Specialty Mental Health Services

AFFORDABLE CARE ACT UPDATE &
EXPANSION OF MENTAL HEALTH SEMINAR
Progress of Medi-Cal Expansion
 How is enrollment going?
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Approx. # of adults receiving CenCal Health eligibility:
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1,400 in January (500 in SB and 900 in SLO County)
3,300 February (1,350 in SB and 1,950 in SLO County)
Potential 6,500 individuals in CalFresh eligible (both Counties)
Patients being “fast tracked”. State FFS Medi-Cal eligible
initially and then CenCal Health eligible (processing backlog at DSS). Enrollment above projections.
Good news = patients enrolled. Bad news = specialty access
for FFS Medi-Cal members.
 Who is assisting?
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Certified Enrollment Counselors and Department of Social
Services are working quickly to enroll patients
Enrollment in Covered CA
 How is it going?
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January (state-wide): 728,410 enrollment (85% eligible for subsidies)
January (state-wide) 1.5M enrolled in Medi-Cal
 What type of coverage?
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Patients eligible for a subsidy (federal government) selected the Silver
Plan 67% of the time
Patients not eligible for a subsidy selected the lowest cost selected
Bronze, Silver, Platinum and Gold Plans (depending on the cost sharing
they preferred in deductible/copay ratio)
 Covered CA campaigns bringing awareness
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Over 3,000 patients eligible for traditional Medi-Cal in January and
February (6,000 total) – both Counties – enrolled in CenCal Health
Up Next
 What to expect in the future?
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Additional services for Medi-Cal members, including
Mental Health and Substance Use Disorder Services
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Integration of Mental and Physical Health services
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Why is this so important?
What services are available?
Who will be providing them?
The Impact of Mental Illness
 A major impact on an individual’s overall health status
and quality of life.
 Estimated that, on average, people with serious mental
illness die 25 years earlier than the general population.
 Unaddressed mental illness impacts overall health
care costs.
 For Medi-Cal patients with chronic conditions, health
care costs are up to 75% higher w/ mental illness.
National Association of State Mental Health Program Directors, Morbidity and Mortality in People with
Serious Mental Illness (October 2006).
Cynthia Boyd et al., Clarifying Multimorbidity Patterns to Improve Targeting and Delivery of Clinical
Services for Medicaid Populations, Center for Health Care Strategies (December 2010)
Prevalence of Mental Illness in CA
 In California, about 16% of adult population (more
than 4 million people) have mental health care needs.
 Of those, 1 million adults have a severe mental illness
that impairs their daily functioning.
 About 4% of the population has conditions that are
severely disabling and 7% are seriously emotionally
disturbed.
 Significantly higher %s in lower income populations.
Human Services Research Institute, Technical Assistance Collaborative, and Charles Holzer,
California Mental Health Prevalence Estimates (February 2012), accessed January 30, 2013,
Prevalence in Low Income Populations
Profound Lack of Coverage
 A large proportion of Californians lack access to
mental health services and may now be eligible.
 According to the CA Health Interview Survey, less
than half of California adults with mental health needs
received treatment.
 Of those who did, less than one-quarter reported that
the treatment met their needs.
 Of the respondents with mental health needs who
were uninsured, 69% received no treatment at all.
UCLA Center for Health Policy Research, Half a Million Uninsured California Adults with Mental Health
Needs Are Eligible for Health Coverage Expansions (November 2012).
Is Heath Coverage Available?
 Until passage of 2008 federal Mental Health Parity and
Addiction Equity (MHPAE) Act, private health
insurance coverage for mental health benefits was
significantly more limited than coverage for medical
and surgical benefits.
 Historically, even Medicare required higher cost
sharing for mental health services than for medical
services.
Historical Medi-Cal Coverage
 In 1991, CA transferred financial and administrative
responsibility for mental health programs to Counties.
(Carve Out)
 Public mental health services in CA have been
delivered through county systems that operate
separately from other publicly funded health care
services. (Severe Conditions)
 Medi-Cal beneficiaries with less severe mental health
conditions face significant gaps both in coverage and
in access to services.
Technical Assistance Collaborative, California Mental Health and Substance Use Needs Assessment.
Mental Health and the ACA
 Under ACA, health plans in Covered CA must cover 10
Essential Health Benefits, including mental health and
substance use disorder services.
 These services must be provided at parity with medical
and surgical benefits, in accordance with the 2008
federal Mental Health Parity Act.
 Benefits to Medi-Cal patients also must meet these
requirements, offering mild to moderate coverage.
Kirsten Beronio et al., ASPE Issue Brief: Affordable Care Act Expands Mental Health and Substance
Use Disorder Benefits and Federal Parity Protections for 62 Million Americans, US Department of
Health and Human Services (February 20, 2013).
Why CenCal Health?
Ensuring access to coordinated mental health and
physical health services is imperative to improving
population health outcomes.
