Uma K. Zykofsky, LCSW Behavioral Health Director
Department of Health & Human Services Division of Behavioral Health Services
Alcohol & Drug Services
April 24, 2017 Presentation to
Geographic Managed Care Providers
To provide a culturally competent system of care that promotes holistic recovery, optimum health, and resiliency.
We envision a community where persons from diverse backgrounds across the life continuum have opportunity to experience optimum wellness.
Our Mission
Our Vision
Respect, Compassion, Integrity Client and/or Family Driven Service System Equal Access for Diverse Populations Culturally Competent, Adaptive, Responsive and Meaningful Full Community Integration and Collaboration Coordinated Near Home and in Natural Settings Strength-Based Integrated and Evidence-Based Practices Innovative and Outcome-Driven Practices and Systems Wellness, Recovery, and Resilience Focus
Our Values
Service Languages
Culturally competent and linguistically proficient behavioral health services are provided in many languages, including the following threshold languages:
Bi-lingual/bi-cultural staff or interpreters
available at no cost to youth/families Services provided for deaf and hearing
impaired at no cost to youth/families
Cantonese English Hmong
Russian Spanish Vietnamese
Alcohol and Drug Services Continuum of Care
Prevention Services Outpatient Treatment Residential Treatment Medication-Assisted Treatment Detoxification/Withdrawal Management Sober Living Environments Perinatal Services DUI Programs (Driving Under the Influence)
Specialty Courts Drug Diversion Programs
Handout: Alcohol & Drug Services Continuum of Care Fiscal Year 2016-17
Fiscal Year 2015-16 $41,051,121
20 contracted providers
6,514 admissions
Service Brochures
Brochures available on website and in alternate languages at: http://www.dhhs.saccounty.net/BHS/Pages/GI-Provider-Resources-Forms.aspx
Assessment and Referral Access Points
Alcohol & Drug Services System of Care
Entry point for alcohol and drug treatment services
Assessment and Referral to alcohol and drug treatment service provider
Monday – Friday
8:00 A.M. – 5:00 P.M. Last assessment conducted at 4 pm
Drop-In 3321 Power Inn Road, Suite 120
Sacramento 95826
(916) 874-9754
System of Care Sacramento County Jail Probation Department Primary Care Center Guest House Homeless Clinic Juvenile Court Children’s Receiving Home
Recent System Improvements
Increased assessment and referral access points Additional access points being explored Mobile Crisis Support Teams and Mental Health Navigators are conducting
alcohol and drug screening, preliminary assessments, and referrals throughout the community.
Increased service capacity $285,000 grant for ROOM for Dads program to provide after-hours
outpatient and drug treatment services to fathers referred to the Sacramento County Family Treatment Drug Courts.
$1,035,000 to expand residential treatment and detoxification services. Drug court expansion
$280,000 for Early Intervention Family Drug Court expansion to serve an additional 50 families, annually.
Co-Occurring Court to address the needs of individuals with serious mental illness who need specialized substance use treatment.
Current Initiatives Alcohol & Drug Services
Initiative 1
Decrease high daily dose prescriptions by 25% by 2020
Change other prescribing practices; increase alternative pain management
Coordinate prevention across Sacramento County and neighboring jurisdictions, including prescription take-back programs
Earlier treatment (reduce switch from prescriptions to heroin)
Addressing Overdose & Death: Prescription Drugs, Opiates, and Heroin
Initiative 2
Increase access to accurate data related to methamphetamine
Increase access to treatment for individuals who misuse/are dependent on methamphetamine
Increase community capacity to respond to people who misuse/are addicted to methamphetamine
Increase public awareness and professional knowledge about methamphetamine
Addressing Methamphetamine, Alcohol, and Other Drug Use/Abuse
Initiative 3 Improve Substance Use Disorder Services through
an organized service delivery system Full continuum of multiple levels of funded
evidence-based services Increase program oversight, compliance and
quality assurance Improve coordination with other service systems
Drug Medi-Cal Organized Delivery System
(DMC-ODS)
*5-Year State-Wide Waiver Demonstration Project*
Two-Phase Process to Opt-in
1. Implementation Plan Develop plan for Board of Supervisor review/approval Submit plan to California Department of Health Care
Services by the June 2017 deadline
