Drug Medi-Cal
Organized Delivery System
Implementation Plan
Imperial County
Behavioral Health Services
Drug Medi-Cal Organized Delivery System Implementation Plan Imperial County
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Contents Page
Number
Part I – Plan Questions 2
Part II – Plan Description: Narrative Description of the County’s Plan 5
Section 1 – Collaborative Process 5
Section 2 – Client Flow 7
Section 3 – Beneficiary Notification and Access Line 12
Section 4 – Treatment Services 13
Section 5 – Coordination with Mental Health 19
Section 6 – Coordination with Physical Health 21
Section 7 – Coordination Assistance 22
Section 8 – Availability of Services 24
(a) The anticipated number of Medi-Cal clients 25
(b) The expected utilization of services 26
(c) The number and types of providers required to furnish the contracted Medi-Cal services
27
(d) Language capability for the county threshold languages 28
(e) Timeliness of first face-to-face visit, timeliness of services for urgent conditions and access after-hours care
28
(f) The geographic location of providers and Medi-Cal beneficiaries, considering distance, travel time, transportation, and access for beneficiaries with disabilities
29
(g) How will the county address service gaps, including access to Medication Assisted Treatment (MAT) services
32
(h) Appendix – list of network providers 33
Section 9 – Access to Services 33
Section 10 – Training Provided 34
Section 11 – Technical Assistance 35
Section 12 – Quality Assurance 36
Section 13 – Evidence-based Practices 42
Section 14 – Regional Model 44
Section 15 – Memorandum of Understanding 44
Section 16 – Telehealth Services 45
Section 17 – Contracting 45
Section 18 – Additional MAT 47
Section 19 – Residential Authorization 48
Section 20 – One Year Provisional 49
Drug Medi-Cal Organized Delivery System Implementation Plan Imperial County
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P A R T I - P L A N Q U E S T I O N S
This part is a series of questions that summarize the county’s Drug Medi-Cal - Organized Delivery System (DMC-ODS) plan.
1. Identify the county agencies and other entities involved in developing the county plan. (Check all that apply) Input from stakeholders in the development of the county implementation plan is required; however, all stakeholders listed are not required to participate.
County Behavioral Health Agency County Substance Use Disorder Agency Providers of drug/alcohol treatment services in the community Representatives of drug/alcohol treatment associations in the community Physical Health Care Providers Medi-Cal Managed Care Plans Federally Qualified Health Centers (FQHCs) Clients/Client Advocate Groups County Executive Office County Public Health County Social Services Foster Care Agencies Law Enforcement Court Probation Department Education Recovery support service providers (including recovery residences) Health Information technology stakeholders Other (specify)
2. How was community input collected?
Community meetings County advisory groups Focus groups Other method(s) (explain briefly)
3. Specify how often entities and impacted community parties will meet during the implementation of
this plan to continue ongoing coordination of services and activities.
Monthly Bi-monthly Quarterly
Other: Every two weeks
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Drug Medi-Cal Organized Delivery System Implementation Plan Imperial County
Review Note: One box must be checked.
4. Prior to any meetings to discuss development of this implementation plan, did representatives from Substance Use Disorders (SUD), Mental Health (MH) and Physical Health all meet together regularly on other topics, or has preparation for the Waiver been the catalyst for these new meetings?
SUD, MH, and physical health representatives in our county have been holding regular meetings to discuss other topics prior to waiver discussions.
There were previously some meetings, but they have increased in frequency or intensity as a result of the Waiver.
There were no regular meetings previously. Waiver planning has been the catalyst for new planning meetings.
There were no regular meetings previously, but they will occur during implementation.
There were no regular meetings previously, and none are anticipated.
5. What services will be available to DMC-ODS clients upon year one implementation under this county plan?
REQUIRED
Withdrawal Management (minimum one level) Residential Services (minimum one level) Intensive Outpatient Outpatient Opioid (Narcotic) Treatment Programs Recovery Services Case Management Physician Consultation
How will these required services be provided?
All County operated Some County and some contracted All contracted.
OPTIONAL
Additional Medication Assisted Treatment Partial Hospitalization Recovery Residences Other (specify)
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Drug Medi-Cal Organized Delivery System Implementation Plan Imperial County
6. Has the county established a toll free 24/7 number with prevalent languages for prospective clients to call to access DMC-ODS services?
Yes (required) No. Plan to establish by: .
Review Note: If the county is establishing a number, please note the date it will be established and operational.
7. The county will participate in providing data and information to the University of California, Los Angeles (UCLA) Integrated Substance Abuse Programs for the DMC-ODS evaluation.
Yes (required) No
8. The county will comply with all quarterly reporting requirements as contained in the STCs.
Yes (required) No
9. Each county’s Quality Improvement Committee will review the following data at a minimum on a quarterly basis since external quality review (EQR) site reviews will begin after county implementation. These data elements will be incorporated into the EQRO protocol:
Number of days to first DMC-ODS service/follow-up appointments at appropriate level of care after referral and assessment
Existence of a 24/7 telephone access line with prevalent non-English language(s)
Access to DMC-ODS services with translation services in the prevalent non-English language(s)
Number, percentage of denied and time period of authorization requests approved or denied
Yes (required) No
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Drug Medi-Cal Organized Delivery System Implementation Plan Imperial County
P A R T I I – P L A N D E S C R I P T I O N (Narrative)
1. Collaborative Process. Describe the collaborative process used to plan DMC-ODS services. Describe
how county entities, community parties, and others participated in the development of this plan and
how ongoing involvement and effective communication will occur.
Imperial County Behavioral Health Services (ICBHS) developed an internal DMC-ODS implementation
committee composed of representation from Quality Management (QM), Adult Substance Use
Disorder (SUD) Services, Adolescent SUD services, Youth and Young Adult (YAYA) Services Mental
Health, Adult Services Mental Health, and Administration. The members of this committee included
the assistant director; deputy director, behavioral health manager and administrative analyst for Adult
Services; deputy director, behavioral health manager, program supervisor and administrative analyst
for YAYA; and behavioral health manager and administrative analyst for QM. This committee met on
a weekly basis to discuss all elements of the implementation plan and define tasks required as part of
the implementation process.
The committee identified a list of agencies, stakeholders, and individuals that would have a role or
contribution in the implementation of DMC-ODS services. Informational brochures in English and
Spanish were created that provide an overview of the DMC-ODS waiver and a series of community
forums were scheduled in different areas of Imperial County. Newspaper ads were posted inviting the
community to participate in these forums and invitations were delivered to different community
agencies, schools and stakeholders encouraging their participation. In addition, individual
presentations were also held within ICBHS mental health and SUD clinics, other SUD providers, SUD
treatment participants and agencies that were not available to participate in the community forums.
Each presentation included an overview of DMC-ODS waiver services and a series of questions that
assisted in engaging the community and stakeholders providing valuable input in the needs and
priorities for Imperial County. The survey questions were as follows:
1) In your opinion, what is the greatest need for Imperial County related to Alcohol and Drug
treatment services?
2) A. From the DMC-ODS treatment interventions described, what do you think is the most
important?
B. Please explain why.
3) What would you consider to be the greatest challenges/barriers in delivering these services?
Location
Availability of appointments
Hours of service
Bilingual staff
Transportation
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Drug Medi-Cal Organized Delivery System Implementation Plan Imperial County
Confidentiality
Negative views of people seeking services
Other
4) What recommendations do you have to reduce the impact of these challenges/barriers?
5) In your opinion, how will implementation of this new system impact Imperial County residents?
6) What do you recommend to make these services available to Imperial County residents (Example:
location, bilingual staff, office hours, etc.)?
7) Do you have other recommendations for the implementation of these services or additional
comments?
The list of groups and individuals that provided input during these community forums and
presentations includes the following:
Community Groups and Individuals Engaged for Implementation Plan
Imperial County Behavioral Health Services Imperial County Probation
Imperial Valley College U.S. Border Patrol
Imperial Valley LGBTQ Resource Center Central Union High School District
Imperial Valley Regional and Occupational Program Imperial County Office of Education
Imperial County Department of Social Services Imperial County Public Health
Children and Families First Commission Department of Corrections
Imperial Valley Food Bank Sure Helpline Crisis Center
Calexico Unified School District Smart Recovery Group Participants
El Centro Elementary School District Imperial Valley Medical Treatment Center (NTP)
The DMC-ODS implementation committee reviewed and analyzed the data collected and incorporated
the feedback as part of the implementation process. The major themes from the data collected that
impacted the development of the plan are as follows:
Major Themes from Community Forums and Presentations
Family counseling and education Community outreach and education
Increase accessibility to residential facilities Prevention Services
Increase services for adolescents and families Case management services for community
Follow-up services to support recovery Increase focus on individual counseling
Expansion of service hours Accessible location of services
Transportation Home visiting services
Vocational training
ICBHS will continue to provide stakeholders opportunities for involvement in the implementation
process through ongoing meetings with agencies such as Imperial County Public Health Department,
Drug Medi-Cal Organized Delivery System Implementation Plan Imperial County
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Imperial County Probation, Imperial County Department of Social Services, Methadone Clinic,
residential facilities, law enforcement, school districts, ICBHS MH and SUD staff and other local
agencies. Through these meetings, ICBHS will maintain stakeholders updated on the progress of the
implementation plan and will continue to obtain input on how the process can be improved to better
serve Imperial County residents.
2. Client Flow. Describe how clients move through the different levels identified in the continuum of
care (referral, assessment, authorization, placement, transactions to another level of care). Describe
what entity or entities will conduct ASAM criteria interviews, how admissions to the recommended
level of care will take place, how often clients will be re-assessed, and how they will be transitioned to
another level of care accordingly. Include the role of how the case manager will help with the
transition through levels of care. Also describe if there will be timeliness established for the
movement between one level of care to another. Please describe how you plan to ensure successful
care transitions for high-utilizers or individuals at risk of unsuccessful transitions.
The goal of ICBHS is to provide timely access to medically necessary SUD services. Beneficiaries can
access services through different pathways that include referrals from other agencies such as, Imperial
County Probation, Imperial County Department of Social Services, education, health care providers, or
ICBHS MH. Beneficiaries can also access SUD treatment by contacting the 24-hour access number,
contacting one of the SUD treatment facilities, or by walking in to one of the ICBHS SUD or MH clinics.
An intake assessment appointment will be provided within seven (7) working days from the day the
individual requests services at which time medical necessity criteria for SUD services will be
determined. Beneficiaries, who meet medical necessity and ASAM criteria, will have access to a full
continuum of SUD services based on ongoing assessment and identified need during the course of
treatment. Please refer to Figure 1 – Client Flow Chart.
Initial Service Screening Upon request for services, individuals will be screened by an Access and Benefits Worker (ABW), who
will ask a series of questions to determine insurance coverage and eligibility, demographic
information, and the presenting problem(s). Once screened by the ABW, clients will be given an intake
assessment appointment at the appropriate SUD outpatient clinic. Determination for the appropriate
clinic will be based on findings from the initial access screening, geographic accessibility, threshold
language needs, and individuals’ preference. ICBHS will develop procedures on the referral and
screening process, which will be shared and discussed with ICBHS MH and SUD staff and referring
agencies. The referral process will provide multiple points of entry for beneficiaries. Referrals can be
generated from Community Based Agencies, primary care/ emergency department physicians or
governmental agencies such as the Court System, Probation, Parole and School Districts. Additionally,
a beneficiary may be able to access service through a self-referral. community agencies, and
governmental organizations and may refer beneficiaries through the use of a Community Agency
Referral Form which will be provided to these organizations or which will be available on the ICBHS
Drug Medi-Cal Organized Delivery System Implementation Plan Imperial County
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website. Primary Care Physicians will refer clients along with the Screening Brief Intervention and
Referral (SBIRT). Self-referred beneficiaries can begin the screening process by calling the Access
phone number which is available 24 hours per day/ 7 days per week. Additionally, beneficiaries can
walk into clinics and request services. Upon receiving the referral, Access workers will contact or
meet with the beneficiary to complete a screening and gather needed information to make
arrangements to begin treatment services. In addition the eligibility information obtained, additional
inquiry will be made about the reason for requesting services such as the type(s) of substance the
client is using, the situation or crisis which motivated the request for services, and whether or not a
crisis or urgent condition exists. This screening will allow the Access worker to make all the necessary
arrangements to begin treatment services which includes a scheduled appointment for an intake
assessment, at the appropriate regional clinic.
Intake Assessment and Medical Necessity Determination Medical necessity for services must be determined as part of the intake assessment process and will
be performed through a face-to-face session with the beneficiary. Beneficiaries attending the first
appointment at a SUD outpatient clinic will receive a comprehensive bio-psychosocial intake
assessment as well as a risk/severity rating and immediate needs profile based on the American
Society of Addiction Medicine (ASAM) criteria. This assessment will be conducted by a licensed
clinician or registered intern working under the supervision of a licensed clinician. Information
gathered during the intake assessment includes presenting problem(s); family alcohol and drug and
mental health history, social history, medical history and religious history; personal alcohol and drug
use history; developmental history; personal/social history; legal history; medical and mental health
history; other critical information. Based on the information gathered during the intake assessment,
clinicians determine if the beneficiary meets medical necessity for SUD treatment. Beneficiaries must
be diagnosed as having at least one Substance-Related and Addictive Disorder diagnosis, excluding
Tobacco-Related Disorder and Non-Substance Related Disorders, from the Diagnostic and Statistical
Manual (DSM) or, for beneficiaries under the age of 21, a risk for developing a SUD. After establishing
a diagnosis and medical necessity, the ASAM criteria will be applied using the multidimensional
assessment to determine a level of care placement. This information will also guide the recommended
treatment plan.
