Drug Medi-Cal Organized Delivery System
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The Drug Medi-Cal Organized Delivery System (DMC-ODS) provides a continuum of care modeled after the American Society of Addiction Medicine Criteria for substance use disorder treatment services, enables more local control and accountability, provides greater administrative oversight, creates utilization controls to improve care and efficient use of resources, implements evidenced based practices in substance abuse treatment, and coordinates with other systems of care.
This approach provides the beneficiary with access to the care and system interaction needed in order to achieve sustainable recovery.
DHCS initially received approval in August 2015 from the Centers for Medicare & Medicaid Services (CMS) to implement the DMC-ODS through the State's prior Section 1115 demonstration. DHCS received approval from CMS on December 29, 2021 to reauthorize the DMC-ODS in the CalAIM Section 1915(b) waiver through December 31, 2026, alongside the State's other Medi-Cal delivery systems: Medi-Cal managed care, dental managed care, and Specialty Mental Health Services (SMHS). For more information about the CalAIM initiatives and stakeholder engagement process, please visit the CalAIM homepage and CalAIM 1115 Demonstration & 1915(b) Waiver webpage.
The following two tools are available to counties and providers free of charge:
Brief Questionnaire for Initial Placement (BQuIP) – web-based tool
American Society of Addiction Medicine (ASAM) Assessment Interview Guide – printable ASAM Criteria® Assessment tool
The
BQuIP is a fast and free web-based tool that relies on electronic algorithms to help inform the initial placement decision-making process based on limited information. It is designed to generate preliminary recommendations for initial placement for individuals seeking treatment for substance use disorders (SUDs). However, ultimately, the initial placement decision must be made according to the clinical judgment of the individual using the tool and county policy. The BQuIP will not provide a diagnosis and does not replace the necessity and requirement for a full ASAM assessment, as currently required under the Drug Medi-Cal Organized Delivery System (DMC-ODS) waiver. The appropriateness of the provisional placement decision made as a result of using this tool must be confirmed via a comprehensive American Society of Addiction Medicine (ASAM) assessment as soon as possible.
The ASAM Criteria® Assessment Interview Guide is the first publicly available standardized version of the ASAM Criteria assessment. With this release, ASAM and UCLA hope to increase the quality and consistency of patient assessments and treatment recommendations. This resource can also help assist states looking to facilitate continuity and consistency in substance use disorder (SUD) treatment delivery and coverage. Because it is paper-based, offered free to all clinicians, and can be used in many different clinical contexts, the Guide enhances the public utility of The ASAM Criteria's multidimensional assessment approach for the addiction treatment community.
In August 2018, the California Health Care Foundation (CHCF) published a paper titled
“Medi-Cal Moves Addiction Treatment into the Mainstream: Early Lessons from the DMC-ODS Pilots.” This paper provides an overview of the DMC-ODS program and how it differs from the standard Drug Medi-Cal program. It also outlines the experiences and challenges encountered by four early adopter counties – Los Angeles, Marin, Riverside, and Santa Clara.
“How Medi-Cal Expanded Substance Use Treatment and Access to Care” is a follow up to the 2018 paper and includes perspectives from additional counties representing various population sizes and geographic areas throughout the state.
California Advancing and Innovating Medi-Cal (CalAIM)
CalAIM is a multi-year initiative by DHCS to improve the quality of life and health outcomes of our population by implementing broad delivery system, program, and payment reform across the Medi-Cal program. DHCS conducted broad stakeholder engagement to elicit county, provider, and beneficiary feedback on how to improve Medi-Cal programs, including DMC-ODS. As a result of that input, DHCS proposed CMS a set of updates to DMC-ODS, some of which CMS approved for the January – December 2021 extension period (see Information Notice
21-019,
21-020,
21-021, and
21-024), and others which will be effective January 2022, pending CMS approval. The pending policy guidance updates and replaces the Special Terms and Conditions used to describe the program for the years 2015-2020.
Evaluation
The University of California, Los Angeles, Integrated Substance Abuse Programs (UCLA ISAP) is conducting the evaluation to measure and monitor outcomes of the DMC-ODS, using information gathered from existing state data sources, as well as new data collected specifically for the DMC-ODS evaluation. Quantitative methods will be used to analyze trends, while qualitative methods will be used to help interpret quantitative data.