1. Delivery of Non-Specialty Mental Health Services: Potential Role of LACDMH
California Behavioral Health Directors’ Meeting
January 10, 2018
Robin Kay, Ph.D.
Chief Deputy Director, Clinical operations

2. Delivery of Non-Specialty Mental Health Services
Purpose of this presentation
Familiarize Directors with a current initiative involving LACDMH and the two Managed Care Plans for Los Angeles County
History of our discussions
Two workflows
Status of our efforts

3. History ACA Implementation
Establishment of new Medi-Cal benefit for individuals with mild-moderate functional impairment – i.e., those requiring “non-specialty” mental health services
Discussions regarding definition/criteria for mild-to-moderate impairment
Concern about consensus regarding primary entity of responsibility

4. History
2014 La Quinta Retreat Debate: Should County Behavioral Health Programs take responsibility for non-specialty mental health service delivery?
Recognize County Mental Health Departments as networks suited to and able to expand to address the mild-to-moderate Medi-Cal mental health population
Position County Mental Health Departments in the event of elimination of the 1915b waiver
Ensure uninterrupted treatment of those moving between County-run specialty mental health programs and MCPs’ non-specialty mental health services

5. History
2016: Los Angeles County Health Agency is approached by a Managed Care Plan. Purpose: explore integration of specialty and non-specialty mental health care under the MCP
2017: Outcome of Presidential Election raises concerns about future of the ACA
February 21, 2017: Board of Supervisors directs Mitch Katz to develop options regarding how health coverage could be maintained and/or extended in L.A. and California

6. History
August, 2017: Los Angeles County BOS authorizes County leadership to participate in CA-wide stakeholder process to focus on:
Expanding coverage and identifying new revenue streams
Improving system efficiencies and harmonization of coverage programs
16 workgroups:
Create publicly controlled health insurance option
Extend employer mandate at state level beyond ACA
Extend Medicaid to the undocumented
Extend local coverage initiatives for residually uninsured

7. History 16 workgroups continued:
Expand initiatives for reducing unnecessary costs
Transform end of life care
Address social determinants to reduce health costs
Decrease institutionalization
Single payer proposals
New revenues and taxes on health harming practices
Population health and high utilizers
Reproductive health services
Workforce
Decrease administrative costs
Eliminate health disparities and increase social justice
Behavioral health integration including possible integration of county mental health and SUD plans with Medicaid health plans

8. History: Los Angeles County Initiative
Statewide Initiative + Centene Contract with HMA
2 Work Streams:
Establish contracts between 2 MCPs and DMH for mild-t0-moderate services
Enhance the experience of beneficiaries
Add network capacity
Revise assessment and referral pathways to improve access to care
Develop financial and operational model for a risk-based potentially capitated (or other) approach for mental health care
Determine if there are revenue and gain-sharing opportunities through aligned networks, payments, utilization management and better coordination

9. Challenges to be addressed by Work Stream 1
Health Providers
Reduce confusion over specialty vs. non-specialty mental health treatment
Overcome constraints due to reluctance to accept clients previously treated in specialty settings
Managed Care Plans
Network adequacy
Demonstration of utilization
Costs that cannot be captured for the MCPs

10. Challenges to be addressed by Work Stream 1
LACDMH
Challenges with referring clients no longer requiring specialty mental health services
Reluctance to refer clients with histories of recurrent illness
Clients’ reluctance to change providers

11. Current Status: Work Stream 1
Meetings with MCPs and DHS
Pilot on DHS campuses
LACDMH will do assessments on all screened clients referred by PCPs or self-referred; treatment
Attempting to project volume and workforce needed
Workgroups
Contracting
Credentialing
Finance (rates, payment, exchange of claim files, etc.)
Service Delivery Model
Documentation and Data Collection

12. Challenges to be addressed by Work Stream 2
Efficiencies that could reduce costs and improve care
Eliminate redundancies in service delivery or administration
Infuse expertise of managed care to help inform behavioral health services so they are delivered at the appropriate level and in appropriate setting
Gain-sharing approaches resulting from improved health outcomes and reduced costs related to physical health services
Decrease in admissions
Decrease in emergency room utilization
Decrease in untreated health conditions

13. Current Status: Work Stream 2
Meeting with HMA and their actuary
Identify services, levels of care and Medicaid costs
Work with County Counsel on Business Associate Agreement/mechanism
Focus is on Medi-Cal. Identified issues related to non-Medi-Cal reimbursable service that are required to make the system work
Safety net issues

14. Delivery of Non-Specialty Mental Health Services
Questions?