Expansion of Behavioral Health
CenCal Health now offers mental health services for eligible
Medi-Cal members:
 Services for the severely and chronically ill will continue
to be provided through County Mental Health
Departments
 Psychological services for less severe disorders are
covered by CenCal Health (Individual/Group
Psychotherapy/Counseling Services, Psych Medication
Consults, Testing)
 Expanded substance abuse services available through
County Programs
Medi-Cal MHSUD Delivery System
Medi-Cal Managed Care
Plans (MCP)
Target Population: Children and adults in
Managed Care Plans who meet medical
necessity or EPSDT for Mental Health
Services
MCP services to be carved-in
effective 1/1/14*
 Individual/group mental health
evaluation and treatment
(psychotherapy)
 Psychological testing when clinically
indicated to evaluate a mental health
condition
 Psychiatric consultation for medication
management
 Outpatient laboratory, supplies and
supplements
 Screening and Brief Intervention (SBI)
(new service not currently offered)
 Drugs, excluding anti-psychotic drugs
(which are covered by Medi-Cal FFS)
County Mental Health Plan
(MHP)
Target Population: Children and adults who
meet medical necessity or EPSDT criteria for
Medi-Cal Specialty Mental health Services
Outpatient Services
 Mental Health Services (assessments
plan development, therapy,
rehabilitation and collateral)
 Medication Support
 Day Treatment Services and Day
Rehabilitation
 Crises Intervention and Crises
Stabilization
 Targeted Case Management
 Therapeutic Behavior Services
Residential Services
 Adult Residential Treatment Services
 Crises Residential Treatment Services
Inpatient Services
 Acute Psychiatric Inpatient Hospital
Services
 Psychiatric Inpatient Hospital
Professional Services
 Psychiatric Health Facility services
County Alcohol and Other
Drug Programs (AOD)
Target Population: Children and adults
who meet medical necessity or EPSDT
criteria for Drug Medi-Cal Substance Use
Disorder Services
Outpatient Services
 Outpatient Drug Free
 Intensive Outpatient (newly expanded
to additional populations)
 Residential Services (newly expanded
to additional populations)
 Narcotic Treatment Program
 Naltrexone
New Services
 Voluntary Inpatient Detoxification
Services
 (Administrative linkage to County AOD
still being discussed)
* MCP carve-in services, except for SBI, are currently offered through Medi-Cal FFS
As of October 11, 2013
1
New Partner: The Holman Group
 CenCal Health partnered with The Holman Group to
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administer the new mental health benefits on our behalf
The Holman Group, based out of Northridge, CA, is a
well-established Managed Behavioral Health Organization
Arranges for quality mental health services.
Holman has developed a contracted network of mental
health providers available -- now.
Holman offers these services to CenCal Health members
and provides support to PCPs.
How do patients get access?
 CenCal Health will continue to cover outpatient lab,
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supplies and drugs (excluding anti-psychotic drugs)
through our lab and pharmacy network.
We will also cover mental health services within the scope
of PCP practice.
Services for mild to moderate conditions will be provided
through The Holman Group’s provider network.
PCPs may refer members for mental health services by
accessing Holman Group 24 hours a day, 365 days a
year via their toll-free number (800) 321-2843.
Members may also self refer by calling directly.
How are services arranged?
 The Holman Group will conduct initial screening and then
 Arrange for face-to-face assessment w/ mental provider or refer to
another appropriate resource or
 Coordinate with County Mental Health for Specialty Mental Health
services on the PCP’s behalf if member has severe mental illness.
 No defined limits on # of visits w/ mental health provider.
 Benefits are provided based on the level of care needed to
make progress towards treatment goals.
 Note: Couples counseling or family counseling for relational problems
are not covered.
 Medi-Medi members have Medicare Insurance as Primary
(seek care through Medicare benefit first)
A different type of referral
 No RAF necessary, just the call
 Regulations that govern sharing of information related to
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mental health services more restrictive
If PCP needs psychiatric medical consult, information
provided over the phone
If PCP calls Holman to refer and treat with LCSW/MFT,
very little information can be shared (no progress notes)
Remember: Patients must agree to seek treatment
If PCP and Psychiatrist are co-managing patient, info. on
treatment, medication, necessary labs can be shared.
CenCal working with Holman to get info. on our website
800.321.2843
Liz Santillan, Provider Relations Supervisor
Jenny Sanchez, Quality Improvement Coordinator
Who we are?
 For over 35 years, Holman has been providing the most
comprehensive services in the least restrictive setting
 We hold one of the oldest specialty behavioral health
Knox-Keene licenses in the mental health and substance
abuse in CA.
What do we offer?
Holman’s Behavioral Health Benefits Administration Services
include the facilitation of all levels of care, including:
 Individual/group mental health evaluation, screening, testing and
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brief treatment (psychotherapy)
Crisis Intervention and Crisis Stabilization
Psychological testing when clinically indicated to evaluate a
mental health condition
Outpatient services for the purposes of monitoring drug therapy
Outpatient services that include lab work, drugs, and supplies
Psychiatric consultation
Referrals to Other Medi-Cal/Community/County Resources
About Holman
 Holman Healthcare Advisors are compassionate licensed
professionals,
 Range from masters level to psychiatrists who ensure
that the appropriate level of treatment is authorized and
that the member is progressing.