Beneficiaries who meet medical necessity and present a MH need, will be referred for additional MH
evaluation. SUD treatment team staff, which may include a physician, case manager, and/or clinician,
will work in collaboration with MH staff to ensure proper coordination for integrated MH services if
appropriate. ICBHS will develop procedures that will define the process for the proper integration of
MH treatment for those beneficiaries with co-occurring disorders.
In the event that a beneficiary does not meet SUD medical necessity criteria, the clinician will assess
for other immediate needs and will make the necessary referrals to other community agencies,
including MH. If the beneficiary does not meet diagnostic criteria for SUD but is assessed as being at
risk for developing a SUD, the client will be referred for Early Intervention Services, ASAM level 0.5,
through a managed care plan.
Drug Medi-Cal Organized Delivery System Implementation Plan Imperial County
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Medical necessity qualification for ongoing receipt of services [except Narcotic Treatment Programs
(NTP) services] will be determined at least every six months through the reauthorization process for
beneficiaries determined by the medical director or clinician to be clinically appropriate.
Reauthorization for NTP services will be conducted annually.
Reassessment and Transition between Modalities Beneficiaries will receive on-going assessment using ASAM criteria throughout the course of
treatment. Re-assessment can take place at any time and as deemed appropriate. At minimum,
assessment and/or re-assessment will take place at the onset of each treatment modality and every
ninety (90) days thereafter in conjunction with the required treatment plan. Beneficiaries will also be
evaluated at the conclusion of the treatment modality for determination of the next level of care in
the continuum of SUD treatment.
Case managers, who are required to be a Licensed Practitioner of the Healing Arts (LPHA) or a certified
substance abuse counselor (SAC), will work directly with the ICBHS SUD treatment team, other
agencies involved in the beneficiary’s treatment and contract providers to assist in the transition
between treatment modalities. Case managers will work proactively by ensuring that transitions to
other levels of care are effective, timely and complete, which will improve the beneficiaries’ safety
and satisfaction. For beneficiaries who are high utilizers or at risk of unsuccessful transitions and
require a higher level of care, ICBHS will follow the expedited referral process to ensure immediate
transition within modalities. The assigned case manager will work closely with the beneficiary by
providing more intensive services and increasing contacts with the beneficiary, if necessary, until the
transition is complete. Case manager services may continue after this transition, if medically
necessary, and to assist the beneficiary adhere to the recommended treatment. The case manager
will also communicate with other treatment providers to ensure that attention is placed on assisting
the client transition to the higher level of care successfully. Beneficiaries who will transition to a
lower level of care will also continue to receive support by the treatment provider and assigned case
manager to ensure progress is sustained and concerns regarding their recovery are addressed. This
support may include increased case management contacts that will slowly decrease once the
beneficiary demonstrates stability in the lower level of care, interventions to cope with triggers that
may lead to relapse, connecting the beneficiary to health social supports and activities, and providing
linkage to community services that will provide additional support through the SUD treatment.
Beneficiaries will move through the continuum of care as individual progress takes place. Treatment
plans will be individualized and timelines will be set based on the needs of the beneficiary.
Considerations on the number of sessions for individual, group, and family counseling will be made
based on evidence-based models and identified needs. ICBHS will abide by the requirements set by
DHCS related to residential treatment and will work within the mandated maximum stay for
adolescents and adults in residential facilities.
Case managers will also take an important role in helping beneficiaries reach their optimal level of
health, well-being and recovery by addressing their medical, psychosocial, behavioral, and spiritual
needs. In addition, all ICBHS SUD case managers will be trained on evidence-based models that will
address the beneficiaries’ SUD needs, help beneficiaries develop skills that enhance life functioning
Drug Medi-Cal Organized Delivery System Implementation Plan Imperial County
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and promote self-advocacy, self-care, and recovery. Case managers will focus on collaborating with
beneficiaries to establish accountability and responsibility, help with transitions, create a proactive
treatment plan at the start of each treatment modality, and will monitor and follow-up as needed for
the beneficiary’s success.
Residential Evaluation and Authorization All beneficiaries seeking SUD treatment will receive an intake appointment in which a biopsychosocial
assessment of the beneficiary will be conducted by a LPHA. The LPHA will use the ICBHS Intake
Assessment tool that will incorporate all six elements of the ASAM Multidimensional Assessment.
Beneficiaries who at the time of intake are assessed to meet the ASAM criteria for residential
treatment, will be referred and assigned a case manager through the expedited referral process for
immediate placement coordination in a contracted residential facility.
Or, throughout the course of treatment, if the beneficiary is assessed to require a higher level of care,
the treatment team will meet to discuss the case for appropriateness and referral to a residential
facility. The treatment team will review the beneficiary’s current functioning, response to treatment,
and each ASAM dimension to determine severity and need for a higher level of care. A case manager
will be assigned for coordination and facilitation of timely placement, follow-up and discharge
planning.
All prior authorization requests will be reviewed by the SUD Program Supervisor within 24 hours of
request by the treatment provider. The SUD Program Supervisor will review the beneficiary’s intake
assessment, diagnosis, treatment history and the reasons for referral to determine approval or denial
of request. Authorization and tracking of all residential treatment referrals will be conducted by
ICBHS designated staff at each SUD outpatient clinic. ICBHS will grant a prior authorization for the first
seven (7) days of residential treatment based on the results identified on the ASAM assessment. The
residential treatment provider will have the responsibility to submit a request for authorization for up
to a maximum of ninety (90) days on a continuous period for those adult clients who have been
assessed and admitted into a residential facility. One extension of up to thirty (30) days beyond the
maximum length of ninety (90) days may be authorized for one continuous length of stay in a one (1)
year period. The residential treatment provider will also have the responsibility to submit a request
for authorization for up to a maximum of thirty (30) days in one continuous period for adolescent
clients who have been assessed and admitted to a residential facility. Reimbursement will be limited
to two non-continuous thirty (30) day regimens in any one year period. One extension of up to thirty
(30) days beyond the maximum length of stay may be authorized for one continuous length of stay in
a one year period.
Continuum of Care All SUD providers are expected to individualize treatment and use the full continuum of services
available to beneficiaries to ensure clients receive the most appropriate care. Case management
services will help assure clients move through the system and access other needed health and
ancillary services to support their recovery. As beneficiaries complete primary treatment, they will be
connected to recovery services to build connections within the recovery community and continue
developing self-management strategies to prevent relapse.
Referral Source
• Community Agencies
• Court Order
• Self-Referral
• ICBHS
• Early Intervention
SBIRT Level 0.5 • Clinician Completed Intake
Assessment & ASAM
Multidimensional
• Recommends Service
& ASAM Level of Care M e e t s M e d i c a l N e c e s s i t y f o r S U D T r e a t m e n t
Assessment follow-up for
Integrated Mental
Health Treatment
O t h e r S U D S e r v i c e s • Withdrawal Management
Services
• Opioid/Narcotic Treatment Services
• Medication Assisted Treatment
• Recovery Services
• Case Management
Co-Occurring Mental Health Need
Referral to Community
Services & Supports
including Mental Health
Does Not Meet
Medical Necessity but is
at Risk for SUD Referral
to non-DMC
provider
C l i n i c
a l l y M a
n a g e d
W i t h d r a
w a l M a n a
g e m e n t
D i s c h a r g e
Drug Medi-Cal Organized Delivery System Implementation Plan Imperial County
Figure 1 - Client Flow Chart
Client Flow Chart
Drug Medi-Cal Organized Delivery System (DMC-ODS) Waiver
• Referral to Access
• Walk-in to Clinic
• Call to Clinic / Access
• Access Screening
• Appointment within 7 Days of Referral
to Appropriate SUD Outpatient Clinic
C o m p l e t i o n
o f T r e a t m e n t
R e c o v e r y
S e r v i c e s
11
SUD Outpatient Clinic
Does Not Meet Medical Necessity
O u t p a t i e n t
Level 1
• Individual
• Group
• Adolescent: less than 6 hours per week
• Adults: less than 9 hours per week
I n t e n s i v e O u t p a t i e n t
Level 2.1
• Individual
• Group
• Adolescent: 6 or more hours per week
• Adults: 9 or more hours per week
R e s i d e n t i a l
Level 3.1 Level 3.3
Adults with
Cognitive
Impairment
Only
Level 3.5
Adolescent
&
Adults
Intensive
Residential
Adolescent
& Adults
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3. Beneficiary Notification and Access Line. For the beneficiary toll-free access number, what data will
be collected (i.e. measure the number of calls, waiting time, and call abandonment)? How will
individuals be able to locate the access number? The access line must be toll-free, functional 24/7,
accessible in prevalent non-English languages, and ADA-compliant (TTY).
Review Note: Please note that all written information must be available in the prevalent non-English
languages identified by the state in particular service area. The plan must notify beneficiary of free
oral interpretation services and how to access those services.
ICBHS will utilize the current toll-free access line as the beneficiary access line for DMC ODS services.
The access line is available twenty-four (24) hours a day, seven (7) days a week and is available in
English and the MHP’s threshold language, Spanish. Language Line Services are available for
interpretation in other languages. During business hours, the toll-free line is managed by the ICBHS
Access Unit. After hours, the line is managed by trained on-call staff. The access line is ADA-
compliant and all callers are also screened for crisis/urgent conditions and referred appropriately.
The toll-free access line number and information on free oral interpretation and how to access those
services is currently included in the informing materials that are available through the Access Unit and
at each service area and contract provider service locations. All informing material is provided in
English and the MHP’s threshold language, Spanish. ICBHS also notifies beneficiaries of the availability
of the toll-free number, free oral interpretation services and how to access those services through
posters that are displayed at all service areas.
The toll-free access line is also listed on brochures, forms, newspapers, phone books, social and local
media. Each call requesting information about services, appointment requests or identified as
crisis/urgent conditions are logged and the following data is collected:
Caller’s name
Date of call
Contact type (client request)
Referred by
Interpreter needed
Presenting problem
Appointment information
Timeliness of Appointment
Staff who answered call
Information provided to caller/disposition of call
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In addition, ICBHS ShoreTel phone system has the capability to capture data such as: number of calls
received, hold waiting time, and length of call. Data collected will measure timeliness, access and
urgent conditions.
4. Treatment Services. Describe the required types of DMC-ODS services (withdrawal management,
residential, intensive outpatient, outpatient, opioid/narcotic treatment programs, recovery services,
case management, and physician consultation) and optional (additional medication assisted treatment,
recovery residences) to be provided. What barriers, if any, does the county have with the required
service levels? Describe how the county plans to coordinate with surrounding opt-out counties in order
to limit disruption of services for beneficiaries who reside in an opt-out county.
ICBHS will provide the following types of required and optional services:
D M C - O D S S e r v i c e s
Service Type ASAM Level
Required or Optional Provider
A Early Intervention/ Screening, Brief Intervention, and Referral to Treatment (SBIRT)
.05 Provided in partnership with existing primary care provider or managed care provider
Primary Care MDs
Medi-Cal Managed Care Providers
B Outpatient Services/ Outpatient Treatment Services
1 Required ICBHS
Contract Provider
C Intensive Outpatient Treatment Services (IOT)
2.1 Required ICBHS
Contract Provider
E Withdrawal Management Services (WM)
1-WM 3.2-WM
1 Level Required ICBHS
Contract Provider
F Residential Treatment Services (RTS)
3.1, 3.3, 3.7
Required Contract Provider
G Opioid/Narcotic treatment Program (NTP)
OTP Level 1
Required Contract Provider
H Additional Medication Assisted Treatment (MAT) Services
OTP Level 1
Optional ICBHS
Contract Provider
I Recovery Services N/A Required ICBHS
J Case Management N/A Required ICBHS
K Physician Consultation N/A Required ICBHS
L Recovery Residence N/A Optional ICBHS
Service Descriptions:
A. Early Intervention (ASAM Level 0.5)
Screening, Brief Intervention, and Referral to Treatment (SBIRT) for beneficiaries at risk for
developing a SUD will be provided by Imperial County Medi-Cal managed care providers, and local
primary care providers. Beneficiaries at risk of developing a SUD or those with an existing SUD are
identified and offered screening for adults, brief treatment as medically necessary, and, when
indicated, a referral to treatment with formal linkage.
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B. Outpatient Services (ASAM Level 1.0)
Outpatient services consist of up to nine (9) hours per week of medically necessary services for
adults and less than six (6) hours per week of services for adolescents. SUD providers will offer
ASAM Level 1 services including: assessment, treatment planning; individual and group counseling;
family therapy; patient education; medication services; collateral services; crisis intervention
services; and discharge planning and coordination. Services may be provided in-person or by
telephone in any appropriate setting in the community. Services listed above will be provided in an
outpatient setting by ICBHS SUD staff. Staff providing services will consist of certified SACs and
LPHAs.
C. Intensive Outpatient Services (ASAM Level 2.1)
Intensive outpatient involves structured programming provided to beneficiaries as medically
necessary for a minimum of nine (9) hours and a maximum of nineteen (19) hours per week for
adult clients. Adolescents are provided a minimum of six (6) and a maximum of nineteen (19)
hours per week. Services include assessment, treatment planning, individual and/or group
counseling, patient education, family therapy, medication services, collateral services, crisis
intervention services, treatment planning, and discharge planning and coordination. Services may
be provided in person or by telephone in any appropriate setting in the community. Services listed
above will be provided in an outpatient setting by ICBHS SUD staff. Staff providing services will
consist of certified SACs and LPHAs.
