drug medi-cal organized delivery system implementation plan · 2017. 4. 18. · drug medi-cal...

Drug Medi-Cal

Organized Delivery System

Implementation Plan

Imperial County

Behavioral Health Services

Drug Medi-Cal Organized Delivery System Implementation Plan Imperial County

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Contents Page

Number

Part I – Plan Questions 2

Part II – Plan Description: Narrative Description of the County’s Plan 5

Section 1 – Collaborative Process 5

Section 2 – Client Flow 7

Section 3 – Beneficiary Notification and Access Line 12

Section 4 – Treatment Services 13

Section 5 – Coordination with Mental Health 19

Section 6 – Coordination with Physical Health 21

Section 7 – Coordination Assistance 22

Section 8 – Availability of Services 24

(a) The anticipated number of Medi-Cal clients 25

(b) The expected utilization of services 26

(c) The number and types of providers required to furnish the contracted Medi-Cal services

27

(d) Language capability for the county threshold languages 28

(e) Timeliness of first face-to-face visit, timeliness of services for urgent conditions and access after-hours care

28

(f) The geographic location of providers and Medi-Cal beneficiaries, considering distance, travel time, transportation, and access for beneficiaries with disabilities

29

(g) How will the county address service gaps, including access to Medication Assisted Treatment (MAT) services

32

(h) Appendix – list of network providers 33

Section 9 – Access to Services 33

Section 10 – Training Provided 34

Section 11 – Technical Assistance 35

Section 12 – Quality Assurance 36

Section 13 – Evidence-based Practices 42

Section 14 – Regional Model 44

Section 15 – Memorandum of Understanding 44

Section 16 – Telehealth Services 45

Section 17 – Contracting 45

Section 18 – Additional MAT 47

Section 19 – Residential Authorization 48

Section 20 – One Year Provisional 49


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P A R T I - P L A N Q U E S T I O N S

This part is a series of questions that summarize the county’s Drug Medi-Cal - Organized Delivery System (DMC-ODS) plan.

1. Identify the county agencies and other entities involved in developing the county plan. (Check all that apply) Input from stakeholders in the development of the county implementation plan is required; however, all stakeholders listed are not required to participate.

County Behavioral Health Agency County Substance Use Disorder Agency Providers of drug/alcohol treatment services in the community Representatives of drug/alcohol treatment associations in the community Physical Health Care Providers Medi-Cal Managed Care Plans Federally Qualified Health Centers (FQHCs) Clients/Client Advocate Groups County Executive Office County Public Health County Social Services Foster Care Agencies Law Enforcement Court Probation Department Education Recovery support service providers (including recovery residences) Health Information technology stakeholders Other (specify)

2. How was community input collected?

Community meetings County advisory groups Focus groups Other method(s) (explain briefly)

3. Specify how often entities and impacted community parties will meet during the implementation of

this plan to continue ongoing coordination of services and activities.

Monthly Bi-monthly Quarterly

Other: Every two weeks

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Review Note: One box must be checked.

4. Prior to any meetings to discuss development of this implementation plan, did representatives from Substance Use Disorders (SUD), Mental Health (MH) and Physical Health all meet together regularly on other topics, or has preparation for the Waiver been the catalyst for these new meetings?

SUD, MH, and physical health representatives in our county have been holding regular meetings to discuss other topics prior to waiver discussions.

There were previously some meetings, but they have increased in frequency or intensity as a result of the Waiver.

There were no regular meetings previously. Waiver planning has been the catalyst for new planning meetings.

There were no regular meetings previously, but they will occur during implementation.

There were no regular meetings previously, and none are anticipated.

5. What services will be available to DMC-ODS clients upon year one implementation under this county plan?

REQUIRED

Withdrawal Management (minimum one level) Residential Services (minimum one level) Intensive Outpatient Outpatient Opioid (Narcotic) Treatment Programs Recovery Services Case Management Physician Consultation

How will these required services be provided?

All County operated Some County and some contracted All contracted.

OPTIONAL

Additional Medication Assisted Treatment Partial Hospitalization Recovery Residences Other (specify)

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6. Has the county established a toll free 24/7 number with prevalent languages for prospective clients to call to access DMC-ODS services?

Yes (required) No. Plan to establish by: .

Review Note: If the county is establishing a number, please note the date it will be established and operational.

7. The county will participate in providing data and information to the University of California, Los Angeles (UCLA) Integrated Substance Abuse Programs for the DMC-ODS evaluation.

Yes (required) No

8. The county will comply with all quarterly reporting requirements as contained in the STCs.

Yes (required) No

9. Each county’s Quality Improvement Committee will review the following data at a minimum on a quarterly basis since external quality review (EQR) site reviews will begin after county implementation. These data elements will be incorporated into the EQRO protocol:

Number of days to first DMC-ODS service/follow-up appointments at appropriate level of care after referral and assessment

Existence of a 24/7 telephone access line with prevalent non-English language(s)

Access to DMC-ODS services with translation services in the prevalent non-English language(s)

Number, percentage of denied and time period of authorization requests approved or denied

Yes (required) No

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P A R T I I – P L A N D E S C R I P T I O N (Narrative)

1. Collaborative Process. Describe the collaborative process used to plan DMC-ODS services. Describe

how county entities, community parties, and others participated in the development of this plan and

how ongoing involvement and effective communication will occur.

Imperial County Behavioral Health Services (ICBHS) developed an internal DMC-ODS implementation

committee composed of representation from Quality Management (QM), Adult Substance Use

Disorder (SUD) Services, Adolescent SUD services, Youth and Young Adult (YAYA) Services Mental

Health, Adult Services Mental Health, and Administration. The members of this committee included

the assistant director; deputy director, behavioral health manager and administrative analyst for Adult

Services; deputy director, behavioral health manager, program supervisor and administrative analyst

for YAYA; and behavioral health manager and administrative analyst for QM. This committee met on

a weekly basis to discuss all elements of the implementation plan and define tasks required as part of

the implementation process.

The committee identified a list of agencies, stakeholders, and individuals that would have a role or

contribution in the implementation of DMC-ODS services. Informational brochures in English and

Spanish were created that provide an overview of the DMC-ODS waiver and a series of community

forums were scheduled in different areas of Imperial County. Newspaper ads were posted inviting the

community to participate in these forums and invitations were delivered to different community

agencies, schools and stakeholders encouraging their participation. In addition, individual

presentations were also held within ICBHS mental health and SUD clinics, other SUD providers, SUD

treatment participants and agencies that were not available to participate in the community forums.

Each presentation included an overview of DMC-ODS waiver services and a series of questions that

assisted in engaging the community and stakeholders providing valuable input in the needs and

priorities for Imperial County. The survey questions were as follows:

1) In your opinion, what is the greatest need for Imperial County related to Alcohol and Drug

treatment services?

2) A. From the DMC-ODS treatment interventions described, what do you think is the most

important?

B. Please explain why.

3) What would you consider to be the greatest challenges/barriers in delivering these services?

Location

Availability of appointments

Hours of service

Bilingual staff

Transportation

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Confidentiality

Negative views of people seeking services

Other

4) What recommendations do you have to reduce the impact of these challenges/barriers?

5) In your opinion, how will implementation of this new system impact Imperial County residents?

6) What do you recommend to make these services available to Imperial County residents (Example:

location, bilingual staff, office hours, etc.)?

7) Do you have other recommendations for the implementation of these services or additional

comments?

The list of groups and individuals that provided input during these community forums and

presentations includes the following:

Community Groups and Individuals Engaged for Implementation Plan

Imperial County Behavioral Health Services Imperial County Probation

Imperial Valley College U.S. Border Patrol

Imperial Valley LGBTQ Resource Center Central Union High School District

Imperial Valley Regional and Occupational Program Imperial County Office of Education

Imperial County Department of Social Services Imperial County Public Health

Children and Families First Commission Department of Corrections

Imperial Valley Food Bank Sure Helpline Crisis Center

Calexico Unified School District Smart Recovery Group Participants

El Centro Elementary School District Imperial Valley Medical Treatment Center (NTP)

The DMC-ODS implementation committee reviewed and analyzed the data collected and incorporated

the feedback as part of the implementation process. The major themes from the data collected that

impacted the development of the plan are as follows:

Major Themes from Community Forums and Presentations

Family counseling and education Community outreach and education

Increase accessibility to residential facilities Prevention Services

Increase services for adolescents and families Case management services for community

Follow-up services to support recovery Increase focus on individual counseling

Expansion of service hours Accessible location of services

Transportation Home visiting services

Vocational training

ICBHS will continue to provide stakeholders opportunities for involvement in the implementation

process through ongoing meetings with agencies such as Imperial County Public Health Department,


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Imperial County Probation, Imperial County Department of Social Services, Methadone Clinic,

residential facilities, law enforcement, school districts, ICBHS MH and SUD staff and other local

agencies. Through these meetings, ICBHS will maintain stakeholders updated on the progress of the

implementation plan and will continue to obtain input on how the process can be improved to better

serve Imperial County residents.

2. Client Flow. Describe how clients move through the different levels identified in the continuum of

care (referral, assessment, authorization, placement, transactions to another level of care). Describe

what entity or entities will conduct ASAM criteria interviews, how admissions to the recommended

level of care will take place, how often clients will be re-assessed, and how they will be transitioned to

another level of care accordingly. Include the role of how the case manager will help with the

transition through levels of care. Also describe if there will be timeliness established for the

movement between one level of care to another. Please describe how you plan to ensure successful

care transitions for high-utilizers or individuals at risk of unsuccessful transitions.

The goal of ICBHS is to provide timely access to medically necessary SUD services. Beneficiaries can

access services through different pathways that include referrals from other agencies such as, Imperial

County Probation, Imperial County Department of Social Services, education, health care providers, or

ICBHS MH. Beneficiaries can also access SUD treatment by contacting the 24-hour access number,

contacting one of the SUD treatment facilities, or by walking in to one of the ICBHS SUD or MH clinics.

An intake assessment appointment will be provided within seven (7) working days from the day the

individual requests services at which time medical necessity criteria for SUD services will be

determined. Beneficiaries, who meet medical necessity and ASAM criteria, will have access to a full

continuum of SUD services based on ongoing assessment and identified need during the course of

treatment. Please refer to Figure 1 – Client Flow Chart.

Initial Service Screening Upon request for services, individuals will be screened by an Access and Benefits Worker (ABW), who

will ask a series of questions to determine insurance coverage and eligibility, demographic

information, and the presenting problem(s). Once screened by the ABW, clients will be given an intake

assessment appointment at the appropriate SUD outpatient clinic. Determination for the appropriate

clinic will be based on findings from the initial access screening, geographic accessibility, threshold

language needs, and individuals’ preference. ICBHS will develop procedures on the referral and

screening process, which will be shared and discussed with ICBHS MH and SUD staff and referring

agencies. The referral process will provide multiple points of entry for beneficiaries. Referrals can be

generated from Community Based Agencies, primary care/ emergency department physicians or

governmental agencies such as the Court System, Probation, Parole and School Districts. Additionally,

a beneficiary may be able to access service through a self-referral. community agencies, and

governmental organizations and may refer beneficiaries through the use of a Community Agency

Referral Form which will be provided to these organizations or which will be available on the ICBHS


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website. Primary Care Physicians will refer clients along with the Screening Brief Intervention and

Referral (SBIRT). Self-referred beneficiaries can begin the screening process by calling the Access

phone number which is available 24 hours per day/ 7 days per week. Additionally, beneficiaries can

walk into clinics and request services. Upon receiving the referral, Access workers will contact or

meet with the beneficiary to complete a screening and gather needed information to make

arrangements to begin treatment services. In addition the eligibility information obtained, additional

inquiry will be made about the reason for requesting services such as the type(s) of substance the

client is using, the situation or crisis which motivated the request for services, and whether or not a

crisis or urgent condition exists. This screening will allow the Access worker to make all the necessary

arrangements to begin treatment services which includes a scheduled appointment for an intake

assessment, at the appropriate regional clinic.

Intake Assessment and Medical Necessity Determination Medical necessity for services must be determined as part of the intake assessment process and will

be performed through a face-to-face session with the beneficiary. Beneficiaries attending the first

appointment at a SUD outpatient clinic will receive a comprehensive bio-psychosocial intake

assessment as well as a risk/severity rating and immediate needs profile based on the American

Society of Addiction Medicine (ASAM) criteria. This assessment will be conducted by a licensed

clinician or registered intern working under the supervision of a licensed clinician. Information

gathered during the intake assessment includes presenting problem(s); family alcohol and drug and

mental health history, social history, medical history and religious history; personal alcohol and drug

use history; developmental history; personal/social history; legal history; medical and mental health

history; other critical information. Based on the information gathered during the intake assessment,

clinicians determine if the beneficiary meets medical necessity for SUD treatment. Beneficiaries must

be diagnosed as having at least one Substance-Related and Addictive Disorder diagnosis, excluding

Tobacco-Related Disorder and Non-Substance Related Disorders, from the Diagnostic and Statistical

Manual (DSM) or, for beneficiaries under the age of 21, a risk for developing a SUD. After establishing

a diagnosis and medical necessity, the ASAM criteria will be applied using the multidimensional

assessment to determine a level of care placement. This information will also guide the recommended

treatment plan.

