THE JOINT INFORMATIONAL HEARING
OF THE SENATE HEALTH COMMITTEE
AND THE SENATE BUDGET AND FISCAL
REVIEW COMMITTEE SUBCOMMITTEE
NUMBER THREE ON HEALTH AND HUMAN
SERVICES WILL CONVENE. TODAY WE
WILL BE REVIEWING THE STATE'S
PROGRESS ON REFORMING MEDICALS
BEHAVIORAL HEALTH DELIVERY
SYSTEMS THROUGH THE CAL AIM
BEHAVIORAL HEALTH INITIATIVE. AS
ALL OF YOU KNOW, I'M CERTAIN
THAT KELLY UM INITIATIVE WAS
ORIGINALLY PROPOSED IN ABOUT
2019 AND WAS ULTIMATELY LAUNCHED
AROUND 2022. CONTAINED A VARIETY
OF POLICY CHANGES DESIGNED TO
IMPROVE QUALITY OUTCOMES. REDUCE
HEALTH DISPARITIES, SIMPLIFY THE
PROCESS AND ACHIEVE BEHAVIORAL
HEALTH PAYMENT REFORM, AMONG
OTHER CHANGES. THIS AFTERNOON.
WE WILL HEAR FROM
REPRESENTATIVES FROM D. H C. S
WHO WILL PROVIDE UPDATES ON HOW
THE IMPLEMENTATION OF THE CALLUM
INITIATIVE IS PROGRESSING. WE
WILL ALSO HEAR ABOUT THE
IMPLEMENTATION, ITS SUCCESSES
AND ITS CHALLENGES FROM THE
PERSPECTIVE OF COUNTIES FROM
PROVIDERS AND HEALTH CARE
CONSUMERS. WE WILL ALSO PROVIDE
THE PUBLIC AND WELCOME THE
PUBLIC AND PROVIDE ACCESS,
PUBLIC PARTICIPATION AND ACCESS
DURING THIS PROCESS. UM BEFORE
WE BEGIN WITH THE ACTUAL
PRESENTATIONS, I WANT TO GIVE
THE OPPORTUNITY TO THOSE TO MY
RIGHT TO PRESENT THEIR
PERSPECTIVES. FIRST THE
IMMEDIATE PAST CHAIR OF THIS
HEALTH COMMITTEE AND SOMEONE WHO
KNOWS INFINITELY MORE ABOUT
CALLUM AND A VARIETY OF OTHER
HEALTHCARE SUBJECTS. AND I DO,
SENATOR SUSAN EGGMAN. THANK YOU,
SIR. MM SENATOR ROTH IS VERY
GENEROUS, BUT I'M GLAD TO BE
SITTING HERE BY THESE TWO FOLKS
SIDE TODAY AS WE TALK ABOUT, I
THINK ONE OF THE BIGGEST THINGS
THAT WE'RE DOING IN CALIFORNIA,
ESPECIALLY AS IT RELATES TO
BEHAVIORAL HEALTHCARE IS ITALIAN
PROGRAM, SO I'M EXCITED TO GET
AN UPDATE ABOUT IT. I'M EXCITED
TO HEAR BOTH FROM THE
DEPARTMENT'S PERSPECTIVE. HOW
THINGS ARE GOING. I KNOW WE'VE
JUST DONE A LOT OF DATA
COLLECTION AND AS IT RELATES, OF
COURSE, TO THE ACCESS CRITERIA
LIKE HOW IS THAT COMING ALONG AS
IT RELATES TO, I'M ESPECIALLY
INTERESTED IN AND AS I HAVE, UM,
I'VE BEEN TALKING A LOT ABOUT
MENTAL HEALTH, ESPECIALLY AROUND
THE STATE. AND AS WE TALK ABOUT
KELLY, MISS BEING ESSENTIAL
COMPONENT OF OUR ENTIRE
CONTINUUM OF CARE SPECIFICALLY,
HOW IS THAT? NO WRONG DOOR
WORKING OUT. WE KEEP HEARING
THINGS ABOUT PEOPLE NOT BEING IN
THE RIGHT PLACE AT THE RIGHT
TIME OR OR OR NOT UNDERSTANDING
HOW TO BUILD FOR CERTAIN
SERVICES. AND I'M TALKING AS WE
AS WE MOVE INTO TALKING ABOUT SP
43 AS WELL AND THAT
IMPLEMENTATION FOR A LOT FROM
THE COUNTIES ABOUT NOT HAVING
ENOUGH DIRECTION ABOUT HOW TO DO
THOSE KINDS OF THINGS, AND I'M
WONDERING WHERE NO WRONG DOOR
COMES INTO THAT DISCUSSION AND
DIALOGUE. UM I DON'T KNOW ABOUT
HOW THE SCREENING TOOLS ARE
DOING. AND, OF COURSE, THE
BILLING AS SOMEBODY WHO'S BEEN A
PRACTITIONER FOR A LONG TIME,
AND WE KNOW EVERYBODY'S
COMPLAINTS ABOUT BILLING AND
DOCUMENT EVERY COUPLE OF MINUTES
. SO AS WE YOU KNOW, DID THIS
MASSIVE TRANSFORMATION? HOW IS
THAT ACTUALLY GOING? ARE WE
ACTUALLY SEEING MORE PEOPLE ARE
WE ACTUALLY HAVING BETTER
OUTCOMES AND OUR PROVIDERS
UNDERSTANDING? THE REQUIREMENTS
THAT THEY NEED TO FOLLOW IN
ORDER TO GET REIMBURSED FOR
THOSE SERVICES. SO I KNOW THE
DEPARTMENT IS PREPARED TO TALK
ABOUT ALL THOSE THINGS TODAY.
WE'RE JUST EXCITED HERE, BOTH
FROM YOU AS THEN, AS WELL AS
THOSE WHO ARE ON THE GROUND
TRYING TO IMPLEMENT AT THE SAME
TIME, SO I'M LOOKING FORWARD TO
THE CONVERSATION TODAY AND THEN
THE INFORMATION THAT WE RECEIVE.
THANK YOU. THANK YOU, SENATOR.
AND NOW OUR CHAIR OF BUDGET SUB
THREE, SENATOR MENJIVAR. ANY
COMMENTS? YOU SO MUCH. I'M JUST
HAPPY TO BE IN THE SANDWICH OF
LEARNING OUT MEMBERS. THAT'S
WHAT SHE MEANS. LEGISLATORS WHO
REALLY SET THE FOUNDATION FOR
THIS TO MY LEFT AND TO MY RIGHT,
AND I THINK HERE IN THE SENATE
ON THE HEALTH SPACE, THIS TRIO
HAS BEEN REALLY AT THE FOREFRONT
OF A LOT OF THESE ISSUES. AND I
AM LOOKING FORWARD TO I THINK ON
THE BILLY WOULD SENATOR EGGMAN
MENTIONED IS ONE OF MY KEY
POINTS. ALSO AN ADDITIONAL COUNT
HIM IN HOW WE'RE GOING TO TAKE
ADVANTAGE OF THIS AND HELPING
THE NEEDS OF OUR JUVENILES. IN
THE JUSTICE SYSTEM. I KNOW
THAT'S SOMETHING THAT'S GOING TO
BE TIGHT INDIRECTLY TO HELP
FURTHER MOVE TOWARDS A CARE
VERSUS JAIL FIRST MODEL AND THEN
ADDRESSING THE RECIDIVISM RATE,
UM DURING TOURS OF MY DISTRICT
WITH PROVIDERS, THE BILLION
THING IS WHAT CAME UP OFTEN AND
THEN I'M ALSO INTERESTED AS TO
HOW WE ARE IN DIFFERENT COUNTIES
, WHERE SOME COUNTIES ARE
OFFERING ONE SERVICE AND THE
OTHER OTHER COUNTIES ARE
OFFERING ANOTHER SERVICE. I'M
EXCITED WHEN I GOT THE NUMBERS
THAT THE NUMBER ONE SERVICE
BEING PAID OUT AS HOUSING
NAVIGATION, WHICH IS REALLY
PHENOMENAL, MOST EXCITED ABOUT
THE AMOUNT OF MONEY THAT WE'VE
HELPED ON DEPOSITS FOR HOUSING
DEPOSITS AND SO FORTH AND
LOOKING TO SEE HOW WE CAN
FURTHER EXPAND THAT SCENE THAT
WE KNOW THAT THESE ARE HELPING
WITH PREVENTATIVE MEASURES. SO
WITH THAT AH, GET BACK TO YOU,
MR CHAIR. THANK YOU, SENATOR.
LET'S WELCOME OUR FIRST PANEL.
UM MICHELLE BOSS, DIRECTOR
DEPARTMENT OF HEALTH CARE
SERVICES AND BRIAN FITZGERALD
DIVISION CHIEF. LOCAL GOVERNMENT
FINANCING DIVISION. WELCOME.
THANK YOU FOR JOINING US LOOK
FORWARD TO THE PRESENTATION.
GOOD AFTERNOON. CARES AND MEMBER
MICHELLE BOSS DEPARTMENT
DEPARTMENT OF HEALTH CARE
SERVICES. THANK YOU FOR THE
OPPORTUNITY TO PROVIDE AN UPDATE
ON THE BEHAVIORAL HEALTH
COMPONENTS RELATED TO CAL. AIM.
AS YOU KNOW, CAL AIM IS A MULTI
YEAR EFFORT TO IMPROVE THE
QUALITY OF LIFE AND HEALTH
OUTCOMES OF OUR MEDICAL MEMBERS
BY IMPLEMENTING BROADS, DELIVERY
SYSTEM REFORM AND PAYMENT AND
PROGRAM REFORM ACROSS THE
MEDICAL PROGRAM. THE BEHAVIORAL
HEALTH COMPONENTS OF CALAIS MAR
DESIGNED TO SUPPORT THE WHOLE
PERSON INTEGRATED CARE, MOVE THE
MINISTRATIONS FOR SOME OF THE
BEHAVIORAL HEALTH TO MORE
CONSISTENT AND ST STREAMLINE
APPROACH, REDUCING COMPLEXITY
AND ADDING AND FLEXIBILITY FOR
OUR COUNTY PARTNERS, THEREBY
IMPROVING QUALITY AND REDUCING
HEALTH EXPERTS. HEALTH
DISPARITIES. THE INITIATIVES CAN
COLLECTIVELY AIM TO ENSURE THAT
COUNTIES AND PROVIDERS ARE ABLE
TO EFFECTIVELY AND EFFICIENTLY
COORDINATE CARE. SO MEMBERS
REALLY ARE NOT IN THE MIX. THERE
THEY REALLY HAVE ACCESS TO
TIMELY CARE ARE REALLY HAVE KIND
OF THE PROVISION OF STREAMLINED
CARE AS WELL. MANY OF THESE
INITIATIVES LAUNCHED IN 2022,
HOWEVER, WE KNOW THAT
INFLAMMATION IMPLEMENTATIONS
WILL TAKE US THROUGH 2027. THIS
IS A MULTIYEAR EFFORT REALLY,
FUNDAMENTALLY CHANGING THE
DELIVERY SYSTEMS. BOTH CANNOT
BEHAVIOR HOT SIGN IN THE MANAGED
CARE SITE AS WELL. WE HAVE BEEN
COMPREHENSIVELY ENGAGED WITH OUR
STAKEHOLDERS. AND AS I GO
THROUGH THROUGH EACH OF THE
COMPONENTS REALLY CAME OUT WITH
SOME POLICIES AT THE BEGINNING
AND HAVE TAKEN AND FEEDBACK TO
ITERATING QUITE CONTINUOUS
QUALITY IMPROVEMENT AS WE
CONTINUE TO ROLL OUT THE
POLICIES AND FURTHER
IMPLEMENTATION. ALL OF THE
INITIATIVE, I COULD. IS IT ALL
RIGHT, IF WE ASK A QUESTION HERE
OR THERE? I ACTUALLY PREFER THAT
IF YOU DON'T MIND YEAH, JUST I
THINK JUST IN OUR VARIOUS
ASSUMPTIONS OF OUR THOSE COUNTY
HANDLING SOME OF THE PLANS OR
OTHERS, RIGHT IS THAT IS THAT
PART WORKING? IS THAT THE BEST
THAT WE CAN DO? ARE WE FINDING
THROUGH THIS IMPLEMENTATION? I
THINK A LOT OF IT IS REALLY
HAVING CONVERSATIONS AND SOME OF
THE SPECIFIC POLICIES LIKE NO
WRONG DOOR, FOR EXAMPLE, THE
SCREENING AND ACCESS CRITERIA
HAVING REALLY SPECIFIC POLICIES
TO WORK THROUGH TO BUILD IN SOME
OF THOSE PARTNERSHIPS AND REALLY
KIND OF THE TRANSITION. OR THE
HANDS OFF AND KIND OF REALLY
TRYING TO TAKE THE MEMBER OUT OF
THAT EXPERIENCE, AND I WILL SAY,
EVEN JUST THROUGH OUR
CONVERSATIONS, WE HAVE A MEMBER.
ADVISORY COMMITTEE THAT WE
STARTED LAST YEAR AND JUST
HEARING DIRECTLY FROM OUR
MEMBERS ABOUT THOSE EXPERIENCES
AND THEN BRINGING THOSE
EXPERIENCES TO OUR PLANS IN
COUNTY PARTNERS ABOUT THIS IS
STILL HAPPENING, RIGHT? WE STILL
HAVE ISSUES TO ADDRESS AND JUST
TRYING TO CONTINUE TO WORK
THROUGH IT. IT'S NOT GOING TO BE
SOLVED OVERNIGHT. IT IS, YOU
KNOW, IT'S GOING TO TAKE TIME
BECAUSE THESE PROCESSES ARE SO
ENTRENCHED BUT REALLY TRYING TO
EVEN USE JUST LIVE EXAMPLES THAT
WE HEAR AND TRY TO TRIAGE WITH
OUR PARTNERS. OKAY SO FAR THAT
WE THINK THAT'S THE BEST
DELIVERY MODEL. HMM SEPARATING
THOSE TWO THINGS AS WE HAVE.
IT'S KIND OF THE MODEL THAT WE
HAVE TODAY. AND SO YOU KNOW, HOW
DO WE BEST KIND OF IMPLEMENT
THOSE CONNECTIONS AND
PARTNERSHIPS? OKAY. SO MAYBE
I'LL START WITH DOCUMENTATION
REDESIGN. THIS IS ONE OF THE KEY
COMPONENTS OF OUR BEHAVIOR
HEALTH INITIATIVES AS PART OF
KELLY. THIS INCLUDED EFFORTS TO
STREAMLINE AND SIMPLE,
SIMPLIFIED DOCUMENTATION
STANDARDS FOR OUR PROVIDERS
REALLY PRIOR TO LAUNCHING THIS
EFFORT, REQUIREMENTS FOR
ASSESSMENT, TREATMENT, PLANNING
AND DOCUMENTATION, VARIED ACROSS
DELIVERY SYSTEMS AND FUNDING
SOURCES AS WELL AND ACROSS
DIFFERENT FACILITY TYPES. SOME
OF THESE ARE REALLY OUTDATED
PROCESS. THIS IS IN PROCEDURES
THAT HAVE BEEN IN PLACE FOR MANY
YEARS AND HADN'T BEEN REVISITED
IN A LONG TIME. AND SO PART OF
THAT WAS WE INITIALLY PROVIDED
GUIDANCE IN 2022 REGARDING THIS
REDESIGN, AND AGAIN. THE GOAL
WAS TO REALLY REDUCE THAT KIND
OF ADMINISTRATIVE BURDEN, AND
SEVERAL ACTIONS WERE YOU KNOW
IMPLEMENTED. WE'VE WORKED WITH
OUR STAKEHOLDERS TO PROVIDE THAT
ADDITIONAL FEEDBACK AGAIN. THAT
WAS IN 2022, AND AS WE WERE
TRACKING IMPLEMENTATION EFFORTS
AND JUST KIND OF UNDERSTANDING
AREAS THAT MAYBE WE WEREN'T
TRACKING. FOR EXAMPLE, SOME
FEDERAL REQUIREMENTS THAT REALLY
ALSO WERE BURDENSOME TO OUR
PROVIDERS. WE CONTINUE TO KIND
OF ITERATE THROUGH THIS, AND WE
ULTIMATELY RECEIVED TWO FEDERAL
WAIVERS ESSENTIALLY FROM FEDERAL
AGENCIES TO FURTHER STREAMLINE
SOME OF THOSE FEDERAL
REQUIREMENTS. WE CONTINUED OUR
DISCUSSIONS WITH OUR PROVIDERS
AND OUR PLANS AND THEN
IMPLEMENTED ADDITIONAL GUIDANCE
IN 2023 TO REALLY KIND OF READ
WHAT WE'VE LEARNED AND HOW WE'VE
ADDRESSED SOME OF THOSE CHANGES.
IT REPRESENTS REALLY OVER THREE
YEARS OF FEEDBACK AS THE
COUNTIES AND PROVIDERS CONTINUE
TO IMPLEMENT THAT SO WE AGAIN
CONTINUE TO TAKE AND FEEDBACK
BUT REALLY ARE TRYING TO LEARN
AS WE ARE CHANGING SOME OF THESE
FUNDAMENTAL PRINCIPLES AND
POLICIES THAT HAVE BEEN IN PLACE
FOR A VERY LONG TIME. AND WHEN
YOU SAY WE WRITE, THIS IS FROM
THE DEPARTMENT. AND HOW ARE WE
MEASURING THE INTEGRATION DOWN
TO THE COUNTY LEVELS? SO THIS IS
SO THIS IS REALLY AND SO I COULD
MAYBE HAVE A KIND OF A LITTLE
ABOUT WE DID A QUALITATIVE
SURVEY OF OUR COUNTIES, OUR
PLANS AND OUR PARTNERS AND MAYBE
I'LL GO THROUGH ALL OF THE
FINDINGS AFTER I PRESENTED
NETWORK, OKAY, UM, BUT WE HAVE
WE'RE WE HAVE SOME QUALITATIVE
ASSESSMENT, AND WE ARE ALSO
TRYING TO WORK ON QUANTITATIVE
USING DATA CLAIMS DATA, FOR
EXAMPLE, IN SOME OF THESE AREAS
TO UNDERSTAND, BUT WE DON'T HAVE
THAT DATA YET. OKAY? DIRECTING
YOU SPOKE ABOUT YOU KNOW THESE.
PERHAPS SOME OF THE PROVIDERS
USING ANTIQUATED PROCESS FOR
DOCUMENTATION AND SO FORTH. I
WOULD LIKE TO ASK BECAUSE I'M
STILL HEARING SOME PROVIDERS
THAT SOME OF THE DOCUMENTATION
THEY STILL ARE COLLECTING IT
MANUALLY, FOR EXAMPLE, LIKE THE
BEHAVIORAL SCREENING IS DONE
MANUALLY IS CAUSING FURTHER
BURDEN TO THEN UPLOADED SOME
WONDERING WHAT TA WE'RE
PROVIDING, AND IF WE'RE REALLY
STANDARDIZING ACROSS COUNTIES
WHERE WE'RE STILL HEARING, SOME
PROVIDERS ON THE LOCAL LEVEL,
STILL HAVING DIFFICULTY WITH
THAT DOCUMENT IS GOING TO TAKE A
WHILE TO FULLY IMPLEMENT RIGHT
FOR US TO BE ABLE TO GET DOWN TO
EVERY SINGLE PROVIDER. IT'S NOT
REALLY FEASIBLE FOR THE STATE TO
TAKE ON THAT ROLE AND SO REALLY
WORKING WITH OUR COUNTIES AND
OUR SOME OF OUR ASSISTANCE FOLKS
TO KIND OF HELP ON THAT, BUT IT
IS A MATTER OF AS WE LEARN. WE
DO TRY TO ADDRESS BUT IT IS ONE
OF THE BIG THINGS WITH CALLUM.
IT'S REACHING COMMUNITIES AND
KIND OF DIFFERENT CBOS AND
PARTNERS WHO HAVEN'T AND THIS
MAY BE A LITTLE BIT DIFFERENT,
BUT HAVEN'T NECESSARILY BEEN
PART OF THE HEALTH CARE DELIVERY
LANDSCAPE AND SO BUILDING OUT
THOSE CONNECTIONS AND LU█T NOW
KIND OF THE LINES OF DIRECT
COMMUNICATION ON HOW TO DO THAT.
WE ARE THINKING ABOUT YOU KNOW,
HOW DO WE BUILD OUT OUR T A.
IT'S SOMETHING WE'RE NOT REALLY
RESOURCE TO DO. BUT HOW DO WE
BUILD OUT? TA REALLY. THE DIRECT
ENGAGEMENT WITH THE DEPARTMENT
AND PROVIDERS. THE SECOND
QUESTION REGARDED TO DATA
COLLECTION. AND YOU KNOW, I'M
I'M BARELY DIVING INTO ALL OF
THIS AND PLEASE EDUCATE ME ON
THIS ASPECT AS WE STANDARDIZED
DOCUMENTATION AND POTENTIALLY,
MAYBE WE'RE ASSUMING THAT
REMOVING SOME EXTRA THINGS
THAT'S NOT NEEDED TRYING TO MAKE
IT AS STREAMLINED AS POSSIBLE.
BUT WHAT IF ANY, HAVE WE HEARD
REGARDING SOME DOCUMENTATION
THAT IS HARD TO OBTAIN? THAT IS
IMPACTING PROVIDERS WHEN THEY
NEED TO SUBMIT THAT UP, BECAUSE
IT'S KIND OF IT REQUIRES THEM TO
DO HUMAN EFFORT. OR BETTER KNOWN
AS MAN HOURS TO FIND THIS
INFORMATION FROM THEIR CLIENTS.
STAFF HOURS. I'M NOT TRACKING
THAT CONCERN TO MAYBE I CAN
FOLLOW UP. IF YOU HAVE MORE
INFORMATION ON INFORMATION THAT
WE'RE NOW REQUESTING THAT MAYBE
WE HADN'T REQUESTED BEFORE. THE
REASON REASON TO BRING THIS UP
STRAIGHT. SOMETIMES THE NUMBERS
DON'T AREN'T CORRECT. HMM AND,
UM, EITHER SCREENINGS OR THE
MEDICAL PROFILE OF THE OF THE
PATIENT THAT IS REQUIRED. A LOT
OF PROVIDERS HAVE TO GO REALLY
LITERALLY INVESTIGATE WHERE THEY
ARE TO GET MORE INFORMATION TO
SUBMIT ON SOME OF THESE
DOCUMENTS. OKAY? MAYBE I CAN
FOLLOW UP WITH, YOU KNOW, I'M
NOT TRACKING THIS ISSUE. MADAM
DIRECTOR. MY BACKGROUND ARE
INDICATES THAT SOME OF THESE NEW
STANDARDIZED PROCEDURES DON'T
APPLY TO SOME ASPECTS OF THE
BEHAVIORAL HEALTH SYSTEM. FIFA
SERVICES DID I READ THAT RIGHT?
SO THE DOCUMENTATION REDESIGNED
PIECE THAT I JUST MENTIONED JUST
THIS PIECE RIGHT HERE APPLIES TO
COUNTY BEHAVIORAL HEALTH
DEPARTMENT. SO THE COUNTY
ESSENTIALLY MANAGED CARE PLAN
THIS DOES NOT APPLY TO FIFA
SERVICE. DOES THAT CREATE ANY
DIFFICULTIES? IT'S A DELIVERY,
DIFFERENT DELIVERY SYSTEM,
ESSENTIALLY MEDICAL FEE FOR
SERVICES IN KIND OF IN THE
BEHAVIORAL HEALTH SPACE, AND IS
THAT THE LINE ESSENTIALLY IS,
YOU KNOW, NON SPECIALLY
BEHAVIORAL ALSO MILD TO MODERATE
AND IN THE SPECIALTY. IT'S KIND
OF MORE THAN THE MORE SEVERE IN
THE MENTAL HEALTH. AND FOR
ADULTS AND THEN IN TERMS OF
SUBSTANCE USE MANAGED CARE AND
FEVER SERVICES, REALLY, BESIDES
SOME HIGH LEVEL SCREENING, IT'S
REALLY PROVIDED IN THE COUNTY
SIDE. THAT'S WHY I ASKED FOR IS,
IS THAT THE BEST WAY FOR US TO
BE PROVIDING THIS AND I THINK
THEY'RE STILL FINDING OUT. I
MEAN THE SPLIT BETWEEN SPECIALTY
AND NON SPECIALLY HAS BEEN IN
PLACE FOR A WHILE NOW, AND THIS
IS ALL PART OF REALIGNMENT AND
HOW WE'RE OBLIGATED COUNTIES TO
BE PART OF ESPECIALLY MENTAL
HEALTH AND DRUG MEDICAL SIDE OF
THE DELIVERY SYSTEM. THANK YOU.
OKAY SO THE NEXT POLICY TO MAYBE
QUICKLY TALK ABOUT IS THE NO
WRONG DOOR FOR MENTAL HEALTH
SERVICES. WE IMPLEMENTED THIS
WHAT WE CALL THE NO WRONG DOOR,
BUT IT IS FOR MENTAL HEALTH
SERVICES, REALLY? TO CLARIFY THE
RESPONSIBILITIES BETWEEN AGAIN
THE COUNTY MENTAL HEALTH PLANS,
WHICH IS MORE THE SPECIALTY
ASIDE MORE SEVERE SIDE FOR THE
ADULTS IN THE MANAGED CARE SIDE,
WHICH IS THE MILD TO MODERATE,
NON ESPECIALLY SERVICES. AND SO
THIS POLICY SEEKS TO FACILITATE
THE COORDINATION BETWEEN THE TWO
DIFFERENT DELIVERY SYSTEMS
WITHOUT SO THAT AN INDIVIDUAL NO
MATTER WHERE THEY SHOW UP, HAS
ACCESS TO SERVICES, REALLY,
REGARDLESS OF WHERE THEY SHOW
UP, INITIALLY SEEKING CARE.
UNDER THIS UNDER THIS POLICY
MEMBERS CAN GO THROUGH THE
ASSESSMENT PROCESS EVEN BEFORE A
DIAGNOSIS IS ESTABLISHED, SO IT
REALLY SHIFTS THE POLICY SO THAT
MEMBERS RECEIVE TIMELY MENTAL
HEALTH SERVICES AS SOON AS
POSSIBLE AND NOT REALLY
DEPENDENT ON A DIAGNOSIS OR KIND
OF BEING IN THE RIGHT DELIVERY
SYSTEM AGAIN. REALLY THE GOAL OF
THIS WAS TO STREAMLINE THE
EXPERIENCE FOR THE MEMBER SO
WHEREVER THEY SHOWED UP, THEY
WERE, YOU KNOW THEY COULD GET
THIS SERVICES AND TREATMENT THEY
NEED. UM WE PART OF THIS IS
REALLY CLARIFYING AND A LOT OF
THIS IS ABOUT THE KIND OF THE
FINANCIAL RESPONSIBILITY BETWEEN
THE TWO SYSTEMS. WE CLARIFIED
THAT SERVICES ARE COVERED AND
REIMBURSED, EVEN WHEN THEY ARE
PROVIDED PRIOR TO SOMEONE BEING
DETERMINED WHAT THE DIAGNOSIS
CODES MIGHT BE IN PRIOR TO
DETERMINE KIND OF MEDICALLY AN
ASSESSOR CRITERIA AGAIN. THIS
MEANS IF SOMEONE RECEIVES AN
ASSESSMENT FROM THE COUNTY
MENTAL HEALTH PLAN FOR SPECIALLY
MENTAL HEALTH SERVICES ALL
SERVICES PROVIDED DURING THAT
ASSESSMENT PERIOD WILL BE REAL.
