1. 1 Drug Medi-Cal ODS Demonstration Waiver Small County Strategic Planning May 25, 2016

2. Key Components 5-year demonstration Testing a new paradigm for SUD services Counties become managed care plans 1115 will shape how SUD services are delivered after the demonstration See what works and what doesn’t 2

3. Standard Terms and Conditions Comprehensive evidence-based benefit design: Continuum of Care –Required services: Outpatient, Intensive Outpatient, Residential, Narcotic Treatment Program, Withdrawal Management, Recovery Services, Case Management, Physician Consultation –Optional services: Partial Hospitalization, Additional Medication Assisted Treatment –Expansion of Workforce (LPHA’s) 3

4. Standard Terms and Conditions Appropriate Standards of Care: Utilization of The ASAM Criteria Care Coordination Strong Network Development for Access Benefit Management-Utilization Reviews Reporting of Quality Measures 4

5. Pro’s to Opting In Pro’s: –FFP for costs not otherwise matchable –Opportunity to test new services and delivery methods –Increase the success of DMC beneficiaries while decreasing other system health care costs. 5

6. Con’s to Opting In Con’s: –Huge system lift at all levels –Some counties may not receive an approval 6

7. Current Implementation Reviewing County Implementation Plans Finalizing with CMS: –State/County Contract Boilerplate –CPE Protocol –UCLA Evaluation Releasing State Policy Information Notices Providing Regional County TA to Phase 1, 2, 3 Conducting bi weekly TA conference calls 7

8. Implementation Plans What do they look like? –All unique since there are different gaps in different counties –Must meet the minimum access requirements –Innovative –Testing new models, systems and payment –Meet 438 requirements 8

9. County Innovations Pilot to co-locate SUD counselors at MH clinics and/or primary care settings In year 2, exploring co-location of medication assisted treatment at all treatment programs For effective transitions, co-locating residential with Intensive Outpatient services Piloting sobering centers Co-locating MH and SUD clinics 9

10. County Innovations Receiving a list of ER high-utilizers from managed care plans to target interventions Engaging high utilizers through intensive case management Embedding SUD counselors in ER Partnering SUD counselors with probation; working discharges from jail right into treatment 10

11. County Innovations Utilizing one coordinated EHRs with SUD, Physical Health and Mental Health Expanding SBIRT across all systems of care in the county No cost in-custody jail phone lines for brief ASAM screen and treatment assessment Same day referrals to treatment 11

12. County Innovations Designing recovery services modality specifically for youth Accelerating county MH and SUD integration plan roll-out Working on training Judges on ASAM Encouraging Judges to sentence based on ASAM 12

13. County Innovations Requiring weekend and evening hours for all treatment providers Testing and tracking SUD access standards Utilizing managed care access standards Requiring all SUD contractors to become DMC certified 13

14. Regional Model Participating counties with the approval from the State may develop regional delivery systems for one or more of the required modalities or request flexibility in delivery system design. Counties may act jointly in order to deliver these services. 14

15. Regional Models Develop a draft and meet with DHCS to review. DHCS is flexible in the type of regional models proposed Current models in potential development –Coordinated with Managed Care Plans –Establishment of a JPA –County to County Collaboration 15

16. Regional Models Areas regional models are not required –Services provided outside the county (Ex: Residential) Other ideas for Regional Models –Oversight of Quality Assurance Requirements –Capacity Expansion in Bordering Counties 16

17. Opioid Overdoes Rates 2009-2013 17 **Data generated from http://epicenter.cdph.ca.gov on April 21, 2016http://epicenter.cdph.ca.gov

18. 18 Counties with Licensed Narcotic Treatment Programs April 2016 28 Counties Without NTP Services 30 Counties With NTP Services

19. NTP Regulations 19 Hub & Spoke Model: -Medication Unit (MU) -Medication dispensing -Drug Screening -Office Based Narcotic Treatment Network (OBNTN) -NTP treatment excluding medication dispensing & drug screening -Intake and Counseling -Both MU and OBNTN providers must be affiliated with a NTP. -MU & OBNTN providers expand access into communities where NTP services are currently unavailable.

20. More Information DHCS website –FAQs and Fact Sheets –ASAM Designation –Approval Documents/Information Notices http://www.dhcs.ca.gov/provgovpart/Pages/Drug-Medi- Cal-Organized-Delivery-System.aspxhttp://www.dhcs.ca.gov/provgovpart/Pages/Drug-Medi- Cal-Organized-Delivery-System.aspx –Draft Implementation Plans http://www.dhcs.ca.gov/provgovpart/Pages/Drug-Medi- Cal-Organized-Delivery-System.aspxhttp://www.dhcs.ca.gov/provgovpart/Pages/Drug-Medi- Cal-Organized-Delivery-System.aspx Inquiries: DMCODSWAIVER@dhcs.ca.govDMCODSWAIVER@dhcs.ca.gov 20