Medi-Cal Behavioral Health - Oversight and Monitoring Division
Medi-Cal Behavioral Health – Oversight and Monitoring Division (MCBH-OMD) monitors and oversees county behavioral health plans to ensure compliance with state and federal requirements, regulations, and DHCS contract terms for the Specialty Mental Health Services (SMHS), Drug Medi-Cal (DMC), and Drug Medi-Cal Organized Delivery System (DMC-ODS) programs. MCBH-OMD additionally oversees quality and network adequacy of the SMHS and DMC-ODS programs.
Quality and Network Adequacy Oversight Branch
The Quality and Network Adequacy Oversight Branch (QNAOB) is within the Medi-Cal Quality and Oversight Division and is home to four sections: the Access to Care Oversight Section; Behavioral Health Quality Improvement Program (BHQIP) Section; Network Adequacy Oversight Section; and Quality Assessment and Performance Improvement Section. These sections monitor and perform quality assessment reviews of any behavioral health components of the Drug Medi-Cal Organized Delivery System (DMC-ODS) program and Specialty Mental Health Services (SMHS) program.
Access to Care Oversight Section
The Access to Care Oversight Section (ACOS) is found within the Quality and Network Adequacy Oversight Branch (QNAOB). QNAOB is found within the Medi-Cal Behavioral Health Division.
DHCS contracts with 56 county Mental Health Plans (MHP), 30 county DMC-ODS Plans, and one regional DMC-ODS model comprised of seven counties that are responsible for providing, or arranging for the provision of, specialty mental health and drug treatment services to Medi-Cal beneficiaries.
ACOS performs county oversight, technical assistance, and monitoring related to improving access to care. ACOS is specifically responsible for monitoring the compliance of MHP and DMC-ODS counties with timely access requirements, including initial request for first appointment or first specialty mental health service for new beneficiaries; non-urgent follow-up appointments; and ensuring language assistance services are coordinated with scheduled appointments for health care services. ACOS collects and analyzes timely access data and leads policy development and reviews related to timely access. ACOS provides timely access data results, administers corrective action plans, identifies steps to resolve compliance issues, and provides technical assistance to MHPs and DMC-ODS counties.
These timely access compliance and monitoring activities are specific to behavioral health plans. The Managed Care Quality and Monitoring Division monitors timely access requirements for Managed Care Plans.
Provided below are some federal and state laws related to ACOS. These laws are found within the Code of Federal Regulations (CFR), Health and Safety Code (HSC), Welfare and Institutions Code (WIC), and the California Code of Regulations (CCR).
Applicable Laws
Federal:
- 42 CFR Section 438.680 – Network Adequacy Standards
- 42 CFR Section 438.206 – Availability of services
- 42 CFR Section 438.207 – Reporting Requirements
State (Statutes):
- HSC Section 1367.03
- WIC Section 14197
State (Regulations):
- 28 CCR Section 1300.67.04
- 28 CCR Section 1300.67.2.2
Behavioral Health Quality Improvement Program Section
The Behavioral Health Quality Improvement Program Section (BHQIPS) is found within the Quality and Network Adequacy Oversight Branch (QNAOB). QNAOB is found within the Medi-Cal Behavioral Health Division.
The California Advancing and Innovating Medi-Cal Behavioral Health Quality Improvement Program (BHQIP) is an incentive payment program to support Mental Health Plans (MHP), Drug Medi-Cal (DMC) State Plans, and Drug Medi-Cal Organized Delivery Systems (DMC-ODS) as they prepare for changes in the CalAIM initiative and other approved administration priorities.
Incentives are available from FY 2021-2022 to FY 2023-2024 and more information about BHQIP can be found in Behavioral Health Information Notice (BHIN) 21-044, BHIN 21-074, as well as BHIN 22-050 and its corresponding attachments. The attachments for these documents can be accessed on the 2022 Behavioral Health Information Notices webpage.
Every MHP, State Plan, and DMC-ODS are intended to reach various milestones across three goals: 1) payment reform; 2) implementation of CalAIM behavioral health policy changes; and 3) data exchange, by July 2023. Please navigate to the BHQIP incentive program webpage for more information on the BHQIP program.
Network Adequacy Oversight Section
The Network Adequacy Oversight Section (NAOS) is found within the Quality and Network Adequacy Oversight Branch (QNAOB). QNAOB is found within the Medi-Cal Behavioral Health Division.
DHCS contracts with 56 county Mental Health Plans (MHP) and 31 Drug Medi-Cal Organized Delivery System (DMC-ODS) counties that are responsible for providing, or arranging for the provision of, specialty mental health and drug treatment services to Medi-Cal beneficiaries.
NAOS performs compliance oversight and monitoring of the MHPs and DMC-ODS counties, ensuring compliance with the Network Adequacy requirements set forth in Title 42 of the Code of Federal Regulations (CFR). NAOS reviews the Annual Network Adequacy Certification submissions from MHPs and DMC-ODS counties, administers corrective action plans, identifies steps to resolve compliance issues, and provides technical assistance to MHPs and DMC-ODS counties. Below are some of the laws followed in monitoring network adequacy:
These network adequacy compliance and monitoring activities are specific to behavioral health plans. The Managed Care Quality and Monitoring Division monitors network adequacy requirements for Managed Care Plans. Please refer to the Department of Health Care Service Network Adequacy webpage for more information related to network adequacy, including Annual Certification Report, approved Alternative Access Standards, and Corrective Action Plans.
Provided below are some federal and state laws related to NAOS. These laws are found within the CFR, and Welfare and Institutions Code (WIC).
Applicable Laws
Federal:
- 42 CFR 438.206 Availability of Services
- 42 CFR 438.207 Assurance of Adequate Capacity and Services
- 42 CFR 438.68 Network Adequacy Standards
State (Statutes):
Quality Assessment and Performance Improvement Section
The Quality Assessment and Performance Improvement Section (QAPIS) is found within the Quality and Network Adequacy Oversight Branch (QNAOB). QNAOB is found within the Medi-Cal Behavioral Health Division.
QAPIS oversees the work of the External Quality Review Organization (EQRO) for both the Specialty Mental Health Services and the Drug Medi-Cal Organized Delivery System (DMC-ODS). The EQRO performs an analysis and evaluation of aggregate information on access, timeliness and quality of health care services furnished by Mental Health Plans (MHP) and DMC-ODS counties. QAPIS reviews for accuracy and content several EQRO reports that include: (1) one annual report for each reviewed county; (2) quarterly performance improvement plans for each county; and (3) annual aggregate statewide reports for both MHPs and DMC-ODS counties.
QAPIS leads the management and oversight of the Community Mental Health Equity Project, a collaborative effort between the California Department of Public Health (CDPH) Office of Health Equity and Department of Health Care Services (DHCS) Medi-Cal Behavioral Health Division (MCBHD).
QAPIS is also tasked with the review of County Cultural Competency Plan reports, and beginning in 2022, the review of County Quality Improvement Reports. Other functions performed by QAPIS includes serving as the lead program to collect behavioral health data for the development of the CalAIM 1115 waiver report, the management of various program contracts, and participation in various workgroups and initiatives.
Additional Resources
California Advancing and Innovation Medi-Cal (CalAIM):
Medicaid and Medi-Cal General:
Contact Information