 Holman’s care management team consists of two
Medical Directors and outpatient and inpatient health
care advisors.
Provider Network
 The Holman Group has a dynamic global provider
network with over 36,000 licensed clinicians.
 Network providers, accessible to program participants,
are licensed professionals experienced in counseling
people of all ages and ethnic groups on a full spectrum of
issues.
 Our therapists offer up-to-date therapeutic approaches,
such as Cognitive-Behavioral and Solution-Focused
therapies.
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We know what a comforting feeling it is to know that
there is someone available every hour of every day of
the year.
That’s why we have the following features in place
which set us apart from similar organizations, but,
most importantly, keep our members feeling safe.
800-321-2843 is our Nationwide toll-free number with
access to Crisis Intervention 24 hours a day, 365 days a
year.
Provides after-hours services via a Medical Answering
service with access to one of our licensed counselors
who are on call to assist in crisis situations.
Our Member Count
500,000+
County of Santa Barbara
Department of Alcohol, Drug and
Mental Health Services (ADMHS)
Suzanne Grimmesey, MFT
Chief Strategy Officer
Who is ADMHS?
Founded in 1962, the Santa Barbara County Department
of Alcohol, Drug and Mental Health Services (ADMHS)
promotes the prevention of, and recovery, from addiction
and mental illness among individuals, families and
communities, by providing effective leadership and
delivering state-of-the-art, culturally competent services.
Who ADMHS serves?
 ADMHS provides treatment, rehabilitation and support
services to 7,600 clients with mental illness and 4,500 clients
with substance use disorders annually.
 ADMHS clients include children experiencing severe
emotional disorders, adults with severe mental illness and
individuals with co-occurring mental health and substance
use conditions.
What mental health services does
ADMHS offer?
 An array of services are provided countywide for adults,
children and transition-age youth.
 ADMHS serves persons with mental health and/or
alcohol and substance use conditions and individuals
experiencing mental health crises.
 Services are provided on an inpatient, outpatient and
crisis basis. For detailed information about programs
and services, please visit www.admhs.org and place your
cursor over the “Services” tab at the top of the page.
ADMHS Staff
 ADMHS employs approximately 292 full-time equivalent
(FTE) employees.
 In several months when the new Crisis Triage program is
implemented, this number will increase.
 ADMHS also contracts with a number of communitybased alcohol, drug and mental health providers to
provide additional services throughout the county, as
well as with individual practitioners called “network
providers.”
 If patient is experiencing a mental health crisis that
places anyone in immediate danger, call 911.
 If patient is experiencing a mental health crisis that
does not involve immediate danger, and if the person
in crisis has insurance coverage through a health
plan, call the health plan to get a referral to a covered
mental health provider.
 For all others, call ADMHS’ 24hr Toll-Free Access Line at
888.868.1649. The call is toll free number, and someone will
answer to assist you 24 hours per day, 7 days per week.
County of San Luis Obispo
Behavioral Health Department
Greg Vickery, LMFT
Behavioral Health Quality Support Team Division Manager &
Compliance Officer
Target Population
Welfare & Institutions Code 5600.3
Adults with Serious Mental Illness (SMI)
(“Serious” = severe & persistent)
Included diagnosis
“Substantial” functional impairment or imminent risk
of decompensation
Disabled to the degree public assistance, services or
entitlements would be required
Target Population
Welfare & Institutions Code 5600.3
Seriously Emotionally Disturbed (SED)
Youth
Included diagnosis
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“Substantial” functional impairment in two areas
(self-care, school, family, community)
And
• Risk of or removed from home
Or
• Impairments x 6 months or 1 year w/o
treatment
Or
Psychotic features, suicide risk, violence risk
Medical Necessity
CCR, Title 9, 1830.205
Specialty Mental Health Services
Specialty Mental Health Services
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Medication Support
Therapy
Case Management & Rehabilitation Services
Day Treatment/Day Rehabilitation
Crisis Intervention
Crisis Stabilization/Crisis Residential (Coming soon!)
Adult Residential Treatment
Psychiatric Inpatient/Psychiatric Health Facility (PHF)
Therapeutic Behavioral Services (TBS)
“Katie A” services:
Intensive Care Coordination (ICC)
In Home Behavioral Services (IHBS)
To access mental health services,
or for immediate help, such as Mobile Crisis Services,
call 1.800.838.1381 (24 hours/7 days a week)
Your Health Plan
YOUR HEALTH NEWSLETTER, JANUARY 2014
Mental health services for
Medi-Cal
T
What are the Specialty
Mental Health benefits?
here is a change in
Medi-Cal coverage that
expands mental health
and substance use disorder
benefits for CenCal Health
members. Starting January 1,
2014, Medi-Cal will cover
services for substance use
disorder, through the County
Alcohol and Drug Program,
and mental health services
through CenCal Health.
Specialty mental health
services will continue to be
provided by the County
Mental Health Department.
