BEING HERE WELCOME TO THE
ASSEMBLY HEALTH AN ASSEMBLY%
BUDGET SUB COMMITTEE NUMBER ONE
HEARING ON THE PROPOSED
CAROLING BEHAVIORAL HEALTH
CHANGES DUE TO THE CONTINUED
STAY HOME WATER WE ARE
PRACTICING PHYSICAL DISTANCE
SEEN HERE IN THE HEARING ROOM
AND THROUGHOUT THE CAPITOL
BUILDING SO WE'RE ONLY ABLE TO
HAVE A LIMITED NUMBER OF PEOPLE
WATCH AND PARTICIPATE IN THE
HEARING IN PERSON ROSS REQUIRE
THAT MASKS BE WORN IN PHYSICAL
DISTANCE IN BE MAINTAINED BY
ALL MEMBERS OF THE PUBLIC
TESTIFYING WEATHER HERE IN THE
ROOM WHERE ONE OF OUR VIDEO
CONFERENCING SITES. WE DO NOT
HAVE AMASSED WE CAN PROVIDE ONE
FOR YOU. WHEN WE GET TO THE
PUBLIC COMMENTS PORTION OF THE
AGENDA AT ASTON ANY MEMBERS OF
THE PUBLIC- TO TESTIFY EITHER-
IN THE STATE CAPITAL OR IN THE
WITNESS VIDEO ROOM PLEASE
MAINTAIN THE SOCIALDISTANCING
AS YOU MOVE AROUND. IN ADDITION
WE HAVE PANELISTS AND OTHER
MEMBERS OF THE PUBLIC MAKING
USE OF OUR WITNESS CONFERENCE
VIDEO WITNESS VIDEO
CONFERENCING ROOMS HERE IN THE
CAPITAL. AND A FEW OTHER
LOCATIONS THROUGHOUT THE STATE.
THOSE WITNESSES WILL APPEAR ON
THE SCREEN SO MEMBERS CAN WATCH
THE TESTIMONY LIVE FROM OUTSIDE
OF THE HEARING ROOM AND ALSO
ASK THEM QUESTIONS. MEMBERS OF
THE PUBLIC CALLING IN WILL BE
USING A MODERATED TELEPHONE
SERVICE THROUGH WHICH ANY
MEMBER OF THE PUBLIC CAN
PROVIDE COMMENTARY. WHEN WE GET
TO THAT POINT IN THE AGENDA
PALISA BEEN PROVIDED A CALL IN
NUMBER PRIOR TO THIS A HEARING.
THE CALL IN NUMBER FOR PUBLIC
COMMENT FOR THIS HEARING IS
EIGHT SEVEN SEVEN SIX NINE TWO.
EIGHT NINE FIVE SEVEN AND THE
ACCESS CODE IS. TWO FOUR TWO
SIX TWO THREE SEVEN. READ THAT
AGAIN. 877-692-8957 AND THE
ACCESS CODE IS TWO FOUR TWO.
SIX TWO THREE SEVEN YOU CAN
ALSO FIND THE NUMBER ON THE
ASSEMBLY HEALTH COMMITTEE'S
WEBSITE AS WELL AS ON YOUR TV
SCREEN. THE OPERATOR ON THE
LINE WILL GIVE INSTRUCTIONS ON
HOW TO BE PLACED INTO THE QUEUE
DIVIDE YOUR PUBLIC COMMENT.
YOU'RE CALLING IN PLEASE
ELIMINATE ALL BACKGROUND NOISE
THIS INCLUDES MUTING YOUR
LIVESTREAM BROADCAST IN YOUR
SMART DEVICE- TO PREVENT- TO
REDUCE A SOUND DISTORTION. ONCE
YOU'RE IN THE QUEUE YOU ALSO
NEED TO MEET YOURSELF UNTIL
YOU'RE CALLED UPON TO SPEAK. IF
YOU HAVE ANY PROBLEMS WITH THE
MODERATED TELEPHONE SERVICE-
YOU CAN CALL THE COMMITTEE AT
NINE ONE SIX. THREE ONE NINE.
TWO ZERO NINE SEVEN AND MY
STAFF WILL BE THERE TO HELP I.
ALSO WANNA NOTE THAT WE ARE
ACCEPTING WRITTEN PUBLIC
COMMENT THROUGH THE IS HEALTH
COMMITTEES PUBLIC EMAIL. WHICH
IS A H. I'M A DOCTOR COMMITTEE.
AT ASSEMBLY DOT C. A. DOT G. O.
V. WHICH CAN ALSO BE FOUND ON
OUR WEBSITE. WE MAY NEED TO
LIMIT HOW LONG EACH PERSON HAS
TO PROVIDE PUBLIC COMMENT. AND
WE THANK YOU IN ADVANCE FOR
YOUR- PATIENCE. I THANK YOU
AGAIN TO ALL OF OUR SPEAKERS
FOR COMEDY AND REQUEST TO BE TO
PRESS PRESENT AT THIS HEARING
DURING THE PANDEMIC. THIS IS
THE FIRST OF TWO INFORMATIONAL
HEARINGS ON CALAMP. TODAY'S
HEARINGS FOCUSED ON THE
PROPOSAL PROPOSED BEHAVIORAL
HEALTH CHANGES. I COMMEND THE
DEPARTMENT FOR THE SCOPE OF THE
CHANGES IN ALL THE WORK THAT
WENT INTO THESE PROPOSALS.
