1. Overview of the Affordable Care Act Implementation within the DHCS Behavioral Health Services Delivery System Presented at the Association for Criminal Justice Research (California) 79 th Semi-Annual Meeting March 21, 2014 Brenda Grealish, Chief Mental Health Services Division

2. 2 Behavioral Health Delivery System Changes There were two fundamental changes to the behavioral health delivery systems that occurred from 2012-2014: 1.Transfer/Merge of the former California Departments of Mental Health and Alcohol and Drug Programs to the Department of Health Care Services 2.January 1, 2014, Implementation of the Affordable Care Act (ACA)

3. 3 New capacity at DHCS came about as a result the Administration’s plans to reorganize for program and financial consolidation, effectiveness, efficiency and improved accountability Often collectively referred to as … “Behavioral Health” Recent re-organization divided major sections of 2 Departments (the former Dept. of Mental Health and Dept. of Alcohol and Drug Programs) –Divided the former DMH into 2 components »State hospital and specialty psychiatric programs in CDCR facilities »Community mental health programs moved to DHCS in 2012 –Integrated the former Dept. of Alcohol and Drug Programs into DHCS »Drug Medi-Cal (DMC) programs moved to DHCS in 2012 »Remaining ADP programs moved to DHCS in 2013 DHCS Behavioral Health Merge

4. Service - Accountability - Innovation 4

5. Medi-Cal Managed Care Effective January 1, 2014, eligible Medi-Cal beneficiaries may receive mental health benefits through Medi-Cal Managed Care Plans (MCPs). These services will continue to be offered as fee-for-service (FFS) benefits for eligible beneficiaries that are not enrolled in an MCP. MCP/FFS Mental Health Services: –Individual and group mental health evaluation and treatment (psychotherapy) –Psychological testing when clinically indicated to evaluate a mental health condition –Outpatient services for the purposes of monitoring medication treatment –Outpatient laboratory, medications, supplies and supplements –Psychiatric consultation –Standard Briefing and Intervention (SBI) 5

6. 6 Specialty Mental Health Services Outpatient Services Mental Health Services (assessment, plan development, therapy, rehabilitation and collateral) Medication Support Services Day Treatment Intensive Day rehabilitation Crisis Intervention Crisis Stabilization Targeted Case Management Inpatient Services Acute psychiatric inpatient hospital services Psychiatric Inpatient Hospital Professional Services if the beneficiary is in a fee-for-service hospital (rather than a Short- Doyle/Medi-Cal acute psychiatric inpatient hospital).

7. 7 Substance Use Disorder Benefits All eligible Medi-Cal beneficiaries may receive the following SUD services through county-administered [Drug Medi-Cal (DMC)] substance use disorder services: Outpatient Drug Free Treatment Narcotic Treatment Services Intensive Outpatient Treatment (prior to ACA, this benefit was limited to pregnant and postpartum women, children, and youth under the age of 21; now available for the general population) Residential Substance Use Disorder Services (prior to ACA, this benefit was limited to pregnant and postpartum women; now available for the general population) Voluntary Inpatient Detoxification Screening and Brief Intervention (this service is available to the general adult population for alcohol misuse, and if threshold levels indicate, a brief intervention is covered. This service would occur in primary care settings.)

8. 8 County Alcohol and Other Drug Programs (AOD) Outpatient Services Outpatient Drug Free Intensive Outpatient (newly expanded to additional populations) Residential Services (newly expanded to additional populations) Narcotic Treatment Program Naltrexone New Services (Administrative linkage to County AOD still being discussed) Outpatient Services Outpatient Drug Free Intensive Outpatient (newly expanded to additional populations) Residential Services (newly expanded to additional populations) Narcotic Treatment Program Naltrexone New Services (Administrative linkage to County AOD still being discussed) Target Population: Children and adults who meet medical necessity or EPSDT criteria for Drug Medi-Cal Substance Use Disorder Services Clear and concise communication and coordination between the County MH/SUD programs and the Medi-Cal Managed Care and FFS programs is key Screening  Assessments  Referrals  Care Coordination  Case Management Medi-Cal Managed Care Plans (MCP) Target Population: All beneficiaries in Managed Care Plans who meet medical necessity criteria MCP services to be carved-in effective 1/1/14 Individual/group mental health evaluation and treatment (psychotherapy) condition Psychological testing when clinically indicated to evaluate a mental health condition Outpatient services for the purposes of monitoring medication treatment (Current list of psychotropic medications will continue to be carved-out.) Outpatient services for the purposes of monitoring medication treatment (Current list of psychotropic medications will continue to be carved-out.) Psychiatric consultation Outpatient laboratory, medications, supplies and supplements Substance Use Screening and Brief Intervention (target 2/1/14 effective date) MCP services to be carved-in effective 1/1/14 Individual/group mental health evaluation and treatment (psychotherapy) condition Psychological testing when clinically indicated to evaluate a mental health condition Outpatient services for the purposes of monitoring medication treatment (Current list of psychotropic medications will continue to be carved-out.) Outpatient services for the purposes of monitoring medication treatment (Current list of psychotropic medications will continue to be carved-out.) Psychiatric consultation Outpatient laboratory, medications, supplies and supplements Substance Use Screening and Brief Intervention (target 2/1/14 effective date) County Mental Health Plan (MHP) (MHP) Outpatient Services Mental Health Services (assessments plan development, therapy, rehabilitation and collateral) Medication Support Day Treatment Services and Day Rehabilitation Crises Intervention and Crises Stabilization Targeted Case Management Therapeutic Behavior Services Residential Services Adult Residential Treatment Services Crises Residential Treatment Services Inpatient Services Acute Psychiatric Inpatient Hospital Services Psychiatric Inpatient Hospital Professional Services Psychiatric Health Facility services Outpatient Services Mental Health Services (assessments plan development, therapy, rehabilitation and collateral) Medication Support Day Treatment Services and Day Rehabilitation Crises Intervention and Crises Stabilization Targeted Case Management Therapeutic Behavior Services Residential Services Adult Residential Treatment Services Crises Residential Treatment Services Inpatient Services Acute Psychiatric Inpatient Hospital Services Psychiatric Inpatient Hospital Professional Services Psychiatric Health Facility services Target Population: Children and adults who meet medical necessity or EPSDT criteria for Medi-Cal Specialty Mental health Services

9. Out-patient specialty mental health (CCR-Title 9 Sec. 1830.205) In-patient specialty mental health (CCR-Title 9 Sec. 1820.205) Out-patient Drug Medi-Cal (CCR-Title 22, Sec. 51303) Out-patient non-specialty mental health (CCR-Title 22, Sec. 51303) Medical Necessity Criteria 9

10. https://www.coveredca.com/ Enrollment 10

11. 11 Contact Information Website: www.dhcs.ca.gov For Medi-Cal Managed Care Mental Health: Sarah.Brooks@dhcs.ca.gov For Specialty Mental Health: Brenda.Grealish@dhcs.ca.gov For Substance Use Disorder Services: Robert.Maus@dhcs.ca.gov Laurie.Weaver@dhcs.ca.gov