State Releases Draft Substance Use Disorder Waiver Terms

The Department of Health Care Services (DHCS) released a draft of the proposed Special Terms and Conditions (STCs) for a substance use disorder wavier it is seeking from the Centers for Medicare and Medicaid Services (CMS) on July 16. This is part of the state’s efforts to create a more organized delivery system within the Drug Medi-Cal program, and it would amend California’s current Section 1115 “Bridge to Reform” Waiver. 
As currently drafted, the DMC organized delivery system amendment would allow counties to opt into the new model. The new model for counties that opt in would:

• Serve adolescent beneficiaries ages 12-17 and adults beneficiaries ages 18-64.
• Establish a continuum of care for services available to address substance use.
• Establish an assessment tool to determine the most appropriate level of care.
• Provide case management services to ensure continuity of care.
• Create a provider contracting appeal process.
• Create a provider certification process, in which the counties conduct application and on-site reviews and issue provisional certification while the State conducts the final approval.
• Grant counties additional oversight and monitoring responsibilities.
• Support coordination and integration across systems.
• Expand service providers to include Licensed Practitioners of the Healing Arts.
• Promote a consumer focus, using evidence based practices.

DHCS continues to solicit stakeholder input on the proposed draft. CSAC will continue to participate in the stakeholder process. Counties are encouraged to participate in the stakeholder process and contact Kelly Brooks-Lindsey at kbrooks@counties.org with questions or concerns.

California’s Section 1115 Waiver Renewal Process Begins

The Department of Health Care Services (DHCS) recently released their concepts for California’s next Section 1115 Waiver. California’s existing Section 1115 “Bridge to Reform” Waiver, which focused on the early expansion of the Affordable Care Act, expires on October 31, 2015.

DHCS’ focus for the successor demonstration project is to expand access, improve quality and outcomes and control the cost of care. In the key concepts presented recently by DHCS, California would:

• Establish a per beneficiary payment per year for Medi-Cal beneficiary categories covered under the waiver. The State would retain federal funding for the difference between the actual expenditures and the pre-established beneficiary amounts. This savings would be invested into the delivery system to ensure access and quality of care to Medi-Cal beneficiaries.
• Reform payment and delivery systems to encourage increased care coordination, case management and initiatives that will reduce the overall cost trend, impact the total cost of care and improve overall health care outcomes. California would also develop incentive payment programs aimed at better integrating behavioral health, mental health and substance use disorder treatment.
• Use a global payment approach that provides federal flexibility to integrate Medicaid Disproportionate Share Hospital and Safety Net Care Pool funding for the public hospital systems.
• Move to a risk-based model for federally qualified health clinics (FQHCs), that would provide incentives and flexibilities to provide care in the more cost-effective and patient-centered manner.
• Implement a successor DSRIP program based on outcomes and be value-oriented with respect to population health. Key areas would include patient safety, complex patients and prevention. California would seek to demonstrate the advancement of Triple Aim goals under the Affordable Care Act. The successor DSRIP would also allow for Non-Designated Public Hospitals to participate in addition to the county public hospital systems.
• Implement pay for performance programs to move toward a coordinated and organized delivery system.
• Explore demonstrations to test how funding shelter and housing services through Medicaid can contribute to increased quality, ensure continuity of care, deliver better health outcomes and reduce the total cost of care.
• Offer subsidies for malpractice insurance premiums of doctors based on the percentage of the doctor’s practices that are devoted to low-income patients as an effort to incentivize providers to serve low-income populations. This is in response to an increasing demand for providers due to the ACA.

DHCS will be hosting a webinar on Friday, July 25 at 2 p.m. to discuss the concept paper and stakeholder process. CSAC will participate and keep counties updated as this process continues.

Legislation

AB 1623 (Atkins) – Support 
Chapter No. 85, Statutes of 2014 

AB 1623, by Assembly Speaker Atkins, authorizes any city, county, or community-based nonprofit organization to establish a multiagency, multidisciplinary family justice center to assist victims of domestic violence, sexual assault, elder abuse, and human trafficking, as specified beginning January 1st of 2015. The bill also specifies additional confidentiality provisions relating to information disclosed by a victim in a family justice center and requires each family justice center to provide mandatory training for all staff members, volunteers, and agency professionals. 

The Governor signed AB 1623 into law on July 7, 2014.

AB 2379 (Weber) – Support 
Chapter No. 62, Statutes of 2014 

AB 2379, by Assembly Member Shirley Weber, will increase information sharing among county Child Welfare Services (CWS) and Adult Protective Services (APS) systems regarding dependent adults. This measure is not a mandate and has no fiscal impacts. CSAC supported this policy change to help the abovementioned county systems carry out their core mission: prevent the pain, suffering, and costs associated with ongoing dependent adult abuse.

The Governor signed AB 2379 into law on June 25, 2014.