2. Fiscal Plan Contingent on approval of Implementation Plan Develop Fiscal Plan for Board review/approval Submit Fiscal Plan to Department of Health Care
Services by deadline (to be determined)
DMC-ODS Waiver Phased Approach
Phase 1 ( in progress) Bay Area
Phase 2 (in progress)
Southern California
Phase 3 (Sacramento County) Central Valley
Phase 4
Northern California
Phase 5 Tribal Delivery System
53 Counties Expressed Interest 20 Implementation Plans Submitted 11 Implementation Plans Approved
Approved Implementation Plans
Bay Area Counties 1. Contra Costa County 2. Marin County 3. Monterey County 4. San Francisco County 5. San Mateo County 6. Santa Clara County 7. Santa Cruz County
Southern California Counties
8. Los Angeles County 9. Riverside County 10. Sonoma County 11. Ventura County
Existing Drug Medi-Cal Services DMC-ODS Waiver Client Eligibility
Adult Eligibility Drug Medi-Cal beneficiary Reside in participating county Meet medical necessity criteria:
• One Diagnostic and Statistical Manual diagnosis for substance-related and addictive disorders (with the exception of tobacco)
• Meet ASAM* criteria definition of medical necessity for services
Youth Eligibility Drug Medi-Cal beneficiary Reside in participating county Meet medical necessity criteria:
• Be assessed as to being at risk for developing a substance use disorder
• Meet ASAM criteria definition of medical necessity for services
*American Society of Addiction Medicine
Existing Drug Medi-Cal Services
Current Substance Use Disorder (SUD) treatment services include: • Outpatient treatment • Intensive outpatient treatment • Naltrexone (Vivitrol) treatment with Treatment Authorization
Request • Medication-Assisted Treatment/Narcotic Treatment Program • Perinatal residential SUD services (limited by IMD exclusion) • Detoxification in a hospital with Treatment Authorization Request
These benefits will remain available to all Drug Medi-Cal
beneficiaries, including those in non-waiver counties
Existing Drug Medi-Cal Services
Services Covered by the Waiver
BOLD = New Services
Services
Early Intervention Outpatient Treatment Residential Treatment Medication-Assisted Treatment (MAT) Withdrawal Management Additional Medication-Assisted Treatment (MAT) Recovery Services Case Management Physician Consultation Coordination with Criminal Justice and Hospitals Increased Quality Assurance
Residential Services For both perinatal & non-perinatal beneficiaries No bed capacity limit (i.e. 16 bed IMD exclusion
does not apply) Provided in California Department of Health Care
Services licensed & certified residential facilities that are also designated to meet ASAM treatment criteria.
Recovery Services Focus on building beneficiary’s self-management
skills and linking to community resources. May be accessed after completing course of
treatment (if triggered, relapsed, or to prevent relapse)
Case Management To assist a beneficiary to access necessary
medical, educational, social, prevocational, vocational, rehabilitative, or other community services.
Physician Consultation DMC physicians consulting with addiction
medicine physicians, addiction psychiatrists, or clinical pharmacists to offer support with complex cases (i.e. medication selection, dosing, side effect management, adherence, drug-drug interactions, or level of care considerations).
Quality Assurance Increased program oversight, compliance, and
quality assurance Evidence-based services ASAM criteria Utilization tools to improve care and manage
resources
Service Descriptions
Coordination with
Hospitals
Waiver counties must describe care coordination plan for achieving seamless transitions of care.
Waiver county shall enter into a Memorandum of Understanding (MOU) with any health plan that enrolls beneficiaries served by DMC-ODS. MOU to include:
Comprehensive Screening Beneficiary Engagement Shared Plan Development/Treatment
Planning Case Management Activities Dispute Resolution Care Coordination/Referral Tracking Navigation Support
Responsibilities for the Waiver
County Implementation Plan/Contract with California Department of Health Care Services
Selective service provider contracting Authorization for residential treatment 24/7 toll-free beneficiary access phone line Beneficiary informing upon first contact Improved quality assurance & utilization management Improved care coordination with health plans & justice
systems
Waiver Implementation Challenges
Provider readiness Increased compliance, oversight, audits,
monitoring, and quality assurance Managing Behavioral Health Realignment match to
make the Waiver viable Rate structure development Training on ASAM: Basis of decision-making on all
levels of care Need for youth residential treatment facility