This is the first article in a series dealing with major changes in the California health care market, and focuses on changes in California’s behavioral health delivery systems. Upcoming articles in the series will address other initiatives in California, including new tools for providing fully personalized care and addressing the social determinants of healthAnd the and new efforts to contain health care costs.
The State of California announced major new initiatives that will significantly transform the California healthcare marketplace and legal landscape for patients, payers, providers, and other stakeholders. This article discusses some of the new expanded behavioral health initiatives available to Californians, which include new options for receiving both mental health services and substance use disorder treatment.
The state’s focus on behavioral health has multiple goals. Like other states and health care payers, California aims to slow growth in the cost of health care and has committed to timely and effective provision of behavioral health services as part of its strategy to reduce long-term health care expenses. California has also identified a significant increase in the need for behavioral health services as a result of the COVID-19 pandemic. Expansion of behavioral health services is also an important component of the state’s response to the homelessness crisis.
New mandatory coverage for school behavioral health services
Through a new Children and Youth Behavioral Health Initiative (CYBHI), California aims to strengthen and redesign behavioral services for children and youth. A central component of the initiative is the expansion of accessible behavioral health services through schools, which may impact existing provider networks and delivery systems.
California law, AB 133 (2021), directs the State Department of Health Care Services (DHCS) to establish a new statewide minimum fee schedule for “school-related” outpatient mental health services or substance use disorder treatment services for students who are 25 years of age or older. less. DHCS intends to use the statewide minimum fee schedule to create a sustainable funding source for school-related behavioral health services, regardless of motivation.
Under AB 133, every health plan regulated by the State of California (including Medicaid plans, Knox-Keene plans, and disability insurance policies) will be required to reimburse school-related behavioral health providers at least the minimum fee amount, regardless of whether the provider He has a contract with the plan. DHCS is directed to “develop and maintain” the network of qualified providers for these school-centered services, but reimbursement will come from payers based on their coverage terms.
New opportunities for virtual behavioral health care for children and young people
Also as part of CYBHI, and possibly in connection with the school-based services described above, DHCS will bring together stakeholders to develop and select evidence-based and “practice-promising” interventions for improving outcomes for children and youth with or at high behavioral risk. health conditions, and will provide grants and incentive payments to stimulate investment in these areas.
The NHS will also purchase a vendor to establish and maintain behavioral health services and support the virtual platform. Once deployed, this virtual platform will expand access to available tele-behavioral health services to millions of California children and youth 25 or younger, regardless of motivation.
Implementation of the new CARE Courts
Under a controversial new law, SB 1338, seven California counties (San Francisco, San Diego, Orange, Riverside, Stanislaus, Tuolumne, and Glenn) will be required to create new Community Assistance, Recovery, and Empowerment (CARE) courts specifically to address people’s needs. Those with severe, untreated mental illness by October 1, 2023. The remaining 51 California counties will follow by December 1, 2024. Once incorporated, individuals (including family, friends, hospital administrators, first responders, and behavioral health professionals) petition the CARE Courts on behalf of For an individual to prove eligibility for support. To qualify, an individual must have a severe mental illness, may not be clinically stable or in voluntary treatment, and must meet other requirements.
CARE courts are empowered to order an individual’s clinical evaluation and establish a CARE plan that can include medication, treatment, social services, housing resources, and public assistance. SB 1338 provides some additional funding to counties to help administer CARE courts. It also requires California health plans (including Knox-Keene plans and insurance policies) to cover evaluations and healthcare services required or recommended under the CARE plan, regardless of whether they are available in-network or out-of-network or have prior authorization obtained.
Clarification and changes to the segmented Medi-Cal behavioral health delivery system
California operates two separate managed behavioral health delivery systems for Medicaid beneficiaries. Consistent with its historic mission to serve local indigent populations, California Districts operates and contracts with behavioral health providers for individuals with severe mental health disorders and/or substance use disorders. In addition, as a result of recent Medi-Cal expansions, Medi-Cal managed health care plans in California cover “mild to moderate” behavioral health services in addition to primary care services. Individuals may be simultaneously enrolled in both plans.
As part of the broader California Advancing and Innovating Medi-Cal (CalAIM) initiative, the state is required to develop new, standardized screening tools for referrals to county behavioral health systems. In addition, the state has introduced a “No Wrong Door” policy which, effective July 1, 2022, allows providers to bill both counties and Medi-Cal managed health care plans for services provided during the evaluation period or before a diagnosis is determined. These changes provide new flexibility to providers when requesting payment for mental health services, and are intended to help ensure that beneficiaries can maintain treatment relationships with providers so that an appropriate referral can be made.
Finally, the state is redesigning how counties pay for Medi-Cal behavioral health services provided through their networks. Under the behavioral health payment reform, counties will no longer be limited to reimbursement based on costs, and will no longer be required to file onerous cost reports. These changes have the potential to affect how counties negotiate their contracts with network providers for Medi-Cal behavioral health, and counties will be encouraged to emphasize the value-based components of reimbursement.