1. TOBY DOUGLAS, SENIOR STRATEGIC ADVISOR SELLERS DORSEY DMC Organized Delivery System Waiver Financing

2. Agenda 1.Waiver Goals/Components 2.Current Assumptions 3.Funding 4.Open Questions 5.Next Steps

3. ODS Waiver Goals The goal is to improve SUD services for California beneficiaries Authority to select quality providers Consumer-focused; use evidence based practices to improve program quality outcomes Support coordination and integration across systems 3

4. ODS Waiver Goals Reduce emergency rooms and hospital inpatient visits Ensure access to SUD services Increase program oversight and integrity Place client in the least restrictive level of care utilizing The ASAM Criteria 4

5. 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 5

6. Overall Assumptions Cost of the waiver will be shared among the federal government, the State, and counties Services (including residential) for the Medicaid Expansion population (i.e., childless adults, 100- 138% parents) will be funded at 100 percent FFP, phasing down to 90 percent FFP in 2020. Services (including residential) for pre ACA populations will continue to be funded at 50 percent FFP

7. Overall Assumptions (cont.) Quality Assurance Activities will be reimbursed at 75% FFP The vast majority of new users of DMC services will be the expansion population (i.e., funded at 100% FFP) Counties will have the ability to set rates for all provider types (except NTP)

8. Federal Certified Public Expenditure Requirements The county will be reimbursed based on actual allowable costs for NTP and Outpatient Claim based on a CMS approved Certified Public Expenditure (CPE) protocol Each provider must submit annually a cost report

9. Funding FFP for all benefits at 50/50 for existing populations; 75/25 for QA and 100% for expansion populations State has moved away from sharing ratio and PUPM State funding will be provided subject to the provisions of 2011 Realignment Pursuant to SBX 1X, annual state funding subject to an appropriation will be available for new benefits (IOT, residential, etc.)

10. Open Questions on Funding How will the state allocate the SBX 1X state funding? For what services can the new funding be used? Does it create the right incentives to achieve the waiver goals if the funding can be used only for some services? What will be the reporting/claiming requirements for the SBX 1X funding? Does it make sense to have no sharing ratio? How does the county protect itself from financial impacts if the funding is insufficient?

11. Potential Principles For New Funding Ease of implementation State and county share in potential financial risks Funding requirements/structure support the goals of the waiver

12. Next Steps Work with state to develop the best approach that meets with the principles of the Counties Decide on an approach within next couple months

13. Questions?