BURST EVEN IF THE MEMBER DOES
NOT MEET, ESPECIALLY MENTAL
HEALTH CRITERIA. SO AGAIN,
REALLY TRYING TO TAKE THE MEMBER
OUT OF THIS KIND OF THE SPLIT
BETWEEN THE TWO DELIVERY SYSTEM
SYSTEMS, AS NOTED, ABOVE, WE
ALLOW FOR CONCURRENT TREATMENT
FROM BOTH DELIVERY SYSTEMS. SO
CAN COUNTY MENTAL HEALTH AND
MANAGED CARE FOR MEMBERS WHO
MEET THE CRITERIA FOR BOTH OF
THE SIXTH SYSTEMS. AND SO JUST
AS AN EXAMPLE, IF A MEMBER HAS
BEEN SEEN A THERAPIST THROUGH
THE THERE WERE MANAGED CARE PLAN
, AND THEIR NEEDS CONTINUE TO
ESCALATE, AND THEY RECEIVE A
REFERRAL TO THE COUNTY
BEHAVIORAL HEALTH PLAN. THEY CAN
CONTINUE TO SEE THE PROVIDER
WITH WHOM THEY'VE HAD BUILT THAT
ESTABLISHED RELATIONSHIP. SO
LONG AS THE SERVICES ARE
COORDINATED AND NOT DUPLICATE,
AND THIS IS REALLY IN
PARTICULARLY IMPORTANT FOR OUR
CHILDREN AND YOUTH WERE THAT
KIND OF THAT BRIGHT LINE BETWEEN
THE SERVICES IS NOT NECESSARILY
AS CLEAR AS IT IS FOR THE FOR
THE ADULTS. THIS ALSO, THIS
POLICY ALSO CLARIFIES THAT
MENTAL HEALTH SERVICES ARE
COVERED AND REIMBURSABLE, EVEN
IF A MEMBER HAS A CO OCCURRING
SUBSTANCE USE DISORDER NEED AS
LONG AS AGAIN THEY ARE
COORDINATED AND NOT DUPLICATED.
SO WE ISSUED WHAT WE CALL
BEHAVIOR. HEALTH INFORMATION
INFORMATION NOTICES OUTLINING
THESE POLICIES BACK IN 2022 AND
AGAIN, WE CONTINUE TO REVISE AND
REALLY THINK ABOUT THESE
POLICIES AND AS THEY GET
IMPLEMENTED IN TRYING TO LEARN
AS YOU KNOW, COUNTIES AND
MANAGED CARES PLANS HAVE THESE
EXPERIENCES. IF I MEET HER
DIRECTOR, LOOKING FORWARD OR NOT
EVEN LOOKING FORWARD, BUT SO
YOU'RE SO WE FEEL LIKE WE'RE
GETTING TO THE PLACE WHERE EVEN
IF YOU'RE IF YOU'RE HAVING SOME
EMOTIONAL ISSUES, YOU WANT TO GO
FOR COUNSELING ALL THE WAY TO BE
COMMITTED TO SECURE, SECURE
FACILITY. WE'RE THERE IS A NEED
TO BE ANY PRE AUTHORITY OF THAT.
SO AGAIN THE QUESTION I'M
GETTING A LOT OF QUESTIONS ON
IMPLEMENTATION OF SP 43 AND HOW
PEOPLE ARE GOING TO BE ABLE TO
BUILD FOR THAT RIGHT. SO WE'RE
TALKING ABOUT NO WRONG DOOR
WOULD NOT APPLY IN THE SAME. NO
WRONG DOOR REALLY WAS SPECIFIC
TO MENTAL HEALTH BECAUSE OF THE
SPECIALLY MENTAL HEALTH CRITERIA
VERSUS THE MENTAL HEALTH, THE
NON ESPECIALLY MENTAL HEALTH
CRITERIA, YOU KNOW, SUBSTANCE
USE ONLY IS REALLY COUNTY
BEHAVIORAL HEALTH PLAN KIND OF
RESPONSIBILITY AGAIN. MANAGED
CARE PLANS HAVE VERY LIGHT, MORE
ASSESSMENT SCREENING OBLIGATIONS
THERE AND SO I THINK, YOU KNOW.
IN PATIENT, YOU KNOW, THAT IS
ESPECIALLY MENTAL HEALTH
CRITERIA. THEY NEED TO MAKE SURE
THAT THEY MEET THE KIND OF THE
CRITERIA TO ACHIEVE INPATIENT
ADMISSION. OKAY I THINK WE'LL
TALK MORE. HOW HOW IS THE
REIMBURSEMENT ACTUALLY WORKING
BECAUSE THEY'RE DIFFERENT
FUNDING STREAMS. SO HOW IS THAT
WORKING SMOOTHLY? SEAMLESSLY I
THINK I HAVEN'T HEARD ISSUES
WITH FUNDING. YEAH INITIATIVE,
OKAY. OKAY UM, THE NEXT, UH,
INITIATIVE IS OUR ADULT ANY OF
THE SCREENING AND TRANSITION
CARE? I THOUGHT YOU WERE. SORRY
SORRY, DIRECTOR. I KNOW YOU
MENTIONED WRONG DOOR BEHAVIOR
HEALTH, BUT WE'RE I DON'T KNOW
IF YOU HEARD HAVE YOU BEEN
HEARING FEEDBACK REGARDING WE
ANNOUNCED A NEW SERVICE
ELIGIBILITY AND A CONSTITUENT OF
PERSONS LIKE OH, MY GOSH, I'M
ELIGIBLE FOR THAT. THIS IS A NEW
ELIGIBILITY. I'M GOING TO GO TO
MY LOCAL CLINIC. QUÊ HC OR WHAT
HAVE YOU AND SAY, HEY, I'M HERE
FOR THIS SERVICE. HOWEVER THE
GUIDELINES HAVE NOT BEEN
DISTRIBUTED YET WHERE I'M
WONDERING IF WE PUT IT INTO
THOUGHT. WHERE DID I LOSE? YOU
DID I'M LOOKING AT YOU
CORRECTLY? UM, WHERE INSTEAD OF
ANNOUNCING A NEW ELIGIBILITY
BEFORE WE HAVE THE GUIDELINES
FOR PROVIDERS, IF WE CAN ALIGN
THAT ANNOUNCEMENT, SO OUR
PROVIDERS ARE BETTER PREPARED TO
PROVIDE THIS NEW SERVICE INSTEAD
OF HAVING PEOPLE GO TO THEIR
LOCATIONS, AND I AM HERE FOR X Y
Z AND NOT REALLY BEING FULLY
PREPARED WITH THE GUIDELINES AND
SO FORTH. UM I APPRECIATE THE
COMMENT. I WOULD SAY WE'VE HEARD
THAT FOR SOME OF OUR OTHER
INITIATIVES. THIS ONE IN
PARTICULAR, JUST RELATED TO KIND
OF COUNTY UNDERSTANDING OF THESE
OBLIGATIONS AND OUR MEDICAL
MANAGED CARE PLAN UNDERSTANDING.
WE ISSUED THE GUIDANCE PRIOR TO
THE POLICY GOING LINE, BUT I
MEAN, I HEAR YOUR FEEDBACK ON
SOME OF THE OTHER, YOU KNOW,
ITEMS THAT WE'VE ROLLED OUT IN
TERMS OF ENSURING WE PROVIDE,
YOU KNOW, WE GENERALLY
COMMUNICATE WITH OUR MEDICAL
MANAGED CARE PLANS, AND THEN THE
PLANS ARE OBLIGATED TO REALLY
PROVIDE THE GUIDANCE TO THE
PROVIDERS THAT THEY CONTRACT
WITH. AND YOU KNOW, IT IS
SOMETHING THAT WE ARE TRYING TO
DO A BETTER JOB AT IS THE DIRECT
RELATIONSHIP TO THE PROVIDERS,
BUT OUR OBLIGATION IS WITH THE
MEDICAL MANAGED CARE PLANS AND
NOT EVERY ENTITY THAT THEY
SUBCONTRACT WITH IT. IN TERMS OF
SOME OF THESE NEW THINGS, WE ARE
TRYING TO DO BETTER THERE. BUT
IT IS IT IS KIND OF
UNDERSTANDING. WHO ARE ALL THE
NETWORKS. WHO ARE ALL THE
PROVIDERS OUT THERE THAT ARE
MEDICAL MANAGED CARE PLANS IN
OUR RESPONSIBILITY OR PART OF
JUST PART A WHERE WE SHARE WITH
THE PLANS, NEW ELIGIBILITY
SERVICES AND SO FORTH. ARE WE
PROVIDING SOME TIME FOR THEM TO
THEN DO THE LEGWORK FOR THEIR
CONTRACT. SERVICES VERSUS US WE
SHARE WITH THE PLANS SAY, HEY,
THAT'S OUR RESPONSIBILITY. WE
ARE NOW GOING TO ANNOUNCE IT TO
THE STATE OR IS THERE THAT'S
GIVEN? ARE THEY GIVEN SOME TIME?
SOME YES, SOME. NO I WILL BE
HONEST WITH YOU. I THINK SOME
WAY YOU KNOW THERE'S BEEN LOTS
OF ENGAGEMENT AHEAD AS THE
POLICY GETS DEVELOPED, AND THEN
THERE'S OTHER THINGS I WOULD SAY
WITH JUST COLLEEN. WE
IMPLEMENTED A LOT VERY QUICKLY,
AND SO YOU KNOW, THE RUNWAY MAY
NOT HAVE BEEN THERE FOR
EVERYTHING THAT WE ALL WOULD
HAVE HOPED FOR. BUT THAT'S WHY
SOME OF THESE THINGS, IT'S JUST
GOING TO TAKE A LITTLE BIT OF
TIME TILL THEY'RE FULLY, YOU
KNOW, FULLY. IMPLEMENTED AND
FULLY SCALED. AS WE'RE LOOKING
TOWARDS THE FUTURE OF ADDING
POTENTIAL NEW THINGS. OTHER
COUNTIES ADDING NEW SERVICES.
ARE WE TAKING THAT INTO
CONSIDERATION NOW AND PERHAPS
CREATING A LONGER RUNWAY? YES,
IT IS DEFINITELY FEEDBACK. WE'VE
HEARD FROM OUR PLANS TO. I MEAN,
WE ALL WANT THIS TO BE
SUCCESSFUL. AND SO THE MORE THE
RUNWAY WE CAN PROVIDE THE
BETTER. SOMETIMES WE'RE UNDER
DEADLINES AND IT YOU KNOW IT IS
THE PUSH TO ROLL OUT AND THEN
KIND OF CONTINUE THE ENGAGEMENT
AFTER THE POLICY ROLLS OUT,
LIKES NOT A HUGE FAN OF THAT
PROCESS, BUT OKAY, WE ARE
WORKING TO DO BETTER THERE. WE
UNDERSTAND. YEAH. OKAY THE NEXT
ONE IS THE ADULT AND YOUTH
SCREENING TRANSITION OF CARE
TOOLS FOR MENTAL MEDICAL MENTAL
HEALTH SERVICES UNDER CAL AIM,
WE IMPLEMENTED STANDARDIZED
STATEWIDE SCREENING AND
TRANSITION CARE TOOLS FOR OUR
MENTAL HEALTH SERVICES, AND THIS
BEGAN JANUARY 1 2023 COUNTY
BEHAVIORAL HEALTH PLANS AND ARE
MANAGED CARE PLANS HAVE BEEN
USING THESE TOOLS TO MAKE TIMELY
, ACCURATE REFERRALS TO THE
APPROPRIATE DELIVERY SYSTEM,
REGARDLESS OF WHICH COUNTY
MEMBER LIVES IN AS WELL. OR WHAT
PLAN THEY'RE ENROLLED IN IT FROM
THE MANAGED CARE SIDE. WE
PREVIOUSLY HAD MULTIPLE
SCREENING IN TRANSITION TOOLS
THAT WERE USED FOR OUR MEMBERS
ACROSS THE STATE, WHICH LED TO
INCONSISTENCIES IN TERMS OF HOW
MEMBERS WERE REFERRED TO COUNTY
BEHAVIORAL HEALTH AND HOW THEY
WERE REFERRED TO ARE MANAGED
CARE PLANS NETWORKS TO ENSURE
AND TO REALLY TRY TO FOSTER THE
ACCESS TO CARE FOR OUR MEMBERS.
WE HAVE STREAMLINED THE PROCESS
BY DEVELOPING ARE REALLY KIND OF
STANDARDIZING THE SCREENING TOOL
. WE HAVE A SEPARATE TOOL FOR
ADULTS IN A SEPARATE TOOL FOR
YOUTH. AND SO THE PURPOSE AND
THIS IS AGAIN FOR WHEN
INDIVIDUALS ARE COMING TO THE
SYSTEMS FOR THE FIRST TIME,
OTHERWISE THERE IN THE KIND OF
THEIR, UM, DELIVERY SYSTEM OF
CARE, THESE TOOLS PROVIDE A
REFERRAL TO THE APPROPRIATE
MENTAL HEALTH US DELIVERY SYSTEM
. SO AS PEOPLE CALL AND THE AS
THEY CONTACT EITHER PLAN ON THE
BEHAVIORAL HEALTH SIDE, OR THE
MEN MANAGED CARE SIDE THAT
INITIAL ASSESSMENT TO KIND OF IS
A TOOL THAT KIND OF EVALUATES
THE INDIVIDUAL AND THEN MAKES
KIND OF A YEAH. KIND OF AN
ASSESSMENT ON WHICH DELIVERY
SYSTEM SHOULD THEY SHOULD BE
REFERRED TO AS PART OF GETTING
THOSE SERVICES. THE SCREENING
TOOLS ARE NOT REQUIRED FOR USE
FOR USE FOR MEMBERS WHO REACH
OUT TO MENTAL HEALTH PROVIDERS
DIRECTLY TO RECEIVE SERVICES. SO
THIS IS YOU KNOW IF THEY SHOW UP
AT SOMEONE'S DOOR NOR THE
SCREENING TOOLS REQUIRED FOR
MEMBERS, WHO ARE REFERRED TO A
MENTAL HEALTH PROVIDER BY
ANOTHER PROVIDER, SUCH AS THEIR
PRIMARY CARE PROVIDER. MENTAL
HEALTH PROVIDERS WHO ARE
CONTACTED DIRECTLY BY MEMBER
SINKING MENTAL HEALTH SERVICES
ARE ABLE TO BEGIN THE ASSESSMENT
PROCESS AND PROVIDE SERVICES
DURING THE ASSESSMENT PERIOD
WITHOUT USING THE SCREENING
TOOLS AGAIN, CONSISTENT WITH THE
NO WRONG DOOR POLICY. IN
ADDITION TO THE SCREENING TOOLS,
WE HAVE DEVELOPED A TRANSITION
OF CARE TOOL TO ENSURE THAT
MEMBERS WHO ARE RECEIVING
SERVICES FROM ONE DELIVERY
SYSTEM ARE TRANSITIONED TO THE
APPROPRIATE DELIVERY SYSTEM AS
NECESSARY. SO THAT, UM WE ENSURE
THAT KIND OF THE CAPACITY AND
THE MOBILITY OF EACH DELIVERY
SYSTEM IS MAINTAINED TO SORT OF
KIND OF THE MEMBERS THAT FALL
INTO THOSE CRITERIA FOR THEIR
SYSTEM, THE DESIGN OF THE
SCREENING AND TRANSITION TOOLS
WE UNDERTOOK AN INTENSIVE TWO
YEAR PERIOD OF RESEARCH,
STAKEHOLDER ENGAGEMENT AND
TESTING IN PARTNERSHIP WITH SOME
OF OUR CLINICAL LEADERSHIP FROM
COUNTY MENTAL HEALTH PLANS AND
MANAGED CARE PLANS, ADVOCACY
ORGANIZATIONS AND PROVIDER
GROUPS. WE ISSUED GUIDANCE ON
THESE PROCESSES AND TOOLS BACK
AT THE BEGINNING OF 2023, AND
WE'VE IMPLEMENTED MANY PUBLIC
WEBINARS AND ON THIS AND SO
AGAIN, REALLY? THE GOAL OF THESE
IS TO ENSURE THAT MEMBERS ARE
RECEIVING SERVICES IN THE
APPROPRIATE DELIVERY SYSTEM IS
THAT IS HOW KIND OF THEIR MODELS
ARE DEVELOPED. AND HOW THESE
TOOLS BEEN RECEIVED BY YOUR
CUSTOMERS, SO I WILL SAY YOU
KNOW SOME COUNTIES AND PLANS.
IT'S DEFINITELY DIFFERENT BY THE
STATE VERY CONSISTENT THAT THE
WAY THE SCREENING TOOLS HAVE
KIND OF IDENTIFIED MEMBERS GOING
TO MANAGE CARE PLANS IN COUNTY
BEHAVIORAL HEALTH PLANS IS VERY
CONSISTENT WITH HOW THEY'VE BEEN
HOW IT'S BEEN RUNNING FOR THE
LAST, YOU KNOW, X MANY YEARS AND
SOME PLANS. IT'S BEEN A LITTLE
OR SOME COUNTIES. IT'S BEEN A
LITTLE BIT DIFFERENT, AND SO
THAT'S FOSTERING CONVERSATIONS
BETWEEN THE PLANS AND THE COUNTY
BEHAVIORAL HEALTH PLANS IN TERMS
OF REALLY IDENTIFYING WHAT IS
THE APPROPRIATE SETTING FOR THE
MEMBER WHERE SHOULD THEY BE
RECEIVING SERVICES? FOR EXAMPLE?
YOU KNOW, COUNTY BEHAVIORAL
HEALTH REALLY IS NOT LEAD ON
MILD TO MODERATE SERVICES,
RIGHT? AND SO INDIVIDUALS WHO
MAYBE HAVE, YOU KNOW HAVE ON A
PATH TO RECOVERY AND ARE STABLE.
MAYBE MAYBE THEY SHOULD BE
TRANSITIONING TO THEIR MEDICAL
MANAGED CARE PLANS AND REALLY
FOSTERING THAT CONVERSATION, SO
THE APPROPRIATE DELIVERY SYSTEM
IS REALLY PROVIDING THE CARE
BECAUSE WE WANT TO ENSURE ACCESS
AND WE DON'T WANT INDIVIDUALS
WHO MAY NOT NEED, YOU KNOW, A
HIGHER LEVEL OF CARE BEING IN
THE SYSTEM. IT SUPPORTS THE
HIGHER LEVEL OF CARE. SO IT IS.
IT'S DEFINITELY BASED ON COUNTY
KIND OF THERE'S NO STATEWIDE UM
YOU KNOW, IT'S DEFINITELY BASED
ON SOME OF THE COUNTY
RELATIONSHIPS. I DO THINK THAT
IT'S FOSTERING CONVERSATIONS
THAT YOU KNOW HAVEN'T HAPPENED
TODAY. THANK YOU. OKAY? I WANTED
TO PROVIDE JUST IN TERMS OF YOUR
QUESTION ABOUT YOU KNOW,
HOWEVER, WE DOING IN THE
EVALUATION SO JUST JUST A COUPLE
OF WEEKS AGO THE WEEK OF
FEBRUARY THE LAST WEEK OF
FEBRUARY, BELIEVE WE RELEASED A
REPORT HIGHLIGHTING SOME OF KIND
OF THE FEEDBACK WE'VE RECEIVED
WITH REGARD TO THESE POLICY
IMPLEMENTATION. UM, AND, UH, SO
THIS KIND OF THE COVERS OF
POLICIES THAT I JUST MENTIONED
AND WE CONDUCTED A STATEWIDE
SURVEY OF OUR MANAGED CARE PLANS
AND COUNTY BEHAVIORAL HEALTH
AGENCIES HAD DEEP DIVE
INTERVIEW. USE WITH A FEW PLANS
AND COUNTIES AND CONSUMER GROUPS
AND PROVIDERS ORGANIZATIONS JUST
TO GET KIND OF THAT QUALITATIVE
UNDERSTANDING FOR HOW THINGS ARE
GOING, AND IN TERMS OF THE
ROLLOUT OF THESE POLICIES WE DO
PLAN TO AND IT'S ALREADY STARTED
, BUT WE JUST DON'T HAVE THE
DATA CONDUCT CLAIMS ANALYSIS AS
WELL, TO HAVE AN UNDERSTANDING
OF, YOU KNOW, HOW ARE THINGS
DIFFERENT? HOW ARE THINGS
CHANGING AND, AS BRIAN WILL
MENTION AS PART OF PAYMENT
REFORM? WE'VE ALSO CHANGING THE
WAY WE ACTUALLY CLAIM FOR THESE
ACTIVITIES BECAUSE WE'RE REALLY
GOING TO GET DOWN TO MORE
REFINED UNDERSTANDING FOR WHAT
BEHAVIORAL HEALTH SERVICES ARE
PROVIDED AT THE COUNTY LEVEL,
BUT JUST KIND OF THESE ARE THE
THINGS THAT WE'RE THINKING
ABOUT. I WOULD SAY. MOST OF OUR
MANAGED CARE PLANS AND COUNTY
BEHAVIORAL HEALTH PLANS REPORT
THAT THE GREATEST SUCCESSES OF
CAL AIM INCLUDE REALLY THAT
IMPROVEMENT IN COORDINATION
BETWEEN THE TWO SYSTEMS
SUPPORTING MEMBERS BY PROVIDING
BETTER AND FASTER ACCESS TO CARE
BY REMOVING SOME OF THE BARRIERS
THAT WE'VE WORKED ATTEMPTING TO
ADDRESS, PARTICULARLY INCREASE
IN ACCESS TO CARE FOR YOUTH. AND
I WOULD SAY IN PARTICULAR, OR
FOSTER YOUTH, JUST GIVEN SOME OF
THE CHANGES IN THE CRITERIA FOR
ACCESS FOR OUR FOSTER YOUTH.
MAKING IT EASIER FOR MEMBERS TO
GET SERVICES IN THOSE
TRANSITIONS, AND THEN THE CARE
COORDINATION BETWEEN PLANS. I
THINK THE FEEDBACK WE RECEIVED
THAT WE HAVEN'T JUST NOT ENOUGH
TIME HAS PASSED TO REALLY
UNDERSTAND THE IMPACT OF THESE
INITIATIVES, BUT YOU KNOW, I
THINK AT THE LOCAL LEVEL,
CONTINUING TO REVISE THEIR WORK
FLOWS AND JUST KIND OF THAT KIND
OF CHANGE MANAGEMENT CHANGE
MANAGEMENT AT THE LOCAL LEVEL
THAT IS NEEDED TO REALLY FULLY
IMPLEMENT. STRUGGLING WITH THE
PACE OF ALL OF THESE EFFORTS,
AND HOW QUICKLY THESE THINGS
HAVE ROLLED OUT. YOU KNOW A LOT
OF WORK, AND SO YOU KNOW, I
THINK IT'S JUST GOING TO TAKE
SOME TIME TO SETTLE AND GET GET
THROUGH IT ALL. AND THEN THE
WORKFORCE CHALLENGES THAT WE ARE
ALL TRACKING AS PART OF THE
BEHAVIORAL HEALTH SPACE AND THEN
KIND OF SOME OF THE LIMITED
ADMINISTRATIVE CAPACITY TO
CONTINUE TO IMPLEMENT THESE UM,
WE USE THAT ON THE STATE SIDE OR
THE PLAN SIDE OR THE COUNTY SIDE
. THIS WAS FEEDBACK. WE HEARD
FROM OUR MANAGED CARE PLANS IN
OUR COUNTY BEHAVIOR, HEALTH
DEPARTMENT, THE CAPACITY TO DO
THE THINGS I CAN T BEHAVIOR,
HEALTH AND MANAGED CARE. I
THINK, PARTICULARLY COUNTY
BEHAVIORAL HEALTH. LET'S SEE
HERE. I THINK THE REFERRAL
TRACKING AND REFERRAL
COORDINATION IS SOMETHING THAT I
THINK WE ALL NEED TO WORK ON.
AND I WILL SAY AS PART OF OUR
MANAGED CARE CONTRACT THAT IS A
PROVISION THAT WILL ALSO GO LIVE
IN 2025 JUST THAT KIND OF CLOSED
LOOP REFERRAL, JUST REALLY A
BETTER WAY TO TRACK REFERRALS
BETWEEN SYSTEMS. UM I WILL SAY.
I THINK WE HAVE ABOUT 91% OF
SURVEY RESPONDENTS REPORTED THAT
MEMBERS ARE BEING NOW DIRECTED
TO THE APPROPRIATE DELIVERY
SYSTEM FOR THE INITIAL CLINICAL
ASSESSMENT BASED ON THE
SCREENING TOOLS AND SOME OF THE
MOST CONSTRUCTIVE FEEDBACK THAT
WE HEARD FROM BOTH ARE MANAGED
CARE PLANS IN OUR MENTAL HEALTH
PLANS IS THAT THE SCREENING
TOOLS CAN SOMETIMES LEAD TO
MEMBERS AS WE TALKED ABOUT GOING
DOWN TO THE WRONG SYSTEM,
DEPENDING ON HOW THEY KIND OF
HAD ESTABLISHED THEIR PROGRAM
BEFORE AND WHERE THEY ARE TODAY.
SO AGAIN, WE'RE CONTINUING TO
MONITOR THESE AND YOU KNOW, I
WANT TO MAKE IMPROVEMENTS AS
THEY CONTINUE TO ROLL OUT AND
ARE REALLY YOU KNOW, I THINK FOR
THE FIRST TIME EVER AT THE END
OF LAST YEAR, WE CONVENE ALL OF
OUR MEDICAL MANAGED CARE PLANS
AND ALL OF OUR COUNTY BEHAVIORAL
HEALTH DEPARTMENTS. IT WAS A BIG
KIND OF ALMOST A SUMMIT. AND
REALLY, I THINK PART OF THIS IS
ABOUT THOSE KIND OF THOSE LINKS
IN THOSE CONVERSATIONS AND
KNOWING I CAN YOU KNOW, I CAN
PICK UP THE PHONE AND CALL YOU
TO REALLY FACILITATE THOSE
CONVERSATIONS AND RELATIONSHIPS.
AND I THINK YOU KNOW BY DOING
THAT. I THINK WE'RE GOING TO
JUST CONTINUE TO IMPROVE WITH
THAT. I'M GOING TO TURN IT OVER
TO BRIAN TO DO A REALLY DEEP
DIVE IN THE PAYMENT REFORM
PIECE. DIRECTOR ROSS PERSEPOLIS.