• Individual and group
mental health evaluation and
treatment (psychotherapy)
• Psychological testing when
clinically indicated to evaluate
a mental health condition
• Psychiatric consultation for
the purposes of monitoring
drug therapy
• Outpatient laboratory,
drugs, supplies and
supplements
• Screening and brief
intervention
These services will continue to be
provided by the County Mental Health
Department also known as the Mental
Health Plan. These services are for members who meet the medically necessary
criteria. Services include but are not
limited to:
rehabilitation
What are the Mental Health
benefits?
What are the Substance Use
Disorder benefits?
These services are provided
through the County Alcohol
and Drug Program, and
include:
• Voluntary inpatient
detoxification
• Intensive outpatient
treatment services
• Residential treatment
services
• Outpatient drug free
services
• Narcotic treatment services
Medi-Cal members will be
able to receive expanded
mental health benefits
through your Medi-Cal
Managed Care Plan which is
CenCal Health. We provide
these services through our
Mental and Behavioral Health
Provider, the Holman Group.
The services include but are
not limited to:
If you or a family member are in crisis and
need immediate attention, call 911 or go to
the nearest hospital emergency room.
Outpatient Services
• Mental health services (assessments,
plan development, individual or group
therapy, rehabilitation and collateral
services)
• Medication support
• Day treatment services and day
• Crisis intervention and crisis
stabilization
• Targeted case management
• Therapeutic behavior services
Residential Services
• Adult and crisis residential treatment
services
Inpatient Services
• Acute psychiatric inpatient hospital
services
• Psychiatric inpatient hospital &
professional services
• Psychiatric health facility services
Where can I find out more
information about the
expanded benefits?
Talk with your Primary Care Provider about
services or treatment, or call CenCal Health,
Member Services at 1-877-814-1861
Monday through Friday, 8 a.m. to 5 p.m.
YOUR HEALTH is published for the members and community partners of CENCAL HEALTH, 4050 Calle Real,
Santa Barbara, CA 93110, telephone 1-800-421-2560, website www.cencalhealth.org.
Donna Slimak
Director of Member Services
Information in YOUR HEALTH comes from a wide range of medical experts. If you have any concerns or
questions about specific content that may aff­ect your health, please contact your health care provider.
Suzanne Michaud, M.P.H.
Health Promotion Educator, Newsletter Editor
Models may be used in photos and illustrations.
Pat Tyler
Member Services Operations Manager
To report FRAUD call 1-866-775-3944.
Your Health 6 www.cencalhealth.org
Su Plan DE salud
YOUR HEALTH NEWSLETTER, JANUARY 2014
Servicios de salud mental para
Medi–Cal
H
ay un cambio en la cobertura de Medi-Cal que
expande los beneficios de
salud mental y de trastorno de
uso de sustancias para los
miembros de CenCal Health. A
partir del 1 de enero de 2014,
Medi-Cal cubrirá los servicios
para trastorno de uso de sustancias, a través del County
Alcohol and Drug Program, y los
servicios de salud mental a
través de CenCal Health. Los
servicios especializados de salud
mental continuarán siendo
proporcionados por el Departamento de Salud Mental del
Condado.
¿Cuáles son los beneficios de
salud mental?
Los miembros de Medi-Cal
podrán recibir los beneficios de
salud mental expandidos a
través de su Plan de Servicios
Coordinados de Medi-Cal que es
CenCal Health. Proveemos estos
servicios a través de nuestro
Proveedor de Salud Mental y de
la Conducta, Holman Group.
Los servicios incluyen, pero no
se limitan a:
• Evaluación individual y
grupal de salud mental y
tratamiento (psicoterapia)
• Pruebas psicológicas cuando
sean clínicamente indicadas
para evaluar una condición de
salud mental
• Consulta psiquiátrica con el
propósito de monitorear la
terapia de medicamentos
• Laboratorio para pacientes
ambulatorios, medicamentos,
suministros y suplementos
• Pruebas de detección e
intervención breve
¿Cuáles son los beneficios para
trastorno de uso de sustancias?
Estos servicios se ofrecen a
través del County Alcohol and
Drug Program, e incluyen:
• Desintoxicación voluntaria
hospitalizada
• Servicios de tratamiento
ambulatorio intensivo
• Servicios de tratamiento
residencial
• Servicios para pacientes
ambulatorios libres de drogas
• Servicios de tratamiento para
uso de narcóticos
Si usted o un miembro de la familia está en
crisis y necesita atención inmediata, llame al
911 o vaya a la sala de emergencias del
hospital más cercano.
SU SALUD se publica para los miembros y socios comunitarios de CENCAL HEALTH,
4050 Calle Real, Santa Barbara, CA 93110,
teléfono 1-800-421-2560, Web site www.cencalhealth.org.
La información de SU SALUD proviene de una gran variedad de expertos médicos.
Si tiene cualquier inquietud o pregunta sobre el contenido específico que pueda afectar
su salud, por favor comunicarse con su proveedor de atención médica.
Se pueden utilizar modelos en fotos e ilustraciones.
¿Cuáles son los
beneficios de servicios
especializados para
salud mental?
Estos servicios seguirán siendo
proporcionados por el Departamento
de Salud Mental del Condado también
conocido como el Plan de Salud Mental.