Beneficiaries who meet medical necessity and present a MH need, will be referred for additional MH

evaluation. SUD treatment team staff, which may include a physician, case manager, and/or clinician,

will work in collaboration with MH staff to ensure proper coordination for integrated MH services if

appropriate. ICBHS will develop procedures that will define the process for the proper integration of

MH treatment for those beneficiaries with co-occurring disorders.

In the event that a beneficiary does not meet SUD medical necessity criteria, the clinician will assess

for other immediate needs and will make the necessary referrals to other community agencies,

including MH. If the beneficiary does not meet diagnostic criteria for SUD but is assessed as being at

risk for developing a SUD, the client will be referred for Early Intervention Services, ASAM level 0.5,

through a managed care plan.


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Medical necessity qualification for ongoing receipt of services [except Narcotic Treatment Programs

(NTP) services] will be determined at least every six months through the reauthorization process for

beneficiaries determined by the medical director or clinician to be clinically appropriate.

Reauthorization for NTP services will be conducted annually.

Reassessment and Transition between Modalities Beneficiaries will receive on-going assessment using ASAM criteria throughout the course of

treatment. Re-assessment can take place at any time and as deemed appropriate. At minimum,

assessment and/or re-assessment will take place at the onset of each treatment modality and every

ninety (90) days thereafter in conjunction with the required treatment plan. Beneficiaries will also be

evaluated at the conclusion of the treatment modality for determination of the next level of care in

the continuum of SUD treatment.

Case managers, who are required to be a Licensed Practitioner of the Healing Arts (LPHA) or a certified

substance abuse counselor (SAC), will work directly with the ICBHS SUD treatment team, other

agencies involved in the beneficiary’s treatment and contract providers to assist in the transition

between treatment modalities. Case managers will work proactively by ensuring that transitions to

other levels of care are effective, timely and complete, which will improve the beneficiaries’ safety

and satisfaction. For beneficiaries who are high utilizers or at risk of unsuccessful transitions and

require a higher level of care, ICBHS will follow the expedited referral process to ensure immediate

transition within modalities. The assigned case manager will work closely with the beneficiary by

providing more intensive services and increasing contacts with the beneficiary, if necessary, until the

transition is complete. Case manager services may continue after this transition, if medically

necessary, and to assist the beneficiary adhere to the recommended treatment. The case manager

will also communicate with other treatment providers to ensure that attention is placed on assisting

the client transition to the higher level of care successfully. Beneficiaries who will transition to a

lower level of care will also continue to receive support by the treatment provider and assigned case

manager to ensure progress is sustained and concerns regarding their recovery are addressed. This

support may include increased case management contacts that will slowly decrease once the

beneficiary demonstrates stability in the lower level of care, interventions to cope with triggers that

may lead to relapse, connecting the beneficiary to health social supports and activities, and providing

linkage to community services that will provide additional support through the SUD treatment.

Beneficiaries will move through the continuum of care as individual progress takes place. Treatment

plans will be individualized and timelines will be set based on the needs of the beneficiary.

Considerations on the number of sessions for individual, group, and family counseling will be made

based on evidence-based models and identified needs. ICBHS will abide by the requirements set by

DHCS related to residential treatment and will work within the mandated maximum stay for

adolescents and adults in residential facilities.

Case managers will also take an important role in helping beneficiaries reach their optimal level of

health, well-being and recovery by addressing their medical, psychosocial, behavioral, and spiritual

needs. In addition, all ICBHS SUD case managers will be trained on evidence-based models that will

address the beneficiaries’ SUD needs, help beneficiaries develop skills that enhance life functioning


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and promote self-advocacy, self-care, and recovery. Case managers will focus on collaborating with

beneficiaries to establish accountability and responsibility, help with transitions, create a proactive

treatment plan at the start of each treatment modality, and will monitor and follow-up as needed for

the beneficiary’s success.

Residential Evaluation and Authorization All beneficiaries seeking SUD treatment will receive an intake appointment in which a biopsychosocial

assessment of the beneficiary will be conducted by a LPHA. The LPHA will use the ICBHS Intake

Assessment tool that will incorporate all six elements of the ASAM Multidimensional Assessment.

Beneficiaries who at the time of intake are assessed to meet the ASAM criteria for residential

treatment, will be referred and assigned a case manager through the expedited referral process for

immediate placement coordination in a contracted residential facility.

Or, throughout the course of treatment, if the beneficiary is assessed to require a higher level of care,

the treatment team will meet to discuss the case for appropriateness and referral to a residential

facility. The treatment team will review the beneficiary’s current functioning, response to treatment,

and each ASAM dimension to determine severity and need for a higher level of care. A case manager

will be assigned for coordination and facilitation of timely placement, follow-up and discharge

planning.

All prior authorization requests will be reviewed by the SUD Program Supervisor within 24 hours of

request by the treatment provider. The SUD Program Supervisor will review the beneficiary’s intake

assessment, diagnosis, treatment history and the reasons for referral to determine approval or denial

of request. Authorization and tracking of all residential treatment referrals will be conducted by

ICBHS designated staff at each SUD outpatient clinic. ICBHS will grant a prior authorization for the first

seven (7) days of residential treatment based on the results identified on the ASAM assessment. The

residential treatment provider will have the responsibility to submit a request for authorization for up

to a maximum of ninety (90) days on a continuous period for those adult clients who have been

assessed and admitted into a residential facility. One extension of up to thirty (30) days beyond the

maximum length of ninety (90) days may be authorized for one continuous length of stay in a one (1)

year period. The residential treatment provider will also have the responsibility to submit a request

for authorization for up to a maximum of thirty (30) days in one continuous period for adolescent

clients who have been assessed and admitted to a residential facility. Reimbursement will be limited

to two non-continuous thirty (30) day regimens in any one year period. One extension of up to thirty

(30) days beyond the maximum length of stay may be authorized for one continuous length of stay in

a one year period.

Continuum of Care All SUD providers are expected to individualize treatment and use the full continuum of services

available to beneficiaries to ensure clients receive the most appropriate care. Case management

services will help assure clients move through the system and access other needed health and

ancillary services to support their recovery. As beneficiaries complete primary treatment, they will be

connected to recovery services to build connections within the recovery community and continue

developing self-management strategies to prevent relapse.

Referral Source

• Community Agencies

• Court Order

• Self-Referral

• ICBHS

• Early Intervention

SBIRT Level 0.5 • Clinician Completed Intake

Assessment & ASAM

Multidimensional

• Recommends Service

& ASAM Level of Care M e e t s M e d i c a l N e c e s s i t y f o r S U D T r e a t m e n t

Assessment follow-up for

Integrated Mental

Health Treatment

O t h e r S U D S e r v i c e s • Withdrawal Management

Services

• Opioid/Narcotic Treatment Services

• Medication Assisted Treatment

• Recovery Services

• Case Management

Co-Occurring Mental Health Need

Referral to Community

Services & Supports

including Mental Health

Does Not Meet

Medical Necessity but is

at Risk for SUD Referral

to non-DMC

provider

C l i n i c

a l l y M a

n a g e d

W i t h d r a

w a l M a n a

g e m e n t

D i s c h a r g e


Figure 1 - Client Flow Chart

Client Flow Chart

Drug Medi-Cal Organized Delivery System (DMC-ODS) Waiver

• Referral to Access

• Walk-in to Clinic

• Call to Clinic / Access

• Access Screening

• Appointment within 7 Days of Referral

to Appropriate SUD Outpatient Clinic

C o m p l e t i o n

o f T r e a t m e n t

R e c o v e r y

S e r v i c e s

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SUD Outpatient Clinic

Does Not Meet Medical Necessity

O u t p a t i e n t

Level 1

• Individual

• Group

• Adolescent: less than 6 hours per week

• Adults: less than 9 hours per week

I n t e n s i v e O u t p a t i e n t

Level 2.1

• Individual

• Group

• Adolescent: 6 or more hours per week

• Adults: 9 or more hours per week

R e s i d e n t i a l

Level 3.1 Level 3.3

Adults with

Cognitive

Impairment

Only

Level 3.5

Adolescent

&

Adults

Intensive

Residential

Adolescent

& Adults


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3. Beneficiary Notification and Access Line. For the beneficiary toll-free access number, what data will

be collected (i.e. measure the number of calls, waiting time, and call abandonment)? How will

individuals be able to locate the access number? The access line must be toll-free, functional 24/7,

accessible in prevalent non-English languages, and ADA-compliant (TTY).

Review Note: Please note that all written information must be available in the prevalent non-English

languages identified by the state in particular service area. The plan must notify beneficiary of free

oral interpretation services and how to access those services.

ICBHS will utilize the current toll-free access line as the beneficiary access line for DMC ODS services.

The access line is available twenty-four (24) hours a day, seven (7) days a week and is available in

English and the MHP’s threshold language, Spanish. Language Line Services are available for

interpretation in other languages. During business hours, the toll-free line is managed by the ICBHS

Access Unit. After hours, the line is managed by trained on-call staff. The access line is ADA-

compliant and all callers are also screened for crisis/urgent conditions and referred appropriately.

The toll-free access line number and information on free oral interpretation and how to access those

services is currently included in the informing materials that are available through the Access Unit and

at each service area and contract provider service locations. All informing material is provided in

English and the MHP’s threshold language, Spanish. ICBHS also notifies beneficiaries of the availability

of the toll-free number, free oral interpretation services and how to access those services through

posters that are displayed at all service areas.

The toll-free access line is also listed on brochures, forms, newspapers, phone books, social and local

media. Each call requesting information about services, appointment requests or identified as

crisis/urgent conditions are logged and the following data is collected:

Caller’s name

Date of call

Contact type (client request)

Referred by

Interpreter needed

Presenting problem

Appointment information

Timeliness of Appointment

Staff who answered call

Information provided to caller/disposition of call


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In addition, ICBHS ShoreTel phone system has the capability to capture data such as: number of calls

received, hold waiting time, and length of call. Data collected will measure timeliness, access and

urgent conditions.

4. Treatment Services. Describe the required types of DMC-ODS services (withdrawal management,

residential, intensive outpatient, outpatient, opioid/narcotic treatment programs, recovery services,

case management, and physician consultation) and optional (additional medication assisted treatment,

recovery residences) to be provided. What barriers, if any, does the county have with the required

service levels? Describe how the county plans to coordinate with surrounding opt-out counties in order

to limit disruption of services for beneficiaries who reside in an opt-out county.

ICBHS will provide the following types of required and optional services:

D M C - O D S S e r v i c e s

Service Type ASAM Level

Required or Optional Provider

A Early Intervention/ Screening, Brief Intervention, and Referral to Treatment (SBIRT)

.05 Provided in partnership with existing primary care provider or managed care provider

Primary Care MDs

Medi-Cal Managed Care Providers

B Outpatient Services/ Outpatient Treatment Services

1 Required ICBHS

Contract Provider

C Intensive Outpatient Treatment Services (IOT)

2.1 Required ICBHS

Contract Provider

E Withdrawal Management Services (WM)

1-WM 3.2-WM

1 Level Required ICBHS

Contract Provider

F Residential Treatment Services (RTS)

3.1, 3.3, 3.7

Required Contract Provider

G Opioid/Narcotic treatment Program (NTP)

OTP Level 1

Required Contract Provider

H Additional Medication Assisted Treatment (MAT) Services

OTP Level 1

Optional ICBHS

Contract Provider

I Recovery Services N/A Required ICBHS

J Case Management N/A Required ICBHS

K Physician Consultation N/A Required ICBHS

L Recovery Residence N/A Optional ICBHS

Service Descriptions:

A. Early Intervention (ASAM Level 0.5)

Screening, Brief Intervention, and Referral to Treatment (SBIRT) for beneficiaries at risk for

developing a SUD will be provided by Imperial County Medi-Cal managed care providers, and local

primary care providers. Beneficiaries at risk of developing a SUD or those with an existing SUD are

identified and offered screening for adults, brief treatment as medically necessary, and, when

indicated, a referral to treatment with formal linkage.


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B. Outpatient Services (ASAM Level 1.0)

Outpatient services consist of up to nine (9) hours per week of medically necessary services for

adults and less than six (6) hours per week of services for adolescents. SUD providers will offer

ASAM Level 1 services including: assessment, treatment planning; individual and group counseling;

family therapy; patient education; medication services; collateral services; crisis intervention

services; and discharge planning and coordination. Services may be provided in-person or by

telephone in any appropriate setting in the community. Services listed above will be provided in an

outpatient setting by ICBHS SUD staff. Staff providing services will consist of certified SACs and

LPHAs.

C. Intensive Outpatient Services (ASAM Level 2.1)

Intensive outpatient involves structured programming provided to beneficiaries as medically

necessary for a minimum of nine (9) hours and a maximum of nineteen (19) hours per week for

adult clients. Adolescents are provided a minimum of six (6) and a maximum of nineteen (19)

hours per week. Services include assessment, treatment planning, individual and/or group

counseling, patient education, family therapy, medication services, collateral services, crisis

intervention services, treatment planning, and discharge planning and coordination. Services may

be provided in person or by telephone in any appropriate setting in the community. Services listed

above will be provided in an outpatient setting by ICBHS SUD staff. Staff providing services will

consist of certified SACs and LPHAs.

