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Alameda County Proposed Implementation Plan for the Drug Medi-Cal 1115 Waiver: The first step for a county to obtain approval for opting into the Drug Medi-Cal 1115 Waiver is to submit a proposed Implementation Plan, using the template of questions provided by the California Department of Health Care Services. Alameda County submitted its proposed Implementation Plan on July 29th, 2016. To review it, click here. Establishing MEDICAL NECESSITY for SUD Treatment For Drug Medi-Cal (DMC) client’s / beneficiary’s medical necessity for their substance use disorder must be met within the first thirty-(30) days of treatment to meet DMC eligibility. The following information and requirements for evaluation and determination of Medical Necessity criteria is provided below:
Addressing parenting issues is an important component of recovery and central to child development and wellness. Additionally, developing and maintaining healthy relationships increases a woman’s self-esteem, improves mental and emotional health, and helps them have fuller lives, in a healthy relationship, both people respect, trust, and support each other. For more information, click here http://www.dhcs.ca.gov/individuals/Pages/Parenting-Health-Relationship-Resources.aspx to access the DHCS web page on parenting and healthy relationships. Treatment Priority for Pregnant Women BHCS regards pregnant women with substance use conditions as a special population needing priority access when seeking substance use treatment. BHCS provides an array of outpatient, intensive outpatient and residential treatment programs designed especially for pregnant women. BHCS is committed to providing priority access to pregnant women in all of its substance use treatment programs that are co-ed or serve women only, whether a perinatal program or not. Follow the link below for translations.
Many referral sources have requested a guide to our continuum of substance use disorder treatment services. Please click here for the Guide, which provides a listing of each program with contact information, description of services, and description of populations served. The BHCS SUD Team will continue efforts to update the Guide so it stays current and useful. ACBHCS SUD Treatment Referral Guide Recommended Evidence-Based Practices for Treatment of Substance Use Disorders The Evidence-Based Practices (EBP) Web Guide features research findings and details about EBPs used to prevent and treat mental and substance use disorders. EBPs integrate clinical expertise; expert opinion; external scientific evidence; and client, patient, and caregiver perspectives so that providers can offer high-quality services that reflect the interests, values, needs, and choices of the individuals served. For more information, click here: http://www.samhsa.gov/ebp-web-guide/substance-abuse-treatment NAADAC had come out with a NAADAC NCPRSS: Nationally Certified Peer Recovery Support Specialist Credential: http://www.naadac.org/NCPRSS. It is a way to extend the entire continuum of care and to help professionalize the peer/recovery coach movement. Many states have allowed for billing of peers in their Medicaid rules. Important links are listed below.
Sample Forms*Please note, ALL providers (excluding NTP) are responsible for implementing the revised forms and SUD & DMC requirements by February 2, 2017. DMC providers will be held to DMC Title 22 regulations and non-DMC providers will not be required to meet medical necessity regulation, the Initial Medical Necessity Justification for Tx, and On-going Justification for Tx, or have an LPHA/physician signature for treatment plans. A “therapist” is a licensed (or registered Intern) with the Board of Psychology or Board of Behavioral Sciences. If you do not employ such professionals, a Certified SUD Counselor must indicate the program is Not DMC Certified. All other DMC requirements must be met regardless of Payor Source (DMC or other).**Forms with this listing are “highly recommended” but not required. The SAMPLE word forms and *required forms listed below allow providers to edit and personalize each form for their agency needs. The forms are intended to assist SUD Providers in the provision of quality services that also meet required state and federal standards of care. The forms are provided to give guidance for clinical documentation and to provide a template that allows service providers to edit the document, for example: pre-print the counselor, therapist or physician name; pre-print the client name and/or other relevant information. The Department of Health Services (DHCS) form 5103 (06/16) “Client Health Questionnaire and Initial Screening Questions” must be completed within the first 30 days of treatment for each client/beneficiary. The information provided in this health questionnaire supports Medical Necessity criteria. Click here.
ResourcesDepartment of Health Care Services (DHCS) webpage: http://www.dhcs.ca.gov/provgovpart/Pages/SUDS-Compliance.aspxDrug Medi-Cal (DMC) Requirements for Determination of Diagnosis and Medical Necessity Fact Sheet SUD Services Forms DHCS – All kinds of forms for you to peruse such as: telephone interviews, health questionnaires for clients and staff, confidential fax cover page, referral letter, referral completion and more. http://www.dhcs.ca.gov/provgovpart/Pages/SUD-Forms-DONOT%20PUSH%20TO%20PROD.aspx Can’t find what you are looking for? Use the Search on the DHCS webpage and type in key words or references to the form or information you are seeking. If you are still unable to find or locate the information you are looking for, contact Sharon Loveseth, DMC Program Specialist-QA-ACBHCS at: sloveseth@acbhcs.org or call 510-567-8244 for further assistance. | ||
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