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CalAIM for BHS Providers 

California Advancing and Innovating Medi-Cal — more commonly known as CalAIM — is a far-reaching, multiyear plan to transform California’s Medi-Cal program and enable it to work more seamlessly with other social services. The goal of CalAIM is to improve outcomes for the millions of Californians covered by Medi-Cal, including those with the most complex needs.

CalAIM includes multifaceted changes to the behavioral health system of care. In San Diego, CalAIM policy and operational changes are being rolled out in stages for the behavioral health network of providers to help ensure clear and consistent communication regarding procedural changes.

To review the State’s FAQ page, visit CalAIM Behavioral Health Initiative Frequently Asked Questions.

All BHS Providers

All BHS Providers

Communication Materials

Topic

Link

For Staff

CalAIM Made Easy

For Clients

Communication Materials for People in Care

For Clients (Spanish)

Communication Materials for People in Care (Spanish)

 

CPT Coding

Topic

Link

Required Training

CPT Coding for Direct Service Providers offered through CalMHSA

 

Optional trainings: CPT Coding 101 and CPT Coding 102  

State Guidance

22-046

Questions?

QIMatters.HHSA@sdcounty.ca.gov

 

 

 

Documentation Redesign

Topic

Link

Required Training

Diagnosis & Problem List and Progress Notes, both offered through CalMHSA

Provider Memo

2023-12-28 BHS Info Notice - DMC-ODS Documentation Reform

BHS SUD QA - SUDURM Summary of Changes December 2023

2023-12-28 BHS Info Notice - SMHS Documentation Reform

State Guidance

23-068

Questions?

QIMatters.HHSA@sdcounty.ca.gov

 

Peer Support Services 

Topic

Link

Provider Memo

2021-10-05 BHS Peer Support Specialist Certification Program 

2023-05-17 Update on Peer Support Services Implementation 

Provider Q&A

Provider Q&A on Peer Support Services (updated 12/04/2023)

Required Training

San Diego Certified Peer Support Specialists – TRAINING REQUIREMENTS

Billing Codes

San Diego Certified Peer Support Specialists – BILLING CODES

State Guidance

​​

23-003​ Extended Deadlines for Medi-Cal Peer Support Specialist Grandparenting and Implementation of Medi-Cal Peer Support Specialist Certification Program Curriculum

22-018 Medi-Cal Peer Support Specialist Supervisors

22-062​ Complaints and Investigations of Medi-Cal Peer Support Specialist Certification Programs

22-061 Medi-Cal Peer Support Specialist Areas of Specialization

22-026​ DMC, DMC-ODS, and Specialty Mental Health Peer Support Services 

Resources

Certified Peers (presentation)

Medi-Cal Peer Support Specialist Certification Registry

To view Medi-Cal Peer Certification application status, log on to the application portal. Applicants with the status “In Revision” must complete additional requests for information to proceed. For any inquiries regarding certification application status, contact PeerCertification@calmhsa.org.

CalMHSA Stakeholder Advisory Council

Questions?

BHS-HPA.HHSA@sdcounty.ca.gov

 

Required CalAIM Trainings

Programs are responsible for ensuring staff complete required trainings. Except where noted below, all BH clinical staff (including their supervisors and managers, as well as SUD Medical Directors) are required to complete the following training offered through CalMHSA.

Training

Notes

CalAIM Overview

applicable to all BHS Programs including administrative and non-clinical staff

Access to Services

 

Assessment

except NTP

Diagnosis & Problem List

except NTP

Progress Notes

except NTP

Care Coordination

 

Screening

applicable to SMHS Programs only 

Administering the Adult & Youth Screening Tools

applicable to SMHS Programs only (optional)

Transition of Care Tool

applicable to SMHS Programs only 

Administering the Transition of Care Tool

applicable to SMHS Programs only (optional)

Discharge Planning

except NTP

CPT Coding for Direct Service Providers

except Peer Support Specialists

 

Instructions for accessing these trainings:https://www.calmhsa.org/calaim-2/

New staff shall complete required training no later than 90 days from hire date.

Instructions for viewing training completion evidence can be found on the CalMHSA site (https://www.calmhsa.org/calaim-2/); this includes how to view the dashboard or download the data.

Questions about the trainings, login, proof of completion, etc. should be sent to: calaim@calmhsa.org

 

DHCS Information Notices on CalAIM

BHIN

Subject

21-073

Criteria for beneficiary access to SMHS, medical necessity, and other coverage requirements

This BHIN outlines the criteria for determining medical necessity and access to specialty mental health services for beneficiaries under the California Medicaid program (Medi-Cal). The implementation of these criteria should be effective from January 1, 2022.

22-011

No Wrong Door for Mental Health Services Policy

 

This BHIN outlines a policy to create a seamless and coordinated system of care, where individuals seeking mental health support can easily navigate and access appropriate services. It highlights the importance of collaboration among various agencies and organizations involved in mental health care, such as healthcare providers, social service agencies, and community-based organizations. The policy emphasizes the need for a person-centered approach, ensuring that individuals receive the right level of care and support tailored to their specific needs. It also promotes the use of technology and data-sharing systems to enhance communication and coordination among service providers. The ultimate goal of the policy is to eliminate barriers and ensure that individuals facing mental health challenges can access timely and effective care through any entry point in the healthcare system, and it is effective from July 1, 2022.