D. Withdrawal Management Services (ASAM Levels 1-WM, 3.2-WM, 3.7, 4.0)

Withdrawal Management services are provided as medically necessary to beneficiaries and

include; assessment, observation, medication services, and discharge planning and coordination.

These services will be provided in an outpatient setting by ICBHS. Staff providing services will be

provided by licensed physicians with a specialty in addiction medicine. ICBHS will offer ASAM Level

1-WM: Ambulatory Withdrawal Management without Extended On-Site Monitoring at

implementation. By end of Implementation Year 2 (IY2) ICBHS will assess the utilization and ASAM

data to make a determination if the need exists for ASAM Level 3.2-WM: Clinically-Managed

Residential Withdrawal Management and ASAM Level 2-WM: Ambulatory withdrawal

management with extended on-site monitoring. If the need for these levels of Withdrawal

Management exists, providers will be identified and attempts will be made to establish provider

contracts.

ICBHS will work with El Centro Regional Medical Center and Pioneers Memorial Hospital and other

area service providers to assist beneficiaries to access Withdrawl Management 3.7 Medically-

Monitored Inpatient Withdrawal Management) and Withdrawl Management 4.0 4.0-WM

(Medically-Managed Inpatient Withdrawal Management) when medically necessary. ICBHS will

coordinate with these providers to ensure a successful


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transition for beneficiaries through discharge planning. Discharge planning will ensure that

beneficiaries are able to access less intensive levels of care available within the DMC-ODS. ICBHS

will establish a MOU that outlines mutual responsibilities, referral, billing, and aftercare systems.

In addition, ICBHS has contracts with two Acute Psychiatric Hospitals that will be utilized to

address the need for ASAM level 3.7 and 4.0 and currently has a process in place for the

placement and transportation of beneficiaries who are in need of this service.

E. Residential Treatment Services (ASAM Levels 3.1, 3.3, 3.5, 3.7 and 4.0)

Residential treatment is a 24 hour, non-institutional, non-medical, short-term service that

provides residential rehabilitation services to youth, adult, and perinatal beneficiaries. Residential

services are provided in facilities designated by DHCS as capable of delivering care consistent with

ASAM Level 3.1: Clinically-Managed Low-Intensity Residential, ASAM Level 3.3: Clinically Managed

Population-Specific High-intensity Residential Services (Adult only), ASAM level 3.5: Clinically-

Managed High-Intensity Residential, ASAM Level 3.7: Medically Monitored Intensive Inpatient

Services, and ASAM Level 4.0: Medically Managed Intensive Inpatient Services Beneficiaries are

approved for residential treatment through a prior authorization process based on the results

identified by the ASAM assessment All prior authorization requests for residential treatment 3.1,

3.5, and 3.7 will be reviewed by the SUD Program Supervisor within 24 hours of request by the

treatment provider. The SUD Program Supervisor will review the beneficiary’s intake assessment,

diagnosis, treatment history and the reasons for referral to determine approval or denial of

request. The residential treatment provider will have the responsibility to submit a request for

authorization for up to a maximum of ninety (90) days on a continuous period for those adult

clients who have been assessed and admitted into a residential facility. One extension of up to

thirty (30) days beyond the maximum length of stay of ninety (90) days may be authorized for one

continuous length of stay in a one year period.

The residential treatment provider will have the responsibility to submit a request for

authorization for up to a maximum of thirty (30) days on one continuous period for adolescent

clients who have been assessed and admitted to a residential facility. Reimbursement will be

limited to two non-continuous thirty (30) day regimens in any one year period. One extension of

up to thirty (30) days beyond the maximum length of stay may be authorized for one continuous

length of stay in a one year period. Under the Early Periodic Screening, Diagnostic and Treatment

(EPSDT) mandate, beneficiaries under age of twenty-one (21) are eligible to receive all appropriate

and medically necessary services needed to correct and ameliorate health conditions that are

coverable under Section 1905(a) Medicaid authority. The DMC-ODS Pilot does not override any

EPSDT requirements.

Perinatal and criminal justice involved clients may receive a longer length of stay based on medical

necessity.


16

Residential treatment services include assessment, treatment planning, individual and group

counseling, client education, family therapy, collateral services, crisis intervention services,

treatment planning, transportation to medically necessary treatment, and discharge planning and

coordination. All providers are required to accept and support patients who are receiving

medication-assisted treatment.

For ASAM Level 3.7 and 4.0, ICBHS will work with El Centro Regional Medical Center and Pioneers

Memorial Hospital to address the needs of beneficiaries with severe withdrawal. In addition,

ICBHS has contracts with Alvarado Parkway Institute and Aurora Behavioral Health Psychiatric

Hospitals. ICBHS has a process in place for evaluating individuals who present need for inpatient

psychiatric care. The SUD clinical and administrative staff will work in collaboration with the Crisis

and Referral Desk team who will coordinate placement and transportation for beneficiaries who

are in need if inpatient psychiatric treatment. The SUD case manager will monitor the process of

treatment, both at the local hospital and psychiatric hospital, will participate in the discharge

planning and will ensure a successful transition to a lower level of SUD care.

Residential services will be provided by contract providers. ICBHS currently has a contract with

McAllister Institute, which is ASAM designated 3.1 and 3.5 and is in the process of visiting other

residential facilities that have received an ASAM designation and are DMC certified or in the

process of becoming certified for the purpose of developing additional contracts. ICBHS will

ensure ASAM level 3.3 is available within 3 years of final approval of the County’s implementation

plan and will follow the County policy and process for selecting new providers. For clients in any

residential treatment program, case management services will be provided to facilitate “step

down” to lower levels of care and support. Based on the ASAM level designation, staffing will

consist of certified substance abuse counselors, allied health professionals, LPHAs, physicians, and

physician extenders.

F. Opioid (Narcotic) Treatment Program (OTP/NTP, ASAM OTP Level 1)

ICBHS will establish a contract with the local licensed Narcotic Treatment Program to offer services

to beneficiaries who meet medical necessity criteria requirements. Services are provided in

accordance with an individualized client plan determined by a licensed prescriber. Prescribed

medications offered include methadone, buprenorphine, naloxone and disulfiram and other

medication covered under the DMC-ODS formulary. There are two NTP clinics in Imperial County,

which are located in the city of El Centro and Calexico. These clinics have the ability to serve the

SUD beneficiaries of Imperial County. The contract with this NTP clinic will clearly define its

responsibility to serve all beneficiaries who are referred for services.

Services provided as part of an OTP include: assessment, treatment planning, individual and group

counseling, patient education, medication services, collateral services, crisis intervention services,

treatment planning, medical psychotherapy, and discharge services. Clients receive between fifty

(50) and two hundred (200) minutes of counseling per calendar month with a therapist or


17

counselor, and when medically necessary, additional services may be provided. Staffing consists of

a licensed physician, certified SACs, LPHAs.

G. Additional Medication Assisted Treatment (MAT) Services (Optional, ASAM Level 1)

ICBHS will offer medically necessary MAT services through ICBHS staff. Services will include;

ordering, prescribing, administering, and monitoring of medication for SUD.

MAT will expand the use of medications for beneficiaries with chronic alcohol - related disorders

and opiate use. Medications will include: naltrexone, both oral (ReVia) and extended release

injectable (Vivitrol), topiramate (Topamax), gabapentin (Neurontin), acamprosate (Campral), and

disulfiram (Antabuse).

Opiate overdose prevention: naloxone (Narcan)

Opiate use treatment: buprenorphine-naloxone (Suboxone) and naltrexone (oral and extended

release) (Note: methadone will continue to be available through the licensed narcotic

treatment program)

For reduction of alcohol craving: naltrexone, both oral (ReVia) and extended release injectable

(Vivitrol), topiramate (Topamax), gabapentin (Neurontin), acamprosate (Campral) and

disulfiram (Antabuse)

Physician consultation will be provided to support implementation in areas such as medication

selection, dosing, side effects management, adherence, and drug-drug interactions. Services

listed above will be provided in an outpatient setting by ICBHS. Staff providing services will be

provided by licensed physicians with a specialty in addiction medicine. In addition, a Licensed

Vocational Nurse (LVN) will assist the physician if there is a need to order labs, communicate with

pharmacies, and will follow up with the beneficiaries on a regular basis to ensure that side effects

are under control and that they are following the recommended regimen. The LVN will also work

in collaboration with case managers and LPHAs for treatment planning and for recommendations

to a higher or lower level of care.

H. Recovery Services (ASAM Dimension 6, Recovery Environment)

Recovery services are available once a beneficiary has completed the primary course of

treatment and during the transition process. These services will be available to beneficiaries

whether they are triggered, have relapsed, or as a preventive measure to prevent relapse.

Services will be provided in the context of an individualized treatment plan that includes specific

goals. This may include the plan for ongoing recovery and relapse prevention that was developed

during discharge planning when treatment was completed. Beneficiaries accessing recovery

services are supported to manage their own health and health care, use effective self-

management support strategies, and use community resources to provide ongoing support.


18

Recovery services may be provided face-to-face, by telephone, or elsewhere in the community.

Services may include: outpatient individual or group counseling to support the stabilization of the

client or reassess the need for further care, recovery monitoring/ recovering coaching, peer to

peer services and relapse prevention, WRAP development, education and job skills, family

support, support groups, and linkages to various ancillary services. Recovery Services will be

provided by ICBHS staff consisting of certified SACs and LPHAs. ICBHS is also in the process of

working with HR and developing a job description for Peer Support Staff as this is not an existing

position. Once this position is approved, Peer Support staff will also be used to provide Recovery

Services to beneficiaries.

Referral to recovery services can be made by any SUD treatment provider, which may include the

case manager, Peer Support, LPHA, physician, or nurse. Appropriateness of referral will be

evaluated by the SUD treatment team prior to the beneficiary’s discharge to ensure proper

coordination of care once the beneficiary has completed treatment. The beneficiary will also be

able to request recovery services if he/she has relapsed, is triggered, or as a preventive measure

to prevent relapse even after he/she has completed treatment.

I. Case Management Services

Case management services support beneficiaries as they move through the DMC-ODS continuum

of care from initial engagement and early intervention, through treatment, to recovery supports.

Case management services are provided for clients who may be pre-contemplative and

challenging to engage, and/or those needing assistance connecting to treatment services, and/or

those clients stepping down to lower levels of care and support. ICBHS will use a comprehensive

case management model based on the ASAM bi-psychosocial assessment to identify needs and

develop a treatment plan. Additionally, ICBHS will follow the SAMHSA/CSAT TIP 27 (Treatment

Improvement Protocol) Comprehensive Case Management for Substance Abuse Treatment to

establish Case Management Services Criteria based on the assessment, needs and location on the

continuum of care and assign case management services as appropriate.

ICBHS will be responsible for coordination and monitoring of case management services for SUD

clients including the coordination of a system of case management services with physical and/or

mental health in order to ensure appropriate level of care.

Case management services are defined as a service that assist a beneficiary to access needed

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

services. These services focus on coordination of SUD care and integration around primary care

especially for beneficiaries with a chronic SUD, and interaction with the criminal justice system, if

needed. Case management services may be provided face-to-face, by telephone and may be

provided anywhere in the community.


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Case management services may include:

a. Comprehensive assessment and periodic reassessment of individual needs to determine the

need for continuation of case management services.

b. Transition to a higher or lower level SUD of care

c. Development and periodic revision of a treatment plan that includes service activities.

d. Monitoring service delivery to ensure beneficiary access to service and the service delivery

system.

e. Monitoring the beneficiary’s progress.

f. Patient advocacy, linkages to physical and mental health care, transportation and retention in

primary care services.

g. Case management shall be consistent with and shall not violate confidentiality of alcohol or

drug patients as set forth in 42 CFR Part 2 and California law at DMC provider sites, and county

locations. Case management will be provided by DMC provider staff consisting of certified

SACs and LPHAs

J. Physician Consultation

The ICBHS Medical Director will be available for consultation with all DMC providers that are seeking expert advice on designing treatment plans for specific DMC ODS beneficiaries. These consultation services are to support DMC providers with complex cases which may address medication selection, dosing, side effects management, adherence, drug-drug interactions, or level of care considerations. Physician consultation services will only be billed and reimbursed to DMC providers.

K. Recovery Residences

Recovery Residences (RR) or sober living homes will be available by contract providers for

beneficiaries who require housing assistance in order to support their health, wellness and

recovery. There is no formal SUD treatment provided at these facilities however residents are

required to actively participate in outside outpatient treatment and/or recovery supports during

their stay. The maximum length of stay is one hundred eighty (180) days. On a case by case basis

a determination will be made whether or not to extend the length of stay. ICBHS is developing

standards for contracted sober living homes and will monitor these standards. Sober living homes

are not reimbursable through Medi-Cal.

Optional Service Levels Pending ASAM Utilization Review

ICBHS will consider whether to offer additional optional services available under the waiver once

baseline data on beneficiary ASAM service need and utilization has been collected and analyzed.

If an unmet need for a service is determined, ICBHS will amend this plan to incorporate the

additional service(s) and will initiate in a process to identify and develop contract providers.

Service levels which ICBHS anticipates for possible expansion include: Withdrawal Management

(ASAM 2-WM, 3.2-WM, 3.7-WM AND 4-WM).