THERE'S A LOT HERE AND I THINK
WILL IMPROVE THE DELIVERY OF
CARE. REDUCE ADMINISTRATIVE
BURDENS AND EXPAND ACCESS TO
CARE. IS ALSO A LOT TO DISCUSS
WE HAVE A VERY A FULL AGENDA SO
I'LL KEEP MY COMMENTS BRIEF.
LIKE TO OUR- INVITE MY CO
CHAIR. AT THE HEARING TODAY AT
DR RAM YOU WANT TO MAKE- IN ANY
OPENING REMARKS. THANK YOU
MISTER CHAIR AND- I WOULD LIKE
TO JUST THANK YOU FOR WANTING
TO ADDRESS THESE ISSUES
TOGETHER. IT'S IMPORTANT FOR US
TO. DEAL WITH MANY OF THE
COMPLEX ISSUES THAT ARE
VULNERABLE CALIFORNIANS ARE
FACING SUCH AS HOMELESSNESS.
BEHAVIORAL HEALTH CARE CRISIS
IS COMPLEX- CHILDREN MEDICAL
NEEDS JUSTICE INVOLVED
POPULATIONS AS WELL AS OUR
GROWING AGING POPULATION. THE
BROADER PROGRAM SYSTEMS AS WELL
AS PAYMENT REFORMS WHICH ARE
INCLUDED IN THE PROPOSAL FOR
CALAIS. ALLOW THE STATE TO TAKE
A POPULATION HEALTH AND PERSON
CENTERED APPROACH TO PROVIDING
SERVICES WITH THE GOAL OF
IMPROVING OUTCOMES FOR ALL
CALIFORNIANS. THE SUGGESTIONS
FROM THE ADMINISTRATION IS THAT
THROUGH AN ITERATIVE SYSTEM
TRANSFORMATION WE CAN INCREASE
BOTH THE HEALTH AND QUALITY OF
LIFE OF CALIFORNIANS WELL
ULTIMATELY REDUCING THE COSTS
OVER TIME. WHILE THESE
PROPOSALS FOUND. IN CURRENT
JING AND ARE WE HAVE A ROLE IN
THE LEGISLATURE TO MAKE SURE
THAT WE DELIBERATE THAT WE
DISCUSSED THAT WE KICKED THE
TIRES ON THESE PROPOSALS AND-
LOOK FORWARD TO HAVING THOSE
IMPORTANT DISCUSSIONS TODAY.
THANK YOU MISTER CHAIR. THANK
YOU DR REGULAR WE HAVE A VERY
FULL AGENDA WITH EIGHT PANELS
TO DISCUSS THE PROPOSED CHANGES
TODAY ALL THE PANELISTS FOR
USING WEBEX SO WE CAN SEE THEM
AS THEY SPEAK. THE HEARING
PAPER HANDOUTS AND POWER POINTS
ARE POSTED ON THE ASSEMBLY
HEALTH COMMITTEE WEBSITE UNDER
THE HEARINGS AND THEN INFO
HEARINGS TAB. DOCTOR RANDY WHEN
I WILL ALTERNATE CHEERING EACH
PANEL AT THE END OF THE HEARING
WILL ALSO BE WILL TAKE PUBLIC
COMMENT. AT THIS POINT I'D LIKE
TO INVITE- DEPARTMENT HEALTH
CARE SERVICES TO GIVE A BRIEF
OPENING COMMENT ON CALLIN
BEFORE WE GO TO OUR FIRST PANEL.
GOOD AFTERNOON DOCTOR ARAMBULA
DR WILL BE THE NUMBERS. ON THEM
WELL LIE FOR THE RECTOR OF THE
DEPARTMENT OF HEALTH CARE
SERVICES. I'M REALLY ONLY GOING
TO FRAME THE CONTEXT OF OUR
KILLING PROPOSALS. AND
EMPHASIZES VIRGIN CITY. AND
THEN TURN IT OVER TO J. C.
COOPER OR CHIEF DEPUTY DIRECTOR
IN STATE MEDICAID DIRECTOR. FOR
A DEEP DIVE INTO THE TOPICS.
QUESTIONS IN YOUR AGENDA. MEDI
CAL IS NOSE AND MEN'S PROGRAM.
REACHES NEARLY FORTY MILLION
PEOPLE OR ONE THIRD OF THE
STATE. OVER HALF OF THE
CHILDREN OF THE STATE. BUT IT'S
ALSO DISJOINTED ALL MARTIN MANY
TO NAVIGATE HELLO. PERHAPS
OVERLY FOCUSED ON PURELY
CLINICAL DISEASE INTERVENTIONS
ARE STILL MARKED BY DISPARITIES
IN HEALTH OUTCOMES- THE
CALENDAR SHOULD HAVE SIX TO
ADDRESS THE WHOLE STRUCTURE OF
THE PROGRAM. TODAY WE WILL BE
DISCUSSING THE BEHAVIORAL
HEALTH COMPONENTS NEXT WEEK THE
PHYSICAL ARE ALSO. NO PROBLEM.
