1. 1 1 Opportunities for Integrating Substance Use Disorder Treatment into Care Coordination Processes Darren Urada, Ph.D. UCLA Integrated Substance Abuse Programs Gale Bataille CCC Co-Chair November 12, 2014

2. 2 2 Session Description 1.Update on Drug Medi-Cal Waiver 2.SBIRT requirements 3.Challenges for SBIRT implementation 4.Long term opportunities to address challenges 5.Planning and discussion

3. Drug Medi-Cal Waiver Update Draft form, likely 2015 implementation Adds services, assessment requirements. Better rates, more county control. Opt in counties would get Additional medication assisted treatment Residential treatment Withdrawal management Case management Recovery residence (block grant funded) Physician consultation Draft (October 16, 2014) http://www.dhcs.ca.gov/provgovpart/Documents/2nd-Draft-STCs-for-stakeholders.pdf

4. Reminder: DMC Waiver text on Coordination with Managed Care Plans and Primary Care The following elements should be implemented at the point of care 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; Care coordination and effective communication among providers; Navigation support for patients and caregivers; and Facilitation and tracking of referrals between systems. The participating county shall enter into a memorandum of understanding (MOU) with any Medi-Cal managed care plan that enrolls beneficiaries served by (Drug Medi-Cal).

5. 5 5 REQUIREMENTS ALREADY IN EFFECT! “Beginning January 1, 2014, MCPs* are responsible to cover and pay for an expanded alcohol screening... Also, MCPs shall cover and pay for brief intervention(s)... Any member identified with possible alcohol use disorders should be referred to the alcohol and drug program in the county where the member resides for evaluation and treatment.” SBIRT Requirements Source: DHCS ALL PLAN LETTER 14-004: http://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2014/APL14-004.pdf *MCPs - Medi-Cal managed care health plans. MCPs must ensure that PCPs carry out the above.

6. 6 6 SBIRT Requirements “When a member answers “yes” to the SHA alcohol pre-screen question, the MCP must ensure that the PCP offers the member an expanded, validated alcohol screening questionnaire.” Source: DHCS ALL PLAN LETTER 14-004: http://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2014/APL14-004.pdf “PCPs must offer the Staying Healthy Assessment (SHA) or other approved tool within 120 days after enrollment and every three years, with annual reviews of the member’s answers.”

7. 7 7 Feedback from Team Lead call No access to residential treatment “Need to educate primary care that even if screening only indicates a little problem, refer them.” Data sharing - screenings in paper format, at PC location

8. 8 8 Long-Term Emerging Opportunities Residential treatment Drug Medi-Cal Waiver Educate primary care SBIRT trainings DMC Waiver MOUs Potential expansion Data sharing Support for data infrastructure under discussion

9. 9 9 DISCUSSION! 1.How is your team integrating or planning to integrate SUD services into your partnership? 2.If you are not a specialty SUD provider, are you capable of providing brief intervention/brief treatment for alcohol or other SUD conditions at your program? What services do you provide? Do you provide Medication Assisted Treatment (for example Suboxone?) 3.If client/patient requires services beyond brief intervention, how do you make, complete and track referrals to specialty SUD? 4.What strategies has your CCC team used to share SUD information? If Primary Care Clinic is conducting SBIRT screening, how is that data shared with the other CCC partners?