D. Withdrawal Management Services (ASAM Levels 1-WM, 3.2-WM, 3.7, 4.0)
Withdrawal Management services are provided as medically necessary to beneficiaries and
include; assessment, observation, medication services, and discharge planning and coordination.
These services will be provided in an outpatient setting by ICBHS. Staff providing services will be
provided by licensed physicians with a specialty in addiction medicine. ICBHS will offer ASAM Level
1-WM: Ambulatory Withdrawal Management without Extended On-Site Monitoring at
implementation. By end of Implementation Year 2 (IY2) ICBHS will assess the utilization and ASAM
data to make a determination if the need exists for ASAM Level 3.2-WM: Clinically-Managed
Residential Withdrawal Management and ASAM Level 2-WM: Ambulatory withdrawal
management with extended on-site monitoring. If the need for these levels of Withdrawal
Management exists, providers will be identified and attempts will be made to establish provider
contracts.
ICBHS will work with El Centro Regional Medical Center and Pioneers Memorial Hospital and other
area service providers to assist beneficiaries to access Withdrawl Management 3.7 Medically-
Monitored Inpatient Withdrawal Management) and Withdrawl Management 4.0 4.0-WM
(Medically-Managed Inpatient Withdrawal Management) when medically necessary. ICBHS will
coordinate with these providers to ensure a successful
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transition for beneficiaries through discharge planning. Discharge planning will ensure that
beneficiaries are able to access less intensive levels of care available within the DMC-ODS. ICBHS
will establish a MOU that outlines mutual responsibilities, referral, billing, and aftercare systems.
In addition, ICBHS has contracts with two Acute Psychiatric Hospitals that will be utilized to
address the need for ASAM level 3.7 and 4.0 and currently has a process in place for the
placement and transportation of beneficiaries who are in need of this service.
E. Residential Treatment Services (ASAM Levels 3.1, 3.3, 3.5, 3.7 and 4.0)
Residential treatment is a 24 hour, non-institutional, non-medical, short-term service that
provides residential rehabilitation services to youth, adult, and perinatal beneficiaries. Residential
services are provided in facilities designated by DHCS as capable of delivering care consistent with
ASAM Level 3.1: Clinically-Managed Low-Intensity Residential, ASAM Level 3.3: Clinically Managed
Population-Specific High-intensity Residential Services (Adult only), ASAM level 3.5: Clinically-
Managed High-Intensity Residential, ASAM Level 3.7: Medically Monitored Intensive Inpatient
Services, and ASAM Level 4.0: Medically Managed Intensive Inpatient Services Beneficiaries are
approved for residential treatment through a prior authorization process based on the results
identified by the ASAM assessment All prior authorization requests for residential treatment 3.1,
3.5, and 3.7 will be reviewed by the SUD Program Supervisor within 24 hours of request by the
treatment provider. The SUD Program Supervisor will review the beneficiary’s intake assessment,
diagnosis, treatment history and the reasons for referral to determine approval or denial of
request. The residential treatment provider will have the responsibility to submit a request for
authorization for up to a maximum of ninety (90) days on a continuous period for those adult
clients who have been assessed and admitted into a residential facility. One extension of up to
thirty (30) days beyond the maximum length of stay of ninety (90) days may be authorized for one
continuous length of stay in a one year period.
The residential treatment provider will have the responsibility to submit a request for
authorization for up to a maximum of thirty (30) days on one continuous period for adolescent
clients who have been assessed and admitted to a residential facility. Reimbursement will be
limited to two non-continuous thirty (30) day regimens in any one year period. One extension of
up to thirty (30) days beyond the maximum length of stay may be authorized for one continuous
length of stay in a one year period. Under the Early Periodic Screening, Diagnostic and Treatment
(EPSDT) mandate, beneficiaries under age of twenty-one (21) are eligible to receive all appropriate
and medically necessary services needed to correct and ameliorate health conditions that are
coverable under Section 1905(a) Medicaid authority. The DMC-ODS Pilot does not override any
EPSDT requirements.
Perinatal and criminal justice involved clients may receive a longer length of stay based on medical
necessity.
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Residential treatment services include assessment, treatment planning, individual and group
counseling, client education, family therapy, collateral services, crisis intervention services,
treatment planning, transportation to medically necessary treatment, and discharge planning and
coordination. All providers are required to accept and support patients who are receiving
medication-assisted treatment.
For ASAM Level 3.7 and 4.0, ICBHS will work with El Centro Regional Medical Center and Pioneers
Memorial Hospital to address the needs of beneficiaries with severe withdrawal. In addition,
ICBHS has contracts with Alvarado Parkway Institute and Aurora Behavioral Health Psychiatric
Hospitals. ICBHS has a process in place for evaluating individuals who present need for inpatient
psychiatric care. The SUD clinical and administrative staff will work in collaboration with the Crisis
and Referral Desk team who will coordinate placement and transportation for beneficiaries who
are in need if inpatient psychiatric treatment. The SUD case manager will monitor the process of
treatment, both at the local hospital and psychiatric hospital, will participate in the discharge
planning and will ensure a successful transition to a lower level of SUD care.
Residential services will be provided by contract providers. ICBHS currently has a contract with
McAllister Institute, which is ASAM designated 3.1 and 3.5 and is in the process of visiting other
residential facilities that have received an ASAM designation and are DMC certified or in the
process of becoming certified for the purpose of developing additional contracts. ICBHS will
ensure ASAM level 3.3 is available within 3 years of final approval of the County’s implementation
plan and will follow the County policy and process for selecting new providers. For clients in any
residential treatment program, case management services will be provided to facilitate “step
down” to lower levels of care and support. Based on the ASAM level designation, staffing will
consist of certified substance abuse counselors, allied health professionals, LPHAs, physicians, and
physician extenders.
F. Opioid (Narcotic) Treatment Program (OTP/NTP, ASAM OTP Level 1)
ICBHS will establish a contract with the local licensed Narcotic Treatment Program to offer services
to beneficiaries who meet medical necessity criteria requirements. Services are provided in
accordance with an individualized client plan determined by a licensed prescriber. Prescribed
medications offered include methadone, buprenorphine, naloxone and disulfiram and other
medication covered under the DMC-ODS formulary. There are two NTP clinics in Imperial County,
which are located in the city of El Centro and Calexico. These clinics have the ability to serve the
SUD beneficiaries of Imperial County. The contract with this NTP clinic will clearly define its
responsibility to serve all beneficiaries who are referred for services.
Services provided as part of an OTP include: assessment, treatment planning, individual and group
counseling, patient education, medication services, collateral services, crisis intervention services,
treatment planning, medical psychotherapy, and discharge services. Clients receive between fifty
(50) and two hundred (200) minutes of counseling per calendar month with a therapist or
Drug Medi-Cal Organized Delivery System Implementation Plan Imperial County
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counselor, and when medically necessary, additional services may be provided. Staffing consists of
a licensed physician, certified SACs, LPHAs.
G. Additional Medication Assisted Treatment (MAT) Services (Optional, ASAM Level 1)
ICBHS will offer medically necessary MAT services through ICBHS staff. Services will include;
ordering, prescribing, administering, and monitoring of medication for SUD.
MAT will expand the use of medications for beneficiaries with chronic alcohol - related disorders
and opiate use. Medications will include: naltrexone, both oral (ReVia) and extended release
injectable (Vivitrol), topiramate (Topamax), gabapentin (Neurontin), acamprosate (Campral), and
disulfiram (Antabuse).
Opiate overdose prevention: naloxone (Narcan)
Opiate use treatment: buprenorphine-naloxone (Suboxone) and naltrexone (oral and extended
release) (Note: methadone will continue to be available through the licensed narcotic
treatment program)
For reduction of alcohol craving: naltrexone, both oral (ReVia) and extended release injectable
(Vivitrol), topiramate (Topamax), gabapentin (Neurontin), acamprosate (Campral) and
disulfiram (Antabuse)
Physician consultation will be provided to support implementation in areas such as medication
selection, dosing, side effects management, adherence, and drug-drug interactions. Services
listed above will be provided in an outpatient setting by ICBHS. Staff providing services will be
provided by licensed physicians with a specialty in addiction medicine. In addition, a Licensed
Vocational Nurse (LVN) will assist the physician if there is a need to order labs, communicate with
pharmacies, and will follow up with the beneficiaries on a regular basis to ensure that side effects
are under control and that they are following the recommended regimen. The LVN will also work
in collaboration with case managers and LPHAs for treatment planning and for recommendations
to a higher or lower level of care.
H. Recovery Services (ASAM Dimension 6, Recovery Environment)
Recovery services are available once a beneficiary has completed the primary course of
treatment and during the transition process. These services will be available to beneficiaries
whether they are triggered, have relapsed, or as a preventive measure to prevent relapse.
Services will be provided in the context of an individualized treatment plan that includes specific
goals. This may include the plan for ongoing recovery and relapse prevention that was developed
during discharge planning when treatment was completed. Beneficiaries accessing recovery
services are supported to manage their own health and health care, use effective self-
management support strategies, and use community resources to provide ongoing support.
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Recovery services may be provided face-to-face, by telephone, or elsewhere in the community.
Services may include: outpatient individual or group counseling to support the stabilization of the
client or reassess the need for further care, recovery monitoring/ recovering coaching, peer to
peer services and relapse prevention, WRAP development, education and job skills, family
support, support groups, and linkages to various ancillary services. Recovery Services will be
provided by ICBHS staff consisting of certified SACs and LPHAs. ICBHS is also in the process of
working with HR and developing a job description for Peer Support Staff as this is not an existing
position. Once this position is approved, Peer Support staff will also be used to provide Recovery
Services to beneficiaries.
Referral to recovery services can be made by any SUD treatment provider, which may include the
case manager, Peer Support, LPHA, physician, or nurse. Appropriateness of referral will be
evaluated by the SUD treatment team prior to the beneficiary’s discharge to ensure proper
coordination of care once the beneficiary has completed treatment. The beneficiary will also be
able to request recovery services if he/she has relapsed, is triggered, or as a preventive measure
to prevent relapse even after he/she has completed treatment.
I. Case Management Services
Case management services support beneficiaries as they move through the DMC-ODS continuum
of care from initial engagement and early intervention, through treatment, to recovery supports.
Case management services are provided for clients who may be pre-contemplative and
challenging to engage, and/or those needing assistance connecting to treatment services, and/or
those clients stepping down to lower levels of care and support. ICBHS will use a comprehensive
case management model based on the ASAM bi-psychosocial assessment to identify needs and
develop a treatment plan. Additionally, ICBHS will follow the SAMHSA/CSAT TIP 27 (Treatment
Improvement Protocol) Comprehensive Case Management for Substance Abuse Treatment to
establish Case Management Services Criteria based on the assessment, needs and location on the
continuum of care and assign case management services as appropriate.
ICBHS will be responsible for coordination and monitoring of case management services for SUD
clients including the coordination of a system of case management services with physical and/or
mental health in order to ensure appropriate level of care.
Case management services are defined as a service that assist a beneficiary to access needed
medical, educational, social, prevocational, vocational, rehabilitative, or other community
services. These services focus on coordination of SUD care and integration around primary care
especially for beneficiaries with a chronic SUD, and interaction with the criminal justice system, if
needed. Case management services may be provided face-to-face, by telephone and may be
provided anywhere in the community.
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Case management services may include:
a. Comprehensive assessment and periodic reassessment of individual needs to determine the
need for continuation of case management services.
b. Transition to a higher or lower level SUD of care
c. Development and periodic revision of a treatment plan that includes service activities.
d. Monitoring service delivery to ensure beneficiary access to service and the service delivery
system.
e. Monitoring the beneficiary’s progress.
f. Patient advocacy, linkages to physical and mental health care, transportation and retention in
primary care services.
g. Case management shall be consistent with and shall not violate confidentiality of alcohol or
drug patients as set forth in 42 CFR Part 2 and California law at DMC provider sites, and county
locations. Case management will be provided by DMC provider staff consisting of certified
SACs and LPHAs
J. Physician Consultation
The ICBHS Medical Director will be available for consultation with all DMC providers that are seeking expert advice on designing treatment plans for specific DMC ODS beneficiaries. These consultation services are to support DMC providers with complex cases which may address medication selection, dosing, side effects management, adherence, drug-drug interactions, or level of care considerations. Physician consultation services will only be billed and reimbursed to DMC providers.
K. Recovery Residences
Recovery Residences (RR) or sober living homes will be available by contract providers for
beneficiaries who require housing assistance in order to support their health, wellness and
recovery. There is no formal SUD treatment provided at these facilities however residents are
required to actively participate in outside outpatient treatment and/or recovery supports during
their stay. The maximum length of stay is one hundred eighty (180) days. On a case by case basis
a determination will be made whether or not to extend the length of stay. ICBHS is developing
standards for contracted sober living homes and will monitor these standards. Sober living homes
are not reimbursable through Medi-Cal.
Optional Service Levels Pending ASAM Utilization Review
ICBHS will consider whether to offer additional optional services available under the waiver once
baseline data on beneficiary ASAM service need and utilization has been collected and analyzed.
