Dear SAPC Providers and Stakeholders,
As you know, after several years of planning and preparation, we are finally ready to launch Los Angeles County’s Substance Use Disorder (SUD) System Transformation made possible by Medicaid (Medi-Cal) expansion and parity provisions of the Affordable Care Act. In addition, leadership from the California Department of Health Care Services (DHCS) enabled counties to improve access to a more comprehensive and outcome-focused continuum of care via the Drug Medi-Cal Organized Delivery System (DMC-ODS) Waiver (known locally as START-ODS). The dedication of Substance Abuse Prevention and Control (SAPC) network providers and stakeholders through continuous engagement in our shared stakeholder process has shaped the development of the delivery system and guided how services will be delivered locally. We believe that this work will ultimately contribute to improved outcomes and sustained recovery for patients. As with any major implementation process, we expect that not everything will go exactly as planned and modifications will have to be made along the way to collectively develop a model system of care in California, and the United States. We will rely on all providers, big and small, to communicate with SAPC about both the successes and challenges of this transition so that we can address issues rapidly and provide technical assistance and training where needed. To effectively track and respond to issues, we ask that you send communication directly to SUDTransformation@ph.lacounty.gov, or at least include this email address as a ‘cc’ when sharing system level-achievements and problems with SAPC leadership/managers.
As we approach Saturday, July 1, 2017 and the launch of START-ODS, network providers and SAPC staff understandably have anxiety about our transition to START-ODS, including apprehension about having to meet new expectations, excitement about new possibilities for patients and new referral sources such as health plans, and so on. While it may seem like everything is changing at once, we want to remind you that our approach will not be a ‘flip of the light switch,’ but rather a ‘raising the dimmer from off to on.’ This isn’t to say that new expectations will be lax, but rather that we understand it will take time for things to run smoothly. We will work with agencies through this process, including having the California Institute for Behavioral Health Solutions (CIBHS) conduct more business development trainings and continuing to have monthly provider trainings.
There are a few areas we would like to highlight as we move into implementation, and we will have more opportunity to discuss these issues at the July 6, 2017 provider meeting:
Substance Abuse Service Helpline (SASH)
The SASH is the new toll-free number that the public (youth and adults) can call 24/7/365 for screening and referral services. The line (1-844-804-7500) will be active July 1, 2017, so please ensure that you have staff available during normal business hours to answer referral calls from the SASH in real time. If there is no answer, SASH staff will move on to the next qualified provider with the goal of setting an intake/assessment appointment while the caller is on the line. See the June 1, 2017 Provider Meeting Video or Handout for more information.
Client Engagement and Navigation Services (CENS)
The CENS will replace the existing Community Assessment Service Centers (CASC), and will be co-located at various County partner sites to support certain populations in connecting with treatment. The CENS will conduct the same brief screening as the SASH and will no longer conduct a full assessment. Similar to the SASH, it will be important to have staff available to answer calls in real time so that the CENS can set an intake/assessment appointment while the individual is present. See the June 1, 2017 Provider Meeting Video or Handout for more information.
Service and Bed Availability Tool (SBAT)
The SBAT is one of the main tools that the public, SASH, and CENS will use to identify referral sites. Therefore, it is important to keep your information updated, including updating appointment/bed availability daily. Instructions are included on the SABT Update Instructions document. (The provider secure logon instructions and screenshots are attached for your reference.) The SBAT will only include DMC-certified locations. For this reason, it is important to notify SAPC as soon as a DMC location is certified to include it in your contract and the SBAT list. To better ensure patient access to services, sites that are not DMC certified (particularly residential locations), may continue to get referrals if DMC certified locations are at capacity. In addition, we are correcting SBAT information issues that were identified in the recent provider review, but if you see errors related to your site(s) after July 1, please contact SAPC to rectify those issues.
Sage and Billing
Sage (SAPC’s new electronic health record-EHR) will not be ready to launch until late summer/early fall. Therefore, you will continue to use the current e-billing system for claims and LACPRS for data collection. See the June 15, 2017 Provider Meeting Handout for more information on the Sage rollout, including the plan for eligibility and medical necessity verification, Sage deployment, and trainings and preparation for EHR implementation. The Rates and Standards Matrix also provides more information on billable services and associated standards.
Screening/Assessment and Authorizations/Pre-Authorizations
All new admissions beginning July 1, 2017 must receive a screening (if all levels of care are not offered by the agency). If the recommended level of care is offered, providers must offer an American Society of Addiction Medicine (ASAM) assessment using County developed or County approved tools. In addition, all new residential treatment admissions on or after July 1, 2017 must be authorized by SAPC using the Service Request Form. Authorizations are also required for Recovery Bridge Housing (using the Recovery Bridge Housing Authorization form). Clinical forms are available on SAPC’s website by selecting the Network Providers button on the home page. See the June 15, 2017 Provider Meeting Handout on Pre/Authorizations for more information.
Drug Medi-Cal and My Health LA
Individuals who are eligible for Medi-Cal or My Health LA, but whose benefits are not yet established cannot be turned away while their benefits are being established. Network providers need to screen individuals and, if treatment services are likely needed, assist individuals in acquiring benefits and establish medical necessity via the assessment process. Through the new case management benefit, providers can be reimbursed for time dedicated to providing benefits acquisition services. Providers will also be reimbursed for delivered treatment services for up to 45 days after admission and completion of LACPRS for: (1) patients who are likely eligible for Medi-Cal and whose complete Medi-Cal application is submitted with a CIN number assigned but whose application was ultimately denied by the State; and (2) patients who need current Medi-Cal benefits re-assigned to Los Angeles County due to a permanent move. See the May 4, 2017 Provider Meeting Video or Handout for more information on establishing Medi-Cal benefits, or the June 1, 2017 Provider Meeting Video or Handout for more information on leveraging case management benefit.
SAPC Provider Manual
Thank you for your dedication, hard work and partnership to make this a successful transition to provide a full spectrum of SUD services for Los Angeles County residents who need substance use disorder treatment services. As noted above, any questions or comments can be directed to SUDTransformation@ph.lacounty.gov, and SAPC staff will be available on Saturday, July 1, 2017 to answer any implementation questions or problems you may encounter as we roll out our new SUD delivery system of care.
Wesley L. Ford
Director, Substance Abuse Prevention and Control
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