SAY THANK YOU TO THE COMMITTEE
FOR ALLOWING US TO DISCUSS
BEHAVIORAL PAYMER REFORM. IT'S
NEAR AND DEAR TO ALL OF OUR
HEARTS AND REALLY LARGE
INITIATIVE JUST AS BACKGROUND,
ESPECIALLY MENTAL HEALTH
SERVICES AND SUBSTANCE USE
DISORDER SERVICES ARE RENDERED
THROUGH THE COUNTY BEHAVIORAL
DELIVERY SYSTEMS PRIOR TO
PAYMENT FORM. COUNTIES WERE
FINANCED FOR THOSE SERVICES
THROUGH CERTIFIED PUBLIC
EXPENDITURE PROCESS. THIS
PROCESS AND FINANCING MODEL WAS
EXTREMELY ADMINISTRATIVELY
BURDENSOME, OFTENTIMES TAKING
YEARS TO RECONCILE COST
REPORTING AND CLOSE OUT THE
BOOKS VERY CHALLENGING FOR
COUNTIES TO BUDGET AND FORECAST
UNDER THAT MODEL. SIMILARLY
COUNTIES DIDN'T HAVE THIS
INCENTIVE FOR PRODUCTIVITY NOR
PROVIDERS BECAUSE OF THE COST
RECONCILIATION REGARDLESS HOW
MANY MEMBERS A PROVIDER OF
COUNTY SAW THEY WOULD ALWAYS BE
RECONCILED THE COST THE COST IT
TOOK TO RENDER THOSE SERVICES
SIMILARLY, UNDER CAUSE BASED
RECONCILIATION. THERE WAS NO
ABILITY FOR COUNTIES TO REINVEST
ANY SURPLUS FUNDS. THE SURPLUS
FUNDS IN A COST BASED WORLD
WOULD BE RECOUPED BY THE
DEPARTMENT SENT BACK TO THE
FEDERAL GOVERNMENT. SO
UNDERPAYMENT REFORM ARE MOVING
AWAY FROM EXCUSE ME. COST BASED
RECONCILIATION. WE HAVE
IMPLEMENTED A FEE FOR SERVICE
MODEL WITH HER EYE TOWARDS A
VALUE BASED PURCHASING MODEL IN
FUTURE YEARS. ON TOP OF THAT
LAYER OF FINANCING. WE'VE ALSO
ASKED COUNTIES TO TRANSITION
THEIR CODING STRUCTURES, WHICH
IS A SIMILARLY LARGE LEFT,
SPECIFICALLY REMOVING FROM HIP
PICK LEVEL TO CODING TO CPT
CODING, AND THAT'S JUST A FANCY
WAY OF SAYING THAT COUNTIES
PRIOR TO PAYMENT REFORM WHERE
USING ABOUT A DOZEN CODES THAT
WERE VERY BROAD INSTRUCTOR
BOSTON SAID. WE DIDN'T GET A LOT
OF GREAT INFORMATION OFF OF IT.
WE WEREN'T REALLY ABLE TO SET
GREAT FINANCING MECHANISMS OFF
OF A DOZEN CODES. WE MOVE THEM
TO CPT CODE IN JULY 1 2023, AND
THAT'S 100. OF CODES VERY
GRANULAR AND WE'RE MUCH MUCH
BETTER POSITION TO ACTUALLY SEE
WHAT CARE IS RENDERED. ON TOP OF
THAT. IT'S A FEDERAL MANDATE
WHERE WE CAN MOVE TO CPT CODES
WE SHOULD AND THAT ALSO
POSITIONS COUNTY MENTAL HEALTH
PLANS TO BE ON PAR WITH OUR
COMMERCIAL INDUSTRY ARE MEDICARE
INDUSTRY AND THEN ALSO, OUR
MEDICAL MANAGED CARE PLANS NOW
WILL BE ABLE TO ACTUALLY SEE THE
DATA. IN A MUCH BETTER LIKE
APPLES TO APPLES COMPARISON AND
IT'S EASY ENOUGH TO BE ABLE TO
DO THAT HUNDREDS OF DIFFERENT
CODES. IT'S A CHALLENGE. THIS IS
COMPLICATED CODING IS
COMPLICATED. THERE'S AN ACTUAL
INDUSTRY JUST ON CODING. THAT IS
ACTUALLY ONE OF THE THINGS THAT
I THINK OUR TEAM IS
UNDERESTIMATED. IS THE LIFT ON
THE HRS FOR COUNTIES AND THE
AMOUNT OF MONEY IT TAKES TO
UPDATE THEM. THE VARIANCE
BETWEEN ELECTRONIC HEALTH RECORD
SYSTEMS BETWEEN THE COUNTIES
BECAUSE THEY GET TO CHOOSE THE
VENDOR AND THEN ALSO THE ABILITY
FOR PROVIDERS TO MAKE THAT
TRANSITION. SO THAT HAS BEEN A
BIG LIFT WHILE WE FOCUS A LOT ON
THE MONEY SIDE OF THINGS, CODING
IS EQUALLY AS CHALLENGING OKAY,
AND THAT'S ON THE PROVIDER OR
THAT'S ON THE PLAN. BOTH SO WE
SET A COACH SUCKS STRUCTURE
THROUGHOUT THE DEPARTMENT THAT
THE COUNTY MUST SUBMIT CLAIMS IN
THIS COACH STRUCTURE. THE COUNTY
THEN ALSO USES THOSE SAME CODES
AND REQUIRES PROVIDERS TO BUILD
THOSE CODES TO THEM, AND THAT
CAN VARY AS WELL FROM PLAN TO
PLAN. DOESN'T SOUND SIMPLE. IT'S
NOT ASK A QUESTION. ABSOLUTELY.
THANK YOU. SO TELL ME A LITTLE
BIT ABOUT THE PROVIDERS AND
THEIR TRANSITION. I MEAN, I KNOW
THAT I KIND OF STEPPED OUT AND
CAME BACK IN. BUT GIVE ME A
LITTLE BIT MORE IN TERMS OF OUR
PEOPLE CATCHING UP. WHERE DO YOU
SEE IT? ARE THEY STEPPING UP TO
THE PLATE OR THEY'RE BEHIND
IMAGES THAT BIG PICTURE? IT'S A
GOOD QUESTION. I THINK THERE'S
VARYING LEVELS OF APTITUDE AND
ABILITY IN THE STATE. I THINK
THAT IT VARIES COUNTY, THE
COUNTY PROVIDER TO PROVIDER WE
HAVE TRIED OUR BEST AT THE STATE
ALONG WITH OUR JOINT POWERS
AUTHORITY. CALL MASON TBH TO
KIND OF WRAP OUR ARMS AROUND THE
PROVIDER COMMUNITY AND ENSURE
THAT WE HAVE TECHNICAL
ASSISTANCE PROVIDED TO HIM.
WE'VE TRAINED THEM THROUGH
WEBINARS AND THINGS OF THAT
NATURE. I WOULD SAY SOME
PROVIDERS, TYPICALLY, THE MORE
RESOURCE PROVIDERS OR LARGER
PROVIDERS DO BETTER BECAUSE THEY
ARE ABLE TO MAKE THAT TRANSITION
QUICKER. THIS IS AN EVER
EVOLVING PROCESS. SO WE ARE ON
ITERATION FIVE OF OUR BUILDING
MANUAL FOR CODING SINCE PAYMENT
REFORM WENT LIVE, SO THERE'S
LOTS OF ITERATIONS AND MOVING
THIS FOLLOW UP TO THAT. SO DO
YOU FIND ANY THAT ARE, I'M JUST
GOING TO SAY. RESISTANT LIKE OR
HAVING A HARD TIME GETTING
THERE, JUST RESISTING THE CHANGE
, NOT FROM A CODING PERSPECTIVE.
I THINK PEOPLE UNDERSTAND THAT
THERE'S BENEFIT IN THIS. I THINK
CHANGE IS HARD AND AGAIN. VERY
AN APTITUDE AND ABILITY AND
FINANCING REALLY SHAKE OUT TO
MAKE A CHALLENGING. I THINK
THAT, YOU KNOW. THERE IS
VARIANCE BETWEEN COUNTIES AND
I'M SURE OUR PROVIDER PARTNERS
IN THE GALLERY WILL ATTEST TO
THIS. THERE'S VARIANCE BETWEEN
COUNTIES, SO IF YOU OPERATE
BETWEEN COUNTIES, IT CAN BE A
CHALLENGE. IF THEY HAVE TWO
DIFFERENT CODING STRUCTURES
AGAIN. WE MEET WITH PROVIDERS
AND PROVIDER ASSOCIATIONS ARE
COUNTIES. EVERY OTHER WEEK OR
SO, TO TRY TO SUSS THESE THINGS
OUT, WHETHER IT'S A SYSTEMIC
STATEWIDE ISSUE OR IF IT'S A
COUNTY SPECIFIC ISSUE TO TRY TO
MAKE IT A LITTLE MORE SEAMLESS
AGAIN. CATALIN PAYMENT REFORM
SPECIFICALLY, WE'RE TRYING TO
MAKE THIS EASIER, NOT HARDER,
BUT THAT TRANSITION IS GOING TO
TAKE SOME TIME TO SMOOTH OUT. I
WOULD SAY ONCE WE START TO FOCUS
ON VALUE BASED PURCHASING, IT
WILL BE NICE TO HAVE THOSE CODES
IN PLACE SO WE CAN ACTUALLY LOOK
AT WHAT'S HAPPENING. AND PROVIDE
A BETTER FINANCING STRUCTURE.
AND THEN THAT NEXT TRANSITION
WON'T HAVE A CODING COMPONENT TO
IT. WE'RE KIND OF MOVING TO
TRAINS AT ONCE. THANK YOU.
WELCOME TO THE CODES. THE CODES
THEMSELVES CHANGE THE CPT CODES
THEMSELVES CHANGE COUNTY TO
COUNTY, OR IS IT JUST TO
TRANSITION BETWEEN THE OLD
SYSTEM TO THE CPT SYSTEM? THAT'S
THE PROBLEM BOTH SO, YEAH, SO IT
DEPENDS ON HOW COUNTIES CAN
IMPLEMENT THEIR CODING
STRUCTURES. TYPICALLY, THEY'RE
THE SAME GOING FORWARD.
BACKWARD, BUT SAY, FOR EXAMPLE,
PROVIDER GOES IS CROSS COUNTY
AND THEY HAVE ONE SET OF
SERVICES THEY RENDER IN ONE
COUNTY, A AND ANOTHER SET OF
SERVICES LIKELY THE SAME OR
SIMILAR. THERE MAY BE A PARING
DOWN OF CODES BASED ON THE
COUNTY. THAT'S AN INDUSTRY
STANDARD THAT WHERE THE ACTUAL
PAIR THEMSELVES CAN PICK THE
CODING STRUCTURE AS LONG AS
THOSE CODES THAT ARE BUILT IN TH
CS OR IN ALIGNMENT WITH WHAT OUR
BILLING MANUAL SAYS. SHOULDN'T
WE HAVE STANDARDIZED CODES OF
THE STATE IS DELIVERING,
PROVIDING THE CODES FOR THE THEM
TO BE ABLE TO USE. CORRECT
THEY'RE LARGE. THEY'RE LARGELY
THE SAME CODES, BUT COUNTIES CAN
PROVIDE DIFFERENT MODIFIERS TO
THOSE CODES AND ALSO ADD ONS TO
THOSE CODES IN ORDER TO TRACK
FINANCING AND OTHER LOCALIZED
THINGS THAT THEY NEED FOR
REPORTING CERTAINLY MUST MAKE IT
DIFFICULT FOR YOU TO DO AN
ANALYSIS. IF THAT WAS ALL
PURPOSE, TRANSITIONING TO CPT
CODES IF YOU CAN'T RELY ON
HAVING THE SAME CODES, COUNTY TO
COUNTY HAVE THE SAME CODES WHEN
THEY COME THE DHC S. THERE'S
BACK CROSSWALKS FROM THE
PROVIDER TO THE COUNTY COUNTY TO
THE STATE. THE COUNTY WILL
ACTUALLY CROSSWALK THE CODES
THAT THEY'VE GIVEN THE PROVIDERS
TO THE MANDATED STANDARDIZED
CODES AT DHC S. WHY WOULDN'T WE
JUST NOT ALLOW THAT AND JUST
HAVE A COMPLETE WE DON'T HAVE
THE AUTHORITY TO DO THAT. UNDER
CURRENT CONTRACTS, AND THAT WE
DON'T DO THAT, NOW AND OTHER
OTHER SPACES LIKE OUR PHYSICAL
MANAGED CARE PLANS. AND THAT'S
NOT AN INDUSTRY. SO IF THEY
BUILD SAY THEY HAVE TO BUILD
COMMERCIAL INSURANCE BLUE SHIELD
IS GOING TO BE DIFFERENT THAN
KAISER OR MEDICARE. WHILE WE'RE
ALL USING CPT CODES, THERE'S
DIFFERENT WAYS TO BUILD. THIS IS
AN INDUSTRY PROBLEM, NOT A
PAYMENT REFORM ISSUE, BUT WE DO
WE ARE MEETING WITH OUR PROVIDER
ASSOCIATIONS KIND ENOUGH TO
REALLY TRACK A LOT OF THE
VARIANCES AND DO A REALLY GOOD
JOB OF SAYING, HEY, THIS IS THE
PROBLEM FOR OUR PROVIDERS,
ESPECIALLY SMALL PROVIDERS THAT
ARE BETWEEN ONE AND 234
COUNTIES. HOW DO WE WHAT
AUTHORITY DOES DEPARTMENT HAVE?
AND WHAT CAN WE PROVIDE TWO
COUNTIES? THIS IS SOMETHING THAT
WE'RE ACTIVELY LOOKING AT ONE OF
THE HIGHEST PRIORITIES. YEAH HOW
HOW IS THE PAYMENT NEGOTIATION
PROCESS WORKING WITH RESPECT TO
PROVIDERS. THAT IS, THAT'S A
GOOD QUESTION AS WELL. THAT'S
BEEN SO WE'D LIKE TO TAKE IT
JUST A STEP BACK AND GIVE SOME
CONTEXT TO HOW WE SET RATES. SO
WE AT THE STATE ALONG WITH OUR
PARTNERS AT THE COUNTY SEAT BHD
AND CALL ME SO WE TOOK THREE
YEARS TO DEVELOP A RATE
STRUCTURE THAT WASN'T IN ONE
SIZE FITS ALL. WE DEVELOPED 12
DIFFERENT RATE METHODOLOGIES
THAT REALLY TRIED TO GET AT
MAXIMIZING FEDERAL FUNDS TO GET
AT WHAT ARE THE LOCAL DRIVERS OF
COSTS BECAUSE CALIFORNIA IS MORE
LIKE A COUNTRY THAN A STATE, AND
SO YOU KNOW, NORTHERN CALIFORNIA
AND SAN DIEGO MAY NOT HAVE THE
SAME COST DRIVER SO REALLY
TRYING TO PARSE THAT OUT. AND
THEN ALSO SEGMENTING OUR
SERVICES OUT TO SAY, OKAY,
INPATIENT SERVICES. REALLY THE
COSTS AND PAYMENTS FOR THEM
REALLY AREN'T LIKE OUTPATIENT
SERVICES. THERE ARE TWO
DIFFERENT WORLDS, AND SO WE
SPENT A VERY, VERY LONG TIME IN
BEING MINDFUL OF THOSE
DEVELOPMENTS, AND WE'VE GOT SOME
REALLY GREAT TALKING POINTS
ABOUT WHAT WE'VE BEEN ABLE TO
ACHIEVE. IN THAT SENSE. ALL THAT
TO BE SAID IT TOOK LONGER THAN
ANTICIPATED, AND WE GAVE
COUNTIES RATES VERY LATE IN SOME
INSTANCES, SO SAY, FOR EXAMPLE,
PAYMENT REFORM WENT LIVE. JULY 1
2023 SOME OF THE LAST RATES THAT
WE GAVE THEM. WE'RE IN MARCH AND
APRIL, AND SO THEY HAD TO TURN
THOSE AROUND, MODEL THEM AND
THEN NEGOTIATE THOSE RATES WITH
THEIR PROVIDER GROUP. I WOULD
SAY OVERALL COUNTIES ARE
UNDERSTANDING THAT THIS IS A
VERY SHORT RUNWAY FOR THEM, BUT
OVERALL THEY'RE GETTING A GREAT
RATE UP FRONT FROM THE STATE OF
THE COUNTY. THEY HAVE COMMITTED
IN GENERAL TO REALLY BEING
MINDFUL ABOUT THE RATE
DISCUSSIONS WITH THEIR PROVIDER
GROUPS, AND THEY HAVE ALSO
COMMITTED IN GENERAL TO
REASSESSING THOSE CONTRACTS
EVERY SIX MONTHS. EVERY YEAR.
I'VE SEEN SOME REALLY CREATIVE
FINANCING LIKE 112 CONTRACTING,
WHERE THEY HAVE A CONTRACT, SAY
FOR A MILLION DOLLARS FOR A YEAR
EACH MONTH, YOU'RE GOING TO GET
THAT 1/12 OF THAT MILLION
DOLLARS AND THEN WE'LL TRUE IT
UP AT THE END OF THE YEAR. JUST
SO YOU KNOW YOU HAVE REVENUE
STREAMS. THEY'RE ALSO SEEING
ALTERNATIVE PAYMENT MODELS LIKE
THROUGH L A WHERE THEY'RE
INCENTIVIZING. CERTAIN
ACTIVITIES FOR PROVIDERS TO
BECOME PROVIDE ADDITIONAL
SERVICES, YOU KNOW, AND REALLY
BE ROBUST IN THEIR SERVICES WHEN
THE MEMBER IS THERE, AND THEY'RE
OPPOSITES, BUT I WOULD SAY FIRST
YEAR WE'RE JUST GETTING THIS OFF
THE GROUND, AND IT'S MAKING SURE
THAT THE PROVIDERS ARE IN A
POSITION TO STAY SOLVENT AND
THAT WE'RE REALLY WORKING
TOWARDS MAINTAINING THOSE
PROVIDER NETWORKS. AND THEN NEXT
YEAR WE'RE REALLY FOCUSING ON
HOW DO WE SHIFT OUR BEST HERE
TOWARDS THOSE LIKE CREATIVE
FINANCING MODELS THAT REALLY
MAXIMIZED COVERAGE AND CARE SO
JUST QUICK QUESTION. SORT OF
TWOFOLD ONE. HAVE YOU RECEIVED
COMPLAINTS FROM PROVIDERS ABOUT
THE PAYMENT REFORM? YES, AND TO
HAVE YOU NOTICED, EVEN THOUGH
WE'RE EARLY INTO THIS. HAVE YOU
NOTICED ANY DIMINUTION IN THE IN
THE PANEL OF PROVIDERS AVAILABLE
AT THE COUNTY PLANS TO DECREASE
WE HAVE SEEN DECREASES. THAT'S
TYPICAL, THOUGH DECREASES
INCREASES. WHAT WE HAVE SEEN IS
THAT WHEN MY WHENEVER WE GET A
CLAIM, SOMEBODY RAISES THEIR
HAND TO SAY, HEY, WE'RE GOING TO
CLOSE THE LINE OF BUSINESS OR
BUSINESS IS GOING TO CLOSE ALL
TOGETHER. THEY TYPICALLY SITE
PAYING REFORM AS AN ISSUE. WHAT
WE HAVE WE INVESTIGATE ALL OF
THOSE, WHETHER IT'S WITH THE
COUNTY OR THE PROVIDER OR BOTH,
AND WE FIND SOME UNDERLYING
TRENDS WITH THAT, WHERE
OFTENTIMES THE ISSUE IS PREDATED
PAYMENT REFORM AND THAT THE
TRANSITION TO A FEE FOR SERVICE
MODEL EXACERBATED THE ISSUE A
LOT OF TIMES AS CENTERS AROUND
DIRECT PATIENT CARE TIME AND SO
WHAT WE'VE SEEN WAS SOME
PROVIDERS WHERE THEY HAVE RAISED
THEIR HANDS, SAYING I HAVE TO
EXIST. EXIT THE MEDICAL SYSTEM.
IT'S BECAUSE THEY HAVE SAY, FOR
EXAMPLE, 15% PRODUCTIVITY AND SO
THAT MEANS THAT 85% OF THEIR
TIME AND I'M NOT SEEING MEMBERS
AND 15% OF THE TIME. THEY ARE
NOT TO SAY THAT THAT'S BAD
BUSINESS PRACTICE, BUT UNDER A
FEE FOR SERVICE MODEL THAT YOU
CAN'T STAY SOLVENT THAT WAY, A
LOT OF IT CENTERS AROUND
STAFFING ISSUES. THAT'S AN
INDUSTRY ISSUE. THAT'S NOT JUST
MEDICAL ISSUE TRYING TO FIND
CLINICIANS. IT'S JUST
IMPOSSIBLE. AND THEN OUR SYSTEM
IS THE MOST CHALLENGING TO
PROVIDE SERVICES IN SO THEY'RE
COMPETING WITH SCHOOL DISTRICTS
AND COMMERCIAL PLANS WITH MILD
AND MODERATE AND THEY'RE MAKING
MORE IN THOSE AREAS TOO SO
PAYMENT REFORM IS TRYING TO
ADDRESS THOSE CONCERNS. I WOULD
ALSO SAY THAT WE HAVE SOME
STANDARDS WITHIN THE MENTAL
HEALTH CONTRACTS THAT REQUIRE
THEM TO NOTIFY THE DEPARTMENT OF
ANY SIGNIFICANT NETWORK CHANGES
SINCE PAYMENT REFORM WENT LIVE.
WE'VE HAD SEVEN OF THOSE THREE
OF THEM HAVE CITED PAYMENT
REFORM. THE DEPARTMENT HAS
INVESTIGATED ALL SEVEN OF THEM.
BUT AGAIN, THAT'S KIND OF JUST
PART FOR THE COURSE YOU KNOW YOU
HAVE PROVIDERS EXIT AND ENTER
THE PROGRAM. OFTENTIMES WHAT
WE'RE ALSO SEEING IS THAT
COUNTIES ARE SWITCHING
UTILIZATION FROM CONTRACT
PROVIDERS BACK TO THE COUNTY
PROVIDERS. AND SO WHILE IT
PROVIDER MAY EXIT BECAUSE
THERE'S LOW PRODUCTIVITY THEY
CAN'T YOU KNOW THERE'S NO PROFIT
THERE. THERE'S NO MARGINS THERE.
THE COUNTY WILL ABSORB THE OR
PROVIDE OR SEND IT TO ANOTHER
PROVIDER THAT MAY BE ABLE TO
PROVIDE A LITTLE BIT MORE
EFFICIENCY REGARDLESS OF THE
COMPLAINTS. AND CAN YOU TELL ME
HOW THE SERVICE RATE COMPARES
GENERALLY TWO ON THE AVERAGE TO
THE COST REIMBURSEMENT. SURE, WE
HAVEN'T DONE AND ANALYSIS OF
THAT WE WERE WORKING WITH CAL
MISA TO DEFINE AN ANALYSIS OF
HOW WELL PEOPLE ARE DOING PRE
IMPOSED PAYMENT FORM. IT IS NOT
APPLES TO APPLES YET AND I WOULD
ALSO LIKE TO SAY OUR DATA ISN'T
THERE. THERE'S THING CALLED
CLAIMS LAGS. SO WE LIKE TO THINK
OF CLAIMING AS REAL TIME
SERVICES RENDERED, IT GETS BUILT
. IT GETS PAID THAT DAY AND THEN
WE KNOW EXACTLY WHAT'S
HAPPENING. YEAH THAT'S NOT HOW
IT'S PROBABLY HAVE TO. IF IT'S
HOSPITAL IS PROBABLY 90 DAYS OR
MORE RIGHT? YEAH COUNTIES WERE
ABOUT SIX MONTHS AT TIMES. SO WE
ARE EIGHT MONTHS INTO PAYMENT
REFORMS. WE'RE FINALLY SEEING
CLAIMS DATA COME IN. OKAY THANK
YOU. SIMILAR BUT NOT WITHIN THE
PAYMENT REFORM. CAN WE TALK
ABOUT I CAN. I CAN IMAGINE THIS
IS ADDING AN ADDITIONAL LAYER OF
DIFFICULTY REGARDING OUR RECENT
PUBLICATION OF THE OF RATES AND
ON OUR STATEWIDE AND THEN
PROVIDERS SEEING THAT NOT
MATCHING UP TO WHAT THEY'RE
GETTING. SURE IF THAT'S A REALLY
GOOD QUESTION AND A POINT OF
CONTENTION FOR A LOT OF FOLKS
FROM THE COUNTY PERSPECTIVE, IT
PUTS THEM AT A DISADVANTAGE FROM
A LEVERAGE PERSPECTIVE TO SAY,
YOU KNOW, HERE'S WHAT THE COUNTY
IS BEING PAID PROVIDERS WANT TO,
YOU KNOW, HAVE A LARGE WHAT THEY
QUALITY PASS THROUGH THAT RATE.
BUT WHAT I THINK WHAT GETS
MISSED IN A LOT OF THIS IS THAT,
UM COUNTIES ARE PAID ONE RATE
FOR A SERVICE AND THE COUNTY HAS
TO BUDGET A GLOBAL BUDGET FOR
ALL SERVICES. THERE MAY BE A
LOSS IN THERE SOMEWHERE AND
WHERE THEY HAVE A PROFIT, THEY
NEED TO ACTUALLY TAKE SOME OF
THAT PROFIT AND APPLY IT TO THE
LOSS. WE'RE SEEING THAT BETWEEN
OUTPATIENT SERVICES AND
PSYCHIATRIC INPATIENT SERVICES.
THE DEPARTMENT IS WORKING WITH
CMS TO TRY TO RESOLVE THE LOST
COMPONENT OF THIS, THEY'RE
REDUCING THEIR RATES OVER HERE
WITH ONE PROVIDER TO ACCOMMODATE
FOR THIS OTHER ISSUE. AND I
WOULD ALSO SAY THAT AT TIMES,
EVEN WITHIN A LIKE SPECIFIC SET
OF SERVICES. THE COUNTIES ARE
REALLY TRYING TO SAY, OKAY, WHAT
DOES YOUR BUSINESS NEED TO HAVE
FINANCING WISE TO REMAIN SOLVENT
. SO SAY, FOR EXAMPLE, A CLINIC
BASED CLINIC BASED PROVIDER WHO
HAS LOTS AND LOTS AND LOTS OF
PATIENTS COME THROUGH ON A FEE
FOR SERVICE BASIS. THEY'RE GOING
TO DO GREAT. THEREFORE THEIR
RATE MIGHT BE A LOT LESS THAN
WHAT THE DEPARTMENT IS PAYING
THE COUNTY BECAUSE THE COUNTY
ALSO HAS TO PAY THE PROVIDER
THAT'S PRIMARILY FIELD BASE.
THAT'S ONLY GOING TO SEE ONE OR
TWO PATIENTS DURING THE DAY, SO
THEIR RATES MAY BE MUCH, MUCH
MORE THAN WHAT'S PUBLISHED ON
THE DHC S WEBSITE AND WHAT WE
PAY TO THE COUNTY. DO WE HAVE
ANY INSIGHT ON MOVING FORWARD TO
A CAPITATION SYSTEM? WE'RE
LOOKING FORWARD TO THAT. AND
AGAIN. WE'RE IN THE INFANCY OF
PAYMENT REFORM. I CALL IT 1.0
AND 2.0 IS AS COMPLEX WHEN WE
MOVED TO RISK BASED CAPITATION
SIMILAR TO OUR PHYSICAL HEALTH.
MANAGED CARE PLANS REQUIRES
ACTUARIAL SOUNDNESS. THERE'S A
LOT OF OTHER THINGS THAT GO INTO
IT. SO WE ARE MANY YEARS OUT
FROM THAT. SO IT IS NOT. THIS IS
NOT GOING TO BE NEXT YEAR TYPE
THING. OKAY THIS IS ALMOST
CAPITATION. IF THE COUNTY'S
BALANCED RISK AND YOU'RE YOU'VE
GOT A PLAN THAT HAS CERTAIN FEES
FOR CERTAIN C P T S OR WHATEVER.
