With the California Advancing and Innovating Medi-Cal (CalAIM) initiative continuing since its inception in 2019, a drastically new landscape commences on how behavioral health services will be provided. Two main changes occur in the reimbursement phase as it relates to behavioral health organizations. Cost reimbursement and fee-for-service will soon become a thing of the past. These dynamics are occurring as a result of CalAIM’s Behavioral Health Payment Reform.
For cost reimbursement, currently, each county uses a system where organizations billing Medi-Cal are reimbursed based on their costs. For example, if an organization has a contract for $4 million, its billing rates are dependent on how many costs it has and how many units of service it provides. As long as it provides $4 million of services and also has $4 million of allowable expenses, its rates remain. So agencies ensure they have enough costs in terms of salaries, overhead, and other expenses to justify their operations. Reimbursement then is not based on care, but on cost. This system does not reward positive outcomes, only what agencies spent. In the future, counties will change this structure.
As for fee-for-service, the CalAIM initiatives are to replace the fee-for-service system with value-based reimbursement. As indicated on the CalAIM webpage, Medi-Cal managed care health plans (MCPs) … will provide incentive payments to providers for meeting specific measures aimed at improving care for certain high-cost or high-need populations.” This means that an organization will be paid based not on how many visits they have with the client, but on what outcome measures are achieved. The emphasis shifts away from volume to how well the client improves, in terms of symptom reduction, client satisfaction, reduced hospitalizations, or other factors.
To prepare for these changes, organizations need to look at the following:
How an organization compensates its staff. With two jobs currently available for each job seeker, organizations will need to look at how they can streamline their workflows and also retain employees. The good news is that CalAIM is also updating the reasons for recoupment and the documentation requirements. So with paperwork reduction, staff can spend more time with clients.
Treatment protocols and best practices. While many organizations use evidence-based practices, other approaches will need to be developed by diagnosis and age group. Higher intensity services for youths prone to hospitalization, incarceration, or losing placements will need to occur quicker and include the right mix of clinicians, behavioral specialists, and paraprofessionals. New digital technology, such as care coordination and client portals will ensure clients do not fall through the cracks.
Developing a new philosophy of care. Some organizations have gone along with the “business as usual” mantra for years and are unwilling to change with the times. New visions, strategic plans, and thinking about how to make the organization “managed care friendly” are prerequisites in this new world.
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PRAXES is a nationwide behavioral health software, consulting, and training company. No one in the behavioral health industry has a better reputation, and if you give us the chance, we’ll show you why! At PRAXES, our services improve the efficiency and structure of behavioral health agencies serving children and families nationwide. PRAXES brings over 45 years of administrative and clinical expertise. With more than 100 client companies nationwide, we offer the expertise to advance the quality of behavioral health services. We accomplish these goals through our new clinical decision software, our training of best practices, and helping companies meet regulatory standards. At PRAXES, we believe in being creative and fostering new ways to serve children and their families. Our vision is to empower the families our agencies serve with skills that not only improve their functioning, but help them to thrive in their everyday lives. When you give us the chance, you’ll be connected directly to our friendly staff, so you can expect immediate attention to your inquiry. So, don’t wait, call now!
Dan Thorne has unique perspectives on the field of mental health. As a clinician, he has had over 40 years of experience working with clients in the Southern California area. After obtaining his Bachelor’s degree from the University of California at Irvine, he worked with children in the Orange County Juvenile Hall. Here he honed his earliest techniques on at-risk children. After that, he obtained his Master’s degree in Counseling from California State University, Fullerton.
In the 1990’s, Dan turned his attention to the clinical and administrative side of behavioral health organizations. For three years, he was the Assistant Administrator of Starting Point, a chemical dependency facility in Costa Mesa, CA. In 2001, he took an opportunity to be the Director of Harbor View Community Services Center in Long Beach. When he arrived, the Center had only 80 clients and 13 staff. When he left, there were over 400 clients and 75 staff. Dan created several programs through their contract with the Los Angeles County Departments of Mental Health and Child and Family Services. Under his guidance, Harbor View became one of the leading providers of children’s services in Los Angeles County.
While improving the results of the client’s parents at the Center, Dan reflected on his experiences as a parent. His children themselves had special needs such as mental and intellectual challenges, and Dan knew the toll it takes on the parent. In order to help the child, the parent has to be healthy. From this concept, he created his parenting program. After years of refining it, teaching it to his staff at the Center, and then taking the results and comments from these efforts, he became the developer of the current PRAXES program. It is a culmination of Dan’s personal trials and tribulations as a parent along with empirical results and research of over 40 parenting programs.
Our vision at PRAXES is to advance the strength of parents and caregivers of children with special needs (mental health, intellectual, or physical) through education, support, and empowerment. Thus, they can live healthy and functional lives while caring for the child.
Apogee is a clinical decision software designed to help behavioral health practitioners with their treatment and patient engagement. It provides evidence-based and research-based components. Not only do they consist of elements from such practices as Cognitive Behavior Therapy, Seeking Safety, Dialectical Behavior Therapy, Motivational Interviewing, Functional Behavior Analysis, but also the Intensive Models for Parents, Youth, and Children.
PRAXES has over 30 years of accreditation experience. We know what it takes to get your organization accredited. Whether it’s Joint Commission, CARF, or COA, our team can provide an evaluation of your current status and review the standards which need improvements. We will assist you with the policies, documentation, and training required to be accredited.
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