Estos servicios son para miembros que
cumplen los criterios médicamente
necesarios. Los servicios incluyen, pero
no se limitan a:
Servicios para pacientes ambulatorios
• Servicios de salud mental (evaluaciones,
desarrollo de plan, terapia individual o grupal, rehabilitación y servicios colaterales)
• Apoyo con medicamentos
• Servicios de tratamiento y
rehabilitación diurnos
• Intervención de crisis y estabilización
de crisis
• Manejo enfocado de casos
• Servicios terapéuticos de
comportamiento
Servicios residenciales
• Servicios de tratamiento residencial
para adultos y crisis
Servicios para pacientes hospitalizados
• Servicios de hospitalización
psiquiátrica aguda
• Servicios psiquiátricos
hospitalizados y profesionales
• Servicios en centro de salud
psiquiátrica
¿Dónde puedo encontrar más
información acerca de los
beneficios expandidos?
Hable con su Proveedor de Cuidado Primario acerca de servicios o tratamiento,
o llame a CenCal Health, Servicios para
Miembros al 1-877-814-1861 de lunes
a viernes, de, 8 a.m. a 5 p.m.
Suzanne Michaud, M.P.H.
Educadora de Promoción de la Salud, Editora
Donna Slimak
Directora de Servicios para Miembros
Pat Tyler
Administradora de Operaciones de Servicios para Miembros
Para reportar un FRAUDE llame al 1-866-775-3944.
Su Salud 6 www.cencalhealth.org
December 2013
Covered California Enrollment Statistics Feb. 19, 2014
14%
102,200
Covered California
non-subsidized
Oct. 1-Jan. 31 Enrollment
Individuals Who Selected Plans
728,410
Subsidy eligible
Not subsidy eligible
86%
626,210
626,210
102,200
Cumulative Enrollment
subsidized
Cumulative Applications Completed
individual eligibility determinations
800K
728,410
1,222,506
1.2M
600K
500,108
900K
730,449
400K
600K
200K
300K
109,296
114,452
30,830
Oct.
995/day
Nov.
Dec.
Jan.
2,613/day 12,096/day 6,302/day
Medi-Cal
Oct.-Jan. Enrollment
1,529,000
Likely eligible
877,000
Transitioning from LIHP 652,000
attachment 1
219,639
Oct.
Nov.
Dec.
Jan.
3,692/day 4,538/day 16,572/day 17,627/day
43%
652,000
Transitioning
to Medi-Cal
from LIHP
57%
877,000
Likely
eligible
Covered California Enrollment Statistics Feb. 19, 2014
Oct.-Jan. Enrollment by Metal Tier
Subsidy eligible
Non-subsidy eligible
Silver
29%
Silver
67%
Bronze
21%
Bronze
34%
Platinum
18%
Gold 6%
Platinum 5%
Minimum Coverage <1%
attachment 2
Gold
14%
Minimum
Coverage 6%
February 10, 2014
Dear Primary Care Provider:
The Affordable Care Act (ACA) builds on the mental health parity law by expanding mental health services
for many patients, including those covered by the Medi-Cal Program. The State has provided funding for
CenCal Health to cover mental health services for mild to moderate conditions and we welcome the
opportunity. As you know, many mild to moderate mental and physical health conditions are co-occurring
and currently being managed by primary care providers with little assistance. CenCal Health knows that
improving access to mental health services positively impacts physical health conditions and the health and
wellbeing of our members. Please take a moment and review the enclosed material to better understand how
these important health benefits can be accessed by your patients. Also, please join us at our upcoming
seminar to learn more. An invitation is enclosed.
Background
Beginning January 1, 2014 mental health and substance use disorder services were expanded for current and
newly eligible Medi-Cal members. CenCal Health will now cover outpatient services for members impacted
by mild to moderate mental health conditions and will also cover alcohol screening, brief intervention and
referral for treatment when provided by Primary Care Providers (PCPs). Specialty Mental Health services for
severe mental illness (including crisis response, inpatient and residential treatment) will continue to be the
responsibility of the County Mental Health Departments. The Counties will also continue to be responsible
for treatment of members that meet criteria for Alcohol and Substance Use Disorder Services.
Behavioral Health Partner
CenCal Health has partnered with The Holman Group to administer the new mental health benefits on
behalf of the CenCal Health. The Holman Group, based out of Northridge, CA, is a well-established
Managed Behavioral Health Organization that arranges for quality mental health services. Holman has
developed a contracted network of mental health providers available to offer these services to CenCal Health
members and to provide support to PCPs.
New Covered Health Benefits
The mental health services covered by CenCal Health include:
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Individual and group mental health evaluation and treatment (psychotherapy);
Psychological testing, when clinically indicated to evaluate a mental health condition;
Outpatient services for the purposes of monitoring drug therapy;
Outpatient laboratory, drugs, supplies and supplements (excluding anti-psychotic drugs which are
covered by the State Medi-Cal Fee-For-Service Program);
Psychiatric consultation; and
Screening, Brief Intervention and Referral to Treatment (SBIRT)
4050 Calle Real, Santa Barbara, CA 93110
1288 Morro Street Ste. 100, San Luis Obispo, CA 93401
805.685.9525 • Toll-Free 800.421.2560 • CenCalHealth.org
There are no defined limits on the number of visits a member can have with a mental health professional.