BUT THE COUNTY CAN SAY WELL, I'M
LOSING MONEY OVER HERE ON THIS
FOR THIS FEE THAT YOU'VE GIVEN
ME. I'M GONNA TAKE IT AWAY FROM
THIS ONE AND SHIFTED OVER HERE.
THAT'S THAT'S RISK BASED
CAPITATION SORT OF, ISN'T IT AS
I UNDERSTAND IT, YES. SO
RESPECTS, CAPITATION TENDS TO BE
A PER MEMBER PER MONTH, RIGHT?
EXCEPT WHAT WE'RE DOING IS THE
COUNTY IS GOING TO GET A BUNCH
OF MONEY FOR SERVICES. AND THEY
JUST MOVE IT AROUND. YEAH I
THINK THAT FEE FOR SERVICE IS
FUNDAMENTALLY DIFFERENT THAN
RISK BASED CAPITATION BUT OTHER
BUT IF IT WEREN'T THEN THE FEE
THAT IS IN YOUR PLAN FOR A
PARTICULAR SERVICE WOULD BE
RECEIVED BY THE PROVIDER LESSON.
ADMINISTRATIVE COST, WHATEVER
THAT IS, AND THAT'S NOT WHAT
YOU'RE SUGGESTING IS HAPPENING.
WE DON'T WE TAKE THE
ADMINISTRATIVE COSTS NOW THAT'S
PAID SEPARATELY IN AND ABOVE
THOSE RATES. WHY ISN'T THE
PROVIDER RECEIVING THE FEE?
LET'S END THE PLAN THAT YOU HAVE
ISSUED. I'M WELL, WHAT YOU
SUGGESTED, IS IF THE GIFT IF THE
COUNTY PLAN IS LOSING MONEY ON A
PARTICULAR SERVICE, THEY MIGHT
NEGOTIATE A LOWER FEE THAN IS
COVERED IN YOUR PLAN WITH A
PROVIDER. TO USE THE EXCESS TO
COVER THE LOSS ON THE OTHER
SERVICE. IN MY MISSING THIS.
YEAH. AND THEN THE STATE TRIES
TO RESOLVE THE LOSS COMPONENT OF
THAT WHICH WE'RE DOING NOW AND
ONE OF OUR SECTORS IMPATIENT. I
THINK IT'S KIND OF A KIND OF A
HYBRID A LITTLE BIT OF KIND OF
PURE CAPITATION, WHICH IS BASED
ON THE MEMBER'S CRITERIA.
SENIORS AND PERSONS WITH
DISABILITY VERSUS CHILDREN, YOU
KNOW, IT'S THAT'S A LITTLE BIT
DIFFERENT THAN KIND OF PURE FEE
FOR SERVICE, BUT THE FLEXIBILITY
THAT IS PROVIDED UNDER PAYMENT
REFORM GETS TO THE POINT OF A
LITTLE BIT OF THE FLEXIBILITY
THAT CAPITATION PROVIDES FOR ITS
? YEAH PROBABLY WHY THE
PROVIDERS DON'T UNDERSTAND IT.
RIGHT YOU SEE THE PROVIDERS THAT
HAVE AND HAVE NOTS KIND OF IN
THEIR EYES. SO THEY SAY WHEN IT
COMES TO THE FEE SCHEDULE, THEY
SAY, OKAY, THE DEPARTMENT IS
PAYING $100 FOR THE SERVICE THAT
I RENDER. I'M GETTING $70 OF
THAT. BUT YOU DON'T HEAR THE
OTHER PROVIDER. THAT'S GETTING
$140 BECAUSE THEY ARE PRO COST
PROFILE FOR THE SERVICES. THE
SAME SETS OF SERVICES ARE
LARGELY DIFFERENT, SO THE COUNTY
HAS TO BALANCE ALL OF THAT. IT'S
INTERESTING BECAUSE YOU ALREADY
RAKOFF, THE ADMINISTRATOR, THE
COUNTY GETS PAID FOR THE
ADMINISTRATIVE SERVICES MANAGING
THE PROGRAM, SO IT'S SORT OF
STRANGE THAT THERE WOULD BE RATE
MANIPULATION WITHIN THAT PROCESS
OF NEGOTIATION. RIGHT OKAY.
THAT'S A QUESTION FROM SENATOR
RUBIO. THANK YOU, MR CHAIR. I
THINK I WAS, UM THANK YOU ALONG
THE LINES OF WHAT HE WAS JUST
SAYING RIGHT NOW, WHEN I HEARD
YOU SAY THAT YOU PAY LESS HERE
AND THEN MORE THERE, RIGHT?
THAT'S WHAT I HEARD RIGHT NOW,
LIKE MONEY THAT'S AND FORGIVE ME
FOR SAYING THAT THIS HE ALMOST
UNACCOUNTED FOR, LIKE, HOW DO WE
KEEP TRACK OF YOU KNOW, BUT I
TRY TO EXPLAIN IT TO MR ROTH AND
I WAS HAVING A HARD TIME
FOLLOWING. SO UM, THAT'S JUST ME
. BUT I WAS THINKING JUST ALONG
THE LINES I HEARD YOU SAY, YOU
KNOW, BECAUSE WE DON'T GET PAID
ENOUGH HERE. THEN WE PAY IT OVER
HERE, SO I THOUGHT THAT WE PAID
FOR WHATEVER THE REIMBURSEMENT
WAS, BUT I'M GOING TO SAY THE
WAY HE SAID IT RIGHT. A PAYMENT
MANIPULATION. BUT CAN YOU GO
DEEPER INTO THAT HELPED ME
UNDERSTAND THAT? BECAUSE NOW I'M
HAVING TROUBLE UNDERSTANDING HOW
YOU TAKE IT FROM ONE AND GIVE IT
TO THE OTHER ONE THAT WAS IN THE
REIMBURSEMENT FOR THAT.
PARTICULAR ITEM? SURE, SO THE
RATE PAID TO THE TO THE COUNTY
BY THE STATE IS ALWAYS GOING TO
BE THE SAME. SO THERE'S NO RATE
NEGOTIATION, THE CPT CODE AND
THE PRACTITIONER TYPE THEY GET.
THAT RATE HAS BEEN SAID AND DONE
WHEN THE COUNTY LOOKS AT THE
PROVIDER'S RENDERING THAT
SERVICE THEY HAVE TO ACTUALLY
LOOK AT THE LINES OF BUSINESS,
WHILE IT MIGHT BE THE SAME
SERVICE FROM A CODING
PERSPECTIVE. IT REALLY ISN'T SO
THE ACTUAL ASSESSMENT OR
CRITICAL TREATMENT OR CRISIS
STABILIZATION, WHERE IT HAPPENS,
AND THE COSTS ASSOCIATED TO
RENDER THAT HAVE TO BE ACCOUNTED
FOR COUNTIES HAVE ARE YOU GIVE
US AN EXAMPLE BASED SERVICES
VERSUS A CLINIC SERVICE? SO
WHERE YOU'RE THEY'RE BOTH PAID
THE SAME AMOUNT. ARE YOU SAYING
THEY'RE NOT FROM THE STATE OF
THE COUNTY? YES. OKAY IN THE
COUNTY HAS TO NEGOTIATE RATES
AND THE COUNT IN THE STATE
DELEGATES THAT CONTRACTING
AUTHORITY AND RATE NEGOTIATION
TO THE COUNTY MENTAL HEALTH PLAN
. OKAY SO YOU'RE SAYING LIKE
ONE. SOMEBODY'S COMING INTO
OFFICE. THEY HAVE A VISIT.
SCHEDULED EVERY 15 MINUTES. THE
OTHER ONE. SOMEBODY'S OUT OF THE
FIELD. THEY MIGHT HAVE TO GO
DOWN A HILL TO AN EMBANKMENT TO
PROVIDE THAT SAME SERVICE REACH.
AN ENGAGEMENT IS A HUGE LOSS
LEADER FOR THOSE TYPES OF
PROVIDERS, AND WE WANT TO MAKE
SURE THAT WE ENSURE THAT BECAUSE
WHEREVER THE MEMBER IS THE
COUNTY STILL OBLIGATED TO TREAT
THEM. AND SO WHILE IT'S MORE
EFFICIENT AND FINANCIALLY VIABLE
TO HAVE SOMEBODY IN A CLINIC, A
HOMELESS PERSON LIKELY ISN'T
GOING TO GO THERE. WE HAVE TO
CONTRACT WITH THESE PROVIDERS
THAT REALLY DON'T HAVE A VOLUME
OF SERVICES TO RENDER THOSE
MANDATED SERVICES AND THAT'S
EXPENSIVE. SO WHILE IT MAY BE
CODED THE SAME WAY, IT'S REALLY
NOT THE SAME SERVICE THAT MAKE
MORE SENSE FOR EVERYBODY, YOU
KNOW? YEAH OKAY. LET'S CONTINUE
THE CONVERSATION. THANK YOU SO
MUCH. ANYTHING FURTHER, SIR. I
THINK I THINK I'VE LOST ACTUALLY
TACKLED MY WHOLE AGENDA. SO
THANK YOU FOR THAT, AND I'LL
TURN IT BACK. SOCRATIC METHOD IS
FABULOUS. I ACTUALLY PREFER THIS
FURTHER QUESTIONS, CENTER
MANAGER DIRECTOR YET I'D LIKE TO
COME BACK AND TELL ME THIS IS
APPROPRIATE SPACE HERE. MAYBE WE
CAN DIVE MORE INTO SOME THREE
ISSUES. I WOULD LIKE TO LEARN
MORE ABOUT HOW WE'RE ADDRESSING
BEHAVIORAL. LET ME BACK UP. I
REMEMBER THERE WERE CERTAIN
POPULATIONS THAT WE'RE FOCUSING
ON UNDER COWEN AS A WHOLE, UM,
WONDERING HOW WELL CALCIUM IS
MEETING THE NEEDS OF UNDERSERVED
SURVIVORS OF VIOLENCE AND
HEARING SOME FROM SOME
PROVIDERS. IS THAT AN ELIGIBLE
CATEGORY? FOR THE FOR THESE
SERVICES. SO I THINK YOU'RE
REFERRING TO ENHANCE CARE
MANAGEMENT, WHICH IS A MEDICAL
BENEFIT BY POPULATION OF FOCUS
ABOUT THIS IN SUB THREE, THEN,
SURE, IF I CAN JUST ASK ONE MORE
QUESTION ON CONTRACTING BECAUSE
AS YOU'RE PROVIDING ALL THESE
NEW SERVICES, I'M INTERESTED IN
NAVIGATION SERVICES AND
COMMUNITY HEALTH WORKER AND ALL
OF THOSE THINGS ARE THE PLANTS
ABLE TO CONTRACT WITH ENOUGH
PEOPLE. DO WE HAVE ENOUGH
PROVIDERS? SO UH, COMMUNITY
HEALTH WORKERS IS A MANAGED CARE
BENEFIT AT THIS TIME UNDER BH
CONNECT THE WAIVER WE HAD BEFORE
THE FEDERAL GOVERNMENT THAT'S
ADDING IT AS AN OPTIONAL BENEFIT
FOR COUNTY BEHAVIOR HALLS. SO
TODAY, ONLY MEDICAL MANAGED CARE
PLANS ARE ABLE TO BUILD FOR
COMMUNITY HEALTH WORKERS. AND SO
I THINK WE ARE CONTINUING TO
BUILD OUT OUR COMMUNITY HEALTH
WORKER BENEFIT IN THE WORKFORCE
AND ALSO RECOGNIZE THAT AS PART
OF ENHANCED CARE MANAGEMENT, A
LOT OF COMMUNITY HEALTH WORKERS
ARE ACTUALLY DOING. THE OUTREACH
AND ENGAGEMENT IS ONE OF THE 47
SERVICES OF ENHANCED CARE
MANAGEMENT, SO THEY ARE DOING
THAT WORK, AND I THINK AS WE
CONTINUE TO BUILD THIS OUT, IT'S
KIND OF ONE OF THE THINGS THAT I
THINK WE THINK IS CRITICAL TO
REALLY ADDRESSING SOME OF THE
KIND OF THE QUALITY AND METRICS
THAT WE'RE TRYING TO ACHIEVE.
THANK YOU ONE OTHER OKAY.
EVERYTHING OKAY? COLLEAGUES.
OTHER QUESTIONS. EXCELLENT THANK
YOU FOR THE PRESENTATION. YOU'RE
NOT LEAVING, THOUGH, RIGHT? NO
YOU CAN WHERE YOU CAN STAY THERE
. WE CAN BRING THE NEXT PANEL
UP. BUT LET'S BRING THE NEXT
PANEL UP. THAT'S UP TO YOU,
MICHELLE. JUST STICK AROUND.
GREAT. THANKS, RICHARD. I'M
LEARNING HOW TO RUN A HEARING
YOUR PRO OKAY? WELCOME AND
HERE'S HOW WE'RE GOING TO DO
THIS, SO I DON'T BUTCHER NAMES.
WE'RE GOING TO HAVE YOU
INTRODUCE YOURSELVES FOR THE
RECORD STARTING TO MY LEFT. YOUR
RIGHT, MA'AM. YES MA'AM, RENAMES
SAVAGE SANGUINE AND THE
EXECUTIVE DIRECTOR OF THE
CALIFORNIA PAN ETHNIC HEALTH
NETWORK. THANKS FOR COMING. YES,
MA'AM ADRIAN SULTAN WITH THE
CALIFORNIA ALLIANCE OF CHILD AND
FAMILY SERVICES. WELCOME HI
DOCTOR, LEANDER CLARK HARVEY,
CEO OF CALIFORNIA COUNCIL OF
COMMUNITY BEHAVIORAL AGENCIES.
SEE YOU AGAIN. GOOD AFTERNOON
CHAIR MEMBERS, MICHELE CABRERA
WITH THE COUNTY BEHAVIORAL
HEALTH DIRECTORS. ASSOCIATION
OKAY, THANK YOU FOR JOINING US
FOR SHAREHOLDER PERSPECTIVES.
YOU'VE HEARD THE FIRST PANEL SO
TAKE IT AWAY. WHO WANTS TO BE
FIRST? I WILL TAKE THAT HONOR.
THANK YOU, MA'AM. HI GOOD
AFTERNOON. SO, AS I SAID, I AM
MICHELLE CABRERA, EXECUTIVE
DIRECTOR FOR C BHD, REPRESENTING
THE COUNTY BEHAVIORAL HEALTH
DIRECTORS FOR ALL 58 COUNTIES
RESPONSIBLE FOR THE DELIVERY OF
MEDICAL SPECIALTY MENTAL HEALTH
AND SUBSTANCE USE DISORDER
SERVICES, BOTH AS PREPAID
INPATIENT HEALTH PLANS FOR
SPECIALTY MENTAL HEALTH AND
THROUGH DRUG, MEDICAL AND DRUG
MEDICAL ORGANIZED DELIVERY
SYSTEM. PLANS FOR SUBSTANCE
USED. DISORDERS. C B H D, A,
ALONG WITH OTHER STAKEHOLDERS
ENGAGED IN EARLY CONVERSATIONS
WITH THE STATE RELATED TO
CALLUM, STARTING IN 2019. AT
THAT TIME WE WERE TRYING TO
SOLVE FOR A NUMBER OF PROBLEMS
OUTLINED IN YOUR BACKGROUND
PAPER AND ALSO HIGHLIGHTED BY
DIRECTOR BASS AND RYAN ON THE
EARLIER PANEL. WE LIFTED UP THE
OVERLY BURDEN SOME DOCUMENTATION
AND PAYMENT REQUIREMENTS THAT
RESULTED IN AN OVER EMPHASIS ON
COMPLIANCE. SELF DENIALS OR
RECRUITMENT FOR SERVICES THAT
MIGHT EXPOSE US TO AUDIT RISK
RATHER THAN ORIENTING OUR SYSTEM
TO THE DELIVERY OF MEDICALLY
NECESSARY SERVICES FOR
BENEFICIARIES. FOR EXAMPLE, SEE
BHD HIGHLIGHTED THE OVERLY
RESTRICTIVE ELIGIBILITY CRITERIA
FOR KIDS AND IN PARTICULAR FOR
FOSTER YOUTH. THE OLD SPECIALTY
MENTAL HEALTH CRITERIA LED TO
FEDERAL AND STATE AUDIT DENIALS
OF LEGITIMATE MEDICAL HEALTH
SERVICES WHEN PROVIDERS WERE
UNABLE TO ADEQUATELY DOCUMENT
THAT CHILDREN MET THE DIAGNOSTIC
AND SEVERITY REQUIREMENTS SET BY
CALIFORNIA A DIAGNOSIS WAS THE
GOLDEN TICKET TO ENTRY INTO
COUNTY SERVICES. BUT IT ALSO
BOXED PROVIDERS IN AND DIDN'T
GIVE THEM ENOUGH ROOM TO UPDATE
AND CHANGE THEIR UNDERSTANDING
OF THE CHILD'S CONDITIONS OVER
TIME WITHOUT RISK OF LOSING
REIMBURSEMENT FOR THE SERVICES.
THEY WERE DELIVERING THESE
CHALLENGES ASSOCIATED WITH
DOCUMENTATION AND REIMBURSEMENT
HAVE CONTRIBUTED TO DRIVING
PROVIDERS OUT OF OUR SAFETY NET
AT A TIME WHEN WE NEED THEM THE
MOST, HOWEVER, THE AMBITIOUS
VISION OF COUNT AIM AND TRYING
TO MEASURE THE IMPACT OF THOSE
REFORMS TO DATE CANNOT BE VIEWED
IN ISOLATION. FIRST KELLY WAS
INITIALLY PUT ON HOLD FOR TWO
YEARS DUE TO THE PANDEMIC,
TRYING TO STAND UP BROAD
SWEEPING REFORMS WHILE STILL
COMING OUT OF THE PANDEMIC HAS
PUT ADDITIONAL STRAIN ON AN
ALREADY SHAKY FOUNDATION OF
WORKFORCE SHORTAGES, ALONG WITH
INCREASE DEMAND FOR SERVICES
RESULTING FROM THE PANDEMIC. IN
ADDITION, CALLUM REFORMS HAVE
HAPPENED ALONGSIDE A WHOLE SLEW
OF OTHER NEW BEHAVIORAL HEALTH
REFORM INITIATIVES, INCLUDING
THE CHILDREN AND YOUTH
BEHAVIORAL HEALTH INITIATIVE.
TBH CHIP CARE COURT LPS REFORMS.
THE NEW MOBILE CRISIS BENEFIT
JUST TO NAME A FEW. WE'VE
COUNTED 13 NEW SPECIALTY
BEHAVIORAL HEALTH BENEFITS THAT
ARE COMING ON BOARD BETWEEN 2022
AND 2024 FOR COUNTY BEHAVIORAL
HEALTH, AND THAT'S NOT EVEN
COUNTING THOSE OTHER, UM, REFORM
INITIATIVES THAT ARE HAPPENING.
IN PARALLEL. SINCE 2022 DHC S
HAS BEEN LASER FOCUSED ON
IMPLEMENTATION OF CALLUM AND
WITH GOOD REASON. THE NEW
GRANULAR CODE SET WE HEARD ABOUT
EARLIER WITH RESPECT TO MEDICAL
BILLING HAS ACTUALLY BEEN A
FEDERAL REQUIREMENT AND INDUSTRY
STANDARD THROUGH MOST OF HEALTH
CARE SINCE THE 19 EIGHTIES FOR
SERVICE PAYMENT REFORMS WILL
BRING OUR SYSTEM INTO THE LATE
20TH CENTURY WAYS OF FINANCING
HEALTHCARE. AND BY DEVELOPING A
FEE FOR SERVICE RATE STRUCTURE
WILL BE ABLE TO HELP PREPARE OUR
SYSTEM. LEE THE FOUNDATION
REALLY FOR A CAPITATION AND
OTHER VALUE BASED PAYMENTS
MOVING FORWARD. SO THINK OF
THESE AS SORT OF NECESSARY
FOUNDATIONAL PIECES THAT CAN
HELP US SORT OF MODERNIZE AND
GET IN LINE WITH THE REST OF HOW
HEALTHCARE WORKS AND TO SOME
EXTENT, AS MR FITZGERALD WAS
MENTIONING SOME OF THE SORT OF
KINKS AND CHALLENGES AND
PROBLEMS ARE REALLY INHERENT TO
HOW MODERN HEALTH CARE WORKS.
TODAY WE'RE FAR ENOUGH INTO
IMPLEMENTATION OF THESE VARIOUS
CALLUM REFORMS TO HAVE A SENSE
OF HOW IT'S GOING SO FAR, EVEN
IF MANY OF THOSE REFORMS ARE
STILL IN THEIR EARLY INFANCY, I
WILL FOCUS MY COMMENTS ON THREE
MAIN AREAS OF KILLEEN THAT ARE
FLAGGED IN THE PAYMENT IN THE
BACKGROUND. PAPER PAYMENT REFORM
, DOCUMENTATION REFORM AND NO
WRONG DOOR, BUT I'M HAPPY TO
SPEAK TO OTHER PIECES OF THE
REFORM. THE FIRST WAVE OF
REFORMS INCLUDED THE NEW
ELIGIBILITY CRITERIA, NO WRONG
DOOR AND DOCUMENTATION REFORM
WHEN C BHD AND PROVIDERS
PROVIDED FEEDBACK TO D, H C S ON
THE NEED TO CONTINUE TO
STREAMLINE DOCUMENTATION
REQUIREMENTS GOING FOR FURTHER
THAN THE STATE'S INITIAL
GUIDANCE STAGE. CS ENGAGED US IN
A MONTH LONG PROCESS, RESULTING
IN UPDATED GUIDANCE ISSUED THIS
PAST DECEMBER. ELIGIBLE EXPANDED
ELIGIBILITY CRITERIA HAVE
INCREASED THE NUMBER OF CHILDREN
AND YOUTH ELIGIBLE FOR OUR
SERVICES, THE NEW SCREENING IN
TRANSITION TOOLS THAT ALSO WENT
LIVE AROUND THE SAME TIME HAVE
ALSO IDENTIFIED A NUMBER OF
CHILDREN AND YOUTH WHO ARE MORE
APPROPRIATE TO BE SERVED THROUGH
MEDICAL MANAGED CARE IS MILD TO
MODERATE BENEFIT, MEANING THAT
COUNTIES HAVE NOT SEEN A HUGE
NET CHANGE IN THE NUMBER OF
CHILDREN IN YOUTH WERE SERVING,
ALTHOUGH THE CHILDREN AND YOUTH
WERE BEING SCREENED INTO OUR
SYSTEM DO HAVE OF THOSE MORE
COMPLEX NEEDS, WHICH IS
APPROPRIATE. OVERALL FROM THE
PROVIDER IN COUNTY RISK
PERSPECTIVE, WE RECEIVED THE
FOLLOWING FEEDBACK FROM ONE OF
OUR COUNTIES. THE LARGEST IMPACT
HAS BEEN THROUGH DOCUMENTATION
REDESIGN UPDATED CRITERIA FOR
ASSESSING SPECIALTY MENTAL
HEALTH AND THE ABILITY TO SERVE
CLIENTS PRIOR TO ASSESSMENT OR
NO WRONG DOOR. WE HAVE SEEN
POSITIVE IMPACTS ON OUR CLINICAL
STAFF. THEY'RE STARTING TO FEEL
THE IMPACT OF DOCUMENTATION,
REDESIGN AND FEELING LESS. UM
YOU KNOW, PRESSURE ON
DOCUMENTATION. ACCESS TO CARE
FOR CLIENTS HAS IMPROVED DUE TO
OUR ABILITY TO SERVE CLIENTS
PRIOR TO THEIR ASSESSMENT AND
CLIENTS ARE GETTING SERVICES
THEY NEED WHEN THEY NEED THEM.
INSTEAD OF HAVING US HAVING TO
SAY WE CAN'T HELP THEM UNTIL YOU
DO, X Y Z WITH RESPECT TO
PAYMENT REFORM, WHERE LESS THAN
A YEAR INTO IMPLEMENTATION
COUNTIES PARTNERED CLOSELY WITH
THE STATE IN DEVELOPING THE PLAN
BASED FEE FOR SERVICE RATES. AND
DESPITE A STRONG PARTNERSHIP
WITH THE STATE AND REDEVELOPMENT
, WE HAVE ENCOUNTERED A NUMBER
OF ISSUES THAT HAVE MADE
IMPLEMENTATION MORE CHALLENGING
FIRST COUNTIES, AS MENTIONED
PRIOR DID NOT RECEIVE FINAL
RATES UNTIL ABOUT A MONTH BEFORE
IMPLEMENTATION, WHICH LIMITED
THEIR ABILITY TO APPROPRIATELY
MODEL AND NEGOTIATE RATES WITH
CONTRACT PROVIDERS. THIS WAS
STRICTLY A MATTER OF THE
AGGRESSIVE TIMELINE WE WERE ON,
AND WE GAVE OUR PROVIDERS A
HEADS UP THAT THE FIRST YEAR
WOULD BE A CHALLENGE FOR THESE
REASONS. IN ADDITION, MULTIPLE
COUNTIES AND PROVIDERS HAVE HAD
TO CONTEND WITH CHANGES TO THEIR
ELECTRONIC HEALTH RECORDS ALSO
MENTIONED BEFORE THAT, IN THE
SHORT RUN, HAVE COMPLICATED
CODING AS WELL AS PAYMENT
TRANSITIONS. WE'VE DUG INTO THE
SPECIFIC FUND ISSUES RAISED BY
COUNTIES AND PROVIDERS,
SOMETIMES LEARNING THAT THE
CHURCH TRANSITION MORE THAN
ANYTHING HAS BEEN A BIT OF A
DRAG ON PAYMENT REFORM AND
CODEINE TRANSITIONS AS WELL,
ALONG WITH THE MULTIPLE ACROSS
THE MULTIPLE HR VENDORS, SO THIS
IS LIKE MANY, MANY DIFFERENT THR
TRANSITIONS HAPPENING, PROBABLY
AT ONCE. WE DO EXPECT THAT THESE
ISSUES WILL RESOLVE OVER TIME,
THOUGH, AS THE SORT OF CODING
ISSUES GET WORKED OUT, AND AS
FOLKS BECOME MORE COMFORTABLE
AND FAMILIAR WITH THOSE HRS, AND
THEY'RE ABLE TO, UM AND REPORT
OUT BETTER DATA, EACH COUNTY
RECEIVED ITS OWN RATES AS WELL,
WHICH WAS REALLY IMPORTANT AND
PART OF WHAT MADE THIS SUCH A
HEAVY LIFT. BECAUSE THERE WAS
LIMITED TIME TO MODEL AND
NEGOTIATE RATES WITH OUR
PROVIDERS. COUNTIES DID TAKE
DIFFERENT APPROACHES, DEPENDING
ON HOW THEIR SYSTEMS SET UP AND
WHAT KIND OF DATA THEY HADN'T
GOING IN IN COUNTIES WHERE
PROVIDERS WERE WILLING TO
COLLABORATE WITH US, WE WERE
ABLE TO DEVELOP TIERED RATE
STRUCTURES, WHICH, WITH
INCENTIVES BUILT IN ON TOP TO
PROVIDE THOSE PROVIDERS WITH
OPPORTUNITIES FOR EXTRA FUNDING
BEYOND DIRECT SERVICES. TO
ENCOURAGE THINGS LIKE THR
UPGRADES OR VALUE BASED PAYMENT
APPROACHES IN OTHER PLACES THAT
COUNTY PAID FOR ACTUARIAL
CONSULTANTS TO MODEL THE IMPACT
OF PAYMENT REFORM FOR THOSE
INDIVIDUAL PROVIDERS, AS WELL AS
PROVIDING CASH ADVANCES TO THEIR
CONTRACTED PROVIDERS. SOME
COUNTIES WENT WITH A STRAIGHT
PERCENTAGE OF THE COUNTY RATE,
WHICH HAS BEEN PASSED ALONG TO
PROVIDERS AND STILL OTHERS
AGREED TO MAKE THEIR PROVIDERS
WHOLE FOR THE FIRST YEAR OF
PAYMENT REFORM. OF THE VERY
APPROACHES. WE HAVE LEARNED
QUITE A BIT. SEE BHD A PARTNERED
WITH DCS IN OUR JOINT POWERS
AUTHORITY. CALL MESA TO DEVELOP
A WHOLE RANGE OF FREE TRAINING
AND T A BEFORE, DURING AND AFTER
PAYMENT REFORM IMPLEMENTATION TO
SUPPORT. BOTH ARE COUNTIES AS
WELL AS OUR PROVIDERS. PH D. A
HAS REQUESTED THAT OUR PROVIDER
ASSOCIATIONS BRING SPECIFIC
CONCERNS WITH COUNTIES. UM TO US
SO THAT WE CAN HELP SORT THROUGH
THOSE CONCERNS ALONGSIDE, OR
PROVIDERS AND COUNTIES. I WANT
IN PARTICULAR THINK THE ALLIANCE
FOR THE STRONG PARTNERSHIP WITH
OUR COUNTY MEMBERS IN ISSUE
SPOTTING IN CASE WORKING
PROBLEMS THAT HAVE BEEN RAISED
WITH BHD THROUGH THIS PROCESS.
