Medi-Cal Behavioral Health - Policy Division
Medi-Cal Behavioral Health – Policy Division (MCBH-PD) oversees the policy and program areas of the Specialty Mental Health Services, Drug Medi-Cal (DMC), and Drug Medi-Cal Organized Delivery System (DMC-ODS) programs. Specifically, MCBH-PD oversees State Plan Amendments for county behavioral health plans; behavioral health CalAIM development and implementation activities, including for Peer Support Services, No Wrong Door, Documentation Redesign, Behavioral Health Administrative Integration, and Screening and Transition of Care Tools; 988; the Mobile Crisis Services benefit; Community Assistance, Recovery, and Empowerment (CARE) Act; the California Behavioral Health Community-Based Continuum (CalBH-CBC) Demonstration waiver; Recovery Incentives Program; Family First Prevention Services Act; and Complex Care cases.
Legislations and Regulations Branch
The Legislation and Regulations Branch oversees legislation, regulations, and program development activities for MCBH-PD within the Department of Health Care Services (DHCS). The branch consists of two sections – the Legislation and Regulations Section and Program Implementation Section.
The Legislation and Regulations Section
The Legislations and Regulations Section is responsible for the development, oversight, and implementation of all legislation and regulations activities for MCBH-PD. The section acts as a liaison on behalf of the Division with DHCS' Legislative and Government Affairs (LGA) Office regarding legislative matters and DHCS' Office of Regulations (OOR) for regulatory affairs.
The Legislation and Regulations Section consists of two Units:
- Legislation Unit
- Regulations Unit
The Legislation and Regulations Section works on numerous deliverables throughout the year, including
Legislative Bill Analysis
The legislative bill analysis process includes analyzing legislation to develop, draft, and make recommendations on pending legislation and laws pertaining to the state and federal government, policy reports, bill analyses, enrolled bill reports, and briefing documents for behavioral health services in response to assignments/requests from the Department of Health Care Services (DHCS) Office of Legislative and Governmental Affairs (LGA) and/or inquiries from internal and external stakeholders for the purpose of guiding lawmaking.
Regulations
The regulations process includes independently researching and evaluating federal and state mandates and its impact to existing regulations, policies and contractual requirements to determine whether and what changes to current regulations, policies, and contractual requirements need to be made. Once determined, regulations text, which includes accompanying documents such and an Initial Statement of Reasons, Statements of Determination and Informative Digest is developed and refined.
The Program Implementation Section
The Program Implementation Section is responsible for development of several components of the CalAIM Initiative. This section revises policy documents and assists with development and initial implementation of legislative requirements.
The Program Implementation Section consists of two Units:
- Program Implementation Unit 1
- Program Implementation Unit 2
The Program Implementation Section implements several CalAIM Initiatives, including
Medi-Cal Peer Support Services
Senate Bill (SB) 803, chaptered in 2020, authorized DHCS to seek federal approvals to add Peer Support Specialists as a Medi-Cal provider type and Peer Support Services as a distinct service type under the Specialty Mental Health Services (SMHS), Drug Medi-Cal (DMC), and Drug Medi-Cal Organized Delivery System (DMC-ODS) delivery systems in counties opting to participate in this program. DHCS has acquired these federal approvals through the Medicaid waiver and State Plan Amendment processes. SB 803 also directed DHCS to develop state standards for Medi-Cal Peer Support Specialist Certification Programs that may be implemented by counties or agencies representing counties, who opt in to provide these programs.
The Medi-Cal Peer Support Services benefit went live on July 1, 2022, with the first Peer Support Services Certification Examinations taking place in September 2023.
For more information on Medi-Cal Peer Support Services, please visit CalAIM Behavioral Health Initiative.
No Wrong Door
DHCS will implement a “no wrong door" policy to ensure beneficiaries receive mental health services regardless of the delivery system where they seek care (via County Behavioral Health, Medi-Cal Managed Care Plan, or the Fee for Service delivery system). This policy would allow beneficiaries who directly access a treatment provider to receive mental health services, and to have that provider reimbursed for those services by their contracted plan, even if the beneficiary is ultimately transferred to the other delivery system due to their level of impairment and mental health needs. In certain situations, beneficiaries may receive coordinated, non-duplicative services in multiple delivery systems, such as when a beneficiary has an ongoing therapeutic relationship with a therapist or psychiatrist in one delivery system while requiring medically necessary services in the other. DHCS seeks to clarify that patients with co-occurring mental health and substance use disorder (SUD) conditions may be treated by providers in each of the behavioral health delivery systems, as long as the covered services are not duplicative and meet specified requirements for contracting and claiming.
For more information on No Wrong Door, please visit CalAIM Behavioral Health Initiative.
Screening & Transition of Care Tools for Medi-Cal Mental Health Services
Currently, multiple behavioral health screening and transition of care tools are in use for Medi-Cal beneficiaries across the state, leading to inconsistencies for when beneficiaries are referred to mental health plan networks versus managed care networks. CalAIM seeks to streamline this process and improve patient care by creating standardized statewide tools. DHCS underwent a robust stakeholder process to develop statewide screening and transition of care tools for both adults and individuals under 21 years old (youth) for use by county mental health plans (MHPs) and Medi-Cal Managed Care Plans (MCPs). DHCS developed standardized screening tool to determine the most appropriate Medi-Cal behavioral health delivery system (MHP or MCP) for beneficiaries seeking an assessment of needs and services for the first time. In addition, DHCS developed a standardized transition of care tool to ensure that Medi-Cal beneficiaries receive timely and coordinated care when completing a transition of services to the other delivery system or when adding a service from the other delivery system to an existing care plan.
For more information on Screening & Transition of Care Tools, please visit CalAIM Behavioral Health Initiative.
Documentation Redesign
DHCS will streamline behavioral health documentation requirements for SUD and SMHS and align with national standards. DHCS will amend requirements around point-in-time treatment plans. DHCS will also remove the requirement for clients to sign the treatment plan. Instead, DHCS will use problem lists to allow active and ongoing updates of a client's evolving clinical picture, with progress notes reflecting the care given, aligning with the appropriate billing codes.
For more information on Documentation Redesign, please visit CalAIM Behavioral Health Initiative.
CalAIM Administrative Integration
Medi-Cal specialty mental health and SUD treatment services are currently administered through separate, unique structures at the county level, which creates many challenges for beneficiaries, counties and providers. DHCS is proposing administrative integration of specialty mental health and SUD services into one behavioral health managed care program. This proposal is distinct from the CalAIM Full Integration Plan proposal which would integrate physical, behavioral, and oral health care into comprehensive managed care plans. The goal is to improve outcomes for beneficiaries through coordinated treatment across the continuum of care. An additional goal and benefit would be to reduce administrative and fiscal burdens for counties, providers, and the state. This initiative is a multi-year effort that begins with the implementation of other CalAIM behavioral health policies, starting in 2022, including Criteria for Mental Health Services, the DMC-ODS Policy Improvements and Behavioral Health Payment Reform. DHCS aims to submit for a single, integrated behavioral health plan in each county or region responsible for providing, or arranging for the provision of, specialty mental health and SUD services under the next 1915(b) waiver, effective in January 2027. Both state-level and county-level activities will be required to achieve this goal.
For more information on CalAIM Administrative Integration, please visit CalAIM Behavioral Health Initiative
Additional Resources
California Advancing and Innovation Medi-Cal (CalAIM):
Medicaid and Medi-Cal General:
Contact Information