Benefits will be arranged and provided based upon medical necessity and the level of care needed to make
progress towards treatment goals. The State has specified that couples counseling or family counseling for
relational problems are not covered.
Accessing Services
CenCal Health will continue to cover outpatient laboratory, supplies, supplements and drugs (excluding antipsychotic drugs) through our lab and pharmacy network. CenCal Health will also continue to cover mental
health services within the scope of primary care physician practice.
Mental Health services for mild to moderate conditions will be provided through The Holman Group’s
provider network. PCPs may refer members for mental health services by accessing The Holman Group 24
hours a day, 365 days a year via their toll-free number (800) 321-2843. Members may also self refer by
calling directly. The Holman Group will conduct an initial screening and arrange for the member to have a
face-to-face assessment with a mental professional or refer to another appropriate resource. They will also
coordinate with the County Mental Health Departments for Specialty Mental Health services on the PCP’s
behalf if it is determined that the member has severe mental illness.
PCPs with integrated mental health providers that are interested in offering these services to members can
join the Holman Group network. To request a contract and credentialing application directly from The
Holman Group, please contact Liz Santillan in Provider Relations at (800) 321-2843 extension 258.
Next Steps
CenCal Health is offering a seminar on the Affordable Care Act (ACA) and the new mental health benefit in
March 2014. Representatives from the Holman Group and your local County Mental Health Department will
be in attendance. Please reference the enclosed invitation and join us. CenCal Health will distribute
additional information on Screening, Brief Intervention and Referral to Treatment (SBIRT) in the coming
months.
Additional Resources
If you have questions or to arrange for an on-site visit at your office to discuss this new benefit and how you
can assist your patients in accessing mental health services, please feel free to contact your CenCal Health
Provider Services Representative at (805) 562-1676. If you would like to learn more about the Holman
Group, visit their website at www.holmangroup.com. A Frequently Asked Questions document and other
resource materials are enclosed for your convenience.
Sincerely,
Marina Owen
Director of Provider Services
Enclosures
4050 Calle Real, Santa Barbara, CA 93110
1288 Morro Street Ste. 100, San Luis Obispo, CA 93401
805.685.9525 • Toll-Free 800.421.2560 • CenCalHealth.org
The Holman Group
Managed Behavioral Health Care
Quick Reference Guide
Referral to Mental Health Services for CenCal Health Medi-Cal Members
THE HOLMAN GROUP
Eligible Patients: CenCal Health children and
adults who need mental health services not
covered by County Mental Health




Individual mental health evaluation and
treatment (psychotherapy)
Group mental health evaluation and
treatment services
Psychological testing when clinically
indicated to evaluate a mental health
condition
Psychiatric consultation for medication
management
COUNTY MENTAL HEALTH
Eligible Patients: Children and adults who meet
medical necessity or EPSDT criteria for Medi-Cal
Specialty Mental health Services








Crises Intervention and Stabilization
Mental Health Services (assessments plan
development, therapy, rehabilitation)
Medication Support
Day Treatment Services and Day
Rehabilitation
Targeted Case Management and
Therapeutic Behavior Services
Crises and Adult Residential Treatment
Acute Psychiatric Inpatient Hospital and
Health Facility Services
Professional Services in Psychiatric
Inpatient Hospital
If The Holman Group suspects a severe condition,
will refer to County Mental Health
If County Mental Health suspects a mild to
moderate condition, will refer to Holman Group
Frequently Asked Questions Mental Health Services for CenCal Health Medi‐Cal Members 1. I thought mental health services were carved‐out. Why is CenCal Health now offering mental health benefits? The Affordable Care Act (ACA) builds on the mental health parity law by expanding mental health services for many patients, including those covered by the Medi‐Cal Program. The State has provided funding for CenCal Health to cover psychology services. Mild to moderate behavioral and physical health conditions are co‐occurring. Improving access to mental health services positively impacts physical health conditions and the health and well‐
being of our members. 2. What new benefits are available for Medi‐Cal members? Beginning January 1, 2014 mental health and substance use disorder services were expanded for current and newly eligible Medi‐
Cal members. CenCal Health will now cover outpatient services for members impacted by mild to moderate mental health conditions and will also cover alcohol screening, brief intervention and referral for treatment when provided by Primary Care Providers (PCPs). These new benefits include individual and group evaluation and treatment (psychotherapy), testing, monitoring of drug therapy, outpatient lab services and psychiatric consultation. 3. Is CenCal Health providing these services directly? No. CenCal Health has partnered with The Holman Group to administer the new mental health benefits on behalf of the CenCal Health. The Holman Group, based out of Northridge, CA, is a well‐established Managed Behavioral Health Organization that arranges for quality mental health services. 