THROUGHOUT WE'VE BEEN CONSISTENT
IN EMPHASIZING THE NEED FOR
COUNTIES TO ENSURE THAT THEY'RE
MAINTAINING ADEQUATE NETWORKS
THAT IS A CORE PILLAR OF THE
MEDICAL PROGRAM. IN THE BEST OF
SCENARIOS, THERE IS TREMENDOUS
OPPORTUNITY FOR COUNTIES AND
PROVIDERS ALIKE TO BENEFIT FROM
A FEW FOR SERVICE RATE STRUCTURE
. I KNOW OF SEVERAL COUNTIES
THAT ARE TAKING CONTRACT
AMENDMENTS TO THEIR BOARDS
BECAUSE THEIR PROVIDERS WHO HAVE
REALLY LEANED INTO PAYMENT
REFORM HAVE BEEN SO SUCCESSFUL
THAT THERE NOW LEADING WHAT HAS
HISTORICALLY BEEN THE CONTRACT
ID AMOUNT FOR THAT PROVIDER. UM
FOR THE FIRST TIME EVER, NEITHER
THE COUNTY PLAN NOR PROVIDERS
WILL BE LIMITED TO THE COST OF
THEIR SERVICES. THIS MEANS THAT
COUNTIES AND PROVIDERS ALIKE
WILL BE ABLE TO MAKE NEW
INVESTMENTS TO GROW THE QUALITY
TO GROW THEIR PROGRAMS AS WELL
AS IMPROVED QUALITY. YEAH,
THAT'S KIND OF THE HOPE FOR THE
PROMISE HERE. SEE BHD IS
DOUBLING DOWN ON OUR EFFORTS TO
SUPPORT PROVIDERS IN COUNTIES AS
WE HEAD INTO YEAR TWO OF PAYMENT
REFORM, WITH SOME OF THESE
LESSONS LEARNED UNDER OUR BELT
FIRST WE'RE BRINGING IN OUR OWN
ACTUARIAL CONSULTANT TO OFFER
TARGETED TRAINING AND TH TWO
COUNTIES AND CONTRACT PROVIDERS
ON HOW TO DEVELOP A TIERED RATE
STRUCTURE. AND TO HELP PROVIDERS
SUCCEED WITH DIFFERENT PROGRAM
MODELS. WE WANT TO BE SURE THAT
THE SUPPORT WE SUPPORT OUR FIELD
BASED AND HOME BASED SERVICES
THAT MAKE OUR SYSTEMS SO UNIQUE
AND EFFECTIVE FOR INDIVIDUALS
AND MEDICAL WHILE OFFERING
STRATEGIES FOR COUNTIES IN OUR
PROVIDERS TO INCREASE DIRECT
SERVICE TIME AND MAXIMIZE THESE
OPPORTUNITIES. WE'RE ALSO
TRACKING INDIVIDUALS COUNTIES
PERFORMANCE, ALONG WITH DATA
FROM THE HCS TO ENSURE WE CAN
DISTINGUISH WHICH COUNTIES CAN
BE HELPED SOLELY THROUGH
TRAINING AND TO AND WHICH MAY
NEED TO ADJUST RATES TO BETTER
REFLECT THE COST OF DOING
BUSINESS IN THEIR COUNTY OR
REGION. IT'S TOO SOON TO TELL.
HOWEVER, IN MANY CASES, FINALLY,
RATES WILL NEED TO CONTINUALLY
BE ADJUSTED OVER TIME TO REFLECT
NEW SERVICES AND STATUTORY
REQUIREMENTS, SUCH AS THE
MANDATED INCREASE IN MINIMUM
WAGE WAGE WITH SB 525 SIGNED
INTO LAW LAST YEAR. WE'RE
GRATEFUL TO THE GOALS OF CALLUM
INTO OUR PARTNERSHIP WITH THE
STATE AND OUR PROVIDERS AND
WORKING TO EXPAND ACCESS TO
SPECIALTY BEHAVIORAL HEALTH
SERVICES FOR MEDICAL
BENEFICIARIES. REMEMBER AT THE
TOP? I TALKED ABOUT SORT OF THE
PROBLEM WE WERE TRYING TO SOLVE
FOR REALLY. IT WAS TRYING TO
BRING OUR SYSTEM INTO THE LEAK
20TH CENTURY OF HEALTHCARE
DELIVERY. TRYING TO REMOVE SOME
OF THOSE REALLY ONEROUS
DOCUMENTATION AND OTHER
REQUIREMENTS THAT PUT US ALL AT
RISK, AND WE ARE WORKING TOWARDS
THAT GOAL. STILL, IT'LL TAKE
SOME TIME BECAUSE THESE ARE A
LOT OF CHANGES, AND THEY'RE ALL
HAPPENING AT ONCE AND HAPPY TO
ANSWER ANY QUESTIONS YOU MIGHT
HAVE. THANK YOU. THANK YOU VERY
MUCH. PLEASE PROCEED. YES, THANK
YOU. I'M DOCTOR LEANDER CLARK
HARVEY AGAIN AS PSYCHOLOGISTS IN
THE CEO OF CBS, WHERE STATEWIDE
ADVOCACY ORGANIZATION
REPRESENTING MENTAL HEALTH AND
SUBSTANCE USE DISORDER CLIENTS
ACROSS THE STATE. AS DESCRIBED
EARLIER. CAL AIM HAS GREAT
SYMBOLISM AND PROMISE IT'S
INNOVATIVE APPROACH AND A HUGE
OPPORTUNITY TO ADDRESS A
MULTITUDE OF DISPARITIES THAT
EXIST FOR BEHAVIORAL HEALTH
CLIENTS IN OUR STATE BY
PROMOTING INTEGRATED MODELS OF
CARE AND ADDRESSING SOCIAL
DETERMINANTS OF HEALTH AND A
VERY NEW WAY. THAT'S WHY WE
BELIEVE IT'S SO IMPERATIVE THAT
WE COUNTIES PROVIDERS AND THE
ADMINISTRATION REALLY WORKS
TOGETHER TO GET A GREAT DESPITE
THE PROMISE OF CALLUM THIS PANEL
HAS BEEN ASKED TO DISCUSS SOME
OF THE MECHANICS THAT NEED TO BE
FINE TUNED, INCLUDING
IMPLEMENTATION OF PAYMENT REFORM
THREAT TO THE LIVELIHOOD OF MANY
OF OUR BEHAVIORAL HEALTH
PROVIDERS, WHICH MY COLLEAGUE
WILL DISCUSS NEXT AND ALSO
INCLUDING ADMINISTRATIVE BURDEN,
WHICH IS WHITTLING AWAY AT THE
PRODUCTIVITY OF OUR BEHAVIORAL
HEALTH WORKFORCE. SO WHAT IS
THIS ADMINISTRATIVE BURDEN THAT
KEEPS BEING TOSSED AROUND? WILL
SIMPLY IT IS EXCESSIVE AND
UNNECESSARY REQUIREMENTS. C B H
A HAS BEEN SERVING OUR MEMBERS
FOR DECADES, AND THE TOP
ADMINISTRATIVE BURDEN IDENTIFIED
HAS AND CONTINUES TO BE VARYING
CLINICAL PAPERWORK REQUIREMENTS
FROM THE NUMEROUS COUNTIES THAT
THEY CONTRACT WITH. THIS IS WHY
WE COMMISSIONED A STUDY EIGHT
YEARS AGO THAT FOUND THAT IT
TAKES CALIFORNIA CLINICIANS
APPROXIMATELY FIVE TIMES LONGER
TO COMPLETE PAPERWORK THAN
CLINICIANS AND OTHER STATES.
IT'S BEEN EIGHT YEARS SINCE THIS
INITIAL STUDY, BUT THE PROBLEM
CONTINUES TO PERSIST. EVEN WITH
KELLY. IT'S NOT JUST THE STUDY.
IT'S NOT JUST ANECDOTAL
TESTIMONY THAT WE HEAR FROM OUR
PROVIDERS. I SPEAK FOR FROM
FIRSTHAND KNOWLEDGE WHEN I
PRACTICE AT HOSPITALS IN
SOUTHERN CALIFORNIA, I WAS A
PART OF INTEGRATED CARE TEAMS,
BUT MY PHYSICIAN TRAINEES AND
COUNTERPARTS DID NOT EXPERIENCE
THE SAME LEVEL OF PAPERWORK
REQUIREMENTS. THAT THE
BEHAVIORAL HEALTH CLINICIANS
DEAD. THAT WAS 14 YEARS AGO. THE
ISSUE PERSISTS AND WORSE, AS MY
COLLEAGUE HAS SAID, OUR
PROVIDERS TODAY HAVE HAD TO ALSO
BRAVE A PANDEMIC THAT IS
EXACERBATED MENTAL HEALTH NEEDS,
CAUSING A CRISIS IN THE
WORKFORCE AND MUCH LESS CAPACITY
FOR TRACKING, VEERING AND
EXCESSIVE PAPERWORK REQUIREMENTS
. WE LITERALLY CANNOT AFFORD TO
BURN OUT OUR WORKFORCE DUE TO
ADMINISTRATIVE BURDEN. HIRING
TEAMS OF INDIVIDUALS TO MANAGE
VARYING PAPERWORK REQUIREMENTS,
AS MANY OF OUR AGENCIES DO
ACROSS COUNTIES IS JUST
UNTENABLE, ESPECIALLY WHEN
AMAZON FEDEX ARE PAYING MORE
THAN CLINICAL POSITIONS. IMAGINE
GOING TO SCHOOL FOR A MASTER'S
DEGREE AND HAVING COMPARABLE PAY
NOW, AS DIRECTOR BOSS SHARE DHC
S HAS ATTEMPTED TO SOLVE THIS BY
PROVIDING GUIDANCE AND TRIMMING
DOWN DOCUMENTATION REQUIREMENTS
THEY HAD TH I N BUT WE MUST
CONTEND THAT WITHOUT REQUIRED
STANDARDIZATION. WE'RE IN THE
SAME SPOT WITH UNEVEN PAPERWORK
REQUIREMENTS ACROSS COUNTIES. IN
FACT, OUT OF 70, CBO'S THAT WE
SURVEYED JUST LAST YEAR, ONLY
ONE SAID THAT THEY WERE
RECEIVING RELIEF BECAUSE OF THE
CHANGES MADE IN THE PAST YEAR.
SO WHAT? WE APPRECIATE THE HELP
AND WE APPRECIATE THE WORK
GROUPS AND WE APPRECIATE ALL OF
THAT. IT'S GETTING TO THE POINT
WHERE WE HAVE TO LOOK AT OTHER
REMEDIES. THERE HAVE BEEN
PRODUCTIVE CONVERSATIONS. IF I
COULD ASK A QUESTION, JUST SURE.
NÓI I ENCOURAGE THE QUESTIONS IF
YOU'LL PERMIT SURE, OF COURSE.
YEAH NO, JUST AS THIS ISSUE
BECAUSE WE ASKED I'M SORRY, MR.
WHAT'S YOUR LAST NAME? MR MR SER
FITZGERALD. MR. FITZGERALD UM,
BECAUSE I THINK IT'S THE SAME
ISSUE. YOU'RE TALKING ABOUT THAT
THAT COUNTIES CODE IN DIFFERENT
WAYS. IT IS THE SAME ISSUE WE'RE
TALKING ABOUT. IT'S RELATED.
IT'S WHAT IT'S RELATED. OKAY? SO
TO MR ROBERT, WHY DON'T WE HAVE
STANDARDIZATION ACROSS COUNTIES?
WELL FOR STARTERS ON THE CODING
SIDE IS MR FITZGERALD MENTIONED
IT IS INDUSTRY STANDARD MEETING
COMMON TO ALL HEALTHCARE FOR
THERE TO BE DIFFERENT CODING,
AND TYPICALLY, THE CODING STUFF
HAPPENS ON THE BACK END. IT'S IN
THE E H R. IT'S HOW THAT'S
PROGRAMMED. WHY DO COUNTIES HAVE
DIFFERENT CODING REQUIREMENTS?
OFTENTIMES IT'S BECAUSE THEY'VE
GOT DIFFERENT KINDS OF GRANTS
AND OTHER PROGRAMS THAT THEY
NEED. TO ATTACH DIFFERENT
MODIFIERS TO AN EXAMPLE OF THIS
WOULD BE IF YOU'RE TRYING TO
TRACK HOW MANY OF YOUR CLIENTS
ARE HOMELESS BECAUSE YOU'VE GOT
REPORTING THAT YOU NEED TO DO
FOR LPS PURPOSES, THEN YOU MIGHT
REQUIRE THAT AS A PART OF THAT
CLINICIANS CODE SET SO THAT YOU
CAN SEE OKAY. HOW MANY OF MY
CLIENTS WHO ARE COMING IN ARE
HOMELESS, SO THE MORE COMPLEXITY
OR MANAGING THE MORE GRANTS THE
MORE DIFFERENT ENTITIES YOU
MIGHT BE CONTRACTED WITH? IF
YOU'RE A SUBCONTRACTOR TO A
MANAGED CARE PLAN FOR ECM
PURPOSES? IS THIS WHAT YOU'RE
TALKING ABOUT? MOSTLY ANDREW
CLARK. THAT'S INTERESTED THAT
THERE IS GOING TO BE ADDITIONAL
REQUIREMENTS BASED ON YOU KNOW,
AS MICHELLE'S DESCRIBING SOME OF
THE OTHER GRANTS. THAT'S NOT
WHAT WE'RE TALKING ABOUT INITIAL
PAPERWORK AT THE BASE. COULD BE
HELPFUL. JUST STANDARDIZING
FORMS COULD BE HELPFUL. THERE
ARE VERY SIMPLE THINGS TO DO,
AND THERE HAS BEEN WORK. THERE
HAS BEEN WORK GROUPS. THERE HAVE
BEEN CONVERSATIONS, BUT HOW LONG
ARE WE GOING TO BE EXPECTED TO
DO THAT? HOW LONG DO WE KEEP
DOING THAT AND THE WORK WITH THE
COUNTIES AND THE DEPARTMENT HAS
BEEN PRODUCTIVE. BUT IF A COUNTY
JUST DECIDES THAT THEY DON'T
NECESSARILY WANT TO ADOPT THAT,
BECAUSE IT'S NOT MANDATED. IT'S
A SUGGESTION, RIGHT? STRONG
SUGGESTION. WE'RE STILL IN THE
SAME PLACE AND BEING IN A SPACE
WHERE I AM, REPRESENTING
PROVIDERS AND HEARING DAY IN AND
DAY OUT, AND ABOUT HOW THESE
VERY THINGS THAT SEEM VERY
LITTLE RIGHT. AND IT SEEMS LIKE
YOU KNOW, WELL, 58 COUNTIES.
THEY SHOULD HAVE FLEXIBILITY AND
HOW THEY DO THIS. IT REALLY DOES
TRICKLE DOWN AND IMPACT PROGRESS
AND PRACTICE A SPECIALLY WITH
SOME OF OUR MEMBERS THAT HAVE
CLINICS IN VARYING COUNTIES. WE
KNOW PEOPLE THAT ARE DEALING
WITH FIGHTS WITH THEIR COUNTIES
OR HAVE BEEN BECAUSE IT WAS ON
THE YELLOW PAPER VERSUS THE
GREEN PAPER OR THINGS LIKE THAT,
AND THERE HAS BEEN WORK TO
REDUCE SOME OF THAT, BUT IT'S
NOT SOLVED AND UNTIL IT'S SOLVED
UNTIL WE HAVE SOMEONE THAT'S
WILLING TO SAY THIS IS WHAT WE
HAVE TO DO AT A BASE LEVEL. WE
WILL CONTINUE TO HAVE AN EVEN
REQUIREMENTS. PILE UP ACROSS
DIFFERENT COUNTIES. IT'S JUST
HUMAN NATURE, BUT IT'S NOT
HELPING THE PROVIDER GIVE AN
EXAMPLE OF SOME OF THOSE INITIAL
FORMS. YOU'RE SPEAKING TO AND
TAKE FORMS. MY COLLEAGUE CAN
ALSO THEY'VE DONE, DON'T WE?
DON'T WE HAVE THOSE NOW WITH A
MORE STANDARDIZED FORMS THAT
WE'RE USING? I WAS GOING TO SAY,
I MEAN, IF THERE'S A COUNTY THAT
IS REQUIRING A CERTAIN COLOR
FORM AND THAT'S PART OF THIS
CONCERN. WE'RE HAPPY TO TALK
TRACK DOWN WHERE THAT CONCERN IS
AND TALK TO THAT COUNTY AND SEE
WHAT'S GOING ON. YOU KNOW THAT
THAT SEEMS LIKE A PRETTY EASY,
STRAIGHTFORWARD FIX. UM A LOT OF
DECADES WELL, BUT THAT'S WHAT
I'M SAYING THAT THE PROBLEMS OF
THE PRIOR DECADES ARE EXACTLY
WHAT CALLUM IS ATTEMPTING TO
RESOLVE AND THE NEW
DOCUMENTATION STANDARDS AND
REQUIREMENTS AS CLINICIANS TO
PUT IN PROGRESS NOTES INTO
THEY'RE HRS, WHICH IS PART OF
WHERE THAT RECORD SHOULD LIVE
FOR MULTIPLE CLINICIANS TO BE
ABLE TO. WE HAVE A STANDARDIZED
INTAKE FORM BECAUSE IT IT'S
AGAIN. THIS ASSESSMENTS ARE
STANDARDIZED. AND THEN WE HAVE
PROGRESS NOTES IN THE IN THE
CLINICIAN. I'M GETTING A YES AND
A NOTE HERE. WHAT? THAT YES,
THERE ARE THINGS THAT THE B H I
N THE INFO NOTICE THAT THE DHS
HAS PUT OUT HAS SAID YOU NEED TO
DO THIS. MY POINT IS THAT UNTIL
THERE'S SOMETHING THAT SAYS, YOU
HAVE TO DO IT. YOU HAVE TO DO IT
THIS WAY. AND THIS IS THE BASE.
WE WILL CONTINUE HUMAN NATURE TO
CREATE THINGS AND DIFFERENT
REASONS FOR THAT. TRADITIONALLY,
IT'S BEEN BECAUSE COUNTIES HAVE
SAID, WELL, YOU KNOW, WE'RE
BECAUSE OF AUDIT RISK RIGHT AND
WE WANT TO DO MORE TO COVER
OURSELVES. BUT WHAT THAT'S LED
TO IS OVER HERE. THIS COUNTY
HEARD THAT THIS COUNTY OVER HERE
GOT DING. SO WE'RE GOING TO ADD
MORE INDIE. HCS HAS RESPONDED
AND SAID, THIS IS WHAT YOU HAVE
TO DO AT THE END OF THE DAY IF
THERE CONTINUES TO BE AN
AUTONOMY AGAIN ACROSS ALL OF
THESE MULTIPLE DIFFERENT
COUNTIES, THERE WILL BE
DIFFERENCES AND THAT WILL IMPACT
THE WORKFORCE. AND WE ARE SEEING
THAT DAY IN AND DAY OUT. YES
WITH COLLEEN HAS THERE BEEN SOME
STANDARDIZATION HAVE
ACKNOWLEDGED THAT? YES, AND I'M
ALSO ACKNOWLEDGING THAT I HEAR
FROM PROVIDERS DIRECTLY AND WE
SURVEY THEM AND THE RESULTS ARE
NOT THAT EVERYTHING IS GOING
WELL. ARE THERE A FEW? YES VERY,
BUT NOT THE MAJORITY AT ALL. AND
SO WE HAVE TO BE HONEST ABOUT
WHERE PEOPLE ARE AT LEAST THOSE
THAT I REPRESENT AND TALK TO
YOU. SO THESE ARE THESE ARE THE
CAL AIM FORMS WE SCHEDULED. I
MEAN, THE SCREENING THE
TRANSITION OF CARE. WE'RE
TALKING ABOUT LOCAL OPTION
COUNTY TRACKING LOGS, INTAKE
FORMS THAT ARE NOT PRESCRIBED BY
THE KELLEN PROCESS. THESE ARE
BASIC, WE CAN KEEP IT AS LOW AND
WE'VE HAD LEGISLATION IN THE
PAST AND WE HAVE A BILL RIGHT
NOW AROUND BASIC INTAKE FORMS.
THAT'S ONE WAY TO START. IS
THERE DOCUMENTATION STREAMLINING
THAT NEEDS TO HAPPEN IN OTHER
AREAS, TOO? YES WE'RE SAYING IF
YOU COULD AT LEAST DO THIS BASIC
INTAKE FORM LEVEL OF
DOCUMENTATION AND STREAMLINING
IT WOULD BE VERY HELPFUL. TWO
MEMBERS. THANK YOU, MA'AM,
SENATOR RUBIO. THANK YOU, MR
CHAIR. I MEAN, I GUESS THAT'S
WHY WE'RE HERE, RIGHT? WE'RE
TRYING TO FIGURE OUT HOW WE BEST
SUPPORT THE SYSTEM, THE
INFRASTRUCTURE, BUT I HEAR YOUR
FRUSTRATION ABOUT HAVING JUST
DIFFERENT REQUIREMENTS FOR
DIFFERENT COUNTIES. BUT I GUESS
IT REALLY, UM YOU KNOW IF I CAN
ASK YOU I MEAN, HERE. WE'RE
TRYING TO SOLVE PROBLEMS AND YOU
HAVE CONCERNS IF HE CAN GIVE US
YOUR TOP TWO ITEMS BESIDES JUST
BASIC INTAKE FORMS. GIVE ME THE
TOP TWICE AND YOU'D LIKE TO SEE
US FOCUSED ON SO THAT WE CAN
MAKE THINGS A LITTLE BIT MORE,
YOU KNOW, BETTER SYSTEM FOR YOU
GUYS. NO IT'S NOT MY TURN. BUT
I'M HAPPY TO JUMP IN YOUR TIME
WITH THE CALIFORNIA ALLIANCE OF
CHILD AND FAMILY SERVICES. I
WOULD SAY ONE OF THE BIGGEST
PAIN POINTS FOR OUR PROVIDERS
RIGHT NOW IS THE FACT THAT, UM
MANY OF OUR PROVIDERS HAVE TO
ACTUALLY INPUT A DIFFERENT CODE
THAT DOES NOT MATCH THE DHC S
BILLING MANUAL. CPT CODES AND WE
HAVE BEEN BRINGING THESE ISSUES.
THIS IS NOT A SURPRISE TO SEE
BHD A OR THE H C S. WE HAVE BEEN
BRINGING THAT ISSUE FORWARD. UM
AND IMAGINE FOR, YOU KNOW, A
PROVIDER THAT HAS TO NAVIGATE 15
, PLUS COUNTIES AND HAVING TO
NAVIGATE THE DIFFERENT CODES
THAT DON'T MATCH THE DHC S BILLY
MANUAL. SO I WOULD SAY FOR US
FOR THE ALLIANCE. THAT'S ONE OF
THE BIGGEST PAIN POINTS IN TERMS
OF THIS ADDITIONAL BURDEN. THIS
ADDITIONAL DOCUMENTATION
ADMINISTRATIVE BURDEN. BUT CAN
YOU SPEAK TO MR FITZGERALD'S
POINT ABOUT? LIKE SAY, SAY, FOR
EXAMPLE, THAT WE USE FOR THAT
SOMEBODY COMING INTO A CLINICAL
OFFICE RECEIVING 50 MINUTES.
SOMEBODY RECEIVING THAT DOWN IN
ENCAMPMENT THAT THOSE ARE THE
PERSON IS GOING TO HAVE
DIFFERENT DIFFERENT METHODS AND
EVERYTHING TO GET DOWN THERE. IS
THAT WHAT YOU'RE TALKING ABOUT
THAT SAME EXAMPLE IF WE CAN KEEP
USING THAT MR. WELL I WAS I WAS
GOING TO ADD ON THAT EXAMPLE.
THERE'S ALSO AN ELEMENT HERE
AROUND THE TIME THAT IT TAKES TO
GET TO A HOMELESS ENCAMPMENT.
CORRECT RIGHT? THERE'S COMMUNITY
BASED SERVICES, AND THAT'S
SOMETHING I WAS GOING TO GET
INTO. IN MY COMMENTS AROUND
MAKING SURE THAT THAT IS
ADEQUATELY FINANCED BECAUSE
SOMETIMES OUR MEMBERS ARE
TRAVELING HOURS, RIGHT. WE'RE
OUR PEOPLE ARE THE MEDICAL
POPULATION THAT WE ARE SERVING.
THEY'RE NOT COMING INTO CLINICS
BY AND LARGE. WE ARE GOING OUT
TO COMMUNITY AND THIS THIS IS
OURS. YOU KNOW, IN SOME CASES,
WE WANT TO MAKE SURE THAT THIS
IS ADEQUATELY FINANCED THE
COMMUNITY BASED FIELD BASED
DELIVERY SYSTEM. I'D LIKE TO ADD
THAT SOME COUNTIES HAVE BEEN IN
COMMUNICATION WITH PROVIDERS
AROUND TRAVEL TIME. AND EVEN
THOUGH INITIALLY THE EXPERIENCE
WAS THAT TRAVEL TIME JUST ISN'T
GOING TO BE REIMBURSED. THERE
HAVE BEEN SOME IMPROVEMENTS WITH
A FEW COUNTIES. BUT AGAIN, IT'S
A NICE EXAMPLE OF ITS UNEVEN,
RIGHT. SO YOU'RE IN ONE COUNTY,
PROVIDING THE SAME SERVICE TO
MAYBE THE SAME POPULATION TRAVEL
TIME MIGHT NOW THAT COUNTY MIGHT
SAY THAT WE'RE ABLE TO HELP WITH
TRAVEL TIME. ANOTHER COUNTY
ISN'T I THINK THE BASE OF THIS
IS CREATING AS MUCH
STANDARDIZATION AS AS POSSIBLE
BECAUSE PROVIDERS OPERATE ACROSS
MULTIPLE COUNTIES SO THAT THAT
GRANULAR GRANULAR LEVEL WE'RE
TALKING ABOUT IS IT STILL MIGHT
BE THE SAME SERVICE. BUT IF IT'S
LIKE, IF YOU HAVE TO LOOK FOR SO
LONG, THAT WOULD BE A DIFFERENT
CODE. THAT MAKES SENSE. SO I
JUST THE 50 MINUTE HOUR, RIGHT?