If an unmet need for a service is determined, ICBHS will amend this plan to incorporate the
additional service(s) and will initiate in a process to identify and develop contract providers.
Service levels which ICBHS anticipates for possible expansion include: Withdrawal Management
(ASAM 2-WM, 3.2-WM, 3.7-WM AND 4-WM).
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Service Level Barriers
ICBHS anticipates the following barriers to providing a number of services within the DMC-ODS
continuum of care: start-up costs associated with starting new facilities and programming, facility
location challenges, (including zoning, lease procurement, construction, hiring, training and
retaining of qualified staff), DMC certification delays, geographic location and related beneficiary
transportation barriers. Additionally, barriers exist that prevents the provision of residential
services for adolescents due to the lack of ASAM certified providers.
Coordination with Surrounding Counties
ICBHS is surrounded by San Diego and Riverside Counties who are both opt-in counties. ICBHS will
provide original DMC modalities to any beneficiary in an opt-out county seeking services within
Imperial County, coordinate with neighboring counties to ensure beneficiaries can access services
easily and quickly, and will work together as needed, when a regional approach is required to
deliver a component of the continuum of care (e.g. youth residential treatment).
5. Coordination with Mental Health. How will the county coordinate mental health services for
beneficiaries with co-occurring disorders? Are there minimum initial coordination requirements or
goals that you plan to specify for your providers? How will these be monitored? Please briefly describe
the county structure for delivering SUD and mental health services. When these structures are
separate, how is care coordinated?
ICBHS provides SUD and MH services to residents of Imperial County. Each program is supervised
under a single executive management structure consisting of a director, assistant director, medical
director, a deputy director and managers for youth and young adult services, and for adult services.
SUD staff and programming are integrated into the organization, sharing the same policies and
procedures, administrative support, and often facilities with mental health. The DMC-ODS provides
further opportunity to fully align ICBHS programs and services not only for cases of co-occurring
disorders, but to assure that there is no “wrong door” when an individual makes the decision to seek
treatment and begin their recovery.
Prior to the implementation of the Mental Health Services Act (MHSA), SUD and MH services were
organized in separate departments with little interaction between staff and contract providers. Upon
implementation of MHSA the two departments began collaborating on service delivery to individuals
with co-occurring SUD and MH disorders. This collaboration eventually led to a reorganization that
established ICBHS as a single administrative structure for both SUD and MH services.
During this time period several changes in program systems have created a seamless method of
responding to beneficiaries request for services. This began with the ICBHS Access Unit which now is
responsible for service requests for both SUD and MH treatment requests. SUD assessments screen for
mental illness and provide referral for further assessment and psychiatric evaluation when necessary.
Likewise, MH assessments screen for and diagnose SUD conditions and also provide referrals to the
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MHSA Full Service Partnership services. Care coordination and referral procedures have been created
to maximize response time and inclusion of the beneficiary in treatment planning. Additionally,
collaborative relationships have been established with the Self-Management and Recovery Training
(SMART) Recovery community as well as the National Alliance on Mental Illness (NAMI).
During the DMC-ODS planning process, it has been the intent of ICBHS to avoid the development of a
separate system for service delivery, but rather, to integrate SUD services within structures of ICBHS.
Using this approach, ICBHS can build upon the support structures that already exist, not duplicating
existing systems, and broadening the existing infrastructure to further support residents seeking
treatment for SUD. This includes expanding quality assurance and improvement functions by extending
the oversight of the Quality Management Unit to include DMC-ODS programs and services, as well as
to staff and contract providers. The experience and skill of quality review staff in cooperation with
fiscal, technical, and administrative staff will prove invaluable during performance reviews, audits,
reporting, and evaluations, assuring compliance within DMC-ODS requirements. This approach
provides the support to conduct regular internal reviews and ongoing monitoring to test for
compliance and help to achieve performance standards and benchmarks. Additionally, this creates
opportunities for more holistic quality improvement measures that incorporate both SUD and MH
practices, which will have greater impact on client outcomes when conducted within an integrated
service delivery system.
Currently, ICBHS coordinates services between programs for individuals with co-occurring disorders
through coordinated treatment plans and services. Service teams remain in regular communication
with one another since employees belong to the same organization and are often co-located sharing
the same email, calendaring, and telephone systems. All HIPAA and 42 CFR Part 2 requirements are
met.
Coordination with Physical Health. Describe how the county will coordinate physical health services
within the waiver. Are there minimum initial coordination requirements or goals that you plan to
specify for your providers? How will these be monitored?
Physical health services will be coordinated primarily through collecting and monitoring health-related
client specific information about medical history, current medical conditions and treatment. This will
be done through the initial assessment process and updated during follow up visits as needed. A
medical history is obtained at the first appointment via the medical information sheet which is
reviewed and discussed with the client including the date of the last physical exam.
The medical director will review the medical history sheet, medical records and communicate with the
client’s primary care provider regarding treatment, medications or other issues as needed. The medical
director will order lab work for each client to obtain baseline information regarding their current status
as needed. If necessary, a referral is made to local primary care physicians for further testing of Human
Immune-Deficiency Virus (HIV), Hepatitis C and/or other Sexually Transmitted Diseases (STDs).
Drug Medi-Cal Organized Delivery System Implementation Plan Imperial County
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During the course of treatment, any changes in the client’s health will be noted and reported to the
medical director. If clients do not have a primary care provider, treatment staff will encourage the
client to obtain a primary care doctor to attend to and monitor their healthcare needs. Referrals for
medical needs will be made as necessary. Clinicas De Salud del Pueblo is a community outpatient
medical clinic located in the major population areas within the county. A large segment of our
population utilizes these clinics for routine medical care. Referrals will be made reciprocally between
ICBHS and Clinicas de Salud del Pueblo.
Imperial Valley Medical Clinic, a contract provider engages in Narcotic Treatment (methadone)
services. Clients’ health care is monitored by the medical director for IV Medical Clinic. Referrals for
continuing medical care are made to local healthcare resources. McAllister Institute, a contract
provider for a social model residential detoxification and recovery services, requires the completion of
a medical history and screening form. Any medical needs are addressed by taking residents to area
health clinics for services.
Minimum initial coordination requirements or goals for providers will emphasize maintaining up to
date information on the client’s health status. Additionally, providers will be expected to establish
goals for beneficiaries to obtain or maintain a relationship with a primary care provider, provide
education and awareness of health-related conditions, as well as, referrals to health care providers.
This will be identified as a service for beneficiaries in contracts/ MOUs with ICBHS. Additionally, this
will be identified as an area to be monitored by ICBHS contract compliance staff.
Coordination Assistance. The following coordination elements are listed in the STCs. Based on
discussion with your health plan and providers; do you anticipate substantial changes and/or need for
technical assistance with any of the following? If so, please indicate which and briefly explain the
nature of the challenges you are facing.
Comprehensive substance use, physical, and mental health screening
Beneficiary engagement and participation in an integrated care program as needed
Shared development of care plans by the beneficiary, caregivers and all providers
Collaborative treatment planning with managed care
Care coordination and effective communication among providers
Navigation support for patients and caregivers
Facilitation and tracking of referrals between systems
a) Comprehensive substance use, physical, and mental health screening / g) Facilitation and
tracking of referrals between systems
ICBHS currently provides comprehensive substance use and mental health screening by staff at the
various clinical divisions within Imperial County and has established Memorandums of
Understanding (MOUs) with Clinicas De Salud Del Pueblo, Inc. and formerly with Imperial County
Public Health. Provision of services include the coordination of medical clearance examination for
individuals participating in the ICBHS exercise program, tuberculosis testing, HIV testing, and other
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sexually transmitted disease testing. The Memorandums of Understanding (MOU) also address
protocols related to the facilitation and tracking of referrals between systems and the method of
reimbursement. Additionally, ICBHS has MOUs with the two county Medi-Cal managed care health
plans (California Health and Wellness and Molina Healthcare of California) which define
coordination of mental health, and SUD services for Medi-Cal beneficiaries. Providers meet on a
quarterly basis with ICBHS staff to discuss issues or concerns related to the coordination process.
ICBHS will use this coordination infrastructure established in the aforementioned MOUs to build
the DMC-ODS care coordination infrastructure with additional providers.
Prior to the implementation of the DMC-ODS waiver, all ICBHS substance use treatment staff will
receive thorough training on the treatment criteria for Addictive, Substance-Related, and Co-
Occurring Conditions (ASAM Criteria). Once staff are trained, the ASAM criteria will be used in
ensuring comprehensive screening is conducted on each individual presenting with substance use
concerns.
b) Beneficiary engagement and participation in an integrated care program as needed
ICBHS has trained both SUD and MH staff in Motivational Interviewing (MI) and other evidence-
based models which heavily emphasis engagement techniques. These techniques have been used
within the divisions to promote the working alliance with individuals from the start of treatment.
However, since the integration of services will include various outside contract providers, it is
anticipated that training in MI and other engagement strategies among contract providers may be
limited. For this reason, one challenge may be that contract providers may lack the necessary
training in engagement strategies to increase the participation of individuals in an integrated care
program. One way to address this would be to include the contract providers in internal ICBHS
trainings related to engagement strategies.
c) Shared development of care plans by the beneficiary, caregivers and all providers
Currently, ICBHS has integrated SUD and MH treatment to the extent that employees from each
program are co-located, refer to each program, and communicate amongst treatment team
members from each program with the necessary releases of information. This has allowed for
shared communication related to the individuals’ treatment needs and progress, including
participating in treatment team meetings when needed. Additionally, providers from outside of
ICBHS are not consistently involved in the development of care plans for all individuals. This will
require collaboration between ICBHS and various providers while still adhering to HIPAA and 42
CFR.
d) Collaborative treatment planning with managed care
ICBHS is already actively engaged in collaborative treatment planning with the two managed care
plans in Imperial County. The adherence to current MOUs with California Health and Wellness and
Molina Healthcare of California and quarterly meetings have been successful in the collaborative
treatment planning with managed care. This system will continue to be followed and added to in
Drug Medi-Cal Organized Delivery System Implementation Plan Imperial County
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order to enhance the process. However, part of the initial implementation will require educating
the managed care plans on the specific levels of care and referral and assessment protocols for the
DMC-ODS.
e) Care coordination and effective communication among providers
With the established MOUs between ICBHS and Clinicas De Salud Del Pueblo, and the two managed
care plans, a foundation already exists for care coordination and effective communication between
providers. These established protocols will be the foundation for creating a comprehensive
protocol for enhancing care communication and coordination amongst providers. However, one
challenge anticipated with care coordination and effective communication among providers is
ensuring that all providers understand the requirements related to 42 CFR, Part 2. This will also
include the need to update forms, policies, procedures, and protocols to enable the communication
necessary for effective care coordination and communication. This will be particularly challenging
given the fact that records from each ICBHS program (SUD and MH) are currently kept separate
and therefore, not easily accessible by treatment staff from each program. It will be necessary to
ensure that the integration of records (while still adhering to HIPAA and 42 CFR) is prioritized to
allow for easy accessibility of chart reviews by direct treatment staff for the purpose of delivering
an integrated approach to treatment. Some technical assistance may be required in this area.
f) Navigation support for patients and caregivers
With the implementation of targeted case management and recovery services in the DMC-ODS, it is
expected that individuals receiving services and their caregivers will be provided with effective
navigation support with an emphasis on family education. There are currently no anticipated
challenges in this area.
6. Availability of Services. Pursuant to 42 CFR 438.206, the pilot County must ensure availability and
accessibility of adequate number and types of providers of medically necessary services. At minimum,
the County must maintain and monitor a network of providers that is supported by written agreements
for subcontractors and that is sufficient to provide adequate access to all services covered under this
contract. In establishing and monitoring the network, describe how the County will consider the
following:
The anticipated number of Medi-Cal clients.
The expected utilization of services by service type.
The numbers and types of providers required to furnish the contracted Medi-Cal services.
A demonstration of how the current network of providers compares to the expected utilization by
service type.
Hours of operation of providers.
Language capability for the county threshold languages.
Specified access standards and timeliness requirements, including number of days to first face-to-
face visit after initial contact and first DMC-ODS treatment service, timeliness of services for urgent
Drug Medi-Cal Organized Delivery System Implementation Plan Imperial County
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conditions and access afterhours care, and frequency of follow-up appointments in accordance with
individualized treatment plans.
The geographic location of providers and Medi-Cal beneficiaries, considering distance, travel time,
transportation, and access for beneficiaries with disabilities
How will the county address service gaps, including access to MAT services?
As an appendix document, please include a list of network providers indicating, if they provide MAT,
their current patient load, their total DMC-ODS patient capacity, and the populations they treat (i.e.,
adolescent, adult, perinatal).
The anticipated number of Medi-Cal clients
As of July 2015, Imperial County had approximately 75,866 Medi-Cal beneficiaries according to
local health officials. Prevalence estimates vary. Up to 14.2% of the Medicaid population meets
the diagnostic criteria for a substance use disorder according to NSDUH (2008-2010) National
Survey of Drug Use and Health, 2013 American Community Survey), while the California
Department of Health Care Services (DHCS Behavioral Health Needs Assessment, chapter 7, page
178) estimates 10.3% of the population meets criteria for a SUD. Using these prevalence estimates
ICBHS projects between 10,773 and 7,814 Medi-Cal beneficiaries have a SUD and could benefit
from treatment.
