Overview of BH Service Delivery in Cal MediConnect Coordinating Behavioral Health under Cal MediConnect October 3, 2013 PRESENTATION TO HASC – CAPG SOCAL CONTRACTS COMMITTEE

Overview of BH Service Delivery in Cal MediConnect Cal MediConnect plans are responsible for all Medicare-covered mental health and substance use services CAL MEDICONNECT PLAN BENEFITS COUNTY-ADMINISTERED CARVE OUT BENEFITS Traditional Medicare Covered Benefits Inpatient Mental Health Partial Hospital Programs (PHP) Intensive Outpatient (IOP) Office or Facility-Based Professional Services Inpatient Detox Alcohol Misuse Counseling Substance Abuse Counseling (OP) Residential Detox Opioid replacement therapy Alcohol or Drug Intensive Outpatient Specialty Mental Health and Drug-Medi-Cal MH Rehab Services (ACT, Vocational, etc.) Targeted Case Management Crisis Intervention Services Crisis Stabilization Services Acute Residential Treatment Day Rehabilitation Day Treatment Intensive Methadone Maintenance Cal MediConnect Requires Coordination through a BH MOU with LA DMH BEHAVIORAL HEALTH SERVICES REMAIN FRAGMENTED UNDER THE DEMONSTRATION

Overview of BH Service Delivery in Cal MediConnect LA Care has selected Beacon as its preferred behavioral health vendor at the request of LA DMH and DPH SCOPE OF SERVICES Functional Area Services Network College Health IPA outpatient network Beacon inpatient network County directly operated & contracted legal entities Credentialing Claims Payment Adjudication and Payment Coordination of Benefits for Medi-Cal carved out services Utilization Management Higher Levels of Care Crisis Response Care Management Lead CM for SMI (Assessment & ICP) Convene and Lead ICT Participate on ICT for Secondary Dx Quality monitoring NCQA Reporting County Integration Administer MOU Data Exchange Behavioral Health Care Management Team (BHCMT) LA Care & Subcontracted Plans Beacon College Health IPA private network LA DMH/DPH Contracted providers SINGLE POINT OF COORDINATION FOR BEHAVIORAL HEALTH PROVIDERS