Uma K. Zykofsky, LCSW Behavioral Health Director

Department of Health & Human Services Division of Behavioral Health Services

Alcohol & Drug Services

April 24, 2017 Presentation to

Geographic Managed Care Providers

To provide a culturally competent system of care that promotes holistic recovery, optimum health, and resiliency.

We envision a community where persons from diverse backgrounds across the life continuum have opportunity to experience optimum wellness.

Our Mission

Our Vision

Respect, Compassion, Integrity Client and/or Family Driven Service System Equal Access for Diverse Populations Culturally Competent, Adaptive, Responsive and Meaningful Full Community Integration and Collaboration Coordinated Near Home and in Natural Settings Strength-Based Integrated and Evidence-Based Practices Innovative and Outcome-Driven Practices and Systems Wellness, Recovery, and Resilience Focus

Our Values

Service Languages

Culturally competent and linguistically proficient behavioral health services are provided in many languages, including the following threshold languages:

Bi-lingual/bi-cultural staff or interpreters

available at no cost to youth/families Services provided for deaf and hearing

impaired at no cost to youth/families

Cantonese English Hmong

Russian Spanish Vietnamese

Alcohol and Drug Services Continuum of Care

Prevention Services Outpatient Treatment Residential Treatment Medication-Assisted Treatment Detoxification/Withdrawal Management Sober Living Environments Perinatal Services DUI Programs (Driving Under the Influence)

Specialty Courts Drug Diversion Programs

Handout: Alcohol & Drug Services Continuum of Care Fiscal Year 2016-17

Fiscal Year 2015-16 $41,051,121

20 contracted providers

6,514 admissions

Service Brochures

Brochures available on website and in alternate languages at: http://www.dhhs.saccounty.net/BHS/Pages/GI-Provider-Resources-Forms.aspx

Assessment and Referral Access Points

Alcohol & Drug Services System of Care

Entry point for alcohol and drug treatment services

Assessment and Referral to alcohol and drug treatment service provider

Monday – Friday

8:00 A.M. – 5:00 P.M. Last assessment conducted at 4 pm

Drop-In 3321 Power Inn Road, Suite 120

Sacramento 95826

(916) 874-9754

System of Care Sacramento County Jail Probation Department Primary Care Center Guest House Homeless Clinic Juvenile Court Children’s Receiving Home

Recent System Improvements

Increased assessment and referral access points Additional access points being explored Mobile Crisis Support Teams and Mental Health Navigators are conducting

alcohol and drug screening, preliminary assessments, and referrals throughout the community.

Increased service capacity $285,000 grant for ROOM for Dads program to provide after-hours

outpatient and drug treatment services to fathers referred to the Sacramento County Family Treatment Drug Courts.

$1,035,000 to expand residential treatment and detoxification services. Drug court expansion

$280,000 for Early Intervention Family Drug Court expansion to serve an additional 50 families, annually.

Co-Occurring Court to address the needs of individuals with serious mental illness who need specialized substance use treatment.

Current Initiatives Alcohol & Drug Services

Initiative 1

Decrease high daily dose prescriptions by 25% by 2020

Change other prescribing practices; increase alternative pain management

Coordinate prevention across Sacramento County and neighboring jurisdictions, including prescription take-back programs

Earlier treatment (reduce switch from prescriptions to heroin)

Addressing Overdose & Death: Prescription Drugs, Opiates, and Heroin

Initiative 2

Increase access to accurate data related to methamphetamine

Increase access to treatment for individuals who misuse/are dependent on methamphetamine

Increase community capacity to respond to people who misuse/are addicted to methamphetamine

Increase public awareness and professional knowledge about methamphetamine

Addressing Methamphetamine, Alcohol, and Other Drug Use/Abuse

Initiative 3 Improve Substance Use Disorder Services through

an organized service delivery system Full continuum of multiple levels of funded

evidence-based services Increase program oversight, compliance and

quality assurance Improve coordination with other service systems

Drug Medi-Cal Organized Delivery System

(DMC-ODS)

*5-Year State-Wide Waiver Demonstration Project*

Two-Phase Process to Opt-in

1. Implementation Plan Develop plan for Board of Supervisor review/approval Submit plan to California Department of Health Care