4. What is not changing with regards to CenCal Health benefits? CenCal Health will continue to cover outpatient laboratory, supplies, supplements and drugs (excluding anti‐psychotic drugs) through our lab and pharmacy network. CenCal Health will also cover mental health services within the scope of primary care physician practice. 5. Is there a change to the services covered by County Mental Health? No. Specialty Mental Health services for severe mental illness (including crisis response, inpatient and residential treatment) will continue to be the responsibility of the respective County Mental Health Departments. The Counties will also continue to be responsible for treatment of members that meet criteria for Alcohol and Substance Use Disorder Services. 6. Which providers can my CenCal Health Medi‐Cal members now see? Psychiatric and psychological services will be provided through The Holman Group’s provider network. The Holman Group has a contracted network of mental health providers throughout Santa Barbara and San Luis Obispo County to offer services to CenCal Health members with mild to moderate conditions and provide support to PCPs. 1 February 2014 Frequently Asked Questions Mental Health Services for CenCal Health Medi‐Cal Members 7. How do I refer my patients with mild to moderate mental health conditions? PCPs may refer members for mental health services by accessing The Holman Group 24 hours a day, 365 days a year via their toll‐free number (800) 321‐2843. Members may also self refer by calling directly. No Referral Authorization Forms (RAFs) are needed. 8. What happens when my patients call The Holman Group? The Holman Group will conduct an initial screening and arrange for the member to have a face‐to‐face assessment with a mental professional or refer to another appropriate resource. They will also coordinate with the County Mental Health Departments for Specialty Mental Health services on the PCP’s behalf if it is determined that the member has severe mental illness. 9. Which CenCal Health Medi‐Cal patients can be referred to The Holman Group? Both current and newly eligible CenCal Health Medi‐Cal members. These programs are called Santa Barbara Health Initiative (SBHI) and San Luis Obispo Health Initiative (SLOHI). The Holman Group also takes referrals for CenCal Health’s non‐Medi‐Cal programs, including the Santa Barbara Healthy Kids Program. 10. Which CenCal Health Medi‐Cal patients should not be referred to The Holman Group? Members with Medicare or Other Health Coverage should access outpatient mental health through their primary carrier first prior to accessing their CenCal Health benefit. 11. Are medication consultations from a psychiatrist available to CenCal Health providers? Yes. The Holman Group provides psychiatric medication consultation. Providers can call The Holman Group via their toll‐free number (800) 321‐2843. 12. Are there visit limits for psychology services? No. There are no defined limits on the number of visits a member can have with a mental health professional. Benefits will be arranged and provided based upon medical necessity and the level of care needed to make progress towards treatment goals. The State has specified that couples counseling or family counseling for relational problems are not covered. 13. What if our practice has behavioral health providers? PCPs with integrated mental health providers that are interested in offering these services to members can join the Holman Group network. To request a contract and credentialing application directly from The Holman Group, please contact Liz Santillan in Provider Relations at (800) 321‐2843 extension 258. 14. Where do I get additional education? If you have questions or to arrange for an on‐site visit at your office to discuss this new benefit and how you can assist your patients in accessing mental health services, please feel free to contact your CenCal Health Provider Services Representative at (805) 562‐1676. 2 February 2014 Hoja de Datos
Departamento de Servicios de Alcohol, Drogas y Salud Mental del Condado.
ADMHS (por sus siglas en ingles)
Información de ADMHS
300 N. San Antonio Road Building 3
Santa Barbara, CA 93110
(805) 681-5200
www.admhs.org
Takashi Wada, M.D., M.P.H. Director
Provisional
 Fundado en 1962, El departamento de Servicios de Alcohol, Drogas y Salud Mental del
Condado de Santa Barbara (ADMHS) promueve la prevención y/o recuperación de adicciones y/o
dificultades de Salud Mental en las personas, familias y comunidades, ofreciendo servicios
avanzados y culturalmente apropiados..
¡¡Estamos en la Red!! Visítenos en
www.admhs.org haz clic donde dice “en español”
¿Qué Servicios hay disponibles?
Hay una serie de servicios que se ofrecen en todo el condado para niños, jóvenes y adultos.
ADMHS ofrece servicios para personas con dificultades de Salud mental y/o problemas del
alcohol y otro uso de substancias, para personas que están pasando por una crisis de salud
mental. Estos servicios se ofrecen con o sin hospitalización de acuerdo con la situación de cada
persona. Para más información detallada por favor visite la página de internet www.admhs.org y
haga clic en la parte de arriba donde dice “En Español” después haga clic donde dice “como
obtener servicios.”
¿Quién Provee los Servicios?
ADMHS tiene aproximadamente un equivalente de 292 empleados de tiempo completo. En unos
cuantos meses más este número de empleados aumentara cuando el nuevo programa de
evaluación de crisis sea implementado. El número de empleados aumentara aproximadamente a
un equivalente de 315 empleados de tiempo completo. ADMHS también tiene contratos con
diferentes proveedores de servicios en la comunidad así como también tiene contrato con otros
profesionales de la red de proveedores que ofrecen servicios adicionales.
¿Cómo se puede tener acceso a los servicios?