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Service Level Barriers

ICBHS anticipates the following barriers to providing a number of services within the DMC-ODS

continuum of care: start-up costs associated with starting new facilities and programming, facility

location challenges, (including zoning, lease procurement, construction, hiring, training and

retaining of qualified staff), DMC certification delays, geographic location and related beneficiary

transportation barriers. Additionally, barriers exist that prevents the provision of residential

services for adolescents due to the lack of ASAM certified providers.

Coordination with Surrounding Counties

ICBHS is surrounded by San Diego and Riverside Counties who are both opt-in counties. ICBHS will

provide original DMC modalities to any beneficiary in an opt-out county seeking services within

Imperial County, coordinate with neighboring counties to ensure beneficiaries can access services

easily and quickly, and will work together as needed, when a regional approach is required to

deliver a component of the continuum of care (e.g. youth residential treatment).

5. Coordination with Mental Health. How will the county coordinate mental health services for

beneficiaries with co-occurring disorders? Are there minimum initial coordination requirements or

goals that you plan to specify for your providers? How will these be monitored? Please briefly describe

the county structure for delivering SUD and mental health services. When these structures are

separate, how is care coordinated?

ICBHS provides SUD and MH services to residents of Imperial County. Each program is supervised

under a single executive management structure consisting of a director, assistant director, medical

director, a deputy director and managers for youth and young adult services, and for adult services.

SUD staff and programming are integrated into the organization, sharing the same policies and

procedures, administrative support, and often facilities with mental health. The DMC-ODS provides

further opportunity to fully align ICBHS programs and services not only for cases of co-occurring

disorders, but to assure that there is no “wrong door” when an individual makes the decision to seek

treatment and begin their recovery.

Prior to the implementation of the Mental Health Services Act (MHSA), SUD and MH services were

organized in separate departments with little interaction between staff and contract providers. Upon

implementation of MHSA the two departments began collaborating on service delivery to individuals

with co-occurring SUD and MH disorders. This collaboration eventually led to a reorganization that

established ICBHS as a single administrative structure for both SUD and MH services.

During this time period several changes in program systems have created a seamless method of

responding to beneficiaries request for services. This began with the ICBHS Access Unit which now is

responsible for service requests for both SUD and MH treatment requests. SUD assessments screen for

mental illness and provide referral for further assessment and psychiatric evaluation when necessary.

Likewise, MH assessments screen for and diagnose SUD conditions and also provide referrals to the


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MHSA Full Service Partnership services. Care coordination and referral procedures have been created

to maximize response time and inclusion of the beneficiary in treatment planning. Additionally,

collaborative relationships have been established with the Self-Management and Recovery Training

(SMART) Recovery community as well as the National Alliance on Mental Illness (NAMI).

During the DMC-ODS planning process, it has been the intent of ICBHS to avoid the development of a

separate system for service delivery, but rather, to integrate SUD services within structures of ICBHS.

Using this approach, ICBHS can build upon the support structures that already exist, not duplicating

existing systems, and broadening the existing infrastructure to further support residents seeking

treatment for SUD. This includes expanding quality assurance and improvement functions by extending

the oversight of the Quality Management Unit to include DMC-ODS programs and services, as well as

to staff and contract providers. The experience and skill of quality review staff in cooperation with

fiscal, technical, and administrative staff will prove invaluable during performance reviews, audits,

reporting, and evaluations, assuring compliance within DMC-ODS requirements. This approach

provides the support to conduct regular internal reviews and ongoing monitoring to test for

compliance and help to achieve performance standards and benchmarks. Additionally, this creates

opportunities for more holistic quality improvement measures that incorporate both SUD and MH

practices, which will have greater impact on client outcomes when conducted within an integrated

service delivery system.

Currently, ICBHS coordinates services between programs for individuals with co-occurring disorders

through coordinated treatment plans and services. Service teams remain in regular communication

with one another since employees belong to the same organization and are often co-located sharing

the same email, calendaring, and telephone systems. All HIPAA and 42 CFR Part 2 requirements are

met.

Coordination with Physical Health. Describe how the county will coordinate physical health services

within the waiver. Are there minimum initial coordination requirements or goals that you plan to

specify for your providers? How will these be monitored?

Physical health services will be coordinated primarily through collecting and monitoring health-related

client specific information about medical history, current medical conditions and treatment. This will

be done through the initial assessment process and updated during follow up visits as needed. A

medical history is obtained at the first appointment via the medical information sheet which is

reviewed and discussed with the client including the date of the last physical exam.

The medical director will review the medical history sheet, medical records and communicate with the

client’s primary care provider regarding treatment, medications or other issues as needed. The medical

director will order lab work for each client to obtain baseline information regarding their current status

as needed. If necessary, a referral is made to local primary care physicians for further testing of Human

Immune-Deficiency Virus (HIV), Hepatitis C and/or other Sexually Transmitted Diseases (STDs).


22

During the course of treatment, any changes in the client’s health will be noted and reported to the

medical director. If clients do not have a primary care provider, treatment staff will encourage the

client to obtain a primary care doctor to attend to and monitor their healthcare needs. Referrals for

medical needs will be made as necessary. Clinicas De Salud del Pueblo is a community outpatient

medical clinic located in the major population areas within the county. A large segment of our

population utilizes these clinics for routine medical care. Referrals will be made reciprocally between

ICBHS and Clinicas de Salud del Pueblo.

Imperial Valley Medical Clinic, a contract provider engages in Narcotic Treatment (methadone)

services. Clients’ health care is monitored by the medical director for IV Medical Clinic. Referrals for

continuing medical care are made to local healthcare resources. McAllister Institute, a contract

provider for a social model residential detoxification and recovery services, requires the completion of

a medical history and screening form. Any medical needs are addressed by taking residents to area

health clinics for services.

Minimum initial coordination requirements or goals for providers will emphasize maintaining up to

date information on the client’s health status. Additionally, providers will be expected to establish

goals for beneficiaries to obtain or maintain a relationship with a primary care provider, provide

education and awareness of health-related conditions, as well as, referrals to health care providers.

This will be identified as a service for beneficiaries in contracts/ MOUs with ICBHS. Additionally, this

will be identified as an area to be monitored by ICBHS contract compliance staff.

Coordination Assistance. The following coordination elements are listed in the STCs. Based on

discussion with your health plan and providers; do you anticipate substantial changes and/or need for

technical assistance with any of the following? If so, please indicate which and briefly explain the

nature of the challenges you are facing.

Comprehensive substance use, physical, and mental health screening

Beneficiary engagement and participation in an integrated care program as needed

Shared development of care plans by the beneficiary, caregivers and all providers

Collaborative treatment planning with managed care

Care coordination and effective communication among providers

Navigation support for patients and caregivers

Facilitation and tracking of referrals between systems

a) Comprehensive substance use, physical, and mental health screening / g) Facilitation and

tracking of referrals between systems

ICBHS currently provides comprehensive substance use and mental health screening by staff at the

various clinical divisions within Imperial County and has established Memorandums of

Understanding (MOUs) with Clinicas De Salud Del Pueblo, Inc. and formerly with Imperial County

Public Health. Provision of services include the coordination of medical clearance examination for

individuals participating in the ICBHS exercise program, tuberculosis testing, HIV testing, and other


23

sexually transmitted disease testing. The Memorandums of Understanding (MOU) also address

protocols related to the facilitation and tracking of referrals between systems and the method of

reimbursement. Additionally, ICBHS has MOUs with the two county Medi-Cal managed care health

plans (California Health and Wellness and Molina Healthcare of California) which define

coordination of mental health, and SUD services for Medi-Cal beneficiaries. Providers meet on a

quarterly basis with ICBHS staff to discuss issues or concerns related to the coordination process.

ICBHS will use this coordination infrastructure established in the aforementioned MOUs to build

the DMC-ODS care coordination infrastructure with additional providers.

Prior to the implementation of the DMC-ODS waiver, all ICBHS substance use treatment staff will

receive thorough training on the treatment criteria for Addictive, Substance-Related, and Co-

Occurring Conditions (ASAM Criteria). Once staff are trained, the ASAM criteria will be used in

ensuring comprehensive screening is conducted on each individual presenting with substance use

concerns.

b) Beneficiary engagement and participation in an integrated care program as needed

ICBHS has trained both SUD and MH staff in Motivational Interviewing (MI) and other evidence-

based models which heavily emphasis engagement techniques. These techniques have been used

within the divisions to promote the working alliance with individuals from the start of treatment.

However, since the integration of services will include various outside contract providers, it is

anticipated that training in MI and other engagement strategies among contract providers may be

limited. For this reason, one challenge may be that contract providers may lack the necessary

training in engagement strategies to increase the participation of individuals in an integrated care

program. One way to address this would be to include the contract providers in internal ICBHS

trainings related to engagement strategies.

c) Shared development of care plans by the beneficiary, caregivers and all providers

Currently, ICBHS has integrated SUD and MH treatment to the extent that employees from each

program are co-located, refer to each program, and communicate amongst treatment team

members from each program with the necessary releases of information. This has allowed for

shared communication related to the individuals’ treatment needs and progress, including

participating in treatment team meetings when needed. Additionally, providers from outside of

ICBHS are not consistently involved in the development of care plans for all individuals. This will

require collaboration between ICBHS and various providers while still adhering to HIPAA and 42

CFR.

d) Collaborative treatment planning with managed care

ICBHS is already actively engaged in collaborative treatment planning with the two managed care

plans in Imperial County. The adherence to current MOUs with California Health and Wellness and

Molina Healthcare of California and quarterly meetings have been successful in the collaborative

treatment planning with managed care. This system will continue to be followed and added to in


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order to enhance the process. However, part of the initial implementation will require educating

the managed care plans on the specific levels of care and referral and assessment protocols for the

DMC-ODS.

e) Care coordination and effective communication among providers

With the established MOUs between ICBHS and Clinicas De Salud Del Pueblo, and the two managed

care plans, a foundation already exists for care coordination and effective communication between

providers. These established protocols will be the foundation for creating a comprehensive

protocol for enhancing care communication and coordination amongst providers. However, one

challenge anticipated with care coordination and effective communication among providers is

ensuring that all providers understand the requirements related to 42 CFR, Part 2. This will also

include the need to update forms, policies, procedures, and protocols to enable the communication

necessary for effective care coordination and communication. This will be particularly challenging

given the fact that records from each ICBHS program (SUD and MH) are currently kept separate

and therefore, not easily accessible by treatment staff from each program. It will be necessary to

ensure that the integration of records (while still adhering to HIPAA and 42 CFR) is prioritized to

allow for easy accessibility of chart reviews by direct treatment staff for the purpose of delivering

an integrated approach to treatment. Some technical assistance may be required in this area.

f) Navigation support for patients and caregivers

With the implementation of targeted case management and recovery services in the DMC-ODS, it is

expected that individuals receiving services and their caregivers will be provided with effective

navigation support with an emphasis on family education. There are currently no anticipated

challenges in this area.

6. Availability of Services. Pursuant to 42 CFR 438.206, the pilot County must ensure availability and

accessibility of adequate number and types of providers of medically necessary services. At minimum,

the County must maintain and monitor a network of providers that is supported by written agreements

for subcontractors and that is sufficient to provide adequate access to all services covered under this

contract. In establishing and monitoring the network, describe how the County will consider the

following:

The anticipated number of Medi-Cal clients.

The expected utilization of services by service type.

The numbers and types of providers required to furnish the contracted Medi-Cal services.

A demonstration of how the current network of providers compares to the expected utilization by

service type.

Hours of operation of providers.

Language capability for the county threshold languages.

Specified access standards and timeliness requirements, including number of days to first face-to-

face visit after initial contact and first DMC-ODS treatment service, timeliness of services for urgent


25

conditions and access afterhours care, and frequency of follow-up appointments in accordance with

individualized treatment plans.

The geographic location of providers and Medi-Cal beneficiaries, considering distance, travel time,

transportation, and access for beneficiaries with disabilities

How will the county address service gaps, including access to MAT services?

As an appendix document, please include a list of network providers indicating, if they provide MAT,

their current patient load, their total DMC-ODS patient capacity, and the populations they treat (i.e.,

adolescent, adult, perinatal).

The anticipated number of Medi-Cal clients

As of July 2015, Imperial County had approximately 75,866 Medi-Cal beneficiaries according to

local health officials. Prevalence estimates vary. Up to 14.2% of the Medicaid population meets

the diagnostic criteria for a substance use disorder according to NSDUH (2008-2010) National

Survey of Drug Use and Health, 2013 American Community Survey), while the California

Department of Health Care Services (DHCS Behavioral Health Needs Assessment, chapter 7, page

178) estimates 10.3% of the population meets criteria for a SUD. Using these prevalence estimates

ICBHS projects between 10,773 and 7,814 Medi-Cal beneficiaries have a SUD and could benefit

from treatment.

SAMHSA data indicate 10.8 percent of those who needed treatment received treatment in a

specialty program. Given this, ICBHS anticipates serving between 1,163 and 844 beneficiaries in

the first year of implementation. The table below presents the actual beneficiary counts with

prevalence and penetration high and low estimates for adults and youth for ICBHS. The

Department of Health Care Services (DHCS) in the 2013 Behavioral Health Needs Assessment

estimated the penetration rate at 7% for Imperial County. This results in a caseload range of 754

to 547 beneficiaries. For planning purposes ICBHS will be using the SAMHSA methodology

because with the implementation of the DMC-ODS there will be a more structured outreach and

engagement processes as well as a full continuum of services that will be more responsive to the

treatment needs of this population than has previously existed. Therefore, ICBHS will use an

estimate high of 1,163 and an estimate low of 844.

