Recent changes to Medi-Cal rules may soon dramatically expand Contra Costa County's ability to refer and cover patients who need treatment for substance use disorder (SUD).

The Behavioral Health Division is closely following the state Department of Health Care Services' negotiations to amend the federal 1115 waiver governing the delivery of drug treatment services to Medi-Cal beneficiaries, and it appears change is near.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2009 to 2013.

The proposed Drug Medi-Cal Waiver (DMC) would expand SUD treatment, including residential and medication-assisted treatment, to all Medi-Cal beneficiaries by referral from their medical providers. Medi-Cal has historically provided limited residential treatment coverage exclusively for pregnant or postpartum patients only.

The change would eliminate some current facility eligibility restrictions and beneficiaries will receive services based on a diagnosed medical necessity. DMC requires providers to use American Society of Addiction Medicine (ASAM) criteria as a framework for placing patients into appropriate levels of care.

As many beneficiaries needing treatment now arrive in residential treatment by referral from the criminal justice system, empowering doctors and psychiatrists could profoundly change how these services are delivered.

The twelve Bay Area counties will be among the first to implement DMC, and all are required to use community engagement processes to prepare implementation plans showing how they will create organized systems of care to serve their communities.

Behavioral Health through its Alcohol and Other Drugs (AOD) program has already begun preparing for the waiver, and is in the process of conducting a preliminary gap analysis, recruiting providers and working with Contra Costa Health Plan to ensure that members are effectively served.

Contra Costa's County Implementation Plan (CIP) will also include community-based providers, consumers, criminal justice and medical providers, and other stakeholders. AOD service providers, Behaviorists, medical staff and other key stakeholders & partners have received ASAM Criteria training.

For more information, contact Fatima Matal Sol at Fatima.MatalSol@hsd.cccounty.us. 

The plan update, approved in June by the Contra Costa County Board of Supervisors, sets aside $43.1 million during each of the next two fiscal years to fund more than 80 programs and plan elements, including $6 million for the electronic mental health records project that began this year.

The MHSA, enacted in 2004, provides a philosophical framework for the state's behavioral health system of care and provides substantial funding to county and local agencies to develop programs that are consumer driven, family focused, community based, culturally and linguistically competent, and integrated with other appropriate health and social services.

Contra Costa followed a community planning process involving consumers and families, stakeholders and service providers in 2014 to develop its 3-year MHSA plan, as required by law, and uses a similar process to update the plan annually.

The community planning process will soon begin for the final update to the MHSA 3-year plan. The process is expected to finish in early 2016, so that any budget recommendations coincide with the county's larger budget deliberations for the 2016-17 fiscal year.

Visit cchealth.org/mental health to read the 2015-16 MHSA Plan Update. Contact Warren Hayes at Warren.Hayes@hsd.cccounty.us for more information.

The Contra Costa Board of Supervisors has approved Behavioral Health's plan to implement Laura's Law in Contra Costa County, and a program to serve as many as 75 community residents with serious mental illnesses could begin as soon as November.

The first year of the assisted outpatient treatment program will be funded with $2.25 million in Mental Health Services Act funding and about $400,000 from the General Fund for county counsel, the Public Defender's Office and Contra Costa Superior Court.

"This design is a care-first approach that consists of extensive outreach and engagement efforts to assist referred individuals to participate in services voluntarily," Behavioral Health Director Cynthia Belon told the board at its June 16 meeting.

Laura's Law is a state measure allowing counties to impose court-ordered assisted outpatient treatment for people with records of hospitalizations and violence resulting from serious mental illness.

The plan was hammered out through a series of community and stakeholder meetings led by Behavioral Health.

The division has since issued a request for proposals to bring a community-based provider on board for its Assertive Community Treatment (ACT) team, a mobile, multidisciplinary team that provides 24-7 intervention service for people whose mental health issues cause them serious functioning difficulties.

Contra Costa's program will serve about 37 court-placed consumers and a similar number who participate voluntarily. It will include a care team with family partners and peer support to work with consumers at every step of the process, and emphasis on outreach to encourage voluntary participation.

For more information, contact David Seidner at David.Seidner@hsd.cccounty.us.