23-068

Updates to Documentation Requirements for all SMHS and DMC-ODS services

This BHIN updates and clarifies documentation requirements for all SMH, DMC, and DMC-ODS services. This notice builds on DHCS’ goal of streamlining and standardizing clinical documentation requirements for Specialty Mental Health Services (SMHS), DMC, and DMC-ODS delivery systems. The updated documentation requirements better align with the Centers for Medicare and Medicaid Services’ (CMS) national coding standards and physical health care documentation practices. This BHIN updates member chart documentation requirements for most SMH, DMC, and DMC-ODS services (exceptions are noted within). The updated standards are effective January 1, 2024. This documentation policy was initially developed and published in 2022 and subsequently updated based on feedback from stakeholders, including county behavioral health directors, consumer advocates, labor organizations representing county behavioral health workers, and behavioral health treatment providers. Changes in documentation requirements that directly affect SDCBHS system of care practices will be communicated to providers.

22-065

Adult and Youth Screening and Transition of Care Tools for Medi-Cal Mental Health Services

This BHIN provides guidance and tools for the screening and transition of care for adults and youth in MHS program. The update aims to assist healthcare providers and organizations in effectively identifying and supporting individuals with mental health needs as they transition between different levels of care. It emphasizes the importance of standardized screening tools and assessment protocols to ensure accurate identification of mental health conditions. The BHIN provides a comprehensive overview of the screening tools available for both adults and youth, including their purpose, administration procedures, and scoring guidelines. It also outlines strategies for effective transition planning and coordination between providers, ensuring continuity of care for individuals moving from one level of care to another. The tools and recommendations provided in the BHIN are intended to support the delivery of high-quality mental health services within the Medi-Cal MHS program, ultimately improving outcomes for individuals with mental health needs. The updates are effective January 1, 2023.

Adult Screening Tool for Medi-Cal Mental Health Services

Youth Screening Tool for Medi-Cal Mental Health Services

Transition of Care Tool for Medi-Cal Mental Health Services (Adult and Youth)​

24-001

Drug Medi-Cal Organized Delivery System (DMC-ODS) Requirements for the Period of 2022 – 2026

This BHIN outlines Drug Medi-Cal Organized Delivery System (DMC-ODS) program requirements pursuant to CalAIM, effective January 2022 through December 2026, including program updates.

23-017

Specialty Mental Health Services and Drug Medi-Cal Services Rates

This BHIN outlines Counties’ SMHS and DMC-ODS fee schedules effective July 1, 2023 and the State’s methodology used to calculate them.

23-023

Elimination of Cost Reporting Requirements for Counties and Providers

This BHIN is a policy statement from DHCS regarding the elimination of cost reporting requirements for counties and providers of Medi-Cal services. Effective July 1, 2022, MHPs, DMC-ODS, and DMC counties will no longer be required to submit an annual Medi-Cal cost report. This policy change eliminates the need for counties to collect and submit cost reports from subcontracted network providers for Medi-Cal reimbursement purposes. However, counties may still need to collect cost information from subcontracted network providers for various reasons, such as compliance with DHCS cost reporting policies for services rendered before BH Payment Reform implementation on July 1, 2023, or when required by state or federal law. Please note that only the Certified Public Expenditures (CPE) submission requirement is being waived by the State.

DMC-ODS Providers

Providers of Drug Medi-Cal Organized Delivery System Services

Please note to also review the information for BHS All Providers

DMC-ODS Policy Improvements

Topic

Link

State Guidance

24-001​ D​rug Medi-Cal Organized Delivery System Requirements for the Period of 2022–2026

Questions?

QIMatters.HHSA@sdcounty.ca.gov

 

 

 

SMHS Providers

Providers of Specialty Mental Health Services

Please note to also review the information for BHS All Providers

Criteria for Services

Topic

Link

State Guidance

21-073 

Questions?

QIMatters.HHSA@sdcounty.ca.gov

No Wrong Door

Topic

Link

State Guidance

22-011 

Questions?

QIMatters.HHSA@sdcounty.ca.gov

Standardized Screening and Transition of Care Tools

Topic

Link

Provider Memo

2023-02-22 – BHS Provider Memo – Screening and Transition Tool (docx) 

Required Training

Screening and Transition of Care Tool trainings, both offered through CalMHSA

Optional trainings through CalMHSA: Administering the Adult & Youth Screening Tools and Administering the Transition of Care Tool

State Guidance

22-065

Adult Screening Tool for Medi-Cal Mental Health Services

Youth Screening Tool for Medi-Cal Mental Health Services

Transition of Care Tool for Medi-Cal Mental Health Services (Adult and Youth)

Questions?

QIMatters.HHSA@sdcounty.ca.gov

 

 

This webpage was last updated on: 02/08/2024