Medi-Cal Beneficiary Estimates Based on 2015 Actuals

With Prevalence and Penetration Estimates by Adult and Youth

Pre-2014 Medi-Cal Adult Beneficiaries

Total Prevalence Penetration

14.2% 10.3% 10.8%

High Low High Low

2015 Actual Medi-Cal Beneficiaries 75,866 10,773 7,814 1,163 844 2015 Actual Medi-Cal Adult Beneficiaries 46,528 6,607 4,792 714 517

2015 Actual Medi-Cal Youth Beneficiaries 29,388 4,173 3,027 451 327

Prevalence and Penetration Calculations Projected Over 5 Years


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A c t u a l P r o j e c t i o n

Percent Jun

2014 Oct

2015 FY

15-16 FY

16-17 FY

17-18 FY

18-19

Prevalence Est. Low 10.3% 7,814 7,892 7,971 8,051 8,131 Prevalence Est. High 14.2% 10,773 10,881 10,990 11,100 11,211

SAMHSA w/SUD Dx Receiving Tx

10.8% High 1,163 1,175 1,187 1,199 1,211

Low 844 852 861 870 879


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a) The expected utilization of services

Imperial County used a number of historical and forecasted approaches in determining service

utilization and projections. The table below details services utilization reported from existing data

collection systems. This information is based on actual treatment admissions for Fiscal Year 2013-

2014 and Fiscal Year 2014-2015.

During Fiscal Year 2013-2014, 93.76% of treatment admissions were for outpatient and non-

residential services. During Fiscal Year 2014-2015, 93.73% of the admissions were for outpatient

and non-residential services. For Fiscal Year 2013-2014, 6.24% of the treatment admissions were

in residential modalities. For Fiscal Year 2014-2015, 6.27% of the treatment admissions were in

residential modalities.

Medi-Cal Beneficiary SUD Treatment Admission by Modality

FY 13-14 FY14-15

Non Residential / Outpatient Treatment / Recovery

Actual % Subtotal

% Grand Total

Actual % Subtotal

% Grand Total

Outpatient Drug Free 648 59.00% 55.38% 735 63.04% 59.08%

Outpatient (Medications) 0 0

NTP Maintenance 292 26.62% 24.96% 344 29.50% 27.65%

Outpatient Detoxification 0 0

Outpatient Detox (non-med) 0 0

Outpatient Detox (med) 0 0

NTP Detox 157 14.31% 13.42% 87 7.46% 7.00%

Subtotal 1,097 93.76% 1,166 93.73%

Residential Inpatient

Detoxification (hospital) 0 0

Detoxification (non-hospital) 0 0

Residential (30 days or less) 73 100.00% 6.24% 78 100.00% 6.27%

Residential (30 days or more) 0 0

Subtotal 73 78

Grand Total 1,170 100% 1,244 100%


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b) The number and types of providers required to furnish the contracted Medi-Cal Services

The table below details the beneficiary high and low penetration estimates to establish the

needed network capacity to meet beneficiary demand. Actual admission percentages multiplied

by the high and low penetration of overall medical beneficiaries demonstrates results in projected

caseloads.

Medi-Cal Beneficiary SUD Treatment Admissions by Modality with Caseload Estimates for Current and Future Years Through FY 2016-17

F Y 1 3 - 1 4 F Y 1 4 - 1 5

Non-Residential Outpatient Actual % ODS Estimated

Actual % ODS Estimated

High Low High Low

Treatment Recovery 1,163.00 844.00 1,163.00 844.00 Outpatient Drug Free 648 55.38% 644.07 467.41 735 59.08% 687.10 498.64

Outpatient (medication) NTP Maintenance 292 24.96% 290.28 210.66 344 27.65% 321.57 233.36 Day Care Habilitative Outpatient Detox Outpatient Detox (non-med) Outpatient Detox (med) NTP Detox 157 13.42% 156.07 113.26 87 7.00% 81.41 59.08

Subtotal 1,097 93.76% 1,090.42 791.33 1,166 93.73% 1,090.08 791.09

Residential inpatient Detox (hospital) Detox (non-hospital) Residential (30 days or less) 73 6.24% 72.57 52.67 78 6.27% 72.92 52.92

Residential (30 days or more) Subtotal 73 72.57 52.67 78 6.27%

Total 1,167 100.00% 1,162.99 844.00 1,244 100.00% 1,163.00 844.00

F Y 1 5 - 1 6 F Y 1 6 - 1 7

Non-Residential Outpatient

Actual

% ODS Estimated Actual

(projected 1%)

% ODS Estimated

High Low High Low

Treatment Recovery 1,163.00 844.00 1,163.00 844.00 Outpatient Drug Free 693 54.23% 630.69 457.70 699.93* 54.22% 630.60 457.60

Outpatient (medication) NTP Maintenance 347* 27.15% 315.75 229.15 350.47* 27.15% 315.80 229.20

Day Care Habilitative Outpatient Detox Outpatient Detox (non-med) Outpatient Detox (med) NTP Detox 159* 12.44% 144.68 105.00 160.60* 12.44% 144.70 104.90

Subtotal 1,199 93.82% 1,091.12 791.85 1,211.00 93.81% 1,091.10 791.76

Residential inpatient Detox (hospital) Detox (non-hospital) Residential (30 days or less) 79* 6.18% 71.87 52.15 79.80* 6.18% 71.90 52.16 Residential (30 days or more)

Subtotal 79 79.80 Total 1,278 100.00% 1,163.00 844.00 1,290.80 100.00% 1,163.00 844.00

Figures marked with (*) indicate 1% growth from previous year. Actual figures are unknown.

Currently, ICBHS has five Substance Abuse Counselors providing DMC services to the adolescent population and one Substance Abuse Counselor providing services to adults and older adults who


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have a dual SUD and mental health diagnosis. To meet the estimated need for the ODS waiver ICBHS will contract with the number of providers necessary to meet estimated need at the time of implementation. ICBHS is in the process of recruiting the following additional providers: Adult SUD Services

Outpatient, Intensive Outpatient, Case Management and Recovery Services:

Eight certified Substance Abuse Counselors

Six Licensed Practitioners of the Healing Arts

Adolescent SUD Services Outpatient, Intensive Outpatient, Case Management and Recovery Services:

Three certified Substance Abuse Counselors

Six Licensed Practitioners of the Healing Arts Adolescent and Adult SUD Services

Medication Assisted Treatment:

One part-time physician

One Licensed Vocational nurse

Opioid (Narcotic) Treatment Program: ICBHS will contract with the local NTP clinic for these services

Residential and Withdrawal Management:

ICBHS will continue to utilize the services that are currently contracted and described in this plan and will develop additional contracts to meet the need of Imperial County Beneficiaries.

c) Language capability for the county threshold languages

Currently, 80% of ICBHS employees are bilingual/bicultural and 64% of ICBHS employees provide

interpretation services. ICBHS employees will be required to abide by the Imperial County

Behavioral Health Services language access policies specifically in providing interpretation and

translation services to all clients. In addition, ICBHS employees providing or requiring

interpretive services will be required to attend mandatory “How to Work With Interpreters”

training to ensure proper use of interpreters in service provision. ICBHS through its Quality

Management Unit will ensure that DMC providers comply with the language access requirements

for its beneficiaries. ICBHS does not currently track the percent of bilingual employees working at

contract facilities, but will begin tracking this as part of the ICBHS annual cultural competency

plan.

d) Hours of Operation of Providers

Provider Hours of Operation

Adult El Centro SUD Clinic Monday-Friday 8:00am to 5:00pm


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Adult Brawley SUD Clinic Monday-Friday 8:00am to 5:00pm

Adult Calexico SUD Clinic Hours to be determined

Adolescent El Centro SUD Clinic Monday-Friday 8:00am to 5:00pm

Adolescent Brawley SUD Clinic Monday-Friday 8:00am to 5:00pm

Adolescent Calexico SUD Clinic Hours to be determined

Imperial Valley M edical Clinic

(Narcotic Treatment Program)

Monday-Friday 8:00am to 5:00pm

McAllister Institute

(Residential Treatment)

24 hours per day/ 7 days per week

f) Timeliness of first face-to-face visit, timeliness of services for urgent conditions and access after-

hours care

T i m e l i n e s s o f C a r e

Type of Care Time Frame

Non Urgent / Routine Appointment offered within seven (7) working days through scheduled appointments and walk-in assessments.

Urgent Conditions Request for services for an urgent condition will be provided within one (1) hour of the request.

Emergency Anyone who is experiencing a medical or Substance Use Disorder emergency will be directed to the nearest hospital for services.

The ICBHS standard is for each beneficiary to be offered a first appointment within seven (7)

working days of initial request for service for non-urgent services. To improve timely access to

services for all beneficiaries, ICBHS will collect baseline data to identify problem areas and

solutions, with the goal of all beneficiaries being offered an appointment within seven (7)

working days of a request for non-urgent services.

Urgent conditions require immediate attention but do not require inpatient hospitalization.

Urgent conditions may be identified during the course of treatment, a scheduled intake

assessment or during a walk in screening/assessment. ICBHS offers walk in assessments that are

available Monday-Friday from 8am to 5pm at each regional clinic site or at the Assessment

Center. Once ICBHS identifies the presence of a beneficiary’s urgent condition, arrangements are

made for an expedited appointment at one of the ICBHS regional clinics for SUD Services.

Beneficiaries will have access to services afterhours through a toll free 800 phone number

twenty-four (24) hours per day, seven (7) days per week. After hours calls are screened and

triaged by an on-call certified substance abuse counselor for risk and appropriate referrals are

made.


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All beneficiaries experiencing a medical or SUD emergency will be directed to the nearest hospital

for services.

f) The geographic location of providers and Medi-Cal beneficiaries, considering distance, travel

time, transportation, and access for beneficiaries with disabilities

ICBHS currently has a total of eleven (11) SUD clinics located in the major population centers of

Imperial County. Adult Services has one outpatient SUD clinic located in El Centro and Adolescent

Services has ten (10) clinics located in El Centro, Calexico and Brawley; nine of which are school-

based clinics located in different high schools. Additional SUD clinics are currently being planned

for development to ensure that services are accessible to underserved and unserved populations;

especially those residing in the outline areas of Imperial County. The development of these clinics

will allow beneficiaries to have access to SUD services closest to their city of residence.

Additionally, public transportation is available which provides transportation from the outlying

cities to nearby bus stops. Public transit is handicapped accessible as well as each of the clinic

sites.

The following table is a list of DMC certified providers or in the process of seeking certification as

an ICBHS DMC provider.

Provider Number Provider Name Service Location

1303 Adolescent Outpatient Drug Free (ODF) Clinic

Outpatient/ Intensive Outpatient

1295 State Street, Suites 104-105 El Centro CA 92243

1309 Adult Outpatient Drug Free (ODF) Recovery Center

Outpatient/ Intensive Outpatient

2695 S. 4th

Street, 2nd

Floor El Centro, CA 92243

1310 Brawley Union High School Outpatient/ Intensive Outpatient

480 N. Imperial Avenue Brawley, CA 92227

1311 Calexico High School Outpatient/ Intensive Outpatient

1030 Encinas Avenue Calexico, CA 92231

1312 Desert Valley High School Outpatient/ Intensive Outpatient

104 Magnolia Street Brawley, CA 92227

1315 Aurora High School Outpatient/ Intensive Outpatient

641 Rockwood Avenue Calexico, A 92231

1318 Central Union High School Outpatient/ Intensive Outpatient

1001 W. Brighton Avenue El Centro, CA 92243

1319 Calexico High School 2 (9th

Grade) Outpatient/ Intensive Outpatient

824 Blair Avenue Calexico, CA 92231

1320 Valley Academy School Outpatient/ Intensive Outpatient

253 E. Ross Avenue El Centro, CA 92243

1321 Del Rio Academy School Outpatient/ Intensive Outpatient

1501 I Street Brawley, CA 92227

1322 Calexico Academy School Outpatient/ Intensive Outpatient

813 Andrade Avenue, Rooms A&B Calexico, CA 92231


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Provider Number

Provider Name Service Location

Pending Adult ODF Brawley, Outpatient Outpatient/ Intensive Outpatient

To be determined

Pending Adult ODF Calexico, Outpatient Outpatient/ Intensive Outpatient

To be determined

Pending Adolescent ODF Brawley, Outpatient Outpatient/ Intensive Outpatient

To be determined

Pending Adolescent ODF Calexico, Outpatient Outpatient/ Intensive Outpatient

To be determined

Imperial County Medi-Cal Certified Providers providing SUD services are shown by geographic

location.

1310 Brawley Union High School

1312 Desert Valley

High School 1321

Del Rio Academy

1303 Adolescent ODF 1309 Adult ODF 1318 Central Union High School 1320 Valley Academy Imperial Valley Medical Clinic (NTP Services)

1311 Calexico High School

1315 Aurora High School

1319 Calexico High School

2 (9th

grade) 1322 Calexico

Academy School


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The table below indicates one way travel time and distance from outlying areas to SUD Clinic sites.