WE GO INTO A CLINIC FOR THAT.
THAT WOULD BE ONE CODE THE SAME
SERVICE, BUT IT'S PROVIDED. IN
THE FIELD AND THE FIELD. IT
WOULD BE A DIFFERENT CODE YOU'RE
SUGGESTING BUT WHICH WHICH ADDS
TO THE PROBLEM OF RIGHT OR AM I
INCORRECT? WHAT I WAS TALKING
MORE ABOUT IS YOU COULD HAVE THE
SAME SERVICE. LET'S SAY ONE OF
OUR PROVIDERS WHO'S ACTUALLY
HERE IN THE AUDIENCE SPECIFIC
CLINICS WHO HAVE SERVICES IN
MULTIPLE COUNTIES, RIGHT. YOU
CAN PROVIDE THE STATE SET OF
SERVICES BUT IF IN ONE COUNTY
TOLD THAT YOU MAY BE REIMBURSED
FOR TRAVEL TIME AND THE OTHER
YOU AREN'T ALL OF THAT GOES INTO
THE BOTTOM LINE OF ARE YOU GOING
TO BE ABLE TO PROVIDE THAT
SERVICES THOSE SERVICES TO THAT
POPULATION? AND YOU DON'T WANT
TO HAVE AN UNEVEN PROVISIONS
WERE IN ONE COUNTY. YOU CAN IN
ONE COUNTY. YOU CAN'T JUST NOTE
THAT ON THE TRAVEL TIME ISSUE,
THERE IS NO CPT CODE CURRENTLY
FOR TRAVEL. AND SO, UM, THAT
DOES NEED TO BE FACTORED INTO
THE OVERALL CONTRACTED RATE FOR
THAT PROVIDER, WHICH IS WHY
WE'RE SEEING TO YOUR POINT THAT
SOME PROVIDERS WILL BE PAID MORE
IF THE PROGRAM MODEL IS SUCH
THAT THEY'VE GOT MORE HIGH
INTENSITY. AND MORE FIELD BASED
SERVICES, WHICH IS PART OF WHY
THE SETTING SORT OF COACHING AND
THE T AND THE TRAINING THAT
WE'RE PROVIDING TWO COUNTIES IS
HOW TO SET UP A TIERED RATE
STRUCTURE. SO BASICALLY THE HIGH
VOLUME CLINIC BASED VERSUS THE
MORE FIELD BASED AT HOME BASED
PROVIDERS AND PROVIDING
DIFFERENT RATES TO PROVIDERS,
DEPENDING ON THE KIND OF PROGRAM
THAT THEY HAVE, AND THE
COMPLEXITY, ACUITY AND
CHALLENGES ASSOCIATED WITH
BRINGING IN CLIENTS AND DOING
DIRECT THESE TWO FACE SERVICES,
RIGHT BECAUSE FOR SERVICE IS ALL
ABOUT. YOU DELIVER A SERVICE TO
SOMEBODY YOU GET PAID FOR THAT
SERVICE, RIGHT? THE MORE PEOPLE
YOU SEE THE MORE MONEY YOU GET.
AND SO THE MODIFIERS, THOUGH,
ARE PART OF WHAT IS VERY ACROSS
DIFFERENT PLANS, AND THAT'S JUST
TRUE OF ALL HEALTH CARE PLANS,
WHETHER IT'S COMMERCIAL,
MEDICARE, UM, MEDICAL MANAGED
CARE OR COUNTY BEHAVIORAL
HEALTH. WILL HAVE THE OPTION TO
SET UP DIFFERENT CODES, AND SOME
OF THAT MIGHT BE VARIED BECAUSE
THINGS ARE NEW, AND PEOPLE ARE
TRYING TO FIGURE OUT HOW TO DO
THIS THE RIGHT WAY. SOME OF IT
IS ABOUT THOSE MODIFIERS. LIKE I
SAID, UM, AND WE'RE REALLY ALL
JUST SORT OF LEARNING TOGETHER
ABOUT WHAT THE BEST APPROACHES
ARE. BUT THE IDEA THAT THE PLAN
WOULD SET CODES ACCORDING TO
WHAT WORKS BEST FOR THEM, THAT
IS INDUSTRY STANDARD. DR WITH
YOUR EXAMPLE WITH SERVICE
PROVIDERS SAYING, HEY, WE'RE
WORKING IN DIFFERENT COUNTIES. I
GET IT HERE AND I DON'T GET IT
HERE THEN, ARE THEY OPTING OUT
TO NOT DO IT TO JUST MAKE IT
EVIL? EVEN THEY'RE NOT ABLE TO
FEEL SIMPLE AND SOME ARE YES,
AND I THINK YOU'RE SEEING THAT
THERE'S BEEN A SERIES AND CALL
MATTERS, WHICH IS THE VOICES OF
PRAYER PROVIDERS, SAYING, THIS
IS AN ISSUE. THIS IS HOW IT'S
IMPACTING US. THIS ISN'T JUST
ONE OR TWO, AND IT'S NOT JUST
THE SMALL ONES. THERE'S BEEN
LOTS OF THINGS SAD ABOUT THAT.
THERE ARE SOME VERY LARGE
AGENCIES THAT HAVE BEEN AT RISK
AND HAD TO CUT WORKFORCE AND
THIS ISN'T JUST, YOU KNOW. WE
ONLY HAVE THIS MUCH WORK FORCE
SO WE CAN ONLY DO THIS MUCH
SERVICE. WE WERE CUTTING
WORKFORCE RIGHT? AND THAT'S NOT
BECAUSE WE DON'T HAVE ENOUGH
SERVICE. OFTENTIMES THAT'S JUST
THE RATES THAT ARE NEGOTIATED
AREN'T GOOD ENOUGH TO SUSTAIN
OPERATIONS. HMM. YOU KNOW, I'M
NOT A DATA ANALYST, BUT IF I
WERE SLICING IN DATING DATA
BASED ON THE CPT CODE, AND IF
THE IF THE AMOUNT PAID IS
DIFFERENT, BASED ON WHERE THE
SERVICE IS DELIVERED, AS OPPOSED
TO THE SERVICE ITSELF. I DON'T
KNOW WHAT THAT DATA POINT WOULD
GIVE ME IF I WANTED TO DO SOME
ANALYSIS. I DON'T KNOW IF THAT'S
IMPORTANT IN YOUR BUSINESS, BUT
VERY MUCH SO CERTAINLY IS NOT
VERY DATA IS NOT PARTICULARLY
USEFUL. I WOULD THINK SO WOULD
SEEM TO ME THAT WOULD NEED TO BE
AT LEAST A SUBCATEGORY OF THE
CPT CODE FOR SERVICES DELIVERED
IN OFFICE VERSUS SERVICES
DELIVERED IN THE FIELD. AND EVEN
THAT IS THE FIELD PIECE WOULDN'T
BE PARTICULARLY USEFUL BECAUSE
YOU WOULDN'T KNOW WHETHER IT WAS
PAYING FOR SOMEBODY TO DRIVE
THREE HOURS FROM RIVERSIDE TO
BLYTHE, THOR. WHATEVER. UM MY
MAKING SENSE FOR NONE OVER HERE.
I'M JUST A NON PROVIDER PERSON.
I THINK PART OF THIS AND IT GOES
TO KIND OF A BIGGER POINT.
BEYOND CAL AIM IS LIKE THE MORE
DETAILED DATA REPORTING WE WANT
OUT OF THESE SYSTEMS. THE MORE
REQUIREMENTS ARE GOING TO FALL
ON COUNTY CENTER PROVIDERS TO
COLLECT THAT MORE GRANULAR DATA,
RIGHT? AND SO THERE IS A BALANCE
HERE BETWEEN EXPANDING THE
GRANULARITY OF DATA BUT ALSO
WANTING TO MAKE THINGS SIMPLE
ENOUGH ON PROVIDERS THAT IT
DOESN'T BECOME THAT TIPPING
POINT OF ADMINISTRATIVE BURDEN.
RIGHT AND I THINK PART OF WHAT
YOU'RE HEARING FROM OUR
PROVIDERS IS WE WANT THINGS TO
BE THE SAME EXACTLY ACROSS ALL
PLANS. PART OF WHAT YOU'LL HEAR
FROM US IS THAT'S NOT QUITE HOW
LIKE HEALTHCARE MORE BROADLY, IS
WORKING WHEN YOU CONTRACT WITH A
MANAGED CARE PLAN FOR ECM, OR
COMMUNITY SERVICES. THOSE PLANS
WILL EACH HAVE THEIR OWN
DIFFERENT WAYS OF DOING BUSINESS
AND THEIR OWN UNIQUE
REQUIREMENTS. PART OF WHAT'S
DIFFERENT FOR US IS WITH OUR
PROVIDERS WERE COVERING A MUCH
BROADER RANGE OF SERVICES AND
ABRUPT, BROADER RANGE OF SERVICE
TYPES AND PROGRAMMATIC TYPES.
AND SO THERE'S JUST INHERENT
COMPLEXITY IN THE BROADER RANGE
OF SERVICES THAT WE ARE ABLE TO
CONTRACT WITH THESE PROVIDERS
FOR AND I'D SAY WITH THEM AND
SEE US IN THAT EXAMPLE WE'RE NOT
SEEING YES, THERE IS COMPLEXITY
THERE. WE'RE ALSO SEEING A LOT
OF PROBLEMS THERE BECAUSE OF THE
VARYING RATES AND THE VERY LOW
RATES THAT THEY OFFER OUR
PROVIDERS, EVEN THOUGH THAT'S
BEEN SET UP AS A, YOU KNOW, A
CATCHMENT FOR OTHER SERVICES AND
POPULATIONS. THAT'S NOT
NECESSARILY WORKING INCREDIBLY
WELL, EITHER. THAT'S RIGHT.
WHATEVER YOU HAVE RUBIO YEAH. I
WANT TO JUST TOUCH WHAT YOU JUST
SAID RIGHT NOW. AND YOU KNOW,
THE MORE THEY WE REQUIRE DATA,
THE MORE COMPLEX IT BECOMES, BUT
IT WOULD APPEAR TO ME THAT YOU'D
WANT TO CAPTURE THE MOST
IMPORTANT PART THAT IMPACTS
REIMBURSEMENT. WHAT WE'RE SAYING
IS, YOU KNOW SERVICE, UH, IN THE
OFFICE VERSUS SERVICES IN THE
FIELD. I THINK TO ME THAT'S A
BIG PART OF UNDERSTANDING LIKE
THE REIMBURSEMENT AND SO I DON'T
KNOW HOW WE FIX IT, BUT IT GOES
BACK TO WHAT I SAID HERE. WE'RE
HERE TO FIX THE PROBLEM. AND I
GUESS I MEAN, HOW DO WE GET A
REPORT IN TERMS OF WHAT WOULD BE
LIKE THE TOP 10 ITEMS THAT YOU
NEED TO FIGURE OUT IN TERMS OF
MAKING IT EQUITABLE TO REIMBURSE
? I IMAGINE YOU KNOW HOW COLOR
I'M NOT MAKING THIS UP? OF
COURSE IT'S SUCH A, YOU KNOW.
YOU KNOW, MINOR THING, BUT HOW
MANY HOURS YOU SPEND ON THE
FIELD? THAT'S THAT'S CRITICAL,
RIGHT? AND SO EVEN THOUGH IT
DOES ADD A LITTLE BIT MORE
COMPLEXITY AND MORE TIME IT'S
CRITICAL LIKE WE NEED TO KNOW
THAT THAT INFORMATION NO MATTER
HOW COMMERCENTRE BECOMES TO
GATHER THAT DATA, I THINK IT'S
IMPORTANT TO FIGURE OUT WHAT'S
THE MOST IMPORTANT IN TERMS OF
REIMBURSING AND I HEARD YOU ALSO
SAID I'M SORRY, DOCTOR. I THINK
I HEARD YOU SAY THAT. BECAUSE
THE NEGOTIATIONS NOT YOU KNOW,
IT DOESN'T COVER OPERATIONS.
THEN YOU HAVE TO CUT. YOU KNOW
PEOPLE AND THAT KIND OF
DIMINISHES WHAT WE'RE TRYING TO
DO HERE, WHICH IS PROVIDING
QUALITY SERVICE SO
INTERCONNECTED, BUT I THINK WE
NEED TO FORGIVE ME, BUT GET PAST
THE BURDENSOME OF REPORTING, BUT
IF IT'S NECESSARY, IT'S
NECESSARY. WE NEED TO REPORT
WHAT'S NECESSARY. BUT I GUESS
IT'S JUST PART OF A COMMON THANK
YOU. YES MA'AM. I WANTED TO ADD
SOMETHING TO THIS CONVERSATION
IS REALLY IMPORTANT. WHICH IS A
LETTER THAT THE HCS SENT TO ALL
OF THE COUNTY BEHAVIORAL HEALTH
DIRECTORS IN DECEMBER AND
SOMETHING THAT WE AT THE
ALLIANCE AND MEMBERS ARE LOOKING
FORWARD TO WHICH IS TARGETED
PROVIDER RATE DESIGN. SO THE HCS
HAS SAID THIS TO THE COUNTY'S
STRONGLY AND UNEQUIVOCALLY
RECOMMENDS THAT COUNTIES
IMPLEMENT PROVIDER RATE
DEVELOPMENT STRATEGIES THAT
INCORPORATE THESE ADJUSTMENTS.
ASSUMPTIONS INPUTS THAT ONE SIZE
ALL FIT RATES DO NOT ACCOUNT FOR
FIELD BASIN IN HOME MODELS. SO
THERE IS AN EXPECTATION OF THE
STATE OF DHC S THAT THIS
HAPPENED, BUT THERE WOULD NOT BE
A ONE SIZE FITS ALL YOU KNOW
RATE APPROACH. AND UM, IT DIDN'T
HAPPEN THIS YEAR IN THE FIRST
YEAR OF PAYMENT REFORM, SO WE
ARE REALLY LOOKING FORWARD TO
THIS. YOU KNOW THE IDEA AND WILL
CONTINUE TO, YOU KNOW, UPLIFT
EXAMPLES THAT ARE WORKING ACROSS
THE STATE. BUT THIS IS A CENTRAL
RECOMMENDATION IN THIS LETTER TO
THE COUNTIES, THE INTENT THAT
THERE BE A SEPARATE CPT CODE,
THEN FOR FIELD SERVICES. SO
SENATOR THERE ARE MODIFIERS FOR
EACH OF THE CPT CODES THAT GO ON
TOP. THIS IS PART OF WHAT WE'RE
TALKING ABOUT, RIGHT THAT TALK
ABOUT THE LOCATION OF SERVICE,
SO THAT'S ALREADY BUILT INTO THE
CODE SIDE, OKAY? THANK YOU,
DOCTOR. WE CUT YOU OFF. IT'S
FINE BECAUSE WE GOT INTO A
LITTLE BIT OF ALL OF IT. I THINK
WE'RE WELL PREPPED TO GO TO MY
COLLEAGUE ADRIAN AT THE
ALLIANCE, SO I'LL JUST END BY
SAYING LIKE IT'S DIRE TIMES. WE
GET OUT. WE'RE APPRECIATIVE OF
THE WORK THAT DHC S THE
COUNTIES. ALL OF OUR PROVIDERS
ARE TRYING TO DO TOGETHER AND WE
HAVE TO DO MORE AND OUR
WORKFORCE IS LEAN AND
ADMINISTRATIVE BURDEN IS JUST
WAY TO HAVE A THANK YOU FOR
CONVENING THIS CONVERSATION
ABOUT THIS IMPORTANT ISSUE.
OBVIOUSLY, THERE'S LOTS OF
COMPLEXITIES AND LOTS OF
PERSPECTIVES, AND IT'S GOING TO
TAKE ALL OF US. BEING WILLING TO
WORK TO COME TOGETHER TO SOLVE
IT. THANK YOU. THANK YOU.
SHELTON ADRIAN SHELTON WITH THE
CALIFORNIA ALLIANCE OF CHILD AND
FAMILY SERVICES. THANK YOU,
SENATOR. SO MUCH FOR HAVING THIS
IMPORTANT HEARING TODAY.
ALLIANCE MEMBERS ARE THE
NONPROFIT ORGANIZATION SERVING
CHILDREN AND YOUTH AND FAMILIES
IN OUR SAFETY NET PROGRAMS AND
ALL OF THE 58 COUNTIES. THE
ALLIANCE MEMBERS CONTRACT WITH
BOTH THE COUNTIES AND MANAGED
CARE PLANS TO PROVIDE BEHAVIORAL
HEALTH SERVICES TO VULNERABLE
YOUTH AND YOUNG ADULTS AND
ADULTS AND THEIR FAMILIES. SO
CHANGES TO THE MEDICAL PROGRAM
HAVE A PROFOUND EFFECT ON THE
POPULATIONS THAT WE SERVE. AND
SO WE'RE VERY GRATEFUL TO BE
PART OF THIS IMPORTANT HEARING,
SO I JUST WANTED TO DRAW A
COUPLE OF EXAMPLES ABOUT WHO
ALLIANCE MEMBERS ARE CHILDREN
COME INTO OUR MEMBERS PROGRAMS
HAVING EXPERIENCED OFTEN
PROFOUND PHYSICAL AND EMOTIONAL
ABUSE ALLIANCE MEMBERS WITH
EXTENSIVE AND SPECIALIZED
TRAINING AND STAFF, STABILIZED
CHILDREN IN CRISIS AND WORK TO
REBUILD THEIR TRUST, OFTEN WITH
THE GOAL OF REUNIFYING THAT THE
CHILDREN WITH THEIR FAMILIES,
AND SO AS YOU CAN, AS YOU MIGHT
IMAGINE, THIS IS INTENSELY
EMOTIONAL WORK REQUIRING HIGHLY
TRAINED STAFF. AND YOUTH ARE
ALSO ALSO ALSO REFERRED TO OUR
MEMBERS PROGRAMS FROM SCHOOLS,
SO ALLIANCE MEMBERS ARE ALSO
REALLY CRITICAL TO ACADEMIC
SUCCESS AS WELL. WE
WHOLEHEARTEDLY SUPPORT AND AGREE
WITH THE GOALS OF KILLEEN.
HAVING SERVING, YOU KNOW, THE
MEDICAL POPULATION ARE MEMBERS
ARE KEENLY AWARE OF THE UNIFYING
PHYSICAL HEALTH, BEHAVIORAL,
HEALTH AND SOCIAL SUPPORTS THAT
IS VITAL TO OUR COMMUNITIES,
WELL BEING AND SO FOR CHILDREN
AND YOUTH, IN PARTICULAR COLUMN
IS AN OPPORTUNITY TO BOTH EXPAND
ACCESS AND IMPROVE QUALITY OF
CARE. A ROBUST NETWORK OF
COMMUNITY BASED ORGANIZATIONS
DEEPLY ROOTED IN THE POPULATIONS
THAT WE SERVE IS A FOUNDATION
FOR CALLUM SUCCESS, SO IT'S ALSO
IMPORTANT TO RECOGNIZE THAT MANY
OF OUR PROGRAMS ARE REALLY
STRUGGLING RIGHT NOW, AS THEY
ARE CAUGHT BETWEEN SOARING COSTS
AND PAYMENT RATES THAT DON'T
NECESSARILY MATCH AND IN MANY
CASES, YOU KNOW THIS. THIS DOES
HAVE TO DO WITH HOW THE COUNTIES
ARE SETTING THEIR RATES FOR
THEIR NONPROFIT, YOU KNOW,
PROVIDERS. AND THIS WAS DONE AS
C B H J MENTIONED THIS WAS DONE
VERY QUICKLY, RIGHT? THERE WAS
NOT A LOT OF ROOM FOR
NEGOTIATION. FIRST YEAR HAS BEEN
VERY TUMULTUOUS, TO SAY THE
LEAST. UM AND SO, IN SOME CASES,
PAYMENT REFORM UNDER CAL AIM HAS
REALLY ACCELERATED THE FINANCIAL
THREAT THAT YOU KNOW THERE ARE
NONPROFIT MEMBERS HAVE AND THERE
ARE SOME EXAMPLES, AND WE JUST
DID. A RECENT SURVEY ABOUT OUR
PROVIDERS THAT ARE BECAUSE OF
THE LOSSES THAT THEY'RE TAKING
ARE REALLY CONSIDERING
DOWNSIZING OR, IN SOME CASES,
LEAVING THE COUNTY ALTOGETHER
AND AGAIN, WE ARE IN CONSTANT
COMMUNICATION WITH C B, H D AND
D HCS ABOUT THESE ISSUES. WE
BRING THESE ISSUES RIGHT AWAY.
WE DID NOT LET THEM FESTER. SO
YOU KNOW WE BRING THE CRISIS OR
BRING THE ISSUE AND REALLY TRY
TO PROBLEM SOLVING THAT'S
ACTUALLY WORKED IN THE NUMBER OF
CASES. UM AND WE ALSO YOU KNOW
AGAIN. UM UM WE HAVE AN ENORMOUS
OPPORTUNITY YOU KNOW, TO ADDRESS
THE CHALLENGES THAT WE HAVE THE
BEHAVIORAL HEALTH CRISIS THAT WE
HAVE AMONG OUR CHILDREN AND OUR
YOUTH, BUT YOU KNOW TO JUST
RAISE THESE POINTS AGAINST CBOS
ARE OFTEN CAUGHT BETWEEN LOW
PAYMENT RATES IN THE COUNTY
CONTRACTS AND THE SURGING, YOU
KNOW, HOUSING HOUSING PRICES AS
AN EXAMPLE AND THE FUNDING
THAT'S NEEDED TO ATTRACT A
HIGHLY SPECIALIZED WORKFORCE. UM
SO WE, YOU KNOW, WE ALSO GREATLY
APPRECIATE INITIATIVES THAT HAVE
BEEN ROLLING OUT IN OUR STATE
UNDER H CHI AND OTHERS AROUND
WORKFORCE. BUT WE HAVE TWO
FUNDAMENTAL, FUNDAMENTALLY
ADDRESS THIS STRUCTURAL ISSUE
AROUND RATES THROUGH TO TRULY
MAKE A DIFFERENCE. UM MY
COLLEAGUE MENTIONED
DOCUMENTATION. SO JUST JUST TO
SAY WE HAVE SEEN SOME RELIEF. I
MEAN, ABSOLUTELY. THERE HAS BEEN
A SECOND ROUND OF GUIDANCE THAT
HAS COME OUT TO THE COUNTIES TO
OUR PROVIDERS. WE HAVE SEEN SOME
RELIEF, BUT THERE ARE STILL SOME
ISSUES WHERE PROBLEM SOLVING. WE
BROUGHT UP THE CODES ISSUE
EARLIER THAT THAT'S A BIG ONE.
SO WE STILL HAVE YOU KNOW, WE IN
PARTNERSHIP WITH THE OTHER
PROVIDER ASSOCIATIONS DO HAVE A
LEGISLATIVE PROPOSAL ON THE
TABLE AROUND THE AROUND THESE
ISSUES. AND THEN ALSO TO ACHIEVE
OUR STATE'S GOALS AROUND EQUITY
AND RESPONSIVENESS TO THE NEEDS
OF OUR MOST MARGINALIZED
COMMUNITIES. CALIFORNIA IS GOING
TO BE EVEN MORE RELIANT ON
COMMUNITY BASED ORGANIZATIONS
THAT ARE ROOTED IN THE DIVERSE
COMMUNITIES THAT THEY'RE SERVING
THESE COMMUNITIES. THESE
COMMUNITIES THAT ARE MEMBERS
SERVE LACK TRANSPORTATION. THEY
ARE MISTRUSTFUL OF GOVERNMENT
FOR GOOD REASON. THEY'RE NOT
COMING INTO THE PROGRAM. THEY'RE
NOT COMING INTO CLINICS. WE'RE
GOING OUT TO SERVE THEM IN HOMES
AND SCHOOLS AND COMMUNITIES. UM
SO YOU KNOW IN OUR MEMBERS
SUCCEED BECAUSE THEY BUILD TRUST
BECAUSE THEY ARE GOING TO THE
STREETS. EXAMPLE I WAS RIGHT ON
TO SERVE THE MOST UNDERSERVED.
AND AGAIN GOING BACK TO THIS
REALLY IMPORTANT LETTER THAT DHC
S INITIATED. WE'RE VERY GRATEFUL
FOR IT THAT THIS PAYMENT PAYMENT
MODELS BASED ON THE ONE SIZE
FITS ALL. UM JUST START OR NOT
ARE NOT GOING TO WORK FOR OUR
FOR OUR MEMBERS AND THE
COMMUNITIES THAT THEY SERVE. SO
AGAIN. WE'RE VERY GRATEFUL FOR
THE PARTNERSHIP THAT WE HAVE
WITH BHD. A AND WITH THE HCS. UM
WE HAVE TO GET PAYMENT REFORM,
RIGHT? WE'RE LOOKING FORWARD TO
THE FUTURE. LEE. WE KNOW THIS
FIRST YEAR WAS GOING. YOU KNOW
WHAT WAS IT WAS ROUGH, BUT WE'RE
TRYING TO PROBLEM SOLVE. WE'RE
LOOKING FORWARD TO THAT. UM AND
I JUST WANT TO THANK THE
COMMITTEE BECAUSE I KNOW
INDIVIDUALLY YOU ALL WORK ON
BILLS THAT ADDRESS THE
BEHAVIORAL HEALTH CRISIS ADDRESS
OUR FOSTER YOUTH CRISIS. AND SO
WE'RE LOOKING FORWARD TO BEING A
RESOURCE. PLEASE CONSIDER THE
ALLIANCE AND OUR MEMBERSHIP
RESOURCE AS AS WE PROBLEM SOLVE,
WE WOULD LOVE TO, UM, YOU KNOW,
SUGGESTED FOLLOW UP, CALLUM
HEARING, YOU KNOW, SOON AS WE
ARE GETTING INTO THE NEXT CLEAR,
THANK YOU SO MUCH FOR YOUR
LEADERSHIP. THANKS TO YOUR
PRESENTATION, COLLEAGUES. ANY
QUESTIONS, MADAM EXECUTIVE
DIRECTOR, YOU'RE NEXT, AND I
FEEL A LITTLE OUT OF PLACE ON
THIS HAND. I'M NOT A PROVIDER.
I'M NOT ACCOUNTING. I'M NOT DHC
S IN YOUR POSITION. WITH YOU. SO
I WAS A LITTLE NOT GETTING RID
OF THAT, BUT, UM, MY
ORGANIZATION, THE CALIFORNIA PAN
ETHNIC HEALTH NETWORK RECEIVED
PEN, WHERE A STATEWIDE HEALTH
ADVOCACY ORGANIZATION WE WORK
WITH THE CONSUMERS, MEDICAL
MEMBERS AND OUR FOCUS REALLY IS
ON, ELIMINATING REDUCING AND
ELIMINATING RACIAL DISPARITIES.