SAMHSA data indicate 10.8 percent of those who needed treatment received treatment in a
specialty program. Given this, ICBHS anticipates serving between 1,163 and 844 beneficiaries in
the first year of implementation. The table below presents the actual beneficiary counts with
prevalence and penetration high and low estimates for adults and youth for ICBHS. The
Department of Health Care Services (DHCS) in the 2013 Behavioral Health Needs Assessment
estimated the penetration rate at 7% for Imperial County. This results in a caseload range of 754
to 547 beneficiaries. For planning purposes ICBHS will be using the SAMHSA methodology
because with the implementation of the DMC-ODS there will be a more structured outreach and
engagement processes as well as a full continuum of services that will be more responsive to the
treatment needs of this population than has previously existed. Therefore, ICBHS will use an
estimate high of 1,163 and an estimate low of 844.
Medi-Cal Beneficiary Estimates Based on 2015 Actuals
With Prevalence and Penetration Estimates by Adult and Youth
Pre-2014 Medi-Cal Adult Beneficiaries
Total Prevalence Penetration
14.2% 10.3% 10.8%
High Low High Low
2015 Actual Medi-Cal Beneficiaries 75,866 10,773 7,814 1,163 844 2015 Actual Medi-Cal Adult Beneficiaries 46,528 6,607 4,792 714 517
2015 Actual Medi-Cal Youth Beneficiaries 29,388 4,173 3,027 451 327
Prevalence and Penetration Calculations Projected Over 5 Years
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A c t u a l P r o j e c t i o n
Percent Jun
2014 Oct
2015 FY
15-16 FY
16-17 FY
17-18 FY
18-19
Prevalence Est. Low 10.3% 7,814 7,892 7,971 8,051 8,131 Prevalence Est. High 14.2% 10,773 10,881 10,990 11,100 11,211
SAMHSA w/SUD Dx Receiving Tx
10.8% High 1,163 1,175 1,187 1,199 1,211
Low 844 852 861 870 879
Drug Medi-Cal Organized Delivery System Implementation Plan Imperial County
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a) The expected utilization of services
Imperial County used a number of historical and forecasted approaches in determining service
utilization and projections. The table below details services utilization reported from existing data
collection systems. This information is based on actual treatment admissions for Fiscal Year 2013-
2014 and Fiscal Year 2014-2015.
During Fiscal Year 2013-2014, 93.76% of treatment admissions were for outpatient and non-
residential services. During Fiscal Year 2014-2015, 93.73% of the admissions were for outpatient
and non-residential services. For Fiscal Year 2013-2014, 6.24% of the treatment admissions were
in residential modalities. For Fiscal Year 2014-2015, 6.27% of the treatment admissions were in
residential modalities.
Medi-Cal Beneficiary SUD Treatment Admission by Modality
FY 13-14 FY14-15
Non Residential / Outpatient Treatment / Recovery
Actual % Subtotal
% Grand Total
Actual % Subtotal
% Grand Total
Outpatient Drug Free 648 59.00% 55.38% 735 63.04% 59.08%
Outpatient (Medications) 0 0
NTP Maintenance 292 26.62% 24.96% 344 29.50% 27.65%
Outpatient Detoxification 0 0
Outpatient Detox (non-med) 0 0
Outpatient Detox (med) 0 0
NTP Detox 157 14.31% 13.42% 87 7.46% 7.00%
Subtotal 1,097 93.76% 1,166 93.73%
Residential Inpatient
Detoxification (hospital) 0 0
Detoxification (non-hospital) 0 0
Residential (30 days or less) 73 100.00% 6.24% 78 100.00% 6.27%
Residential (30 days or more) 0 0
Subtotal 73 78
Grand Total 1,170 100% 1,244 100%
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b) The number and types of providers required to furnish the contracted Medi-Cal Services
The table below details the beneficiary high and low penetration estimates to establish the
needed network capacity to meet beneficiary demand. Actual admission percentages multiplied
by the high and low penetration of overall medical beneficiaries demonstrates results in projected
caseloads.
Medi-Cal Beneficiary SUD Treatment Admissions by Modality with Caseload Estimates for Current and Future Years Through FY 2016-17
F Y 1 3 - 1 4 F Y 1 4 - 1 5
Non-Residential Outpatient Actual % ODS Estimated
Actual % ODS Estimated
High Low High Low
Treatment Recovery 1,163.00 844.00 1,163.00 844.00 Outpatient Drug Free 648 55.38% 644.07 467.41 735 59.08% 687.10 498.64
Outpatient (medication) NTP Maintenance 292 24.96% 290.28 210.66 344 27.65% 321.57 233.36 Day Care Habilitative Outpatient Detox Outpatient Detox (non-med) Outpatient Detox (med) NTP Detox 157 13.42% 156.07 113.26 87 7.00% 81.41 59.08
Subtotal 1,097 93.76% 1,090.42 791.33 1,166 93.73% 1,090.08 791.09
Residential inpatient Detox (hospital) Detox (non-hospital) Residential (30 days or less) 73 6.24% 72.57 52.67 78 6.27% 72.92 52.92
Residential (30 days or more) Subtotal 73 72.57 52.67 78 6.27%
Total 1,167 100.00% 1,162.99 844.00 1,244 100.00% 1,163.00 844.00
F Y 1 5 - 1 6 F Y 1 6 - 1 7
Non-Residential Outpatient
Actual
% ODS Estimated Actual
(projected 1%)
% ODS Estimated
High Low High Low
Treatment Recovery 1,163.00 844.00 1,163.00 844.00 Outpatient Drug Free 693 54.23% 630.69 457.70 699.93* 54.22% 630.60 457.60
Outpatient (medication) NTP Maintenance 347* 27.15% 315.75 229.15 350.47* 27.15% 315.80 229.20
Day Care Habilitative Outpatient Detox Outpatient Detox (non-med) Outpatient Detox (med) NTP Detox 159* 12.44% 144.68 105.00 160.60* 12.44% 144.70 104.90
Subtotal 1,199 93.82% 1,091.12 791.85 1,211.00 93.81% 1,091.10 791.76
Residential inpatient Detox (hospital) Detox (non-hospital) Residential (30 days or less) 79* 6.18% 71.87 52.15 79.80* 6.18% 71.90 52.16 Residential (30 days or more)
Subtotal 79 79.80 Total 1,278 100.00% 1,163.00 844.00 1,290.80 100.00% 1,163.00 844.00
Figures marked with (*) indicate 1% growth from previous year. Actual figures are unknown.
Currently, ICBHS has five Substance Abuse Counselors providing DMC services to the adolescent population and one Substance Abuse Counselor providing services to adults and older adults who
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have a dual SUD and mental health diagnosis. To meet the estimated need for the ODS waiver ICBHS will contract with the number of providers necessary to meet estimated need at the time of implementation. ICBHS is in the process of recruiting the following additional providers: Adult SUD Services
Outpatient, Intensive Outpatient, Case Management and Recovery Services:
Eight certified Substance Abuse Counselors
Six Licensed Practitioners of the Healing Arts
Adolescent SUD Services Outpatient, Intensive Outpatient, Case Management and Recovery Services:
Three certified Substance Abuse Counselors
Six Licensed Practitioners of the Healing Arts Adolescent and Adult SUD Services
Medication Assisted Treatment:
One part-time physician
One Licensed Vocational nurse
Opioid (Narcotic) Treatment Program: ICBHS will contract with the local NTP clinic for these services
Residential and Withdrawal Management:
ICBHS will continue to utilize the services that are currently contracted and described in this plan and will develop additional contracts to meet the need of Imperial County Beneficiaries.
c) Language capability for the county threshold languages
Currently, 80% of ICBHS employees are bilingual/bicultural and 64% of ICBHS employees provide
interpretation services. ICBHS employees will be required to abide by the Imperial County
Behavioral Health Services language access policies specifically in providing interpretation and
translation services to all clients. In addition, ICBHS employees providing or requiring
interpretive services will be required to attend mandatory “How to Work With Interpreters”
training to ensure proper use of interpreters in service provision. ICBHS through its Quality
Management Unit will ensure that DMC providers comply with the language access requirements
for its beneficiaries. ICBHS does not currently track the percent of bilingual employees working at
contract facilities, but will begin tracking this as part of the ICBHS annual cultural competency
plan.
d) Hours of Operation of Providers
Provider Hours of Operation
Adult El Centro SUD Clinic Monday-Friday 8:00am to 5:00pm
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Adult Brawley SUD Clinic Monday-Friday 8:00am to 5:00pm
Adult Calexico SUD Clinic Hours to be determined
Adolescent El Centro SUD Clinic Monday-Friday 8:00am to 5:00pm
Adolescent Brawley SUD Clinic Monday-Friday 8:00am to 5:00pm
Adolescent Calexico SUD Clinic Hours to be determined
Imperial Valley M edical Clinic
(Narcotic Treatment Program)
Monday-Friday 8:00am to 5:00pm
McAllister Institute
(Residential Treatment)
24 hours per day/ 7 days per week
f) Timeliness of first face-to-face visit, timeliness of services for urgent conditions and access after-
hours care
T i m e l i n e s s o f C a r e
Type of Care Time Frame
Non Urgent / Routine Appointment offered within seven (7) working days through scheduled appointments and walk-in assessments.
Urgent Conditions Request for services for an urgent condition will be provided within one (1) hour of the request.
Emergency Anyone who is experiencing a medical or Substance Use Disorder emergency will be directed to the nearest hospital for services.
The ICBHS standard is for each beneficiary to be offered a first appointment within seven (7)
working days of initial request for service for non-urgent services. To improve timely access to
services for all beneficiaries, ICBHS will collect baseline data to identify problem areas and
solutions, with the goal of all beneficiaries being offered an appointment within seven (7)
working days of a request for non-urgent services.
Urgent conditions require immediate attention but do not require inpatient hospitalization.
Urgent conditions may be identified during the course of treatment, a scheduled intake
assessment or during a walk in screening/assessment. ICBHS offers walk in assessments that are
available Monday-Friday from 8am to 5pm at each regional clinic site or at the Assessment
Center. Once ICBHS identifies the presence of a beneficiary’s urgent condition, arrangements are
made for an expedited appointment at one of the ICBHS regional clinics for SUD Services.
Beneficiaries will have access to services afterhours through a toll free 800 phone number
twenty-four (24) hours per day, seven (7) days per week. After hours calls are screened and
triaged by an on-call certified substance abuse counselor for risk and appropriate referrals are
made.
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All beneficiaries experiencing a medical or SUD emergency will be directed to the nearest hospital
for services.
f) The geographic location of providers and Medi-Cal beneficiaries, considering distance, travel
time, transportation, and access for beneficiaries with disabilities
ICBHS currently has a total of eleven (11) SUD clinics located in the major population centers of
Imperial County. Adult Services has one outpatient SUD clinic located in El Centro and Adolescent
Services has ten (10) clinics located in El Centro, Calexico and Brawley; nine of which are school-
based clinics located in different high schools. Additional SUD clinics are currently being planned
for development to ensure that services are accessible to underserved and unserved populations;
especially those residing in the outline areas of Imperial County. The development of these clinics
will allow beneficiaries to have access to SUD services closest to their city of residence.
Additionally, public transportation is available which provides transportation from the outlying
cities to nearby bus stops. Public transit is handicapped accessible as well as each of the clinic
sites.
The following table is a list of DMC certified providers or in the process of seeking certification as
an ICBHS DMC provider.
Provider Number Provider Name Service Location
1303 Adolescent Outpatient Drug Free (ODF) Clinic
Outpatient/ Intensive Outpatient
1295 State Street, Suites 104-105 El Centro CA 92243
1309 Adult Outpatient Drug Free (ODF) Recovery Center
Outpatient/ Intensive Outpatient
2695 S. 4th
Street, 2nd
Floor El Centro, CA 92243
1310 Brawley Union High School Outpatient/ Intensive Outpatient
480 N. Imperial Avenue Brawley, CA 92227
1311 Calexico High School Outpatient/ Intensive Outpatient
1030 Encinas Avenue Calexico, CA 92231
1312 Desert Valley High School Outpatient/ Intensive Outpatient
104 Magnolia Street Brawley, CA 92227
1315 Aurora High School Outpatient/ Intensive Outpatient
641 Rockwood Avenue Calexico, A 92231
1318 Central Union High School Outpatient/ Intensive Outpatient
1001 W. Brighton Avenue El Centro, CA 92243
1319 Calexico High School 2 (9th
Grade) Outpatient/ Intensive Outpatient
824 Blair Avenue Calexico, CA 92231
1320 Valley Academy School Outpatient/ Intensive Outpatient
253 E. Ross Avenue El Centro, CA 92243
1321 Del Rio Academy School Outpatient/ Intensive Outpatient
1501 I Street Brawley, CA 92227
1322 Calexico Academy School Outpatient/ Intensive Outpatient
813 Andrade Avenue, Rooms A&B Calexico, CA 92231
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Provider Number
Provider Name Service Location
Pending Adult ODF Brawley, Outpatient Outpatient/ Intensive Outpatient
To be determined
Pending Adult ODF Calexico, Outpatient Outpatient/ Intensive Outpatient
To be determined
Pending Adolescent ODF Brawley, Outpatient Outpatient/ Intensive Outpatient
To be determined
Pending Adolescent ODF Calexico, Outpatient Outpatient/ Intensive Outpatient
To be determined
Imperial County Medi-Cal Certified Providers providing SUD services are shown by geographic
location.