Location Distance Travel Time

Holtville to El Centro 11 Miles 19 minutes Ocotillo to El Centro 28 Miles 29 minutes

Seeley to El Centro 11 Miles 15 minutes Calexico to El Centro 12 Miles 17 minutes

Heber to El Centro 6 Miles 12 minutes

Imperial to El Centro 3 Miles 10-15 minutes

Brawley to El Centro 14 Miles 22 minutes

Calipatria to Brawley 11 Miles 17 minutes

Salton City to Brawley 36 Miles 43 minutes

Niland to Brawley 19 Miles 27 minutes

This table indicates Imperial County Centers of Population Growth from 2010 to 2015

(US Census Data)

City 2010 2015 Difference El Centro 42,592 43,956 3.2%

Calexico 38,573 40,053 3.2%

Brawley 24,953 25,897 3.8%

Imperial 14,752 17,095 15.9%

Calipatria 7,705 7,424 -3.6%

County of Imperial 174,528 180,191 3.2

Imperial County’s methodology for estimating the demand for services and projected number of

beneficiaries is based on a Medi-Cal beneficiary data, prevalence and penetration rates, historical

and actual treatment admissions. Data supports the conclusion that the geographic locations of El

Centro, Brawley and Calexico as high service demand locations that would be the targeted locations

for service delivery in the DMC-ODS implementation in Imperial County. Additionally, these cities

listed above are geographically spread throughout the County (see County Map) and as a group are

adjacent to or within transportation corridors to which will assist with accessibility to DMC-ODS

service sites.

Accessing treatment services for persons with disabilities

ICBHS requires all SUD providers to serve persons with disabilities in compliance with SAPTBG and

DHCS requirements and the following policies and regulations.

Americans with Disabilities Act of 1990

Section 540 of Rehabilitation Act of 1973

45 Code of Federal Regulations (CFR), Part 84, Non-discrimination on the Basis of Handicap in

programs or Activities Receiving Federal Financial Assistance


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Title 24, California Code of Regulations (CCR) Part 2, Activities Receiving Federal Financial

Assistance; and

Unruh Civil Rights Act California Civil Code (CCC) Sections 51 through 51.3 and all applicable laws

related to services and access to services for persons with disabilities.

Regardless of where a person enters the ICBHS system, that person will receive an initial intake

assessment at one of the SUD clinics closest to the individual’s place of residence, which will

determine level of care. ICBHS will make accommodations to serve persons with physical disabilities,

including vision and hearing impairments. In addition, services must be made available to all

individuals with mobility, communication or cognitive impairments as required by federal and state

laws and regulations.

Beneficiaries are advised of their right to receive services and any complaints and grievances are

investigated and appropriate and timely action is taken to ensure access.

e) How will the county address service gaps, including access to MAT services?

ICBHS has one contract provider for adolescent residential services which is limited to 14 day detox

services. Residential services for adolescents requiring more than 14 days of treatment is not

currently available due to the lack of ASAM certified providers. This represents a gap in the continuity

of care. ICBHS will continue efforts to locate a qualified provider and develop provider contracts for

ASAM level 3.1, 3.3 and 3.5 certified facilities for adolescent residential services for up to 30 day

length of stay.

ICBHS will offer medications beyond the NTP requirements to ensure beneficiaries have access to a

full complement of medications to support SUD treatment and recovery. ICBHS will extend the use of

MAT interventions by expanding the use of medications for:

Opiate overdose prevention: naloxone (Narcan).

For opiate use treatment: buprenorphine-naloxone (Suboxone) and naltrexone (oral and extended

release)

For reduction of alcohol craving: naltrexone, both oral (ReVia) and extended release injectable

(Vivitrol), topiramate (Topamax), gabapentin (Neurontin), acamprosate (Campral) and disulfiram

(Antabuse)

ICBHS will integrate the use of MAT into SUD clinics. MAT services will be provided if medically

necessary and in accordance with an individualized treatment plan determined by a licensed

physician. MAT services will be made available to beneficiaries at the outpatient clinic locations

based on clinical need and the beneficiaries consent. There are no service gaps identified in the

delivery of MAT services.


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f) As an appendix document, please include a list of network providers indicating, if they provide

MAT, their current patient load, their total DMC-ODS patient capacity, and the populations they

treat (i.e., adolescent, adult, perinatal).

See Appendix

7. Access to Services. In accordance with 42 CFR 438.206, describe how the County will assure the

following:

Meet and require providers to meet standards for timely access to care and services, taking into

account the urgency of need for services.

Require subcontracted providers to have hours of operation during which services are provided to

Medi-Cal beneficiaries that are no less than the hours of operation during which the provider offers

services to non-Medi-Cal patients.

Make services available to beneficiaries 24 hours a day, 7 days a week, when medically necessary.

Establish mechanisms to ensure that network providers comply with the timely access

requirements.

Monitor network providers regularly to determine compliance with timely access requirements.

Take corrective action if there is a failure to comply with timely access requirements.

a) Meet and require providers to meet standards for timely access to care and services, taking into

account the urgency of need for services. All providers and network providers will be required to

meet the standards for timely access to care and services, taking into account the urgency of need

for services as established by ICBHS. ICBHS will ensure that all beneficiaries have timely access to

the services and levels of care, as appropriate. The behavioral health standards for timeliness of

services will be the same for ODS services and will be analyzed and evaluated as part of the quality

improvement process.

First Face-to-Face Visit. First appointment will be scheduled as soon as possible, within a 7 day

standard for intake appointment after the initial request for outpatient services.

Urgent Conditions. Services for urgent conditions are responded to immediately, within 60

minutes.

Emergencies. Upon identification of emergency conditions, Access Line staff and providers will

contact appropriate emergency medical services for intervention.

b) Require subcontracted providers to have hours of operation during which services are provided

to Medi-Cal beneficiaries that are no less than the hours of operation during which the provider

offers services to non-Medi-Cal patients. ICBHS will include in the provider contract the

requirement to have hours of operation during which services are provided to Medi-Cal


34

beneficiaries are no less than the hours of operation during which the provider offers services to

non-Medi-Cal patients. This requirement will be monitored by the ICBHS QM Unit.

c) Make services available to beneficiaries 24 hours a day, 7 days a week, when medically

necessary. All Medi-Cal beneficiaries will be able to access services 24 hours a day, 7 days a week

through the toll-free access line and outpatient clinics during business hours.

d) Establish mechanisms to ensure that network providers comply with the timely access

requirements. The ICBHS QM Unit will establish mechanisms to inform and ensure that network

providers comply with the timely access requirements.

e) Monitor network providers regularly to determine compliance with timely access requirements.

The ICBHS QM Unit will be responsible for tracking and monitoring the timeliness to service data

and ensure access to services is provided within established standards, at least annually.

f) Take corrective action if there is a failure to comply with timely access requirements. When

provides fail to meet and/or comply with timely access standards established by ICBHS, the

following may occur:

The submission of a corrective action plan;

Possible fiscal sanctions; or

Possible termination or adjustment of a contract.

8. Training Provided. What training will be offered to providers chosen to participate in the waiver?

How often will training be provided? Are there training topics that the county wants to provide but

needs assistance?

ICBHS Center for Clinical Training (CCT) has developed a series of training academies for clinicians,

staff providing case management services, nursing staff and other support staff such as mental health

workers and community service workers. All new clinicians are required to attend an eight-week

clinical development academy in which they are trained on a series of clinical topics that include

assessment, diagnosis, treatment planning, evidence-based interventions, laws and regulations,

documentation standards, mental status exam, among other clinical topics. Clinicians then attend an

advanced clinical training on a yearly basis in which they receive follow-up from the first clinical

development training and training on advanced clinical skills.

Staff providing case management services receive a six week academy in which they are trained on

assessment related to their scope of practice, cognitive-behavioral techniques, treatment planning,

documentation standards, laws and regulations, and other policies and procedures related to their job


35

assignment. All certified substance abuse counselors who will be conducting case management

services will be required to attend this academy, specifically to receive training on the aspect of

providing case management services to beneficiaries.

All current clinicians and certified substance abuse counselors are also trained on motivational

interviewing and attended twelve (12) months of consultation with the trainer of the model. New

clinicians and certified substance abuse counselors will be required to attend a motivational

interviewing training and demonstrate skills through their interventions with clients and

documentation. Follow-up trainings will be available to those staff who have received this training.

All clinical staff will also be required to attend training on the different evidence-based models that

will be implemented a part of this pilot program (see section 13 –Evidence-Based Practices); including

the consultation calls as required by each model.

Other training that will be provided with all SUD treatment staff include the following:

ASAM Criteria

SUD Training

Title 22 Regulations

DMC Documentation Standards

Cognitive Behavioral Therapy/Techniques

CLAS Standards

Cultural Competence

Applied Suicide Intervention Skills Training

The ICBHS Staff Development Unit will maintain record of all trainings attended by SUD treatment

staff and will ensure that certifications are maintained up to date. Assigned supervisors will ensure

that staff are scheduled to the required trainings once informed by the Staff Development Unit of

upcoming trainings. Record of trainings attended will be maintained a part of the employee file.

9. Technical Assistance. What technical assistance will the county need from DHCS?

The County anticipates the need for technical assistance from DHCS on the following areas:

Financial and administrative issues related to rate setting, re-evaluating rate structure,

reimbursement structures, claiming mechanisms, documentation requirements, and cost

reporting

Standards associated with cost reporting and audit principals

Any modification to the County’s cost reporting system and process with DHCS

Understanding Certified Public Expenditures


36

Understanding how to report and obtain reimbursement for cross county DMC clients

ASAM training, resources, and tools. A train the trainer model would be preferred to build

internal system capacity and meet ongoing training needs to accommodate new staff and

providers, to ensure inter-rater reliability for placement decisions, and for utilization

management

42CFR/Confidentiality in the context of moving towards an integrated system of care

Use of brief (15-20 minute) ASAM screening tools in a call center/triage setting

Defining, and applying DMC services that are not yet part of the DMC array of benefits, such as

recovery services, case management and physician consultation

Provide a current list of all California Licensed and DMC certified youth residential facilities by

ASAM Level

Assist ICBHS in care coordination with acute services, including:

▫ A list of facilities licensed in California to provide Level 3.7 and 4.0 residential and withdrawal

management services

▫ Facilities that accept full scope Medi-Cal and which Medical aid codes are billable by facility

based on their DRG and NPI numbers for both 3.7 and 4.0 residential and withdrawal

management services

▫ Facilities which can provide services to youth and which serve adults

DHCS licensing and certifications and reimbursement, cost reporting and billing practices for

expanded waiver services including case management and recovery services

Sample monitoring instruments for residential and methadone providers

10. Quality Assurance. Describe the County’s Quality Management and Quality Improvement programs.

This includes a description of the Quality Improvement (QI) Committee (or integration of DMC-ODS

responsibilities into the existing MHP QI Committee). The monitoring of accessibility of services

outlined in the Quality Improvement Plan will at a minimum include:

Timeliness of first initial contact to face-to-face appointment

Frequency of follow-up appointments in accordance with individualized treatment plans

Timeliness of services of the first dose of NTP services

Access to after-hours care

Responsiveness of the beneficiary access line

Strategies to reduce avoidable hospitalizations

Coordination of physical and mental health services with waiver services at the provider level

Assessment of the beneficiaries’ experiences, including complaints, grievances and appeals

Telephone access line and services in the prevalent non-English languages.

Review Note: Plans must also include how beneficiary complaints data shall be collected, categorized

and assessed for monitoring Grievances and Appeals. At a minimum, plans shall specify:


37

How to submit a grievance, appeal, and state fair hearing

The timeframe for resolution of appeals (including expedited appeal)

The content of an appeal resolution

Record Keeping

Continuation of Benefits

Requirements of state fair hearings.

Quality Management Program

The QM Unit oversees the coordination of Quality Improvement program activities. The managed

care behavioral health manager, under the direction of the director, is responsible for the

implementation of QI activities and provision of leadership for the QI Program. The QM Unit is

responsible to the QIC for conducting, monitoring, and evaluation of QI program activities.

Quality Improvement Program The goal of the QI program is to improve access to, and delivery of, mental health and substance use

disorders services while assuring that services are community based, beneficiary directed, age

appropriate, culturally competent, and process and outcome focused. The QI program approach is an

integrative process that links knowledge, structure, and process together in order to assess and

improve quality. This approach is designed to coordinate with performance monitoring activities

throughout the organization including, but not limited to, beneficiary and system outcomes,

utilization management, clinical records review, and monitoring of beneficiary and provider

satisfaction. The QI program will include monitoring activities for timeliness of first initial contact to

face-to-face appointment, frequency of follow-up appointments in accordance with individualized

treatment plans, timeliness of services of the first dose of NTP services, access to after-hours care,

responsiveness of the beneficiary access line, strategies to reduce avoidable hospitalizations,

coordination of physical and mental health services with waiver services at the providers level,

assessment of the beneficiaries’ experience including complaints, grievances and appeals, and

telephone access line and services in the prevalent non-English languages.