AND WE HAVE A BIG FOCUS ON
BEHAVIORAL HEALTH BECAUSE I
THINK WE REALLY UNDERSTAND WHAT
A SIGNIFICANT CONCERN IT IS
ACROSS THE STATE AND HOW
IMPORTANT BEHAVIORAL HEALTH IS
TO ALL OF US IN OUR LIVES. WE UM
WE TALKED TO COMMUNITIES ACROSS
THE STATE EVERY YEAR. WE DO
LISTENING SESSIONS. WE DO
SURVEYS. WE DO FOCUS GROUPS. WE
REALLY WANT TO UNDERSTAND WHAT'S
HAPPENING FROM THE MEMBER AND
THE CONSUMER PERSPECTIVE. AND
YOU KNOW THE KEY THEMES REALLY
HAVEN'T CHANGED THAT MUCH IN
TERMS OF GENERALLY WHAT PEOPLE
EXPERIENCE BEHAVIORAL HEALTH AT
A VERY HIGH LEVEL, BEHAVIORAL
HEALTH SERVICES ARE ALMOST
UNIVERSALLY DIFFICULT TO ACCESS.
UM THE SERVICES THAT ARE
ACCESSED, RARELY ALIGNED WITH
THE CULTURAL AND LINGUISTIC
NEEDS OF OUR MEDICAL MEMBERS AND
MORE OFTEN THAN NOT PEOPLE OF
COLOR, ACTUALLY, WHEN THEY GET
INTO CARE DON'T DON'T
NECESSARILY FIND THE SERVICES TO
BE USEFUL OR HELPFUL. WE
ACTUALLY SEE A LOT OF DROP OFF
RIGHT AMONG COMMUNITIES OF
COLOR, WHO MAY BE ACCESSED ONE
FIRST SERVICE AND NEVER GO BACK.
AND SO THAT'S A REAL CONCERN FOR
US. I THINK THE CONSEQUENCES OF
THESE OF THESE SITUATIONS ARE
QUITE GRAVE FOR COMMUNITIES OF
COLOR. AND SO I REALLY
APPRECIATE THE CALAIS AND
EFFORTS. I APPRECIATE THE
EFFORT. IT'S OF THE COUNTIES AND
THE PROVIDERS, I THINK REALLY
TRYING TO IMPROVE OUR SYSTEM OF
CARE. AND WITH REGARD TO THE
THREE SORT OF SUBSECTIONS OF CAL
AIM THAT ARE THE TOPIC TODAY. I
THINK OUR VIEW IS THEY'RE
NECESSARY, BUT FAR FROM
SUFFICIENT RIGHT AND
PARTICULARLY FAR FROM SUFFICIENT
WHEN WE'RE THINKING ABOUT RACIAL
EQUITY SPECIFICALLY, AND THAT'S
BECAUSE RACIAL EQUITY WHILE IT
WAS SORT OF IN THE AIR, AS PART
OF KELLY ISN'T THE SPECIFIC
FOCUS OF THESE INITIATIVES, AND
WE THINK IT SHOULD BE IF WE WANT
TO IF WE WANT TO ACHIEVE THAT
IMPACT, SO I HAVE MUCH LESS TO
SAY ON PAYMENT REFORM THAT MY
COLLEAGUES OTHER THAN TO SAY,
YOU KNOW, WE REALLY THAT YOU THE
DISCUSSION FROM D HCS, AND WE
THINK IT'S REALLY IMPORTANT THAT
WE'RE MOVING IN THIS DISCUSSION
IN THIS DIRECTION OF VALUE BASED
PAYMENT, NOT ONLY BECAUSE IT'S
WHAT THE REST OF HEALTHCARE
DOES. BUT BECAUSE WE REALLY CARE
ABOUT THE OUTCOMES, WE CARRY THE
OUTCOMES FOR PEOPLE AND WE CARE
ABOUT HOW TO GET THERE AND WE
DON'T NECESSARILY HAVE THE
SYSTEMS IN PLACE BASED ON HOW WE
PAY OUR PROVIDERS HOW WE WORK
WITH OUR COUNTIES TO REALLY
INCENTIVIZE THAT KIND OF VALUE
AND THOSE GOOD OUTCOMES AND
THOSE REDUCED RACIAL DISPARITIES
TODAY, RIGHT, SO THIS IS A
PAINFUL STEP, BUT WE CAN'T GET
TO THAT PLACE WITHOUT GOING
THROUGH THIS RIGHT. SO FOR THAT
REASON WE REALLY WERE OPTIMISTIC
ABOUT IT. AND WE HOPE THE STATE
CONTINUES TO MOVE ACTUALLY
SOMEONE QUICKLY TOWARDS MORE
VALUABLE SYSTEM. I WILL SAY SOME
OF THE FOLKS WE WORK WITH ARE
YOUR VERY SMALL COMMUNITY BASED
ORGANIZATIONS, THE ONES WHO ARE
VERY DEEPLY EMBEDDED IN
COMMUNITIES WHO ARE NOT PART OF
THE MEDICAL PROGRAM. TODAY
THEY'RE EVEN SMALLER THAN ADRIAN
AND LEANDRO'S PROVIDERS, RIGHT
AND A LOT OF THE CONVERSATION AT
CALAIS MEN, BEHAVIORAL HEALTH,
AS WELL AS AN ECM AND COMMUNITY
SERVICES HAS BEEN ABOUT HOW DO
WE ACTUALLY BRING SOME OF THOSE
PROVIDERS INTO THE SYSTEM? RIGHT
SOMETIMES WE'RE TALKING AT
COMMUNITY HEALTH WORKERS
CENTURIES. WE'RE TALKING AT
OTHER KINDS OF PROVIDERS, AND I
THINK THERE WE HAVE NOT SEEN
THAT HAPPEN. OPEN YET, RIGHT?
AND I THINK PART OF THAT IS THIS
IS REALLY CHALLENGING, AND I
DON'T THINK THE EMPHASIS HAS
BEEN ON HOW WE SET UP A PAYMENT
STRUCTURE THAT WILL WORK THAT
WILL HELP PEOPLE BUILD A
FOUNDATION THAT WILL HELP
ORGANIZATIONS. REALLY BUILD THE
INFRASTRUCTURE NEEDED TO BE PART
OF THE MEDICAL SYSTEM. SO WE
WOULD REALLY ENCOURAGE THE
LEGISLATURE TO THINK ABOUT HOW
WE CAN DO MORE OF THAT, AS WE
THINK ABOUT PAYMENT. NO WRONG
DOOR. I MEAN, OF COURSE, IT'S A
GOOD THING TO NOT HAVE PEOPLE
BOUNCING BACK AND FORTH AND
LOSING THEIR PROVIDER BETWEEN
SYSTEMS. BUT OUR BIGGER CONCERN
REALLY IS THAT MEDICAL MEMBERS
ARE NOT GETTING TO ANY DOOR AT
ALL. AND SO THAT YOU KNOW, THIS
POLICY IS HELPFUL FOR PEOPLE WHO
FIND THE DOOR. BUT THAT IS NOT
MOST PEOPLE WITH A BEHAVIORAL
HEALTH NEED, AND THAT'S CLEAR
THROUGH SO MUCH DATA THAT WE
HAVE RIGHT WELL OVER HALF CLOSE
TO TWO THIRDS OF PEOPLE WHO HAVE
A MENTAL HEALTH NEED IN ANY
GIVEN YEAR. DON'T GET ANY KIND
OF CARE, RIGHT. THERE IS A HUGE
HUGE GAP THERE, AND THAT'S
REALLY WHERE WE HOPE THEY WILL
BE INCREASED FOCUS GOING FORWARD
, AND THERE'S YOU KNOW, ALL OF
YOU HAVE BEEN CHAMPIONS ON THIS
ISSUE, SO I KNOW I KNOW YOU'RE
DEEPLY UNDERSTAND IT. BUT JUST
TO PUT SORT OF A FINE POINT ON
IT. IF WE LOOK AT THE DATA THAT
DHC S REPORTS IN 2022 LESS THAN
4% OF MEDICAL MEMBERS HAD
CONTINUOUS ENGAGEMENT IN THE
MANAGED CARE PLANS, SERVICES
RIGHT, AND WE LOOK AT THAT IN
PARTICULAR BECAUSE THOSE RATES
ARE ACTUALLY REALLY, REALLY LOW
LIKE IT'S LOW ON THE SPECIALTY
SIDE. IT'S REALLY, REALLY LOW ON
THE MANAGED CARE SIDE WHEN YOU
THINK ABOUT ACTUALLY HOW LARGE
THAT POPULATION IS OF PEOPLE WHO
NEED A MILD TO MODERATE SERVICE.
THE FACT THAT IT'S 4, I THINK IS
EDIBLE, TROUBLING AND WHEN WE
LOOK AT THAT, ACROSS RACIAL
GROUPS, IT'S LESS THAN 3% FOR
LATINOS. IT'S LESS THAN 2% FOR
ASIANS AND PACIFIC ISLANDERS. SO
WE'RE TALKING PEOPLE REALLY NOT
BEING ABLE TO GET INTO THIS
SYSTEM. AND WE LOOKED INTO A
LITTLE BIT. WHY IS THAT RIGHT?
WE TALKED TO CONSUMERS. WE
ACTUALLY ALSO TALKED TO PRIMARY
CARE PROVIDERS BECAUSE I THINK
ON THE NON SPECIALTY SIDE, THE
PRIMARY CARE PROVIDERS ARE
REALLY IMPORTANT REFERRAL SOURCE
FOR BEHAVIORAL HEALTH. THAT IS
THE DOOR THAT PEOPLE HAVE RIGHT
NOW AND ACTUALLY, WHAT WE FOUND
ACROSS CONSUMERS AND ACROSS
PRIMARY CARE PROVIDERS. THEY
DIDN'T EVEN KNOW THAT YOU WERE
SUPPOSED TO BE ABLE TO GET THIS
SUITE OF BENEFITS FROM YOUR
MANAGED CARE PLAN. AND SO THEY
WERE ALL UNDER THE IMPRESSION IF
YOU ARE, IF YOU HAVE A MENTAL
HEALTH CONDITION THAT IS SEVERE
AND TOUGH. YOU CAN GO TO THE
COUNTY AND OTHERWISE, YOU'RE OUT
OF LUCK, RIGHT? AND SO THIS IS
CONCERNING TO US. THIS IS
ACTUALLY YOU KNOW, IT'S BEEN A
BENEFIT FOR 10 YEARS RIGHT ON
THE MANAGED CARE SIDE. WE
ACTUALLY SPONSORED LEGISLATION
TO REQUIRE THE PLANS TO DO
CULTURALLY LINGUISTICALLY
TAILORED OUTREACH, BOTH TO
MEMBERS AS WELL AS TO PRIMARY
CARE PROVIDERS TO MY
UNDERSTANDING IT HASN'T BEEN
IMPLEMENTED YET BY THE
DEPARTMENT OF PERHAPS THEY CAN
GIVE AN UPDATE, BUT WE DO THINK
THAT'S ONE INITIAL STEP. UM THAT
WOULD BE REALLY IMPORTANT
BECAUSE EVEN IF WE HAVE IT, SO
WE KNOW CURRENTLY THAT FOLKS WHO
RECEIVED TREATMENT IN THE MHS A
RIGHT THAT OVERSIGHT COMMISSION
ONLY TRACKS THAT FUNDING CORRECT
. IS IT POSSIBLE THAT A LOT OF
THE FOLKS THAT WERE MISSING ARE
GOING THROUGH THAT SYSTEM, AND
WE JUST DON'T HAVE ANY
ACCOUNTANT, ACCOUNTING OF THEM
THROUGH THE MEDICAL SYSTEM?
PEOPLE ARE GETTING MHS S¼. PAID
FOR SERVICES. I THINK THOSE
SERVICES WHILE THEY ARE ABROAD
ARE PART OF THE COUNTY SYSTEM.
AND SO REALLY, WHAT WE'RE
MISSING IS THAT PEOPLE WHO HAVE
THAT NON SPECIALTY NEED WHO
SHOULD BE ABLE TO GET CARE FROM
THEIR HEALTH PLAN, AND THAT'S
WHERE WE SEE THE REALLY, REALLY
LOW NUMBERS, AND WE UNDERSTAND
THAT'S A THAT'S ACTUALLY A BIG
POPULATION. RIGHT? THAT'S MOST
OF US WHO MAYBE HAVE A MORE
OCCASIONAL NEED OR OR LESS
SEVERE CONDITION WHO ARE NOT
GETTING ANYTHING. REALLY IF
WE'RE IN THE MEDICAL PROGRAM,
OKAY, THIS DATA EXIST WITH
RESPECT TO OUR MANAGED CARE
PLANS AS TO HOW MANY PATIENTS
WHO REFERRED FROM PRIMARY CARE
PROVIDER TO A BEHAVIORAL HEALTH
PROVIDER. THAT IS A GOOD
QUESTION. I DON'T KNOW THE
EXTENT TO WHICH THE STATE TRACKS
AT OR EVEN HOW MANY REFERRALS
THEY GET FROM THEIR COUNTIES,
RIGHT? I DON'T KNOW THE ANSWER
TO THAT. YEAH I DON'T KNOW.
MICHELLE KNOWS THE ANSWER FROM
THE COUNTIES. WELL, I THINK AN
IMPORTANT SORT OF LINK BACK TO
THE CALI IN BEHAVIORAL HEALTH
INITIATIVES ARE THE SCREENING IN
TRANSITION TOOLS. RIGHT? SO ONE
OF THE THINGS THAT WE'VE
ENCOUNTERED IN THE
IMPLEMENTATION OF THAT WHICH IS
A PLAN TO PLAN CONVERSATION.
IT'S RIGHT, RIGHT. IT'S SORT OF
TO KAREN'S POINT. SOMEBODY
MANAGED TO FIND THE DOOR NOW.
WHERE SHOULD THEY GO RIGHT AND
ONE OF THE THINGS THAT THE
SCREENING IN TRANSITION TOOLS
HAVE DONE IS THEY HAVE MORE
APPROPRIATELY SORTED. PEOPLE WHO
OUGHT TO BE SERVED UNDER MEDICAL
MANAGED CARE. THEY END UP GOING
OVER TO MEDICAL MANAGED CARE,
AND THAT ACTUALLY HAS HAD AN
IMPACT. UM BOTH IN TERMS OF OUR
CONTRACTED PROVIDERS ARE COUNTY
DIRECT PROVIDED SERVICES AS WELL
AS THE BENEFICIARIES. SO IT'S
CHANGING. AS I MENTIONED IN MY
COMMENTS, THE SEVERITY OF WHO
WE'RE SEEING, AND IT MEANS THAT
IN SOME CASES, SOME OF OUR
CONTRACT PROVIDERS WERE ACTUALLY
SEEING QUITE A NUMBER OF PEOPLE
WHO SHOULD HAVE BEEN SEEN BY THE
MEDICAL MANAGED CARE PLANS. I
ASKED OUR COUNTY IN ONE CASE
WHERE THERE WAS A PROVIDER WHO
WAS CLOSING DOWN A PROGRAM AS A
RESULT OF THIS, I SAID, DID YOU
PUT THEM IN TOUCH WITH THE
MEDICAL MANAGED CARE PLAN TO SEE
IF THOSE LESS SEVERE FOLKS COULD
WHO THEY'VE BEEN SEEING WHO
SHOULD HAVE BEEN COVERED UNDER
THE MANAGED CARE PLAN IF THEY
CAN CONTRACT WITH THAT PROVIDER
THAT COUNTY WAS CONTACTED WITH?
THEY SAID YES, BUT THE MANAGED
CARE PLAN DOESN'T PAY WELL
ENOUGH. SO THE PROVIDERS OPTING
TO CLOSE THE PROGRAM RATHER THAN
CONTINUE UNDER CONTRACT WITH
MANAGED CARE PLAN, AND I THINK
THAT IS ONE OF THE ISSUES THAT
THE MANAGED CARE PLAN TAXES
TRYING TO RESOLVE IS BRINGING
THOSE NON SPECIALTY PROVIDER
RATES UP SO THAT THEY CAN BETTER
BUILD BETTER NETWORKS,
BASICALLY, BECAUSE IF THEY DON'T
HAVE TRUE NETWORKS OR NETWORKS
THAT ARE APPROPRIATE TO MEET THE
NEEDS OF THE MEDICAL POPULATION.
THEN PEOPLE AREN'T GOING TO BE
ABLE TO GET TO THEM. BUT THIS
ISSUE ABOUT SORT OF PRIMARY CARE
AND REFERRALS IS SUPER IMPORTANT
AND REALLY APPRECIATE THAT AND
LET ME JUST ASK YOU WHAT'S THE
WRONG WHAT'S THE DOOR IS THE
DOOR OF THE MEDIC, AL PRIMARY
CARE PROVIDER. ISN'T THAT THE
DOOR WHEN YOU GET TO YOUR PLAN,
AND IT'S YOUR PRIMARY CARE CAN
BE AND BECAUSE THAT'S WHERE SO
MANY PEOPLE SEEK CARE RIGHT AND
WHERE THEY FIRST EXPRESSED THEIR
MENTAL HEALTH SYMPTOMS IT CAN
BE, BUT PEOPLE IN MEDICAL CAN GO
DIRECTLY TO BEHAVIORAL HEALTH
SERVICE. BUT THEY'RE NOT GOING
ANYWHERE. SO I'M JUST TRYING TO
FIGURE OUT SO IF THE DOOR IS THE
PRIMARY CARE PROVIDER THEN. AND
THERE'S SOME SCREENING TOOL, I
GUESS. IS IT A TYPICALLY SO
PEOPLE WILL CALL THE COUNTY
ACCESS LINE IF THEY KNOW THAT
COUNTY IS A THING, RIGHT? SO IF
YOU KNOW COUNTY HAS BEHAVIORAL
SERVICES YOU'LL CALL COUNTY
ACCESS LINE COUNTY ACCESS
LANGUAGE. DO THE ASSESSMENT.
THEY'LL SCREEN YOU WILL TELL
YOU, YOUR MANAGED CARE PLAN IS X
Y Z. YOU SHOULD CALL THEM AND
HERE'S LET'S HELP YOU OUT,
RIGHT? UM IF SOME COMMUNITY IN
SOME COMMUNITIES PEOPLE ARE
AWARE THAT MEDICAL MANAGED CARE
HAS A MENTAL HEALTH BENEFIT, BUT
BASED ON THE DATA, IT LOOKS LIKE
THOSE FOLKS TEND TO BE THE WHITE
BENEFICIARIES AND MEDICAL THAT
HAVE THAT AWARENESS ABOUT THAT'S
INTERESTING HOW THE DEMOGRAPHICS
SORT OF LINE UP THERE AND THEN
YOU HAVE TO THINK ABOUT OTHER
SORT OF ENTRY POINTS FOR PEOPLE
INTO OUR SYSTEMS, RIGHT? FOR US
AS COUNTY BEHAVIORAL HEALTH WERE
VERY TIGHT AND WITH CHILD
WELFARE ARE VERY TIGHT IN WITH
JUSTICE INVOLVED INDIVIDUALS
WITH A NEW HOUSED INDIVIDUALS,
AND SO WE'VE GOT DIFFERENT SORT
OF COMMUNITIES THAT ARE
NATURALLY FEEDING INTO COUNTIES.
AND THEN WE'VE GOT PARTNERSHIPS
WITH SCHOOLS. AND SO I THINK ONE
OF THE QUESTIONS IS THROUGH C Y
B H I OR THINGS GOING TO CHANGE
BUT REALLY GETTING THE PRIMARY
CARE FOLKS TO BETTER UNDERSTAND
TO SEE PENS POINT. WHETHER THE
BENEFIT EXISTS AND HOW TO ACCESS
THE BENEFIT. IT'S ACTUALLY NOT
THAT HARD. IN THEORY, IT'S A
SPECIAL SPECIALIST REFERRAL IF
THEY NEED SPECIALTY CARE, AND IF
NOT, IT'S TO WHOMEVER THE
MANAGED CARE PLAN IS CONTRACTED
WITH TO DELIVER THOSE SERVICES,
BUT IT'S THAT LACK OF AWARENESS
THAT SORT OF DRIVING THE
CONFUSION. WELL, BECAUSE I
ASSUME YOU COULD REPORT TO YOUR
PRIMARY CARE PROVIDER WITH SOME
PHYSICAL AILMENT. BUT DURING THE
PROCESS OF DEALING WITH THAT THE
PRIMARY CARE PROVIDER IDENTIFIES
POTENTIAL MENTAL EXACTLY ISSUE
THAT NEEDS TO BE ADDRESSED. AND
SO MY CONCERN IS. HOW ARE WE
MEASURING WHETHER THAT PROVIDER
AT WHETHER IT'S HP OR ONE OF
MOLINA OR ONE OF THE OTHER
CONTRACT PROVIDERS? SENDS THAT
PERSON TO EITHER EITHER THE
COUNTY BECAUSE THEY DON'T KNOW
ANYTHING OTHER THAN COUNTY
MENTAL HEALTH OR SOMEONE WITHIN
THE MANAGED CARE PLAN WHO
HANDLES BEHAVIOR HEALTH ISSUES.
WE NEED TO FIGURE THAT OUT.
THAT'S WHERE WE SEE A BIG THE
PRIMARY CARE PROVIDERS WE SPOKE
WITH, AND WE'RE NOT THE HOLDERS
OF THE DATA, RIGHT? MAYBE DHC S
CAN SHARE MORE ABOUT THE DATA
THEY HAVE. BUT THEY SAID WE
SAID, YOU KNOW, WHAT DO YOU DO?
YOU SCREEN A PATIENT AND YOU
FIND THEY HAVE A BEHAVIORAL
HEALTH NEED AND THEY ALMOST
UNIVERSALLY SAID. WE TELL THEM
TO CALL THE COUNTY ACCESS LINE,
RIGHT? THAT'S OFTEN NOT THE
RIGHT PLACE, AND AT LEAST NOW
THAT THEY CALL THE COUNTY ACCESS
LINE. WE CAN HELP THEM GET TO
THE RIGHT PLACE. BUT I THINK THE
POINT BEING WE TREATMENT YES, A
DELAYS TREATMENT AND YOU KNOW,
EVEN WHEN CONSUMERS ARE ACTUALLY
TRYING TO SEEK THE SERVICES
DIRECTLY FROM THEIR MANAGED CARE
PLAN AND KNOW ABOUT IT, THE
OTHER BARRIERS THAT WE FOUND,
YOU KNOW, YOU CAN GO ON THE
WEBSITE. YOU CAN'T FIND HALF THE
WEBSITE. YOU CAN'T FIGURE OUT
WHO IS THE BEHAVIORAL HEALTH
PROVIDER IN NETWORK AND WE
ACTUALLY TESTED IT IN IN A NON
ENGLISH LANGUAGES. IT'S LIKE
THAT PROVIDER DIRECTORY DOES NOT
EXIST FOR A LOT OF PLANS RIGHT?
AND SO IT'S REALLY, REALLY
DIFFICULT. THE SYSTEM HAS NOT
BEEN SET UP TO BE CONSUMER
FACING, I THINK AND TO REALLY
HELP PEOPLE FIND THE SERVICES,
PARTICULARLY ON THE MANAGED CARE
PLAN SIDE. THANK YOU. THEN
THERE'S A SAME DAY BUILDING
ISSUE RIGHT THERE. UM I JUST
WANT TO TALK ABOUT ONE MORE
THING. IF THAT'S OKAY, WE
APOLOGIZE FOR DERAILING YOUR NO,
THAT'S FINE. I'M REALLY GLAD
WE'RE TALKING ABOUT THIS ISSUE.
I THINK IT'S AN IMPORTANT ONE.
BUT JUST ON THE OTHER TOPIC OF
THE HEARING, WHICH IS THE
DOCUMENTATION AND THE SCREENING
AND ASSESSMENT TOOLS, I THINK
ONE SPECIFIC ISSUE THAT COMES UP
FOR US AROUND SCREENING AND
ASSESSMENT TOOLS. THIS IS A
HISTORIC ISSUE. IT'S NOT A NEW
ONE WITH THE STANDARDIZED TOOLS.
BUT IT IS TRANSLATED TOOLS AND I
THINK WE RECOGNIZE IN BEHAVIORAL
HEALTH, A LITERAL TRANSLATION OF
A BEHAVIORAL SCREENING TOOL CAN
GIVE YOU VERY WRONG INFORMATION.
WE TALK ABOUT MENTAL HEALTH
SYMPTOMS VERY DIFFERENTLY IN
DIFFERENT LANGUAGES AND IN
DIFFERENT CULTURES. AND SO THIS
HAS BEEN AN ISSUE. HISTORICALLY
WE'VE TALKED TO IN PARTICULAR
ONE COMMUNITY THAT SPEAKS IN
MEXICAN INDIGENOUS LANGUAGE ON
THE CENTRAL COAST. THERE. FOLKS
HAVE BEEN ROUTINELY TURNED AWAY
FROM COUNTY BEHAVIORAL HEALTH
SERVICES BECAUSE IT DIDN'T LINE
UP WITH THE ASSESSMENT HOW THEY
WOULD DESCRIBE THEIR SYMPTOMS
COUNTIES PREVIOUSLY SOME
COUNTIES HAD HAD, YOU KNOW,
CHANGED, THINGS UNDERSTOOD THEIR
LOCAL COMMUNITY HAS BEEN ABLE TO
CHANGE THINGS. BUT OUR CONCERN
IS WHEN DHC HAS CREATED THE
STANDARDIZED SCREENING TOOLS.
THEY DID A LOT OF CONSUMER
TESTING, AND THEN THEY
TRANSLATED THEM. THEY DID NOT
CONSUMER TEST TO MY KNOWLEDGE,
THE TRANSLATIONS AND SO WE
REALLY FEEL LIKE THAT'S A MISSED
OPPORTUNITY, BUT ONE THAT WE
COULD STILL CORRECT IF WE REALLY
WANTED TO GO OUT AND MAKE SURE
THOSE TOOLS ARE GOING TO WORK IN
DIFFERENT LANGUAGES AND IN
DIFFERENT COMMUNITIES, SO I HOPE
THAT CAN STILL HAPPEN AND I'LL
JUST SORT OF IN CONCLUSIONS SAY,
YOU KNOW, I THINK WE OFTEN
EXPECT EQUITY TO BE A BYPRODUCT
OF CHANGE. IS THAT GENERALLY
LIFT ALL BOATS, BUT SOME OF OUR
BOATS ARE SINKING SO FAST THAT
WE REALLY HAVE TO BE INTENTIONAL
AND FOCUSED ON THOSE ISSUES THAT
ARE PARTICULARLY CONCERNING TO
COMMUNITIES OF COLOR. HAVE IT.
ANSWER ANY MORE QUESTIONS? WE'LL
THANK YOU COLLEAGUES QUESTIONS.