1310 Brawley Union High School
1312 Desert Valley
High School 1321
Del Rio Academy
1303 Adolescent ODF 1309 Adult ODF 1318 Central Union High School 1320 Valley Academy Imperial Valley Medical Clinic (NTP Services)
1311 Calexico High School
1315 Aurora High School
1319 Calexico High School
2 (9th
grade) 1322 Calexico
Academy School
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The table below indicates one way travel time and distance from outlying areas to SUD Clinic sites.
Location Distance Travel Time
Holtville to El Centro 11 Miles 19 minutes Ocotillo to El Centro 28 Miles 29 minutes
Seeley to El Centro 11 Miles 15 minutes Calexico to El Centro 12 Miles 17 minutes
Heber to El Centro 6 Miles 12 minutes
Imperial to El Centro 3 Miles 10-15 minutes
Brawley to El Centro 14 Miles 22 minutes
Calipatria to Brawley 11 Miles 17 minutes
Salton City to Brawley 36 Miles 43 minutes
Niland to Brawley 19 Miles 27 minutes
This table indicates Imperial County Centers of Population Growth from 2010 to 2015
(US Census Data)
City 2010 2015 Difference El Centro 42,592 43,956 3.2%
Calexico 38,573 40,053 3.2%
Brawley 24,953 25,897 3.8%
Imperial 14,752 17,095 15.9%
Calipatria 7,705 7,424 -3.6%
County of Imperial 174,528 180,191 3.2
Imperial County’s methodology for estimating the demand for services and projected number of
beneficiaries is based on a Medi-Cal beneficiary data, prevalence and penetration rates, historical
and actual treatment admissions. Data supports the conclusion that the geographic locations of El
Centro, Brawley and Calexico as high service demand locations that would be the targeted locations
for service delivery in the DMC-ODS implementation in Imperial County. Additionally, these cities
listed above are geographically spread throughout the County (see County Map) and as a group are
adjacent to or within transportation corridors to which will assist with accessibility to DMC-ODS
service sites.
Accessing treatment services for persons with disabilities
ICBHS requires all SUD providers to serve persons with disabilities in compliance with SAPTBG and
DHCS requirements and the following policies and regulations.
Americans with Disabilities Act of 1990
Section 540 of Rehabilitation Act of 1973
45 Code of Federal Regulations (CFR), Part 84, Non-discrimination on the Basis of Handicap in
programs or Activities Receiving Federal Financial Assistance
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Title 24, California Code of Regulations (CCR) Part 2, Activities Receiving Federal Financial
Assistance; and
Unruh Civil Rights Act California Civil Code (CCC) Sections 51 through 51.3 and all applicable laws
related to services and access to services for persons with disabilities.
Regardless of where a person enters the ICBHS system, that person will receive an initial intake
assessment at one of the SUD clinics closest to the individual’s place of residence, which will
determine level of care. ICBHS will make accommodations to serve persons with physical disabilities,
including vision and hearing impairments. In addition, services must be made available to all
individuals with mobility, communication or cognitive impairments as required by federal and state
laws and regulations.
Beneficiaries are advised of their right to receive services and any complaints and grievances are
investigated and appropriate and timely action is taken to ensure access.
e) How will the county address service gaps, including access to MAT services?
ICBHS has one contract provider for adolescent residential services which is limited to 14 day detox
services. Residential services for adolescents requiring more than 14 days of treatment is not
currently available due to the lack of ASAM certified providers. This represents a gap in the continuity
of care. ICBHS will continue efforts to locate a qualified provider and develop provider contracts for
ASAM level 3.1, 3.3 and 3.5 certified facilities for adolescent residential services for up to 30 day
length of stay.
ICBHS will offer medications beyond the NTP requirements to ensure beneficiaries have access to a
full complement of medications to support SUD treatment and recovery. ICBHS will extend the use of
MAT interventions by expanding the use of medications for:
Opiate overdose prevention: naloxone (Narcan).
For opiate use treatment: buprenorphine-naloxone (Suboxone) and naltrexone (oral and extended
release)
For reduction of alcohol craving: naltrexone, both oral (ReVia) and extended release injectable
(Vivitrol), topiramate (Topamax), gabapentin (Neurontin), acamprosate (Campral) and disulfiram
(Antabuse)
ICBHS will integrate the use of MAT into SUD clinics. MAT services will be provided if medically
necessary and in accordance with an individualized treatment plan determined by a licensed
physician. MAT services will be made available to beneficiaries at the outpatient clinic locations
based on clinical need and the beneficiaries consent. There are no service gaps identified in the
delivery of MAT services.
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f) As an appendix document, please include a list of network providers indicating, if they provide
MAT, their current patient load, their total DMC-ODS patient capacity, and the populations they
treat (i.e., adolescent, adult, perinatal).
See Appendix
7. Access to Services. In accordance with 42 CFR 438.206, describe how the County will assure the
following:
Meet and require providers to meet standards for timely access to care and services, taking into
account the urgency of need for services.
Require subcontracted providers to have hours of operation during which services are provided to
Medi-Cal beneficiaries that are no less than the hours of operation during which the provider offers
services to non-Medi-Cal patients.
Make services available to beneficiaries 24 hours a day, 7 days a week, when medically necessary.
Establish mechanisms to ensure that network providers comply with the timely access
requirements.
Monitor network providers regularly to determine compliance with timely access requirements.
Take corrective action if there is a failure to comply with timely access requirements.
a) Meet and require providers to meet standards for timely access to care and services, taking into
account the urgency of need for services. All providers and network providers will be required to
meet the standards for timely access to care and services, taking into account the urgency of need
for services as established by ICBHS. ICBHS will ensure that all beneficiaries have timely access to
the services and levels of care, as appropriate. The behavioral health standards for timeliness of
services will be the same for ODS services and will be analyzed and evaluated as part of the quality
improvement process.
First Face-to-Face Visit. First appointment will be scheduled as soon as possible, within a 7 day
standard for intake appointment after the initial request for outpatient services.
Urgent Conditions. Services for urgent conditions are responded to immediately, within 60
minutes.
Emergencies. Upon identification of emergency conditions, Access Line staff and providers will
contact appropriate emergency medical services for intervention.
b) Require subcontracted providers to have hours of operation during which services are provided
to Medi-Cal beneficiaries that are no less than the hours of operation during which the provider
offers services to non-Medi-Cal patients. ICBHS will include in the provider contract the
requirement to have hours of operation during which services are provided to Medi-Cal
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beneficiaries are no less than the hours of operation during which the provider offers services to
non-Medi-Cal patients. This requirement will be monitored by the ICBHS QM Unit.
c) Make services available to beneficiaries 24 hours a day, 7 days a week, when medically
necessary. All Medi-Cal beneficiaries will be able to access services 24 hours a day, 7 days a week
through the toll-free access line and outpatient clinics during business hours.
d) Establish mechanisms to ensure that network providers comply with the timely access
requirements. The ICBHS QM Unit will establish mechanisms to inform and ensure that network
providers comply with the timely access requirements.
e) Monitor network providers regularly to determine compliance with timely access requirements.
The ICBHS QM Unit will be responsible for tracking and monitoring the timeliness to service data
and ensure access to services is provided within established standards, at least annually.
f) Take corrective action if there is a failure to comply with timely access requirements. When
provides fail to meet and/or comply with timely access standards established by ICBHS, the
following may occur:
The submission of a corrective action plan;
Possible fiscal sanctions; or
Possible termination or adjustment of a contract.
8. Training Provided. What training will be offered to providers chosen to participate in the waiver?
How often will training be provided? Are there training topics that the county wants to provide but
needs assistance?
ICBHS Center for Clinical Training (CCT) has developed a series of training academies for clinicians,
staff providing case management services, nursing staff and other support staff such as mental health
workers and community service workers. All new clinicians are required to attend an eight-week
clinical development academy in which they are trained on a series of clinical topics that include
assessment, diagnosis, treatment planning, evidence-based interventions, laws and regulations,
documentation standards, mental status exam, among other clinical topics. Clinicians then attend an
advanced clinical training on a yearly basis in which they receive follow-up from the first clinical
development training and training on advanced clinical skills.
Staff providing case management services receive a six week academy in which they are trained on
assessment related to their scope of practice, cognitive-behavioral techniques, treatment planning,
documentation standards, laws and regulations, and other policies and procedures related to their job
Drug Medi-Cal Organized Delivery System Implementation Plan Imperial County
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assignment. All certified substance abuse counselors who will be conducting case management
services will be required to attend this academy, specifically to receive training on the aspect of
providing case management services to beneficiaries.
All current clinicians and certified substance abuse counselors are also trained on motivational
interviewing and attended twelve (12) months of consultation with the trainer of the model. New
clinicians and certified substance abuse counselors will be required to attend a motivational
interviewing training and demonstrate skills through their interventions with clients and
documentation. Follow-up trainings will be available to those staff who have received this training.
All clinical staff will also be required to attend training on the different evidence-based models that
will be implemented a part of this pilot program (see section 13 –Evidence-Based Practices); including
the consultation calls as required by each model.
Other training that will be provided with all SUD treatment staff include the following:
ASAM Criteria
SUD Training
Title 22 Regulations
DMC Documentation Standards
Cognitive Behavioral Therapy/Techniques
CLAS Standards
Cultural Competence
Applied Suicide Intervention Skills Training
The ICBHS Staff Development Unit will maintain record of all trainings attended by SUD treatment
staff and will ensure that certifications are maintained up to date. Assigned supervisors will ensure
that staff are scheduled to the required trainings once informed by the Staff Development Unit of
upcoming trainings. Record of trainings attended will be maintained a part of the employee file.
9. Technical Assistance. What technical assistance will the county need from DHCS?
The County anticipates the need for technical assistance from DHCS on the following areas:
Financial and administrative issues related to rate setting, re-evaluating rate structure,
reimbursement structures, claiming mechanisms, documentation requirements, and cost
reporting
Standards associated with cost reporting and audit principals
Any modification to the County’s cost reporting system and process with DHCS
Understanding Certified Public Expenditures
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Understanding how to report and obtain reimbursement for cross county DMC clients
ASAM training, resources, and tools. A train the trainer model would be preferred to build
internal system capacity and meet ongoing training needs to accommodate new staff and
providers, to ensure inter-rater reliability for placement decisions, and for utilization
management
42CFR/Confidentiality in the context of moving towards an integrated system of care
Use of brief (15-20 minute) ASAM screening tools in a call center/triage setting
Defining, and applying DMC services that are not yet part of the DMC array of benefits, such as
recovery services, case management and physician consultation
Provide a current list of all California Licensed and DMC certified youth residential facilities by
ASAM Level
Assist ICBHS in care coordination with acute services, including:
▫ A list of facilities licensed in California to provide Level 3.7 and 4.0 residential and withdrawal
management services
▫ Facilities that accept full scope Medi-Cal and which Medical aid codes are billable by facility
based on their DRG and NPI numbers for both 3.7 and 4.0 residential and withdrawal
management services
▫ Facilities which can provide services to youth and which serve adults
DHCS licensing and certifications and reimbursement, cost reporting and billing practices for
expanded waiver services including case management and recovery services
Sample monitoring instruments for residential and methadone providers
10. Quality Assurance. Describe the County’s Quality Management and Quality Improvement programs.
This includes a description of the Quality Improvement (QI) Committee (or integration of DMC-ODS
responsibilities into the existing MHP QI Committee). The monitoring of accessibility of services
outlined in the Quality Improvement Plan will at a minimum include:
Timeliness of first initial contact to face-to-face appointment
Frequency of follow-up appointments in accordance with individualized treatment plans
Timeliness of services of the first dose of NTP services
Access to after-hours care
Responsiveness of the beneficiary access line
Strategies to reduce avoidable hospitalizations
Coordination of physical and mental health services with waiver services at the provider level
Assessment of the beneficiaries’ experiences, including complaints, grievances and appeals
Telephone access line and services in the prevalent non-English languages.
Review Note: Plans must also include how beneficiary complaints data shall be collected, categorized
and assessed for monitoring Grievances and Appeals. At a minimum, plans shall specify:
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How to submit a grievance, appeal, and state fair hearing
The timeframe for resolution of appeals (including expedited appeal)
The content of an appeal resolution
Record Keeping
Continuation of Benefits
Requirements of state fair hearings.
Quality Management Program
The QM Unit oversees the coordination of Quality Improvement program activities. The managed
care behavioral health manager, under the direction of the director, is responsible for the
implementation of QI activities and provision of leadership for the QI Program. The QM Unit is
responsible to the QIC for conducting, monitoring, and evaluation of QI program activities.
Quality Improvement Program The goal of the QI program is to improve access to, and delivery of, mental health and substance use
disorders services while assuring that services are community based, beneficiary directed, age
appropriate, culturally competent, and process and outcome focused. The QI program approach is an
integrative process that links knowledge, structure, and process together in order to assess and
improve quality. This approach is designed to coordinate with performance monitoring activities
throughout the organization including, but not limited to, beneficiary and system outcomes,
utilization management, clinical records review, and monitoring of beneficiary and provider
satisfaction. The QI program will include monitoring activities for timeliness of first initial contact to
face-to-face appointment, frequency of follow-up appointments in accordance with individualized
treatment plans, timeliness of services of the first dose of NTP services, access to after-hours care,
responsiveness of the beneficiary access line, strategies to reduce avoidable hospitalizations,
coordination of physical and mental health services with waiver services at the providers level,
assessment of the beneficiaries’ experience including complaints, grievances and appeals, and
telephone access line and services in the prevalent non-English languages.
