health Center Services Primary care for all ages Pediatrics or family medicine, adult medicine, geriatric medicine Including Medication Assisted Treatment in primary care for opioid use disorder Co-located or integrated behavioral health, some have contracts to provide substance use disorder and specialty mental health Clinics are required under their 330 designation to provide behavioral health services to all clients regardless of acuity or diagnosis. Outreach, education, enrollment, nutrition, social services Dental Pharmacy Specialty care on site or through telemedicine E.g. Office based OB, chiropractic, podiatry, dermatology, ophthalmology, etc. School-based clinics
FQHCs in SUD/SMH California has a tri-furcated behavioral health system. Specialty Mental Health services are for moderate to severe clients run by the county Mild to moderate behavioral health services are provided through Medi- Cal managed care plans or their subcontractors (Beacon, Optum) Paid by Prospective Payment System (PPS) predetermined, fixed amount per visit by a billable provider. Drug Medi-Cal run by the state, potentially now through the counties under the Drug Medi-Cal Organized Delivery System Waiver (DMC-ODS) Figure: Role of FQHCs in the behavioral health delivery system Specialty Mental Health- CountytMHPo Severe - County MHP Mild to Moderate BH - MCOs FQHC Services Determined by statute, paid by MCOs and State DMC State/County Patients often caught in the grey space which lead to billing issues, duplication of services. Audits and investigation challenges.
SB 323 (Mitchell) Authorize FQHCs and RHCs to elect to enroll as a DMC certified provider or an SMH provider contracted with a specialty mental health plan and provide SMH and DMC services pursuant to the terms of a mutually agreed upon contract. Prohibits the costs associated with those services from being included in the FQHC s or RHC s per-visit PPS rate. Separate staff and separate facilities Increase timely access to behavioral health care needs across California and reduce expensive and less effective avenues, such as emergency rooms. Reduce care coordination burden between entities Improved patient centered, integrated patient care
Models of Partnership to Improve Consumer Access 1. Contractual Arrangements for County Specialty Mental Health and DMC-ODS Services; 2. Creating New Health Center Entities Outside of the FQHC to Provide Specialty Mental Health Services; 3. Bidirectional Co-location with Specialty Mental Health and SUD Partners; and 4. Medication Assisted Treatment for SUD at FQHCs
Arrangement 1: Contractual Arrangements for County SMH and DMC ODS Services
Arrangement 2: Creating New Entities Outside of the FQHC to Provide SMH/DMC Services FQHC New Entity New provider entity is established and collaborates closely with the FQHC and other local partners to provide mental health and SUD services to individuals and families in the community. The new entity is not an FQHC; it is a separate entity that is owned and governed by the FQHC.
Arrangement 3: Bidirectional Co-location with SMH/SUD Partners MH / SUD Provider FQHC FQHC MH / SUD Provider Model 1. Mental health or SUD services offered by a separate provider organization, co-located within a FQHC. Model 2. FQHC primary care services colocated within a mental health or SUD provider organization. There is no arrangement for payment between the co-locating entities. While the provider organizations share physical space, they remain separate for administrative and reimbursement purposes. This arrangement allows for a bi-directional extension of services and the opportunity for greater care coordination without necessitating any payment transaction between the FQHC and the partner organization.
Arrangement 4: MAT for OUD MAT in FQHCs: March 2016: 36 CHCs receive Substance Abuse Service Expansion Awards Extensive Training and Technical Assistance through SAMHSA, Project ECHO, CSAM, CHCF 2017 Access Innovations in MH and SUD Services (AIMS) Integrated Behavioral Health and Nurse Care Manager Models
Contact Us Allie Budenz Associate Director of Quality abudenz@cpca.org Meaghan McCamman Assistant Director of Policy meaghan@healthplusadvocates.org