News & Events
CAADPE announces its SUPPORT for the DMC-ODS Waiver
Drug Medi-Cal Organized Delivery System Waiver
- Provides a continuum of care modeled after the American Society of Addiction Medicine (ASAM) Criteria for SUD treatment services;
- Increases local control and accountability with greater administrative oversight;
- Creates utilization controls to improve care and efficient use of resources;
- Increases program oversight and integrity;
- Provides more intensive services for the criminal justice population which are harder to treat;
- Requires evidence based practices in substance abuse treatment; and
- Increases coordination with other systems of care including physical and mental
This approach is expected to provide the beneficiary with access to the care and system interaction needed in order to achieve sustainable recovery.
Continuum of Services Provided
Counties that opt-in to participate in the DMC-ODS are required to provide a continuum of services to all eligible beneficiaries modeled after The ASAM Criteria. Services required to participate in the DMC-ODS include:
- Early Intervention (overseen through the managed care system)
- Outpatient Services
- Intensive Outpatient Services
- Short-Term Residential Services (up to 90 days with no facility bed limit)
- Withdrawal Management
- Opioid/Narcotic Treatment Program Services
- Recovery Services
- Case Management
- Physician Consultation
The following optional services can also be provided to beneficiaries by counties:
- Additional Medication Assisted Treatment (MAT)
- Partial Hospitalization
- Recovery Residences
Implementation Plan Schedule
County participation in the Waiver is voluntary. Opt-In Counties are required to submit a county implementation plan to DHCS. Plans will be reviewed and approved by DHCS and CMS. Fifty-three (53) counties expressed interest in participating in the Waiver as of January 2015.
- Phase One: Bay Area (June -September 2015)
- Phase Two: Southern California
- Phase Three: Central California
- Phase Four: Northern California
- Phase Five: Tribal Partners
Counties shall have a Quality Improvement Plan and Quality Improvement Committee, as well as shall provide data to evaluate outcomes from the Waiver related to access, quality, cost and integration and coordination of care.
Access and Utilization Management
Counties shall have a toll free access line and shall authorize Residential services. Counties shall also have a Utilization Management Program that assures access to services; assures medical necessity has been established and the beneficiary is at the appropriate level of care and that the interventions are appropriate for the diagnosis and level of care.
Rates are set at the State rates; however, counties can propose coming in higher or lower except for Narcotic Treatment Program (NTP) services. The State will negotiate the proposed rates with the counties and will have final approval. DHCS will continue to set the rate for NTP services.
The University of California, Los Angeles, (UCLA) Integrated Substance Abuse Programs will conduct an evaluation to measure and monitor the outcomes from the DMC-ODS Waiver. The design of the DMC-ODS evaluation will focus on the four key areas of access, quality, cost, and integration and coordination of care.
For Additional Information Regarding the DMC-ODS
- Visit http://www.dhcs.ca.gov/provgovpart/Pages/Drug-Medi-Cal-Organized-Delivery-aspx
- Contact Marlies Perez at Perez@dhcs.ca.gov