There are many changes on the horizon in the delivery and practice of substance use disorder (SUD) treatment services offered in the state of California. For an overview on what these changes are and what they mean, we turned to Elizabeth Stanley-Salazar, RN, MPH, Vice President and Director of Clinical Services of Phoenix House California. Ms. Salazar is a board member of the California Association of Alcohol and Drug Program Executives (CAADPE), which advised the state officials on the restructuring of the service delivery system . She is also a board member of the Medi-Cal Children’s Health Advisory Panel (MCHAP) to the California Department of Health Care Services.
Q: What is Medi-Cal and Drug Medi-Cal?
Elizabeth Stanley-Salazar: First, let’s talk about the current service delivery system, which is funded through the Substance Abuse Treatment and Prevention Block Grant. This is a capped grant program with limited funds, administered through counties in California, to serve the most seriously affected individuals. Twenty percent is dedicated to prevention programs. Medi-Cal in California is generally a managed care insurance product with defined health care benefits to anyone who qualifies financially. These are public insurance programs operating in California since 1966, with the federal funding known as Medicaid. Medi-Cal is the name of the benefit managed by the California Department of Health Care Services ,that now serves more than 11 million Californians–one in three residents. Drug Medi-Cal services are the specialty treatment services managed by the Behavioral Health or Alcohol and Drug Departments in each of California’s 58 counties.
Q: What are the recently approved changes to the system?
A: Thanks to the Affordable Care Act (ACA), more Californians now enrolled in Covered California, a managed care service program, and have access to preciously unavailable health care services at no, or low cost. In 2014, Medi-Cal coverage expanded, providing a greater range of specialty services, such as Drug Medi-Cal, along with more types of health care services for low-income families, children, pregnant women, seniors, persons with disabilities, and adults ages 19-64 without children. One of the most important areas of expansion is residential treatment for adults and adolescents. Previously, Drug Medi-Cal and Department of Health Care Services (DHCS) other services covered only outpatient treatment and a limited type of residential services–perinatal and adolescence–in facilities smaller than 16 beds. The monumental change comes from the approval of the state’s request to expand the coverage to all adults and all licensed residential facilities regardless of their size.
Q: But that expansion was done a couple of years ago.
A: No, here’s the deal: The benefits and services available under Drug Medi-Cal a year ago were very limited, the access was limited, and the array of services were limited. The DHCS, in partnership with counties and providers, developed a continuum of substance use disorder services and submitted a waiver application to the California Centers for Medicare and Medicaid Services (CMS) for these services in 2014, including screening, intervention, outpatient, case management, recovery services, residential services, and most importantly medication assisted treatment. Each county will have the opportunity to opt in or opt out of participation in this waiver. Let me quote Jennifer Kent, DHCS Director: “The Centers for Medicare & Medicaid Services approved our waiver renewal request for Specialty Mental Health Services (SMHS). Not only did we get this approval, but CMS, for the first time, signed off on a five-year renewal term – through June 30, 2020. That’s an enormous accomplishment and an important step toward opening the door to critically needed mental health care – including psychotherapy, psychiatric consultation, lab tests, and medication – to our members all across California. In particular, I want to thank our stakeholders in the mental health community for working tirelessly with us to secure this important waiver. Major kudos to California for getting this done!”
Q: So… Phoenix House and you personally have contributed to this victory. Congratulations!
A: Yes, we worked very hard, in close collaboration with the DHCS, providers, stakeholders, and consumers to understand the specific needs of persons needing services for substance use disorder in California and the gaps in our delivery system. The result is the renewal of the so-called 1915(b) waiver for an extended term of five years. This is the beginning, and now the real work of implementation starts.
A: We currently hold Drug Medi-Cal certification for our outpatient services and we are seeking Drug Medi-Cal (DMC) certification for our residential programs for adolescents in Lake View Terrace and Descanso, as well as for adults in Venice and Santa Ana. We have held a DMC Certification for outpatient services at Lake View Terrace since 2003, and added outpatient treatment certifications in both adult programs this year. There will be many changes to practice and service design. The DMC Organized Delivery System, as it will be known, requires credentialed staff to diagnoses and sign off on treatment plans and utilization of services. Levels of care and utilization will be determined by use of the American Society of Addiction Medicine Placement Criteria. Evidenced-based practices will become the norm.
Q: What is Phoenix House doing to support these changes?
A: We are on target to implement changes in our electronic health care record and our billing systems for the transition to the new diagnosis structure and billing codes. Our Regional Clinical Steering Committee is currently revamping our clinical practices and workflows to meet the federal deadlines for implementation of federal mandates. We are ramping up training for staff and will support development of staff advance education through our tuition program. All departments are on “go live” mode to meet the phase in of the Organized Delivery System in California.
Q: Thanks and congratulations, again!
If you or your loved one – your son or daughter – need substance abuse treatment services, or help dealing with mental health issues by consulting with well-trained, experienced, dedicated and compassionate professionals, please do not hesitate to call us at: 1 888-671-9392.