I WANT TO MAKE A STATEMENT THAT
FOR ALL OF YOU AND FOR THE AND
FOR THE DEPARTMENT AND FOR THE
COUNTY'S, I JUST WANT TO
ACKNOWLEDGE HOW MUCH WORK HAS
GONE ON THE LAST FEW YEARS AND
WILL CONTINUE OVER THE NEXT
DECADE, AND IT'S HUGE AND I JUST
THINK THAT BEARS STATING IT WAS
AN EXCELLENT PRESENTATION. THANK
YOU ALL FOR JOINING US. UM I
SUPPOSE I SHOULD SEE IF, UM,
DIRECTOR BASS OR MR FITZGERALD
WANT TO COME BACK UP AND OFFER
ANY FINAL COMMENTS OR WOULD YOU
PREFER TO STAY THERE? THAT'S
OKAY IN THE IN THE COMFY CHAIR,
COLLEAGUES. ANY QUESTIONS OF
YEAH, YEAH. UH OH, YES, YES.
YES, SIR. UNFORTUNATELY YEAH, I
JUST I GUESS I JUST LIKE TO ASK
EACH OF YOU LIKE, WHAT WAS YOUR
IMPRESSION HEARING FROM PEOPLE?
I'M SURE JUST SOME OF THE SAME
THINGS. YOU'VE HEARD YOUR IN
CONVERSATION WITH THESE FOLKS.
WHAT DO YOU SEE AS YOUR BIGGEST
CHALLENGE GOING FORWARD AND WHAT
DO YOU MOST EXCITED ABOUT? SO I
WILL SAY I MEAN VERY CLEAR THE
BALANCE BETWEEN STATE DIRECTIVE
AND LOCAL FLEXIBILITY AND WE
HEAR IT HERE WE HEAR WITH OUR
MANAGED CARE PLANS AS WELL. AND
SO THERE IT IS. A BALANCE OF
PROVIDING LOCALS OR MANAGED CARE
PLANS BASED ON THEIR REGION OF
THE FLEXIBILITY TO DESIGN THEIR
PROGRAMS TO MEET THEIR NEEDS TO
REFLECTIVE OF THE OTHER REVENUE
SOURCES THAT THEY MAY HAVE, AND
SO IT IS. I THINK IT'S SOMETHING
THAT WE CONTINUE TO WORK THROUGH
OF WHAT IS THE RIGHT BALANCE
THERE. IN TERMS OF, YOU KNOW A
STATEWIDE THIS IS WHAT YOU MUST
DO AND WHAT FEDERAL LAW ALLOWS
US TO SAY AS WELL AND KIND OF
THIS, YOU KNOW, FLEXIBILITY AT
THE LOCAL LEVEL WHERE YOU MOST
EXCITED ABOUT THERE'S AS YOU
KIND OF THERE'S A LOT IN FLIGHT,
AND I THINK YOU KNOW GETTING
THERE. IT'S GOING TO TAKE YEARS
TO REALLY REALIZE ALL OF THIS,
BUT I THINK IT REALLY, REALLY
FUNDAMENTALLY RETHINKING WHAT
HEALTH MEANS. AND SO RECOGNIZING
ALL THE CONTRIBUTORS TO A
PERSON'S WELL BEING IS I THINK
THE VISION AND I THINK YOU KNOW
WE HAVE A ROAD MAP TO GET THERE,
BUT IT'S GOING TO TAKE TIME AND
SO JUST KIND OF SEEING WHERE YOU
KNOW WHERE WE'LL BE IN A FEW
YEARS IS PRETTY EXCITING. THANK
YOU, MR FISHER. UM SO I THINK
I'M MOST EXCITED ABOUT IT AGAIN
AS ACCOUNT DIRECTOR BOSS HEARS
THAT INTEGRATED CARE AND REALLY
THINKING ABOUT PEOPLE
HOLISTICALLY. WE HAVE DEVELOPED
THINGS IN SILOS FOR SO LONG, AND
NOW WE'RE STARTING TO REALIZE
THAT A PERSON CAN BE TREATED
WITH ONE THING AND ANOTHER, NOT
ANOTHER REALLY KIND OF MARCHING
TOWARDS DIETARY SOMEBODY AS A
WHOLE PERSON, WHETHER YOU KNOW
IT'S HOUSING OR JUSTICE OR
HEALTH CARE OR IN EDUCATION.
THAT'S A GREAT WAY TO APPROACH
JUST MAKING PEOPLE BETTER IN
SOCIETY. AS GENERAL, I WOULD SAY
THAT THE THINGS THAT WERE SET UP
HERE TODAY FROM OUR COLLEAGUES
ARE THINGS THAT WE DEAL WITH ON
A WEEKLY MONTHLY BASIS, AND I
DON'T DISAGREE WITH JUST ABOUT
ANY OF IT. BUT I WOULD SAY THAT
I APPRECIATE THEIR PARTNERSHIP.
I THINK OVER THE LAST THREE
YEARS, AT LEAST IN THE PAYMENT
REFORM SPACE AND A FEW OTHER
TANGENTIAL SPACES THAT I'VE BEEN
INVOLVED IN. RELATIONSHIPS AND
COMMUNICATION ARE THERE AND SO
WHILE WE'RE NOT ALWAYS ON THE
SAME SIDE OF THE TABLE, I THINK
WE COME TO THE TABLE WITH GOOD
FAITH EFFORTS AND REALLY TRY TO
RESOLVE PROBLEMS. ACTIVELY
TRYING TO BE PROACTIVE INSTEAD
OF REACTIVE. I WOULD ALSO LIKE
TO ECHO THAT THERE IS A LOT OF
THINGS IN FLIGHT, AND IT IS IT
IS A CHALLENGE AT EVERY LEVEL
WHEN WE CONTINUE EVERY FEW
MONTHS GET ANOTHER GREAT IDEA.
AND IT'S LIKE, OKAY, HERE'S YOUR
GOOD IDEA TODAY AND WE ALL GO IN
A IN A VACUUM. YEP REALLY AGREE
WITH THAT IDEA. WE WILL DO THAT
IN FIVE YEARS. HOW ABOUT THAT?
SO THAT'S WHERE I WOULDN'T AS A
DEPARTING MEMBER. I JUST WANT TO
SAY THAT I REALLY I REALLY
RESPECT AND APPRECIATE HOW YOU
DO AND I UNDERSTAND WHAT IT IS
THAT EVERYBODY'S GOT A GOOD IDEA
THAT THEY THINK SHOULD BE DONE
YESTERDAY. WE SEE THAT EVERY
DAY. I WANT TO THANK YOU.
EXCELLENT EXCELLENT PRESENTATION
. WHAT WAS YOUR THOUGHT? WITH
REGARD TO HOW HOW WE DEAL WITH
PRIMARY CARE PROVIDERS IN THE
MEDICAL CONTEXT WITH MANAGED
CARE PLANS AND ACCESS TO
BEHAVIORAL HEALTH SERVICES AND
MAKING SURE OR TRACK ONE WAY OR
THE OTHER, EITHER TRACKING AND
FINDING OUT THEY'RE NOT OR
TRACKING AND FINDING OUT THEY
ARE AND MAKING SURE THAT THOSE
WITH BEHAVIORAL HEALTH ISSUES
REFERRED ON A TIMELY BASIS. KIDS
THAT IS ONE OF THE THINGS WE'RE
WORKING ON WITH THE CLOSED LOOP
REFERRAL THAT'S GOING TO BE PART
OF KIND OF 2025 REQUIREMENTS SO
WE CAN BE. WE CAN TRACK SOME OF
THOSE REFERRALS AND SEE THAT THE
RESULTS OF THEM. I WILL ALSO SAY
WE'RE WE ARE WORKING WITH OUR
PLANS TO MONITOR
UNDERUTILIZATION OF PRIMARY CARE
AS WELL TO DESIGN FROM LIKE A
POPULATION HEALTH MANAGEMENT
PERSPECTIVE, WHERE ARE THEIR
COHORTS OF INDIVIDUALS OR
POPULATIONS OF FOCUS WHO MAYBE
ARE NOT USED? UTILIZING PRIMARY
CARE AND WHAT INTERVENTIONS DO
WE WANT TO KIND OF DEVELOP SO
THAT YOU KNOW IT IS THAT UPFRONT
INTERVENTION EARLIER ENGAGEMENT
AS POSSIBLE IN TERMS OF MAKING
THE CONNECTIONS OF WHAT MIGHT BE
NEEDED. AND THEN FINALLY, I
WOULD JUST SAY LAST YEAR WE CAME
OUT WITH SOME REALLY FOCUSED
MATERIALS FOR OUR OUR FAMILIES
AND CHILDREN WITH REGARD TO MPS,
DT AND KIND OF THE OBLIGATIONS
OF WHAT THAT MEANS, AND
PARTICULARLY IN THE BEHAVIORAL
HEALTH SPACE OF WHAT CHILDREN
AND YOUTH ARE THEY ARE THE IT IS
AN OBLIGATION OF THE STATE AND
KIND OF OUR VARIOUS DELIVERY
SYSTEMS TO PROVIDE SERVICES. AND
SO THINKING ABOUT HOW DO WE
EDUCATE OUR MEMBERS IN OUR
FAMILIES AND ALSO AS PART OF OUR
NEW MANAGED CARE CONTRACTS
REQUIRING OUR PLANS TO EDUCATE
THEIR PROVIDERS WITH REGARD TO
MPS DT AND WHAT IT MEANS. IT IS
KIND OF, YOU KNOW IF YOU'RE NOT
FROM EARLY PERIODIC SCREENING
AND TREATMENT PSD, SO IT'S THIS
FEDERAL FRAME WITH REGARD TO
WHAT CHILDREN IT'S LIKE WHATEVER
IT TAKES TO IMPACT AMELIORATE
CHILDREN'S NEED, AND SO THERE IS
BROAD KIND OF ABILITIES WITH
REGARD TO KIND OF WHAT IS
AVAILABLE FOR CHILDREN AND
YOUTH, AND SO JUST IN TERMS OF
THE SPACE OF KIND OF HOW WE'RE
THINKING ABOUT PROVIDER
EDUCATION AS WELL, IN TERMS OF
WHAT WHAT DOES HE PSD TEAMING
AND KIND OF THE OBLIGATIONS OF
WHAT A PROVIDER CAN DO, AND IT
CAN BE CREATIVE. THEY'RE A
LITTLE BIT IN TERMS OF WHAT THEY
COULD AUTHORIZE FOR CHILDHOOD,
THINKING ABOUT THAT MORE BROADLY
WITH REGARD TO BEHAVIORAL HEALTH
AND PROVIDER EDUCATION AS WELL.
ANY OTHER QUESTIONS. THANK YOU
VERY MUCH. THANKS FOR STEPPING
BACK UP TO THE BAD A SECOND
TIME. OKAY WE WERE KIND, RIGHT?
YEAH OKAY. WELL THAT CONCLUDES
OUR PANEL PRESENTATIONS AND
APPARENTLY, OUR COMMITTEE
QUESTIONS, SO WE'RE GOING TO
OPEN IT UP TO PUBLIC COMMENT.
ANYONE WISHING TO MAKE COMMENT
ON THE PRESENTATION TODAY?
PLEASE STEP UP. FIRST STATE YOUR
NAME AND AFFILIATION FOR THE
RECORD, AND YOU MAY PROCEED.
THANK YOU VERY MUCH. GOOD
AFTERNOON. ERIN O'BRIEN. I'M THE
CEO OF COMMUNITY SOLUTIONS, ONE
OF THE COMMUNITY BASED PROVIDERS
. WE HAVE BEEN PROVIDING
BEHAVIORAL HEALTH SERVICES FOR
OVER 50 YEARS. WE DO IT TO ALL
THE AGES. 0 TO 5 THAT OLDER
ADULTS ALL THE LEVELS OF
INTENSITY OUTPATIENT UP TO
CRISIS RESIDENTIAL, SO WE'VE
BEEN VERY DEEPLY IMMERSED IN ALL
OF THIS FOR A VERY LONG TIME,
AND I WANT TO START BY THANKING
YOU FOR HOLDING THIS HEARING
TODAY. I THINK IT IS REALLY
IMPORTANT AND ALSO TO ALL OF THE
PARTIES ENGAGED. I KNOW EVERYONE
IS WORKING REALLY HARD TO MAKE
KELLY IN IMPLEMENTATION AND
PAYMENT REFORMS, SUCCESS AND IT
IS NO EASY THING TO DO. I ALSO
WANT TO GIVE A SPECIAL THANKS TO
D. H D. S BECAUSE THEY GAVE ME
MY BEST CHRISTMAS PRESENT THIS
YEAR, WHICH WAS THE LETTER THAT
THEY SENT OUT ON DECEMBER 14TH,
WHICH WAS TO THE BEHAVIORAL
HEALTH DIRECTORS TALKING ABOUT
THEIR EXPECTATIONS ARE IN TERMS
OF HOW PAYMENT REFORM WAS GOING
TO BE DONE, WHICH WAS NOT TO
DOING A PEANUT BETTER APPROACH,
WHICH WAY TOO MANY COUNTIES DID
AND TALKING ABOUT HOW THEIR
RATES WERE SET. AND I THINK PART
OF WHAT KELLY HAS DONE A SET OF
INTERESTING AND PERVERSE
INCENTIVE THAT WASN'T PRESENT
BEFORE BETWEEN HOW THE COUNTIES
ARE REIMBURSED AND HOW THEIR
PROVIDERS ARE REIMBURSED BECAUSE
NOW COUNTIES ORIENT BURST AT A
CERTAIN RATE AND PHDS WAS VERY
THOUGHTFUL IN HOW THEY SET THAT
RATE. BUT THEN THE PROVIDERS HOW
THEIR RATES ARE SET. HOW WE ARE
REIMBURSED IS ENTIRELY UP TO THE
COUNTIES. AND SO IT CREATES AN
INTERESTING AND PERVERSE
INCENTIVE BECAUSE THE DELTA
BETWEEN THE REVENUE THAT THEY'RE
EARNING THROUGH OUR SERVICES AND
WHAT THEY'RE PAYING US BECOMES
THEIRS TO USE WITHIN THE SYSTEM
AS NEEDS BE, AND THAT WAS WAS
WAS REFERENCED, BUT IT BECOMES A
LITTLE BIT PROBLEMATIC BECAUSE
YOU KNOW, I THINK THAT THE
PROVIDERS ARE HIGHLY
INCENTIVIZED TO SERVE. WE ARE
MISSION DRIVEN ORGANIZATIONS AND
SO WE ARE GOING TO BE DOING
EVERYTHING WE CAN TO MAINTAIN
THE SERVICES TO THE BEST OF OUR
ABILITIES. BUT AGENCIES WILL GET
TO PLACES WHERE THERE ARE OUT OF
THAT ABILITY. AND SO THE
CONVERSATIONS THAT WE'RE HAVING
NOW IN TERMS OF HOW DO WE RESET
THE RATES ARE INCREDIBLY
IMPORTANT AND URGENT, BECAUSE AS
I'M UP HERE THIS WEEK FOR THE
ALLIANCE CONFERENCE AND TALKING
WITH COLLEAGUES AROUND THE STATE
LITERALLY, NOT A ONE IS
SUSTAINABLE. AND SO THE
CONVERSATIONS THAT WE'RE HAVING
WITH OUR COUNTIES ARE REALLY
IMPORTANT. THE COUNTY'S
ALIGNMENT WITH THE HC S'S
DIRECTION IS INCREDIBLY
IMPORTANT FOR OUR AGENCY. WE
SERVE PRIMARILY FOR POPULATIONS,
KIDS ADULTS, UM, THE FORMER
SERIOUSLY MENTALLY ILL HOMELESS
PREVIOUSLY HOMELESS AND THE CAR
SOCIALLY INVOLVED. IF OUR COUNTY
WHICH IS AN ACTIVE DISCUSSION
WITH ALL OF THE PROVIDERS TO
AMEND, BUT IF THEY WEREN'T DOING
THAT, WE WOULD BE DOWN TO ONE
DIVISION LEFT. WE WOULD ONLY BE
ABLE TO SERVE THE ADULTS. THAT'S
NOT WHAT ANYBODY NEEDS. SO THESE
CONVERSATIONS, YOUR ATTENTIONS
THAT MATTER IS JUST INCREDIBLY
IMPORTANT. AND I'M VERY GRATEFUL
FOR IT. THANK YOU. THANK YOU,
MA'AM. NEXT, PLEASE. GOOD
AFTERNOON, CHIEF PUBLIC POLICY
OFFICER. PACIFIC CLINICS.
PACIFIC CLINICS IS A STATEWIDE
BEHAVIOR HEALTH AGENCY OPERATING
IN DOZENS OF COUNTIES THROUGHOUT
THE STATE, DELIVERING INTEGRATED
BEHAVIOR, HEALTH AND SOCIAL
SERVICES FOR CHILDREN, ADULTS
AND FAMILIES, SO WE SERVE THE
FULL AGE SPECTRUM WERE MEMBERS
OF BOTH THE CALIFORNIA ALLIANCE
AND C B H A. AND I JUST WANT TO
SAY TO EVERYTHING THAT AARON
JUST SAID, BECAUSE IT'S EXACTLY
THE CONCERNS THAT WE HAVE. UM WE
ARE ALSO VERY APPRECIATIVE OF
THE LEADERSHIP OF THE SENATE
COMMITTEE TO HOLD THIS HEARING
ON CATALIN IMPLEMENTATION. WE'VE
ALL HEARD THAT COMMUNITY BASED
AGENCIES ARE A CENTRAL PARTNER
IN ENSURING WE ARE MEETING THE
NEEDS OF A VERY VULNERABLE
POPULATION. WE SHARE THE
CONCERNS RAISED BY THE PROVIDER
ASSOCIATIONS ON THIS LAST PANEL,
PARTICULARLY ENSURING THAT WE
HAVE A FINANCING SYSTEM THAT
ADEQUATELY COVERS THE COSTS OF
COMMUNITY BASED CARE. SPECIFIC
CLINICS WOULD LIKE TO BE A
RESOURCE TO THIS COMMITTEE AS
KALAM'S CONTINUES TO BE
IMPLEMENTED AND THEIR FUTURE
DISCUSSIONS ABOUT HOW A CALLUM
IS BEING IMPLEMENTED LOCALLY AND
STATEWIDE. THANK YOU. THANK YOU,
MA'AM. NEXT, PLEASE. GOOD
AFTERNOON. MY NAME IS MARIKA
COLLINS. I'M THE DIRECTOR OF
PUBLIC POLICY AND ADVOCACY WITH
DIDI HIRSCH. MENTAL HEALTH
SERVICES IN L. A COUNTY. WE'VE
BEEN AROUND FOR OVER 80 YEARS,
PROVIDING MENTAL HEALTH
SERVICES. AND PREVENTION
SERVICES ACROSS THE AGE LIFESPAN
FROM 0 TO 5, CHILDREN, YOU YOUTH
ADULTS TRANSITIONARY, JUDITH
AND, UM I REALLY WANT TO COMMEND
AND SAY HOW MUCH? I APPRECIATE
YOU HOLDING THIS HEARING BECAUSE
KELLY IS SOMETHING ALL OF THE
PROVIDERS HERE ARE LIVING AND
BREATHING EVERY SINGLE DAY AND
REALLY TRYING TO MAKE THE BEST
OUT OF IT. UM SO THANK YOU FOR
HOLDING THIS HEARING. AS YOU'VE
HEARD FROM ALL OF OUR
ASSOCIATIONS THAT ARE PRESENT
TODAY. CBOS ARE REALLY AND TRULY
THE LIFELINE FOR SERVICE
DELIVERIES IN CALIFORNIA FOR OUR
MOST VULNERABLE CHALLENGING,
DIFFICULT TO TREAT, UM CHILDREN,
YOUTH ADULTS AND WE'RE AS EVER
JUST MENTIONED WERE MISSION
DRIVEN, YOU KNOW, I'M ALSO AT
THE ALLIANCE CONFERENCE AND YOU
KNOW, IT'S A MATTER OF WHAT'S
YOUR DEFICIT THIS YEAR? WHAT'S
YOUR DEFICIT? OH, YOU'RE ONLY
1.5 OR 2 MILLION IN THAT I'M NOT
SPEAKING FROM MY AGENCY. BUT
THOSE ARE THE CONVERSATIONS.
WE'RE HAVING. SO THIS RATES
DISCUSSION IS NOT ABOUT YOU KNOW
HOW MUCH IN THE BLACK ARE YOU?
IT'S IN THE AND THAT'S WE JUST
WANT TO COVER OUR COSTS. WE JUST
WANT TO BE ABLE TO SERVE THE
CHILDREN AND THE AND THE
COMMUNITY MEMBERS, SO I REALLY
WHOLEHEARTEDLY APPRECIATE YOU
HOLDING THIS HEARING, AND I
WOULD JUST ENCOURAGE YOU TO
CONTINUE TO ASK QUESTIONS
CONTINUE TO REALLY JUST ADVOCATE
ON OUR BEHALF AND WILL CONTINUE
TO PROVIDE YOU WITH THE
INFORMATION THAT YOU NEED. SO
THANK YOU VERY MUCH FOR YOUR
TIME TODAY. THANK YOU. THANKS
FOR COMING. THANKS FOR WHAT YOU
DO NEXT, PLEASE. ROBERT HARRIS
ON BEHALF OF SCR, YOU CALIFORNIA
WE RECOGNIZE WE HAVE MEMBERS WHO
ARE WORKED FOR PROVIDERS,
SERVICE AGENCIES AND WHO WORKED
FOR THE COUNTIES AND SO WE'VE
BEEN ENGAGED IN DISCUSSIONS
ABOUT HOW THE RATES AND HOW THEY
AFFECT INDIVIDUALS RIGHT AND
TRYING TO FIND HELP EVERYONE
FIND SOLUTIONS IF WE'D LIKE.
LEANDRA WE'D LIKE ADRIAN. WE
LIKE MICHELLE. WE GET ALONG WITH
THEM, AND WE'RE TRYING TO SOLVE
THAT PARTICULAR PROBLEM. I THINK
THE OTHER PROBLEM THAT EXISTS
RIGHT NOW IN THE SYSTEM IS THE
STIGMA PROBLEM AND THERE ISN'T
STIGMA AGAINST MENTAL ILLNESS.
STIGMA, BUT SUD. IN FACT, HIS
WE'RE REALLY ENCOURAGED BY THE
DEPARTMENT, ACTUALLY BRINGING UP
THE FACT THAT PETE KIDS WITH
ISSUE D ARE ENTITLED TO E P S T.
T BY THE FEDERAL LAW THAT WAS
NEVER TREATED LIKE THAT. THE
COUNTY JUST DIDN'T WANT TO DO
IT. THE PLANS DIDN'T WANT TO DO
IT AND THE STATE DIDN'T WANT TO
DO IT. SO THAT'S IMPORTANT,
BECAUSE IF THAT STIGMA IS GOING
TO STILL EXIST AS WE TRY AND
INTEGRATE EVERYTHING, IT'S NOT.
WE ARE GOING TO GET INTEGRATION.
SO THAT'S THAT'S ONE THING. THE
SECOND THING IS, IF YOU LOOK AT
THE SUD WORKFORCE, OR IF YOU
LOOK AT THE WHOLE BEHAVIORAL
HEALTH WORKFORCE, NO ONE LOOKS
LIKE THE PEOPLE GETTING
SERVICES. NO ONE EXCEPT FOR SUD
COUNSELORS AND BECAUSE OF THE
LOW RATE STRUCTURE, THEY STAY
ABOUT TWO YEARS. BUT EVERYTHING
ONLY PEOPLE WHO LOOK LIKE THE
PEOPLE GETTING SERVICES, SO
WE'VE GOT TO FIGURE OUT SOME WAY
TO FIX THIS RATE STRUCTURE WHERE
IT ISN'T JUST PROPORTIONATE. IT
IS AN UNEQUAL WE DON'T THINK
MELON. YOU KNOW THIS IS MENTAL
HEALTH ISSUES DON'T INCLUDE SUD
BECAUSE THEY DO AND THAT'S
REALLY IMPORTANT THAT WE PAY
ATTENTION TO THAT. BECAUSE
THAT'S WHERE THE RATE INEQUITY
HAPPENS TO WORST, SO THAT'S ALL.
WE REALLY APPRECIATE YOU DOING
THIS HEARING. WE'D LIKE TO SEE
MORE OF THEM AND WE APPRECIATE
EVERYONE'S TRYING TO WORK
TOGETHER, EVEN THOUGH IT'S A
DIFFICULT TO ATION, SO WE'LL
KEEP WORKING ON MAKING IT
HAPPEN. BETTER THANK YOU. THANKS
FOR WORKING TOGETHER. THANKS FOR
COMING NEXT, PLEASE. YES, MA'AM.
GOOD AFTERNOON, MR CHAIR, MADAM
CHAIR AND MEMBERS JULIANA DARE
WITH THE CALIFORNIA STATE
ASSOCIATION OF COUNTIES
REPRESENTING ALL 58 COUNTIES
WANTED TO THANK YOU FOR THE
ROBUST DISCUSSION TODAY AND FOR
YOUR LEADERSHIP IN THIS SPACE
REALLY JUST WANTED TO TAKE THE
OPPORTUNITY TO ACKNOWLEDGE AND
TO APPRECIATE, AS DR EGGMAN HAD
SAYS, JUST THE IMMENSE AMOUNT OF
EFFORT THAT HAS BEEN DONE BY THE
DEPARTMENT COUNTIES. OUR COUNTY
PARTNERS, PROVIDERS AND ALL OF
OUR COMMUNITY. UM ALL OF OUR
COMMUNITY PARTNERS THAT ARE
REALLY ESSENTIAL TO ACTUALLY
MAKE THIS VERY SIGNIFICANT AND
MULTI YEAR INITIATIVE A SUCCESS
WITH THAT AND JUST LOOK FORWARD
TO CONTINUED PARTNERSHIP WITH
YOU. AND WITH ALL OF OUR
PARTNERS. THANK YOU. THANK YOU,
MA'AM. NEXT, PLEASE. GOOD
AFTERNOON CHAIRS AND MEMBERS
TRIM. MURPHY, SPEAKING ON BEHALF
OF THE CALIFORNIA ASSOCIATION OF
ALCOHOL AND DRUG PROGRAM
EXECUTIVES, ALSO KNOWN AS CAT
BEAT COPIES. MEMBERS PROVIDE
SUCH SERVICES AT OVER 400 SITES
THROUGHOUT THE STATE AND
CONSTITUTE THE INFRASTRUCTURE OF
THE STATES. PUBLICLY FUNDED
SUBSTANCE USE DISORDER NETWORK.
CANOPIES CONTINUING TO WORK WITH
THE HCS AND PROVIDE PROVIDERS
EFFORT ON EFFORTS TO ENSURE
ADEQUATE PAYMENT RATES FOR
BEHAVIORAL HEALTH SERVICES,
AUNTIES PAPERWORK AND
DOCUMENTATION BURDENS ON OUR
PROVIDERS. THANK YOU. OKAY THANK
YOU, SIR. ANY OTHER PUBLIC
COMMENT? WELL WITH THAT. I WOULD
LIKE TO THANK OUR PANELISTS FOR
AN EXCELLENT PRESENTATION
MEMBERS OF THE PUBLIC WHO
ATTENDED AND PROVIDED COMMENTS
MY COLLEAGUES WHO ATTENDED STAFF
WHO HELPED SOME OF US PREPARE
AND TO MY RIGHT MY SUPERB
COLLEAGUES FOR PROVIDING THEIR
EXPERIENCE AND THE QUESTIONS
THAT THEY ASKED DURING THE
HEARING. SO WITH ALL OF THAT,
SEE YOU NEXT TIME THIS HEARING
JOINT HEARING INFORMATIONAL
HEARING IS ADJOURNED.