Quality Improvement Committee
ICBHS will integrate DMC-ODS responsibilities into the existing Quality Improvement Committee
(QIC). The QIC is an integral component of the ICBHS Quality Improvement Program. The QIC
members are stakeholders in the MHP and includes a licensed mental health professional. Members
serve a one year term, at a minimum. QIC members are appointed by the MHP Director and include
the following stakeholders:
Assistant Director
Deputy Director – Children Services
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Deputy Director – Youth and Young Adult Services-Mental Health and SUD Services
Deputy Director – Adult Services-Mental Health and SUD Services
Behavioral Health Manager – Managed Care
Behavioral Health Manager – Information Systems
Access Unit Program Supervisor
Quality Management Program Supervisor
Payment Authorization Unit Nursing Supervisor
Fee-for-Service Provider
Licensed Mental Health Professional
Ethnic Services Representative
Administrative Analyst – Quality Management
Beneficiaries
Family members
Patients’ Rights Advocate
The current group of QIC members will be expanded to include additional SUD stakeholders.
The QIC meets monthly to: recommend policy decisions; review and evaluate the results of QI
activities; institute needed QI actions; and ensure follow-up of QI processes. The QIC will receive
and analyze DMC-ODS performance reports and monitor compliance to the data requirements of
the DMC-ODS Standard Term and Conditions (STC’s).
The QM Unit will be responsible for the development of a QI Work Plan that is consistent with
regulations and the DHCS contract. The QM Unit will ensure that required monitoring activities
are outlined in the QI Work Plan and will at a minimum include the following:
a) Timeliness of first initial contact to face-to-face appointment
The MHP established a mechanism to monitor the timeliness of services to ensure
beneficiaries have access to the service delivery system. The QM Unit ensures that
beneficiaries receive an initial routine appointment within the timeless standard as
established by the MHP.
ICBHS will implement the same mechanism for the SUD providers. Quality Management staff
will monitor timeliness to first initial appointment by creating reports based on the following
data elements that will be collected on the ICBHS Access Log:
date/time of initial request
date/time of first offered appointment
date/time of first scheduled appointment
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The goal of first initial face-to-face appointment for all ICBHS SUD providers will be a seven (7)
working day standard.
b) Frequency of follow-up appointments in accordance with individualized treatment plans
The frequency of follow-up appointments will be based on the progress or lack of progress of
the beneficiary. During the course of treatment, if a beneficiary requires more frequent
services, the follow-up appointments will be scheduled according to their needs and in
accordance to the individualized treatment plans.
c) Timeliness of services of the first dose of NTP services
Staff within the NTPs will be required to track the time of first dose of NTP services. The QM
Unit will work closely with NTP providers and develop and implement tracking process for
first dose of NTP services.
d) Access to after-hours care, responsiveness of the beneficiary access line
The QM Unit will be responsible for monitoring access to after-hours care. The request to
access after-hours care will be logged in the ICBHS Access Log. The log will be compared to
the Crisis After- Hours Log to ensure that access was provided as required.
Responsiveness of the beneficiary access line will be monitored by the QM Unit. The QM Unit
will monitor the 24 hour toll-free telephone line by conducting random test calls in English
and the MHP’s threshold language, Spanish. The test calls will be conducted during working
hours, after hours, weekends and holidays to ensure the access line is available.
e) Strategies to reduce avoidable hospitalizations
Beneficiaries will receive on-going assessment using the ASAM criteria throughout the course
of treatment to ensure that the beneficiaries’ SUD needs are met and reduce the risk of
emergencies and hospitalizations. If a beneficiary is assessed to require a higher level of care,
the SUD treatment team will meet to discuss a transition to more intensive treatment within
the continuum of care. Case managers will work directly with the SUD treatment team, other
agencies involved in the beneficiaries’ treatment and contract providers to assist in the
transition between modalities and link them to other needed services and resources. Case
managers will ensure that transitions to other levels of care are effective, timely and
complete, which will improve beneficiaries’ safety and satisfaction.
The SUD treatment team staff will take an important role in helping beneficiaries reach their
optimal level of health, wellbeing and recovery by addressing their MH, SUD, and medical
needs and helping beneficiaries develop skills that enhance life functioning and promote self-
advocacy and self-care.
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In addition, ICBHS offers crisis services for individuals who suffer from co-occurring mental
health and substance use disorders and are experiencing an immediate crisis or are in need of
acute hospitalization. The Crisis and Referral Desk works closely with local hospitals, health
clinics, law enforcement and other community agencies to intervene before or after an acute
crisis, occurs. These services will attempt to resolve the crisis so that the individual does not
have to be admitted into acute care.
Should an individual be hospitalized, ICBHS makes every effort to get involved in discharge
planning and scheduling follow-up MH and/or SUD care. To assist the individual from
requiring further hospitalizations, ICBHS requires that a post-psychiatric home visit be
conducted within three (3) working days of discharge and an outpatient psychiatric
appointment be scheduled within seven (7) calendar days of discharge.
f) Coordination of physical and mental health services with waiver services at the providers
level
The QM staff will monitor the coordination of physical and MH services with waiver services
at the provider level. QM staff will conduct chart audits of SUD treatment providers in an
effort to identify need for coordination of services. Documentation will be reviewed for
evidence that outreach and coordination occurred. For instances where coordination was
required, and no evidence was found, providers will be required to submit a plan of
correction to ensure compliance in this area.
The MOU with ICBHS and the Medi-Cal managed care plans will be another method to
monitor care coordination. The MOU will include a data sharing agreement to facilitate care
coordination and address PHI privacy and security concerns.
In addition, the QM Unit will monitor complaints and grievances focusing on possible patterns
or trends that indicate beneficiary care coordination needs are not being met.
g) Assessment of the beneficiaries’ experience including complaints, grievances and appeals
ICBHS and contract providers take appropriate action to quickly resolve concerns expressed
by beneficiaries. ICBHS has established beneficiary grievance and appeals processes which
comply with regulatory guidelines for both mental health and SUD operations. Grievance and
Appeal Process Notices are required to be posted at provider waiting areas and postings are
monitored during site visits. Grievance and appeals material is translated into the MHP’s
threshold language, Spanish and available at all service locations.
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At the time of initial appointment, beneficiaries are informed of their right to file a grievance,
appeal, or state fair hearing, through the Beneficiary Protection Process brochure. The
Patients’ Rights Advocate is available to provide assistance in filing the grievance and/or an
appeal and to provide technical assistance to management in an effort to ensure that
beneficiary protection requirements are met. Contract providers are required to comply with
the grievance and appeal process requirements as part of their contract and are monitored
on a regular basis.
A grievance can be initiated orally or in writing, ICBHS will notify the beneficiary in writing of
the grievance decision within sixty (60) calendar days of receipt of the grievance. A Notice of
Action – D (NOA-D) will be mailed or hand delivered to the beneficiary when ICBHS fails to act
within the timeframes for resolution of grievance/ appeal. Information on hearing rights,
appeals, state hearing, expedited state hearing, and how to keep the same services while
waiting for a hearing, is included on the back of the NOA-D.
An appeal can be initiated orally or in writing, ICBHS has forty-five (45) calendar days after the
receipt of the standard appeal to notify the beneficiary of the decision. Information on
hearing rights, state hearing, expedited state hearing and how to keep the same services
while waiting for a hearing, is included on the back of the appeal form.
To continue with benefits, a hearing must be requested within ten (10) calendar days from
the date the decision notice was mailed or personally given to the beneficiary or before the
effective date of the change in services, whichever is later.
An expedited appeal can be requested orally or in writing, when the MHP determines, or the
beneficiary and/or the beneficiary’s provider certifies, that taking the time for a standard
appeal resolution could seriously jeopardize the beneficiary’s life, health or ability to attain,
maintain, or regain maximum function. ICBHS has three (3) working days after the receipt of
the expedited appeal to notify the beneficiary of the decision. Information on hearing rights,
state hearing, expedited state hearing, and how to keep the same services while waiting for a
hearing, is included on the back of the expedited appeal form.
Timeframes may be extended up to fourteen (14) calendar days if an extension is requested
by the beneficiary, or if ICBHS feels there is a need for additional information and the delay is
in the best interest of the beneficiary.
Beneficiaries must exhaust the appeal process, prior to having the right to file a state hearing.
The request for a state hearing must be submitted within ninety (90) calendar days after the
decision notice was given personally to the beneficiary or the postmark date that the decision
notice was received.
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To continue with benefits, a hearing must be requested within ten (10) calendar days from
the date that the decision notice was mailed or personally given to the beneficiary or before
the effective date of the change in services, whichever is later.
There are established record keeping procedures where beneficiary complaints data is
collected, categorized and assessed for monitoring of grievances and appeals.
h) Telephone access line and services in the prevalent non-English languages
The telephone access line is handled by bilingual staff (English/Spanish) and Language Line
Solutions is used for interpretation in other languages, as needed. Individuals who are speech
and/or hearing impaired can access services through California Relay Services.
Interpreter services will be offered to individuals who have limited English proficiency at all
programs and clinic sites. Individuals who request services in the County’s threshold
language, Spanish will have access to proficient interpreters free of cost. Individuals who do
not meet the threshold language will be linked to appropriate services through Language Line
Solutions. In addition, individuals with speech and/or hearing impairments can receive
interpretative services through American Sign Language services.
ICBHS prohibits the expectation that family members provide interpreter services. However,
an individual can chose to use a family member or friend as an interpreter after being
informed of the availability of free interpreter services. Minor children should not be used as
interpreters. If under rare circumstances a family member and/or child is used as an
interpreter, (e.g., monolingual parent will not communicate using ICBHS interpreter) ICBHS
will ensure that the reason/justification is well documented in the beneficiary’s clinical
record. SUD providers are required and will be monitored to ensure services are conducted
in accordance with the National Standards for Culturally and Linguistically Appropriate
Services Standards (CLAS).
11. Evidence-based Practices. How will the counties ensure that providers are implementing at least two
of the identified evidence-based practices? What action will the county take if the provider is found to
be in non-compliance?
ICBHS will ensure that providers implement at least two (2) of the identified evidence-based practices
by providing staff with ongoing and follow-up training on the treatment models implemented as part
of this pilot. ICBHS is strongly driven by the use of evidence-based practices and ensures that all staff
providing services to beneficiaries are appropriately trained on specific treatment models. Clinical
and program supervisors monitor compliance with the implementation of these models by conducting
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regular chart reviews to ensure documentation reflects the use of evidence-based interventions as
well as fidelity of the model being implemented. In addition, the program supervisor conducts
monthly observations of group counseling sessions for the purpose of evaluating compliance by the
provider. ICBHS assigns a model “champion” for every evidence-based model for the purpose of
ensuring fidelity. The role of the champion is to track the clients referred to the specific evidence-
based model, attendance of providers to required consultation calls, completion of required outcome
measurement tools, proper use of model sessions, and addresses any issues to the staff’s assigned
clinical and/or program supervisor that may come up during the course of the model implementation.
ICBHS will also ensure that for MHP providers, proper monitoring of these models is in place in the
form of regular chart reviews by the program supervisor and through the Quality Improvement
Review Committees (QIRC). The QIRC meets on a weekly basis and selects charts randomly for a
thorough review. Based on this review, the provider is given feedback and a set of directives to follow
if any areas of concern are found in the review. If a provider is found to be non-compliant, ICBHS will
develop a plan of correction which will be monitored by each program supervisor and management
staff. Repeated failure to comply will result in further disciplinary action, up to termination.
Quality Management staff will also monitor that contract providers meet standards of care set by
DHCS by monitoring these practices through chart reviews. If a contract provider is found to be non-
compliant with meeting minimum evidence-based practices requirements, a Corrective Action Plan
(CAP) will be developed with set directives and timeframes to meet requirements. Continuous failure
to comply may result in termination of contract.
ICBHS has already implemented a series of evidence-based models within its mental health and SUD
clinics. The following models currently being implemented at ICBHS will also be considered as part of
the implementation of this pilot program:
Cognitive Behavioral Therapy
Motivational Interviewing
Functional Family Therapy
Moral Reconation Therapy
Seeking Safety
ICBHS will continue to research on other evidence-based models that are specific for the treatment
of SUD for the purpose of implementing them as part of the ODS pilot.
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12. Regional Model. If the county is implementing a regional model, describe the components of the
model. Include service modalities, participating counties, and identify any barriers and solutions for
beneficiaries. How will the county ensure access to services in a regional model (refer to question 7)?
ICBHS will not be implementing a regional model at this time.
13. Memorandum of Understanding. Submit a signed copy of each Memorandum of Understanding
(MOU) between the county and the managed care plans. The MOU must outline the mechanism for
sharing information and coordination of service delivery as described in Section 152 “Care
Coordination” of the STCs. If upon submission of an implementation plan, the managed care plan(s)
has not signed the MOU(s), the county may explain to the State the efforts undertaken to have the
MOU(s) signed and the expected timeline for receipt of the signed MOU(s).
Review Note: The following elements in the MOU should be implemented at the point of care to
ensure clinical integration between DMC-ODS and managed care providers:
Comprehensive substance use, physical, and mental health screening, including ASAM Level 0.5
SBIRT services;
Beneficiary engagement and participation in an integrated care program as needed;
Shared development of care plans by the beneficiary, caregivers and all providers;
Collaborative treatment planning with managed care;
Delineation of case management responsibilities;
A process for resolving disputes between the county and the Medi-Cal managed care plan that
includes a means for beneficiaries to receive medically necessary services while the dispute is being
resolved;
Availability of clinical consultation, including consultation on medications;
Care coordination and effective communication among providers including procedures for
exchanges of medical information;
Navigation support for patients and caregivers; and
Facilitation and tracking of referrals.