Services by the June 2017 deadline

2. Fiscal Plan Contingent on approval of Implementation Plan Develop Fiscal Plan for Board review/approval Submit Fiscal Plan to Department of Health Care

Services by deadline (to be determined)

DMC-ODS Waiver Phased Approach

Phase 1 ( in progress) Bay Area

Phase 2 (in progress)

Southern California

Phase 3 (Sacramento County) Central Valley

Phase 4

Northern California

Phase 5 Tribal Delivery System

53 Counties Expressed Interest 20 Implementation Plans Submitted 11 Implementation Plans Approved

Approved Implementation Plans

Bay Area Counties 1. Contra Costa County 2. Marin County 3. Monterey County 4. San Francisco County 5. San Mateo County 6. Santa Clara County 7. Santa Cruz County

Southern California Counties

8. Los Angeles County 9. Riverside County 10. Sonoma County 11. Ventura County

Existing Drug Medi-Cal Services DMC-ODS Waiver Client Eligibility

Adult Eligibility Drug Medi-Cal beneficiary Reside in participating county Meet medical necessity criteria:

• One Diagnostic and Statistical Manual diagnosis for substance-related and addictive disorders (with the exception of tobacco)

• Meet ASAM* criteria definition of medical necessity for services

Youth Eligibility Drug Medi-Cal beneficiary Reside in participating county Meet medical necessity criteria:

• Be assessed as to being at risk for developing a substance use disorder

• Meet ASAM criteria definition of medical necessity for services

*American Society of Addiction Medicine

Existing Drug Medi-Cal Services

Current Substance Use Disorder (SUD) treatment services include: • Outpatient treatment • Intensive outpatient treatment • Naltrexone (Vivitrol) treatment with Treatment Authorization

Request • Medication-Assisted Treatment/Narcotic Treatment Program • Perinatal residential SUD services (limited by IMD exclusion) • Detoxification in a hospital with Treatment Authorization Request

These benefits will remain available to all Drug Medi-Cal

beneficiaries, including those in non-waiver counties

Existing Drug Medi-Cal Services

Services Covered by the Waiver

BOLD = New Services

Services

Early Intervention Outpatient Treatment Residential Treatment Medication-Assisted Treatment (MAT) Withdrawal Management Additional Medication-Assisted Treatment (MAT) Recovery Services Case Management Physician Consultation Coordination with Criminal Justice and Hospitals Increased Quality Assurance

Residential Services For both perinatal & non-perinatal beneficiaries No bed capacity limit (i.e. 16 bed IMD exclusion

does not apply) Provided in California Department of Health Care

Services licensed & certified residential facilities that are also designated to meet ASAM treatment criteria.

Recovery Services Focus on building beneficiary’s self-management

skills and linking to community resources. May be accessed after completing course of

treatment (if triggered, relapsed, or to prevent relapse)

Case Management To assist a beneficiary to access necessary

medical, educational, social, prevocational, vocational, rehabilitative, or other community services.

Physician Consultation DMC physicians consulting with addiction

medicine physicians, addiction psychiatrists, or clinical pharmacists to offer support with complex cases (i.e. medication selection, dosing, side effect management, adherence, drug-drug interactions, or level of care considerations).

Quality Assurance Increased program oversight, compliance, and

quality assurance Evidence-based services ASAM criteria Utilization tools to improve care and manage

resources

Service Descriptions

Coordination with

Hospitals

Waiver counties must describe care coordination plan for achieving seamless transitions of care.

Waiver county shall enter into a Memorandum of Understanding (MOU) with any health plan that enrolls beneficiaries served by DMC-ODS. MOU to include:

Comprehensive Screening Beneficiary Engagement Shared Plan Development/Treatment

Planning Case Management Activities Dispute Resolution Care Coordination/Referral Tracking Navigation Support

Responsibilities for the Waiver

County Implementation Plan/Contract with California Department of Health Care Services

Selective service provider contracting Authorization for residential treatment 24/7 toll-free beneficiary access phone line Beneficiary informing upon first contact Improved quality assurance & utilization management Improved care coordination with health plans & justice

systems

Waiver Implementation Challenges

Provider readiness Increased compliance, oversight, audits,

monitoring, and quality assurance Managing Behavioral Health Realignment match to

make the Waiver viable Rate structure development Training on ASAM: Basis of decision-making on all

levels of care Need for youth residential treatment facility