SUD - Drug Medi-Cal - QA
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Documentation of Medical Necessity for Substance Use Disorder Services
Medical Necessity Memo introduces Drug Medi-Cal (DMC) SUD Providers to the Medical Necessity Form developed by QA-BHCS as a way to meet Title 22 DMC requirements for establishing Medical Necessity. Establishing Medical Necessity for DMC clients requires either: Establishing Medical Necessity for Drug Medi-Cal clients requires either:
AMENDED TITLE 22 REGULATIONS JULY 14, 2015: Title 22 California Code of Regulations DMC Regulations amended and endorsed by the State of California as of July 14, 2015. The updated and revised regulations focus on Program Integrity and are intended to ensure firm adherence to regulations in the provision of quality services for your clients. It is important to schedule time to review the regulations with your staff and discuss the importance of adherence to the regulations. Because regulations are not at the top of the reading list for most people, edited version, which includes distinguished section breaks and headers to assist with locating specific sections, i.e., medical necessity, treatment planning, progress notes, is available in addition to the version signed by the State. DMC ANSWERS is a DHCS resource for your questions on Title 22 requirements. All questions to DMC Answers must be submitted using the DMC Answers Request Form. ALCOHOL AND DRUG COUNSELOR: There are three approved organizationsthat DHCS recognizes as accredited organizations to register and certify alcohol and other drug counselors in California. For more information regarding the educational requirements for becoming an alcohol and other drug counselor in California, please contact any of the certifying organizations and/or refer to the Final Regulations of AOD Counselor Certification. DMC-ODS 1115 Waiver Special Terms and Conditions: California's DMC-ODS 1115 Waiver provides a continuum of care modeled after the American Society of Addiction Medicine (ASAM) Criteria for substance use disorder treatment services. The waiver amendment will make improvements to the DMS service delivery system, more local control and accountability in selection of high quality providers, improved local coordination of case management services, implementation Evidence-Based Practices (EBP) in substance abuse treatment, and coordination with other systems of care including physical health. For detail information, please refer to the Special Terms and Conditions (STCs) for DMC-ODS California Bridge to Health Reform System Waiver. Alameda County DMC-ODS Implementation Plan: DMC-ODS 1115 Waiver The first step for a county to obtain approval for opting into the DMC-ODS 1115 Waiver was to submit a proposed DMC-ODS Implementation Plan, using the template of questions provided by the California Department of Health Care Services (DHCS). Alameda County submitted its proposed Implementation Plan on July 29th, 2016, and the plan has been approved by DHCS. Implementation of EBP for the SUD BHCS provider network is outlined and described in the approved DMC-ODS Implementation Plan. Section 10 of the DMC-ODS Plan “Training Provided” lists training activities which include the following EBP: Motivational Interviewing, Screening, Brief Intervention and Referral to Treatment (SBIRT), Cognitive Behavioral Therapy, Motivation Enhancement Therapy (relapse prevention), Seeking Safety, and ASAM Criteria. DHCS ASAM Level of Care Designation QuestionnaireAs a part of the recently approved DMC-ODS, SUD residential providers must identify their capability to provide designated ASAM Level of Care services by answering DHCS ASAM Residential Level of Care Designation Questionnaire (DHCS 4021). After completing the questionnaire, mail or fax to the DHCS SUD Compliance Division and send a copy to Sharon Loveseth or fax to 510-639-1346.DHCS SUD Compliance Division P.O. Box Number 997413 MS 2603 Sacramento, CA 95899-7413 Fax: (916) 322-7388 The Golden ThreadCollaborative Documentation also referred to as Concurrent Documentation is a process in which clinicians/counselors collaborate in the documentation of the Assessment, Service Planning, and ongoing Client-practitioner Interactions (progress notes). The Golden Thread is key to develop meaningful “clinical narrative” that supports the client and services through:
Sample FormsThe Sample Forms are intended to assist SUD Providers in meeting required state and federal standards of care and to give guidance for clinical documentation. The Forms provide a template to edit and personalize each form for their needs. | ||
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