New Medi-Cal Behavioral Health Benefits

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1 New Medi-Cal Behavioral Health Benefits

2 Brief History /1/2014 ACA Medi-Cal Expansion & LIHP Transition 1

3 Eligible Populations Traditional Medi-Cal Age 65 or older Under age 21 An adult, between 21 and 65, with a minor child living with him/her (a child is defined as unmarried and under 21) Blind or disabled Pregnant Certain refugees or Cuban/Haitian immigrants Receiving care in a nursing home Medi-Cal Expansion Covers people up to 138% of the federal poverty level (about $15,800 for an individual) Increased care coverage among nonelderly adults by: Extending Medi-Cal eligibility to childless adults Increasing Medi-Cal eligibility for parents who currently lose access when their incomes slightly exceed the poverty level 2

4 ACA s Essential Benefits CC The ACA ensures that all Medi-Cal health plans offer a comprehensive package of services, known as essential health benefits. Essential health benefits must include: 1. Ambulatory patient services 2. Emergency services 3. Hospitalization 4. Maternity and newborn care 5. Mental Health and Substance Use Disorder Services, including Behavioral Health Treatment 6. Prescription Drugs 7. Rehabilitative and Habilitative Services and devices 8. Laboratory services 9. Preventive and wellness services & chronic disease management 10.Pediatric services (including oral and vision care) 3

5 New Medi-Cal Behavioral Health Benefits CC Starting January 2014, the following mental health benefits will be available through Medi-Cal managed care plans or the fee-for-service delivery system: Individual and group mental health evaluation and treatment (psychotherapy) Psychological testing when clinically indicated to evaluate a mental health condition Outpatient services for the purposes of monitoring drug therapy Outpatient laboratory, drugs, supplies and supplements Psychiatric consultation * Duration, amount and scope still under development 4

6 Mental Health and Substance Use Disorder Services Medi-Cal Managed Care Plans (MCP) OC Mental Health Plan (MHP) County Alcohol and Other Drug Programs (AOD) MCP services beginning 1/1/14 Individual/group mental health evaluation and treatment (psychotherapy) Psychological testing when clinically indicated to evaluate a mental health condition Psychiatric consultation for medication management Outpatient laboratory, supplies and supplements Drugs, excluding anti-psychotic drugs (which are covered by Medi-Cal FFS) Screening and Brief Intervention (SBI) Outpatient Services Mental Health Services (assessments plan development, therapy, rehabilitation and collateral) Medication Support Day Treatment Services and Day Rehabilitation Crises Intervention and Crises Stabilization Targeted Case Management Therapeutic Behavior Services Residential Services Adult Residential Treatment Services Crises Residential Treatment Services Inpatient Services Acute Psychiatric Inpatient Hospital Services Psychiatric Inpatient Hospital Professional Services Psychiatric Health Facility services Outpatient Services Outpatient Drug Free Intensive Outpatient (newly expanded to additional populations) Residential Services (newly expanded to additional populations) Narcotic Treatment Program Naltrexone New Services Inpatient Detoxification Services Administrative linkage to County AOD still being discussed 5

7 Levels of Care: Behavioral Health Specialty Mental Health Services: OC Health Care Agency Severe/Acute Specialty Mental Health Services: OC Mental Health Plan (Beacon) Moderate/Severe Non-Specialty Mental Health Services: Managed Care Plan/CalOptima (Beacon) Mild/Moderate Non-Specialty Mental Health Services: Managed Care Plan/CalOptima (Primary Care Provider) Mild 6

8 Medi-Cal After January 1, 2014 CC Call Primary Care Provider (PCP) for DX and TX. If patient responds to TX, stays with PCP If DX and TX is out of PCP scope, call Managed Care Plan/CalOptima/ Beacon Meets Medical Necessity for Specialty Mental Health Services Mental Health Toll-Free Number 24/7 Assessed for level of care If yes: Services through OC Health Care Agency or OC Mental Health Plan Severe/Acute If no: NEW BENEFIT Managed Care Plan/ CalOptima/ Beacon provides services If no: Referred back to PCP and given community resources Mild Patient must: Have a DX Condition not responsive TX by PCP Have impairment in important area of life functioning or probability of significant deterioration due to MH 7

9 Access Line CC Members Community Resources Network Providers County Programs Primary Care Physicians Call: For screening/assessment and referral to services as appropriate 8

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