Hay tres formas de acceso a los servicios: 1.- Si una persona está pasando por una crisis de salud
mental y esta persona está en riesgo de hacerse daño a si mismo (a) o a otras personas, llame al
9-1-1. 2.- Si una persona está pasando por una crisis de salud mental y no esta en riesgo de
hacerse daño a si mismo (a) o alguna otra persona y la persona que está en crisis tiene cobertura
de a seguranza médica. Por favor de llamar directamente al plan de a seguranza para que le den
una referencia a un proveedor de servicios de salud mental cubierto por la a seguranza. 3.- y
para otras crisis de salud mental favor de llamar a ADMHS al número de acceso gratuito
1-888-868-1649 este número está disponible 24 horas al día, Siete días a la semana.
¿A quién provee servicios ADMHS?
ADMHS anualmente, provee tratamiento, rehabilitación y servicios de apoyo a aproximadamente
7,600 pacientes con dificultades de salud mental y 4,500 personas con desordenes del uso de
substancias. Los pacientes del Departamento de Servicios de Alcohol, Drogas y Salud Mental del
Condado de Santa Barbara incluye niños que sufren de desórdenes emocionales severos, Adultos
con dificultades de Salud Mental severos. Y personas con condiciones conjuntas de salud mental y
de uso de substancias.
Fact Sheet
SANTA BARBARA COUNTY DEPARTMENT OF ALCOHOL,
DRUG AND MENTAL HEALTH SERVICES
ABOUT ADMHS
300 N. San Antonio Road Building 3
Santa Barbara, CA 93110
(805) 681-5200
www.admhs.org
Takashi Wada, M.D., M.P.H. Interim Director
 Founded in 1962, the Santa Barbara County Department of Alcohol, Drug and Mental Health
Services (ADMHS) promotes the prevention of, and recovery, from addiction and mental illness
among individuals, families and communities, by providing effective leadership and delivering stateof-the-art, culturally competent services.
What services are available?
An array of services are provided countywide for adults, children and transition-age youth. ADMHS
serves persons with mental health and/or alcohol and substance use conditions and individuals
experiencing mental health crises. Services are provided on an inpatient, outpatient and crisis
basis. For detailed information about programs and services, please visit www.admhs.org and
place your cursor over the “Services” tab at the top of the page.
Who provides services?
How are services accessed?
www.admhs.org
We are on the Web! Visit us at
ADMHS employs approximately 292 full-time equivalent
(FTE) employees. In several months when the new Crisis
Triage program is implemented, this number will increase to
approximately 315 FTE employees. ADMHS also contracts
with a number of community-based alcohol, drug and mental
health providers, as well as with individual practitioners
called "network providers,” to offer additional services
countywide.
There are three ways to access services: (1) If an individual is experiencing a mental health crisis
that places anyone in immediate danger, call 911. (2) If an individual is experiencing a mental
health crisis that does not involve immediate danger, and if the person in crisis has insurance
coverage through a health plan, call the health plan to get a referral to a covered mental health
provider. (3) For all others, call ADMHS’ 24-Hour Toll Free Access Line at (888) 868-1649. The
call is toll free, and someone will answer to assist you 24 hours per day, seven days per week.
Whom does ADMHS serve?
ADMHS provides treatment, rehabilitation and support services to approximately 7,600 clients
with mental illness and 4,500 clients with substance use disorders annually. ADMHS clients
include children experiencing severe emotional disorders, adults with severe mental illness
and individuals with co-occurring mental health and substance use conditions.
Revised February 21, 2014
For dates of service beginning January 1, 2014, CenCal Health contracted providers
(excluding mental health providers) are able to provide and bill CenCal Health for the
procedure codes below.
HCPCS DESCRIPTION
CODE
PSYCHOTHERAPY AND PSYCHIATRY CPT CODES
90785 Interactive complexity (List separately in addition to the code for primary procedure)
90791 Psychiatric diagnostic evaluation
90792 Psychiatric diagnostic evaluation with medical services
90832 Psychotherapy, 30 minutes with patient and/or family member
90834 Psychotherapy, 45 minutes with patient and/or family member
90837 Psychotherapy, 60 minutes with patient and/or family member
90839 Psychotherapy for crisis; first 60 minutes
90840 Psychotherapy for crisis; each additional 30 minutes (add-on code)
90853 Group psychotherapy (other than of a multiple-family group)
90863 Pharmacologic management, including prescription and review of medication, when
performed with psychotherapy services (add-on code)
RELATED PSYCHOLOGY SERVICES
99366 Medical team conference/interdisciplinary, face-to-face, 30 minutes or more
99368 Medical team conference/interdisciplinary, not face-to-face, 30 minutes or more
PSYCHODIAGNOSTIC SERVICES
96101 Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual
abilities, personality and psychopathology, eg, MMPI, Rorschach, WAIS), per hour of the
psychologist's or physician's time, both face‐to‐face time administering tests to the
patient and time interpreting these test results and preparing the report
96105
96110
96111
96116
96118
96120
Assessment of aphasia, per hour
Developmental screening, with interpretation and report
Developmental testing, with interpretation and report
Neurobehavioral status exam, per hour
Neuropsychological testing, per hour
Neuropsychological testing, administered by computer, with interpretation/report