The MOU’s between the managed care health plans and ICBHS have been in place since 2014;
however, MOU’s will need to be amended to meet the requirements of the DMC-ODS Waiver.
Some of the requirements listed above are referenced within the current MOU. However, ICBHS will
work with both managed care plans in the coming months to draft the needed ODS Waiver language.
ICBHS anticipates executing the amendments by the time this Implementation Plan is approved.
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14. Telehealth Services. If a county chooses to utilize telehealth services, how will telehealth services be
structured for providers and how will the county ensure confidentiality? (Please note: group
counseling services cannot be conducted through telehealth).
ICBHS will not be utilizing telehealth services at this time. If the need to implement this service in the
future is identified, ICBHS will work on structuring a system for providers that follows all
confidentiality requirements.
15. Contracting. Describe the county’s selective provider contracting process. What length of time is the
contract term? Describe the local appeal process for providers that do not receive a contract. If
current DMC providers do not receive a DMC-ODS contract, how will the county ensure beneficiaries
will continue receiving treatment services?
Currently ICBHS provides most of the SUD treatment services through its own providers and an out-
of-county contracted residential treatment facility. The residential treatment facility contract
language will need to be amended to include all DMC ODS provisions and requirements upon waiver
implementation.
Implementation of the DMC ODS Waiver will require ICBHS to contract for NTP and additional
residential treatment facilities. ICBHS will contact the only NTP in Imperial County and it is anticipated
that it will be awarded a contract for DMC ODS services. For residential treatment facilities, ICBHS will
procure residential facilities that have appropriate ASAM designation from DHCS.
When selecting providers, ICBHS will not discriminate against providers that serve high-risk
populations or specialize in conditions that require costly treatment and will not prohibit or otherwise
restrict a licensed waivered or registered professional from acting within the lawful scope of practice,
from advising or advocating on behalf of a beneficiary for whom the provider is providing SUD
services.
Provider Selection Criteria When selecting providers with which to contract, ICBHS requires the following criteria:
Possess the necessary license or certification for each individual practicing as part of a group
Ability to maintain a safe facility that is certified by DHCS
Employ a Medical Director enrolled with DHCS
Ability to store and dispense medications in compliance with all pertinent state and federal laws
and regulations, if applicable
Provides culturally competent services
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Implements two evidence-based practices
Ability to maintain beneficiary records in a manner that meets state and federal standards
Ability to address and meet the quality management, authorization, administrative, and clinical
standards of ICBHS.
Meet additional requirements established by ICBHS as part of the credentialing or other
evaluation process.
Contract Term
All DMC ODS contracts will have a term of one year and expire annually on June 30th. The contract will
be renegotiated in the final quarter of the fiscal year to adjust contract terms to ICBHS budget
allocations, operating costs, and changing need for SUD services.
Appeal Process
In case of a denial, the provider will receive written explanation outlining the reasons for the denial of
contract for DMC ODS services. Any provider who is not selected may appeal ICBHS provider selection
processes within five (5) working days of notification. Appeals must be addressed to the director of
Behavioral Health Services or designee, in writing and shall be limited to the following grounds:
Failure of ICBHS to follow the selection procedures and adhere to requirements specified in the
Provider Handbook.
A violation of conflict of interest as provided by California Government Code Section 87100 et seq.
A violation of state or federal law.
Notification of a final decision on the appeal by the director of Behavioral Health Services or designee
shall be made in writing to the provider within ten (10) working days. The decision of the director of
Behavioral Health Services shall be final and not subject to further review.
Continuation of Services
Should ICBHS terminate or deny renewal of a current provider’s contract for DMC ODS services, ICBHS
will notify the provider at least thirty (30) calendar days prior to the termination of their contract with
the exception of a violation of the Trafficking Victims Protection Act where ICBHS may terminate the
contract immediately. In accordance with the contract language, the provider will make immediate
and appropriate plans to transfer or refer all beneficiaries serviced under the contract to other
agencies for continuing services in accordance to beneficiary’s needs. The ODS manager must
approve all plans for the transfer or referral of beneficiaries before the provider may begin the
transfer or referral process unless such transfer or referrals are previously outlined in the provider’s
contract.
Additional Medication Assisted Treatment (MAT). If the county chooses to implement additional
MAT beyond the requirement for NTP services, describe the MAT and delivery system.
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MAT is the clinically driven use of medications, in combination with counseling and behavioral
therapies, to provide a whole-person approach to the treatment of substance use disorders (SUD).
MAT is provided as part of the ASAM Continuum of Care (OTP Level 1).
ICBHS will offer medications beyond the NTP requirements to ensure beneficiaries have access to a full
complement of medications to support SUD treatment and recovery. ICBHS will extend the use of MAT
interventions by expanding the use of medications for:
Opiate overdose prevention: naloxone (Narcan)
For opiate use treatment: buprenorphine-naloxone (Suboxone) and naltrexone (oral and extended release)
For reduction of alcohol craving: naltrexone, both oral (ReVia) and extended release injectable (Vivitrol), topiramate (Topamax), gabapentin (Neurontin), acamprosate (Campral) and disulfiram (Antabuse)
ICBHS will integrate the use of MAT into SUD and behavioral health clinics. MAT services will be
provided if medically necessary and in accordance with an individualized treatment plan determined by
a licensed physician. MAT services include the ordering, prescribing, administering, and monitoring of
medications for SUD. A set of guidelines will be developed for both SUD and behavioral health care
providers to follow which is described below.
MAT will be made available upon the identification of a beneficiary with an opiate or alcohol addiction.
Identification of an opiate or alcohol addiction will primarily be identified during the initial intake and
diagnosis which occurs at each regional clinic. MAT may be discussed and offered to the beneficiary at
this time. A beneficiary who has previously declined MAT and has been receiving other SUD services
may later decide to receive MAT services.
For those beneficiaries who have been initially diagnosed with an opiate addiction or alcohol addiction,
or already receiving SUD services, the SUD counselor may briefly discuss MAT services as a means to
address symptoms and impairments caused by opiate or alcohol use. This discussion will include an
informational brochure and notifying the beneficiary that a consultation visit with the physician will be
conducted prior to receiving the service. If the beneficiary may prefer SUD services through a NTP
clinic. A referral will then be made to the NTP treatment provider.
If the beneficiary agrees to MAT services the beneficiary’s request for MAT services will be taken to a
clinical team consisting of SUD certified substance abuse counselors, LPHAs, Licensed Vocational Nurse
and the physician. The team will make a referral to the physician for MAT services if clinically
appropriate. Upon receiving the referral, the team will schedule an appointment for the beneficiary
to meet with the MD for an initial consultation to discuss MAT services, review and complete the MAT
agreement, and medication consents. MAT services can begin immediately or based on a scheduled
appointment. Due to the requirement that the beneficiary must be abstinent from opiates for a twelve
(12) hour period, an expedited referral for MAT services may be required. An expedited referral can be
submitted by a certified substance abuse counselor or LPHA to the team supervisor who will obtain an
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appointment time for the Beneficiary to meet with the physician for the initial consultation. Expedited
referrals are available for beneficiaries who have been identified with an alcohol addiction if
appropriate. Outpatient Drug Free (ODF) counseling will be made available during the course of MAT
services. Upon completion of the initial consultation, MAT agreement and medication consents, the
physician will begin the Medication Assisted Treatment Protocol immediately or during the next
scheduled appointment. . In addition, a Licensed Vocational Nurse (LVN) will assist the physician if
there is a need to order labs, communicate with pharmacies, and will follow up with the beneficiaries
on a regular basis to ensure that side effects are under control and that they are following the
recommended regimen. The LVN will also work in collaboration with case managers and LPHAs for
treatment planning and for recommendations to a higher or lower level of care. MAT service providers
will coordinate with SUD providers, physical health care and mental health care providers to connect
the beneficiary to needed services. Once stable MAT clinic clients will be transitioned to primary care
physicians, or a psychiatrist for continued medication services as needed.
If the beneficiary declines MAT services, he/she will be offered or continue other SUD Services
consistent with ASAM Criteria.
16. Residential Authorization. Describe the county’s authorization process for residential services. Prior
authorization requests for residential services must be addressed within twenty-four (24) hours.
Referrals for residential treatment may be initiated through different pathways that include referrals
from other agencies such as, Probation, Department of Social Services, education, health care
providers, or ICBHS. Beneficiaries can also request residential treatment by contacting the 24-hour
Access number, contacting one of the SUD treatment facilities, or by walking in to one of the ICBHS
clinics. All new beneficiaries requesting residential treatment will be scheduled for an intake
assessment to determine medical necessity criteria for SUD services and level of care. All prior
authorization requests for residential treatment will be reviewed by the SUD Program Supervisor
within 24 hours of request by the treatment provider. The SUD Program Supervisor will review the
beneficiary’s intake assessment, diagnosis, treatment history and the reasons for referral to determine
approval or denial of request.
New beneficiaries who at the time of intake are assessed to meet the ASAM criteria for residential
treatment, will be assigned a case manager through the ICBHS expedited referral process who, within
twenty-four (24) hours from approval of prior authorization request , will begin placement
coordination with the County contracted residential facility. If, throughout the course of treatment, an
active beneficiary receiving outpatient or NTP treatment is assessed to require a higher level of care,
the SUD treatment team staff will meet to discuss the case for appropriateness and referral to a
residential facility. The SUD treatment team staff will review the beneficiary’s current functioning,
response to treatment, and each ASAM dimension to determine severity and need for a higher level of
care. A case manager will be assigned for coordination and facilitation of timely placement, follow-up
and discharge planning. If it is determined that the beneficiary requires immediate placement to a
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residential facility due to risk and severity of the SUD condition, the SUD treatment team staff will
begin the placement process through an expedited referral.
Beneficiaries, who are waiting bed availability for placement, will receive supportive, more frequent
and intensive SUD care until admission to a residential facility occurs. The assigned case manager will
also maintain the SUD treatment team staff updated on the status of the client on a weekly or more
frequent basis, if needed, to ensure that the immediate needs of the client are met and reduce the risk
of a SUD emergency. Currently, ICBHS has a contract with one out of county residential facility that is
ASAM designated 3.1 and 3.5 as residential treatment is not available within Imperial County. This has
resulted in an average waitlist of about eight individuals at a time. ICBHS is in the process of visiting
additional residential facilities that have the required ASAM designations and that are DMC certified or
in the process of becoming DMC certified for the purpose of developing additional contracts and
ensure there are no waitlists upon implementation.
Authorization and tracking of all residential treatment referrals will be conducted by ICBHS designated
staff at each SUD outpatient clinic. ICBHS will grant a prior authorization for the first seven (7) days of
residential treatment based on the results identified on the ASAM assessment. The residential
treatment provider will have the responsibility to submit a request for authorization for up to a
maximum of ninety (90) days in on continuous period for those adult clients who have been assessed
and admitted into a residential facility. One extension of up to thirty (30) days beyond the maximum
length of ninety (90) days may be authorized for one continuous length of stay in a one year period.
The residential treatment provider will also have the responsibility to submit a request for
authorization for up to a maximum of thirty (30) days in one continuous period for adolescent clients
who have been assessed and admitted to a residential facility. Reimbursement will be limited to two
non-continuous thirty (30) day regimens in any one year period. One extension of up to thirty (30) days
beyond the maximum length of stay may be authorized for one continuous length of stay in a one year
period.
17. One Year Provisional Period. For counties unable to meet all the mandatory requirements upon
implementation, describe the strategy for coming into full compliance with the required provisions in
the DMC-ODS. Include in the description the phase-in plan by service or DMC- ODS requirement that
the county cannot begin upon implementation of their Pilot. Also include a timeline with deliverables.
Review Note: This question only applies to counties participating in the one-year provisional program
and only needs to be completed by these counties.
Not applicable.
County Authorization
The County Behavioral Health Director (for Imperial County Behavioral Health Services) must review
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and approve the Implementation Plan. The signature below verifies this approval.
Imperial
Imperial County Behavioral Health Services Director County Date
Appendix
Section 8 h )
Agency / Services
Imperial County
Behavioral
Health,
SUD Services
Imperial
Valley
Medical
Clinic
McAllister
Institute
MAT Provided Yes Yes No
Current patient load 693 159 79
Total DMC-ODS patient capacity 1503* 159 79
Populations treated Adults and
Adolescents Adults
Adults and
Adolescents
Additional Staffing Plan for DMC-ODS Expansion of Services:
Mental Health Counselor (MHC)
No. of MHC No. of Cases
per MHC
No. of Cases
per Year
Total No. of Cases
per Year (each MHC)
3 MHC 30 Cases 90 cases 270 cases
Psychiatric Social Worker (PSW)
No. of PSW No. of Cases
per PSW
No. of Cases
per Year
Total No. of Cases
per Year (each PSW)
3 PSW 30 Cases 90 cases 270 cases
Certified Substance Abuse Counselors (CSAC)
No. of CSAC No. of Cases
per CSAC
No. of Cases
per Year
Total No. of Cases
per Year (each CSAC)
3 CSAC 30 cases 90 cases 270 cases
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