Quality Improvement Committee

ICBHS will integrate DMC-ODS responsibilities into the existing Quality Improvement Committee

(QIC). The QIC is an integral component of the ICBHS Quality Improvement Program. The QIC

members are stakeholders in the MHP and includes a licensed mental health professional. Members

serve a one year term, at a minimum. QIC members are appointed by the MHP Director and include

the following stakeholders:

Assistant Director

Deputy Director – Children Services


38

Deputy Director – Youth and Young Adult Services-Mental Health and SUD Services

Deputy Director – Adult Services-Mental Health and SUD Services

Behavioral Health Manager – Managed Care

Behavioral Health Manager – Information Systems

Access Unit Program Supervisor

Quality Management Program Supervisor

Payment Authorization Unit Nursing Supervisor

Fee-for-Service Provider

Licensed Mental Health Professional

Ethnic Services Representative

Administrative Analyst – Quality Management

Beneficiaries

Family members

Patients’ Rights Advocate

The current group of QIC members will be expanded to include additional SUD stakeholders.

The QIC meets monthly to: recommend policy decisions; review and evaluate the results of QI

activities; institute needed QI actions; and ensure follow-up of QI processes. The QIC will receive

and analyze DMC-ODS performance reports and monitor compliance to the data requirements of

the DMC-ODS Standard Term and Conditions (STC’s).

The QM Unit will be responsible for the development of a QI Work Plan that is consistent with

regulations and the DHCS contract. The QM Unit will ensure that required monitoring activities

are outlined in the QI Work Plan and will at a minimum include the following:

a) Timeliness of first initial contact to face-to-face appointment

The MHP established a mechanism to monitor the timeliness of services to ensure

beneficiaries have access to the service delivery system. The QM Unit ensures that

beneficiaries receive an initial routine appointment within the timeless standard as

established by the MHP.

ICBHS will implement the same mechanism for the SUD providers. Quality Management staff

will monitor timeliness to first initial appointment by creating reports based on the following

data elements that will be collected on the ICBHS Access Log:

date/time of initial request

date/time of first offered appointment

date/time of first scheduled appointment


39

The goal of first initial face-to-face appointment for all ICBHS SUD providers will be a seven (7)

working day standard.

b) Frequency of follow-up appointments in accordance with individualized treatment plans

The frequency of follow-up appointments will be based on the progress or lack of progress of

the beneficiary. During the course of treatment, if a beneficiary requires more frequent

services, the follow-up appointments will be scheduled according to their needs and in

accordance to the individualized treatment plans.

c) Timeliness of services of the first dose of NTP services

Staff within the NTPs will be required to track the time of first dose of NTP services. The QM

Unit will work closely with NTP providers and develop and implement tracking process for

first dose of NTP services.

d) Access to after-hours care, responsiveness of the beneficiary access line

The QM Unit will be responsible for monitoring access to after-hours care. The request to

access after-hours care will be logged in the ICBHS Access Log. The log will be compared to

the Crisis After- Hours Log to ensure that access was provided as required.

Responsiveness of the beneficiary access line will be monitored by the QM Unit. The QM Unit

will monitor the 24 hour toll-free telephone line by conducting random test calls in English

and the MHP’s threshold language, Spanish. The test calls will be conducted during working

hours, after hours, weekends and holidays to ensure the access line is available.

e) Strategies to reduce avoidable hospitalizations

Beneficiaries will receive on-going assessment using the ASAM criteria throughout the course

of treatment to ensure that the beneficiaries’ SUD needs are met and reduce the risk of

emergencies and hospitalizations. If a beneficiary is assessed to require a higher level of care,

the SUD treatment team will meet to discuss a transition to more intensive treatment within

the continuum of care. Case managers will work directly with the SUD treatment team, other

agencies involved in the beneficiaries’ treatment and contract providers to assist in the

transition between modalities and link them to other needed services and resources. Case

managers will ensure that transitions to other levels of care are effective, timely and

complete, which will improve beneficiaries’ safety and satisfaction.

The SUD treatment team staff will take an important role in helping beneficiaries reach their

optimal level of health, wellbeing and recovery by addressing their MH, SUD, and medical

needs and helping beneficiaries develop skills that enhance life functioning and promote self-

advocacy and self-care.


40

In addition, ICBHS offers crisis services for individuals who suffer from co-occurring mental

health and substance use disorders and are experiencing an immediate crisis or are in need of

acute hospitalization. The Crisis and Referral Desk works closely with local hospitals, health

clinics, law enforcement and other community agencies to intervene before or after an acute

crisis, occurs. These services will attempt to resolve the crisis so that the individual does not

have to be admitted into acute care.

Should an individual be hospitalized, ICBHS makes every effort to get involved in discharge

planning and scheduling follow-up MH and/or SUD care. To assist the individual from

requiring further hospitalizations, ICBHS requires that a post-psychiatric home visit be

conducted within three (3) working days of discharge and an outpatient psychiatric

appointment be scheduled within seven (7) calendar days of discharge.

f) Coordination of physical and mental health services with waiver services at the providers

level

The QM staff will monitor the coordination of physical and MH services with waiver services

at the provider level. QM staff will conduct chart audits of SUD treatment providers in an

effort to identify need for coordination of services. Documentation will be reviewed for

evidence that outreach and coordination occurred. For instances where coordination was

required, and no evidence was found, providers will be required to submit a plan of

correction to ensure compliance in this area.

The MOU with ICBHS and the Medi-Cal managed care plans will be another method to

monitor care coordination. The MOU will include a data sharing agreement to facilitate care

coordination and address PHI privacy and security concerns.

In addition, the QM Unit will monitor complaints and grievances focusing on possible patterns

or trends that indicate beneficiary care coordination needs are not being met.

g) Assessment of the beneficiaries’ experience including complaints, grievances and appeals

ICBHS and contract providers take appropriate action to quickly resolve concerns expressed

by beneficiaries. ICBHS has established beneficiary grievance and appeals processes which

comply with regulatory guidelines for both mental health and SUD operations. Grievance and

Appeal Process Notices are required to be posted at provider waiting areas and postings are

monitored during site visits. Grievance and appeals material is translated into the MHP’s

threshold language, Spanish and available at all service locations.


41

At the time of initial appointment, beneficiaries are informed of their right to file a grievance,

appeal, or state fair hearing, through the Beneficiary Protection Process brochure. The

Patients’ Rights Advocate is available to provide assistance in filing the grievance and/or an

appeal and to provide technical assistance to management in an effort to ensure that

beneficiary protection requirements are met. Contract providers are required to comply with

the grievance and appeal process requirements as part of their contract and are monitored

on a regular basis.

A grievance can be initiated orally or in writing, ICBHS will notify the beneficiary in writing of

the grievance decision within sixty (60) calendar days of receipt of the grievance. A Notice of

Action – D (NOA-D) will be mailed or hand delivered to the beneficiary when ICBHS fails to act

within the timeframes for resolution of grievance/ appeal. Information on hearing rights,

appeals, state hearing, expedited state hearing, and how to keep the same services while

waiting for a hearing, is included on the back of the NOA-D.

An appeal can be initiated orally or in writing, ICBHS has forty-five (45) calendar days after the

receipt of the standard appeal to notify the beneficiary of the decision. Information on

hearing rights, state hearing, expedited state hearing and how to keep the same services

while waiting for a hearing, is included on the back of the appeal form.

To continue with benefits, a hearing must be requested within ten (10) calendar days from

the date the decision notice was mailed or personally given to the beneficiary or before the

effective date of the change in services, whichever is later.

An expedited appeal can be requested orally or in writing, when the MHP determines, or the

beneficiary and/or the beneficiary’s provider certifies, that taking the time for a standard

appeal resolution could seriously jeopardize the beneficiary’s life, health or ability to attain,

maintain, or regain maximum function. ICBHS has three (3) working days after the receipt of

the expedited appeal to notify the beneficiary of the decision. Information on hearing rights,

state hearing, expedited state hearing, and how to keep the same services while waiting for a

hearing, is included on the back of the expedited appeal form.

Timeframes may be extended up to fourteen (14) calendar days if an extension is requested

by the beneficiary, or if ICBHS feels there is a need for additional information and the delay is

in the best interest of the beneficiary.

Beneficiaries must exhaust the appeal process, prior to having the right to file a state hearing.

The request for a state hearing must be submitted within ninety (90) calendar days after the

decision notice was given personally to the beneficiary or the postmark date that the decision

notice was received.


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To continue with benefits, a hearing must be requested within ten (10) calendar days from

the date that the decision notice was mailed or personally given to the beneficiary or before

the effective date of the change in services, whichever is later.

There are established record keeping procedures where beneficiary complaints data is

collected, categorized and assessed for monitoring of grievances and appeals.

h) Telephone access line and services in the prevalent non-English languages

The telephone access line is handled by bilingual staff (English/Spanish) and Language Line

Solutions is used for interpretation in other languages, as needed. Individuals who are speech

and/or hearing impaired can access services through California Relay Services.

Interpreter services will be offered to individuals who have limited English proficiency at all

programs and clinic sites. Individuals who request services in the County’s threshold

language, Spanish will have access to proficient interpreters free of cost. Individuals who do

not meet the threshold language will be linked to appropriate services through Language Line

Solutions. In addition, individuals with speech and/or hearing impairments can receive

interpretative services through American Sign Language services.

ICBHS prohibits the expectation that family members provide interpreter services. However,

an individual can chose to use a family member or friend as an interpreter after being

informed of the availability of free interpreter services. Minor children should not be used as

interpreters. If under rare circumstances a family member and/or child is used as an

interpreter, (e.g., monolingual parent will not communicate using ICBHS interpreter) ICBHS

will ensure that the reason/justification is well documented in the beneficiary’s clinical

record. SUD providers are required and will be monitored to ensure services are conducted

in accordance with the National Standards for Culturally and Linguistically Appropriate

Services Standards (CLAS).

11. Evidence-based Practices. How will the counties ensure that providers are implementing at least two

of the identified evidence-based practices? What action will the county take if the provider is found to

be in non-compliance?

ICBHS will ensure that providers implement at least two (2) of the identified evidence-based practices

by providing staff with ongoing and follow-up training on the treatment models implemented as part

of this pilot. ICBHS is strongly driven by the use of evidence-based practices and ensures that all staff

providing services to beneficiaries are appropriately trained on specific treatment models. Clinical

and program supervisors monitor compliance with the implementation of these models by conducting


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regular chart reviews to ensure documentation reflects the use of evidence-based interventions as

well as fidelity of the model being implemented. In addition, the program supervisor conducts

monthly observations of group counseling sessions for the purpose of evaluating compliance by the

provider. ICBHS assigns a model “champion” for every evidence-based model for the purpose of

ensuring fidelity. The role of the champion is to track the clients referred to the specific evidence-

based model, attendance of providers to required consultation calls, completion of required outcome

measurement tools, proper use of model sessions, and addresses any issues to the staff’s assigned

clinical and/or program supervisor that may come up during the course of the model implementation.

ICBHS will also ensure that for MHP providers, proper monitoring of these models is in place in the

form of regular chart reviews by the program supervisor and through the Quality Improvement

Review Committees (QIRC). The QIRC meets on a weekly basis and selects charts randomly for a

thorough review. Based on this review, the provider is given feedback and a set of directives to follow

if any areas of concern are found in the review. If a provider is found to be non-compliant, ICBHS will

develop a plan of correction which will be monitored by each program supervisor and management

staff. Repeated failure to comply will result in further disciplinary action, up to termination.

Quality Management staff will also monitor that contract providers meet standards of care set by

DHCS by monitoring these practices through chart reviews. If a contract provider is found to be non-

compliant with meeting minimum evidence-based practices requirements, a Corrective Action Plan

(CAP) will be developed with set directives and timeframes to meet requirements. Continuous failure

to comply may result in termination of contract.

ICBHS has already implemented a series of evidence-based models within its mental health and SUD

clinics. The following models currently being implemented at ICBHS will also be considered as part of

the implementation of this pilot program:

Cognitive Behavioral Therapy

Motivational Interviewing

Functional Family Therapy

Moral Reconation Therapy

Seeking Safety

ICBHS will continue to research on other evidence-based models that are specific for the treatment

of SUD for the purpose of implementing them as part of the ODS pilot.


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12. Regional Model. If the county is implementing a regional model, describe the components of the

model. Include service modalities, participating counties, and identify any barriers and solutions for

beneficiaries. How will the county ensure access to services in a regional model (refer to question 7)?

ICBHS will not be implementing a regional model at this time.

13. Memorandum of Understanding. Submit a signed copy of each Memorandum of Understanding

(MOU) between the county and the managed care plans. The MOU must outline the mechanism for

sharing information and coordination of service delivery as described in Section 152 “Care

Coordination” of the STCs. If upon submission of an implementation plan, the managed care plan(s)

has not signed the MOU(s), the county may explain to the State the efforts undertaken to have the

MOU(s) signed and the expected timeline for receipt of the signed MOU(s).

Review Note: The following elements in the MOU should be implemented at the point of care to

ensure clinical integration between DMC-ODS and managed care providers:

Comprehensive substance use, physical, and mental health screening, including ASAM Level 0.5

SBIRT services;

Beneficiary engagement and participation in an integrated care program as needed;

Shared development of care plans by the beneficiary, caregivers and all providers;

Collaborative treatment planning with managed care;

Delineation of case management responsibilities;

A process for resolving disputes between the county and the Medi-Cal managed care plan that

includes a means for beneficiaries to receive medically necessary services while the dispute is being

resolved;

Availability of clinical consultation, including consultation on medications;

Care coordination and effective communication among providers including procedures for

exchanges of medical information;

Navigation support for patients and caregivers; and

Facilitation and tracking of referrals.

The MOU’s between the managed care health plans and ICBHS have been in place since 2014;

however, MOU’s will need to be amended to meet the requirements of the DMC-ODS Waiver.

Some of the requirements listed above are referenced within the current MOU. However, ICBHS will

work with both managed care plans in the coming months to draft the needed ODS Waiver language.

ICBHS anticipates executing the amendments by the time this Implementation Plan is approved.


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14. Telehealth Services. If a county chooses to utilize telehealth services, how will telehealth services be

structured for providers and how will the county ensure confidentiality? (Please note: group

counseling services cannot be conducted through telehealth).

ICBHS will not be utilizing telehealth services at this time. If the need to implement this service in the

future is identified, ICBHS will work on structuring a system for providers that follows all

confidentiality requirements.

15. Contracting. Describe the county’s selective provider contracting process. What length of time is the

contract term? Describe the local appeal process for providers that do not receive a contract. If

current DMC providers do not receive a DMC-ODS contract, how will the county ensure beneficiaries

will continue receiving treatment services?

Currently ICBHS provides most of the SUD treatment services through its own providers and an out-

of-county contracted residential treatment facility. The residential treatment facility contract

language will need to be amended to include all DMC ODS provisions and requirements upon waiver

implementation.

Implementation of the DMC ODS Waiver will require ICBHS to contract for NTP and additional

residential treatment facilities. ICBHS will contact the only NTP in Imperial County and it is anticipated

that it will be awarded a contract for DMC ODS services. For residential treatment facilities, ICBHS will

procure residential facilities that have appropriate ASAM designation from DHCS.

When selecting providers, ICBHS will not discriminate against providers that serve high-risk

populations or specialize in conditions that require costly treatment and will not prohibit or otherwise

restrict a licensed waivered or registered professional from acting within the lawful scope of practice,

from advising or advocating on behalf of a beneficiary for whom the provider is providing SUD

services.

Provider Selection Criteria When selecting providers with which to contract, ICBHS requires the following criteria:

Possess the necessary license or certification for each individual practicing as part of a group

Ability to maintain a safe facility that is certified by DHCS

Employ a Medical Director enrolled with DHCS

Ability to store and dispense medications in compliance with all pertinent state and federal laws

and regulations, if applicable

Provides culturally competent services


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Implements two evidence-based practices

Ability to maintain beneficiary records in a manner that meets state and federal standards

Ability to address and meet the quality management, authorization, administrative, and clinical

standards of ICBHS.

Meet additional requirements established by ICBHS as part of the credentialing or other

evaluation process.

Contract Term

All DMC ODS contracts will have a term of one year and expire annually on June 30th. The contract will

be renegotiated in the final quarter of the fiscal year to adjust contract terms to ICBHS budget

allocations, operating costs, and changing need for SUD services.

Appeal Process

In case of a denial, the provider will receive written explanation outlining the reasons for the denial of

contract for DMC ODS services. Any provider who is not selected may appeal ICBHS provider selection

processes within five (5) working days of notification. Appeals must be addressed to the director of

Behavioral Health Services or designee, in writing and shall be limited to the following grounds:

Failure of ICBHS to follow the selection procedures and adhere to requirements specified in the

Provider Handbook.

A violation of conflict of interest as provided by California Government Code Section 87100 et seq.

A violation of state or federal law.

Notification of a final decision on the appeal by the director of Behavioral Health Services or designee

shall be made in writing to the provider within ten (10) working days. The decision of the director of

Behavioral Health Services shall be final and not subject to further review.

Continuation of Services

Should ICBHS terminate or deny renewal of a current provider’s contract for DMC ODS services, ICBHS

will notify the provider at least thirty (30) calendar days prior to the termination of their contract with

the exception of a violation of the Trafficking Victims Protection Act where ICBHS may terminate the

contract immediately. In accordance with the contract language, the provider will make immediate

and appropriate plans to transfer or refer all beneficiaries serviced under the contract to other

agencies for continuing services in accordance to beneficiary’s needs. The ODS manager must

approve all plans for the transfer or referral of beneficiaries before the provider may begin the

transfer or referral process unless such transfer or referrals are previously outlined in the provider’s

contract.

Additional Medication Assisted Treatment (MAT). If the county chooses to implement additional

MAT beyond the requirement for NTP services, describe the MAT and delivery system.


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MAT is the clinically driven use of medications, in combination with counseling and behavioral

therapies, to provide a whole-person approach to the treatment of substance use disorders (SUD).

MAT is provided as part of the ASAM Continuum of Care (OTP Level 1).

ICBHS will offer medications beyond the NTP requirements to ensure beneficiaries have access to a full

complement of medications to support SUD treatment and recovery. ICBHS will extend the use of MAT

interventions by expanding the use of medications for:

Opiate overdose prevention: naloxone (Narcan)

For opiate use treatment: buprenorphine-naloxone (Suboxone) and naltrexone (oral and extended release)

For reduction of alcohol craving: naltrexone, both oral (ReVia) and extended release injectable (Vivitrol), topiramate (Topamax), gabapentin (Neurontin), acamprosate (Campral) and disulfiram (Antabuse)

ICBHS will integrate the use of MAT into SUD and behavioral health clinics. MAT services will be

provided if medically necessary and in accordance with an individualized treatment plan determined by

a licensed physician. MAT services include the ordering, prescribing, administering, and monitoring of

medications for SUD. A set of guidelines will be developed for both SUD and behavioral health care

providers to follow which is described below.

MAT will be made available upon the identification of a beneficiary with an opiate or alcohol addiction.

Identification of an opiate or alcohol addiction will primarily be identified during the initial intake and

diagnosis which occurs at each regional clinic. MAT may be discussed and offered to the beneficiary at

this time. A beneficiary who has previously declined MAT and has been receiving other SUD services

may later decide to receive MAT services.

For those beneficiaries who have been initially diagnosed with an opiate addiction or alcohol addiction,

or already receiving SUD services, the SUD counselor may briefly discuss MAT services as a means to

address symptoms and impairments caused by opiate or alcohol use. This discussion will include an

informational brochure and notifying the beneficiary that a consultation visit with the physician will be

conducted prior to receiving the service. If the beneficiary may prefer SUD services through a NTP

clinic. A referral will then be made to the NTP treatment provider.

If the beneficiary agrees to MAT services the beneficiary’s request for MAT services will be taken to a

clinical team consisting of SUD certified substance abuse counselors, LPHAs, Licensed Vocational Nurse

and the physician. The team will make a referral to the physician for MAT services if clinically

appropriate. Upon receiving the referral, the team will schedule an appointment for the beneficiary

to meet with the MD for an initial consultation to discuss MAT services, review and complete the MAT

agreement, and medication consents. MAT services can begin immediately or based on a scheduled

appointment. Due to the requirement that the beneficiary must be abstinent from opiates for a twelve

(12) hour period, an expedited referral for MAT services may be required. An expedited referral can be

submitted by a certified substance abuse counselor or LPHA to the team supervisor who will obtain an


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appointment time for the Beneficiary to meet with the physician for the initial consultation. Expedited

referrals are available for beneficiaries who have been identified with an alcohol addiction if

appropriate. Outpatient Drug Free (ODF) counseling will be made available during the course of MAT

services. Upon completion of the initial consultation, MAT agreement and medication consents, the

physician will begin the Medication Assisted Treatment Protocol immediately or during the next

scheduled appointment. . In addition, a Licensed Vocational Nurse (LVN) will assist the physician if

there is a need to order labs, communicate with pharmacies, and will follow up with the beneficiaries

on a regular basis to ensure that side effects are under control and that they are following the

recommended regimen. The LVN will also work in collaboration with case managers and LPHAs for

treatment planning and for recommendations to a higher or lower level of care. MAT service providers

will coordinate with SUD providers, physical health care and mental health care providers to connect

the beneficiary to needed services. Once stable MAT clinic clients will be transitioned to primary care

physicians, or a psychiatrist for continued medication services as needed.

If the beneficiary declines MAT services, he/she will be offered or continue other SUD Services

consistent with ASAM Criteria.

16. Residential Authorization. Describe the county’s authorization process for residential services. Prior

authorization requests for residential services must be addressed within twenty-four (24) hours.

Referrals for residential treatment may be initiated through different pathways that include referrals

from other agencies such as, Probation, Department of Social Services, education, health care

providers, or ICBHS. Beneficiaries can also request residential treatment by contacting the 24-hour

Access number, contacting one of the SUD treatment facilities, or by walking in to one of the ICBHS

clinics. All new beneficiaries requesting residential treatment will be scheduled for an intake

assessment to determine medical necessity criteria for SUD services and level of care. All prior

authorization requests for residential treatment will be reviewed by the SUD Program Supervisor

within 24 hours of request by the treatment provider. The SUD Program Supervisor will review the

beneficiary’s intake assessment, diagnosis, treatment history and the reasons for referral to determine

approval or denial of request.

New beneficiaries who at the time of intake are assessed to meet the ASAM criteria for residential

treatment, will be assigned a case manager through the ICBHS expedited referral process who, within

twenty-four (24) hours from approval of prior authorization request , will begin placement

coordination with the County contracted residential facility. If, throughout the course of treatment, an

active beneficiary receiving outpatient or NTP treatment is assessed to require a higher level of care,

the SUD treatment team staff will meet to discuss the case for appropriateness and referral to a

residential facility. The SUD treatment team staff will review the beneficiary’s current functioning,

response to treatment, and each ASAM dimension to determine severity and need for a higher level of

care. A case manager will be assigned for coordination and facilitation of timely placement, follow-up

and discharge planning. If it is determined that the beneficiary requires immediate placement to a


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residential facility due to risk and severity of the SUD condition, the SUD treatment team staff will

begin the placement process through an expedited referral.

Beneficiaries, who are waiting bed availability for placement, will receive supportive, more frequent

and intensive SUD care until admission to a residential facility occurs. The assigned case manager will

also maintain the SUD treatment team staff updated on the status of the client on a weekly or more

frequent basis, if needed, to ensure that the immediate needs of the client are met and reduce the risk

of a SUD emergency. Currently, ICBHS has a contract with one out of county residential facility that is

ASAM designated 3.1 and 3.5 as residential treatment is not available within Imperial County. This has

resulted in an average waitlist of about eight individuals at a time. ICBHS is in the process of visiting

additional residential facilities that have the required ASAM designations and that are DMC certified or

in the process of becoming DMC certified for the purpose of developing additional contracts and

ensure there are no waitlists upon implementation.

Authorization and tracking of all residential treatment referrals will be conducted by ICBHS designated

staff at each SUD outpatient clinic. ICBHS will grant a prior authorization for the first seven (7) days of

residential treatment based on the results identified on the ASAM assessment. The residential

treatment provider will have the responsibility to submit a request for authorization for up to a

maximum of ninety (90) days in on continuous period for those adult clients who have been assessed

and admitted into a residential facility. One extension of up to thirty (30) days beyond the maximum

length of ninety (90) days may be authorized for one continuous length of stay in a one year period.

The residential treatment provider will also have the responsibility to submit a request for

authorization for up to a maximum of thirty (30) days in one continuous period for adolescent clients

who have been assessed and admitted to a residential facility. Reimbursement will be limited to two

non-continuous thirty (30) day regimens in any one year period. One extension of up to thirty (30) days

beyond the maximum length of stay may be authorized for one continuous length of stay in a one year

period.

17. One Year Provisional Period. For counties unable to meet all the mandatory requirements upon

implementation, describe the strategy for coming into full compliance with the required provisions in

the DMC-ODS. Include in the description the phase-in plan by service or DMC- ODS requirement that

the county cannot begin upon implementation of their Pilot. Also include a timeline with deliverables.

Review Note: This question only applies to counties participating in the one-year provisional program

and only needs to be completed by these counties.

Not applicable.

County Authorization

The County Behavioral Health Director (for Imperial County Behavioral Health Services) must review


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and approve the Implementation Plan. The signature below verifies this approval.

Imperial

Imperial County Behavioral Health Services Director County Date

Appendix

Section 8 h )

Agency / Services

Imperial County

Behavioral

Health,

SUD Services

Imperial

Valley

Medical

Clinic

McAllister

Institute

MAT Provided Yes Yes No

Current patient load 693 159 79

Total DMC-ODS patient capacity 1503* 159 79

Populations treated Adults and

Adolescents Adults

Adults and

Adolescents

Additional Staffing Plan for DMC-ODS Expansion of Services:

Mental Health Counselor (MHC)

No. of MHC No. of Cases

per MHC

No. of Cases

per Year

Total No. of Cases

per Year (each MHC)

3 MHC 30 Cases 90 cases 270 cases

Psychiatric Social Worker (PSW)

No. of PSW No. of Cases

per PSW

No. of Cases

per Year

Total No. of Cases

per Year (each PSW)

3 PSW 30 Cases 90 cases 270 cases

Certified Substance Abuse Counselors (CSAC)

No. of CSAC No. of Cases

per CSAC

No. of Cases

per Year

Total No. of Cases

per Year (each CSAC)

3 CSAC 30 cases 90 cases 270 cases

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