BEYOND OF THESE OF SPECIFIC
CALTRAIN PROPOSALS THERE OF
COURSE OF THREE OTHER BUILDING
BLOCKS TO THE WHOLE REFORM ALL
THE BEHAVIORAL HEALTH
INFRASTRUCTURE BOND THE SCHOOL
SERVICES EXPANSION ONE
INFRASTRUCTURE FONG AND THE
REPORTER AMOUNT ON THEIR WAY
FOR MANAGED CARE PROVIDERS IN
CALIFORNIA. ALTHOUGH WE HAVE TO
TAKE THE STOCK. ORDERED YOU TO
KEEP THE WHOLE CALLED AND- IN
TERMS OF THE URGENCY. I WOULD
POINT TO THE FACT OF THE- OF
THE PLAN. HELLO THE TERRIBLE
DISPARITY INSPECTION WILL TELL
THE RATES MOBILE. AND LONG TERM
HEALTH NAY OF THIS. ALL
CERTAINLY FOR APRIL HOW NEEDS-
THE INTERNET. ALL I WOULD ALSO
POINT TO THE OF A LINEMAN WITH
THE FEDERAL ADMINISTRATION-
WHICH IS ALSO THE ITS
COMMITMENT IN A- THE SUPPORT
INTEGRATION IN THE MEDICARE
HEALTH. FINALLY THE PRACTICAL.
THE EXPERTS OF KALRA SECTION
ELEVEN SIXTY WAIVER AT THE END
OF THIS YEAR. WILL ANSWER
SOURCES OF SUPPORT FOR SYSTEM.
AND THUS THE IMPORTANCE OF
TOWARD BOMBS WE COMMIT AS IN TO
IMPROVE THE PRO. NOT JUST KEEP
UP THE FLOW SO WITH THAT- ARE
YOU TURN IT TO MY COLLEAGUE ALL
OVER CHIEF DEPUTY DIRECTOR AND
STATE MEDICAL DIRECTOR. TRACY
COOPER. THANK YOU FOR MUCH. AT
GOOD AFTERNOON- SO MY COMMENTS
ARE GOING TO BE SPECIFIC TO-
THE FIRST OVERVIEW THE FIRST
ISSUE ON THE AGENDA SO WE HAVE
NO ADDITIONAL OVER ARCHING
CALLIN PROPOSALS IF YOU DO WANT
ME TO DIG INTO THAT FIRST TOPIC
I'D BE HAPPY TO- HANG ON THE ME
JUST INTRODUCE THE OTHER PANEL
IF YOU DON'T MIND J. C.
PROJECT- SO- THANK YOU OBVIOUS
WE JUST HEARD FROM WILL LIFE ON
THE DIRECTOR OF PARCHMENT OF
HEALTH CARE SERVICES AND GOT
OUR FIRST TO FIRST VIEW TODAY
OF JC COOPER THE CHIEF DEPUTY
DIRECTOR OF HEALTH CARE
PROGRAMS AND THE STATE MEDICAID
DIRECTOR- COREY HAS SHIDA- WILL
BE ON THE PANEL AS WELL. AS A
FISCAL AND POLICY ANALYST WITH
THE L. A. O. THE LEGISLATIVE
ANALYST'S OFFICE RAIN QUIST DR
RYAN QUIST- BEHAVIORAL HEALTH
DIRECTOR SACRAMENTO COUNTY ALSO
SECRETARY TREASURER COUNTY
BEHAVIORAL HEALTH DIRECTORS
ASSOCIATION KIM LEWIS A
MANAGING ATTORNEY FOR NATIONAL
HEALTH LAW PROGRAM. CHRIS STONE
EMERGENCE- LICENSED CLINICAL
SOCIAL WORKER CHIEF EXECUTIVE
OFFICER CALIFORNIA ALLIANCE OF
CHILD AND FAMILY SERVICES
CONNIE PICASSO MARRIAGE AND
FAMILY THERAPIST SANTA CLARA
COUNTY BEHAVIORAL DEPARTMENT-
IT SKEWS ME SANTA CLARA COUNTY
BEHAVIORAL HEALTH SERVICES AND
A MEMBER OF SEIU LOCAL FIVE TWO
ONE. SO HERE WE GO NOW YOUR.
RUNS J. C. RIGHT YOU SO MUCH.
OF THIS. REGARDING THIS THIS
FIRST AT. ON YOUR MEDICAL THIS
HOW LONG BEEN DEFINE IN AND
HEALTH CARE- AND BEHAVE HEALTH-
DOM. AS HEALTHCARE SERVICES
NEEDED TO PREVENT. DIAGNOSE
TREAT AN ILLNESS INJURY
CONDITION DISEASE. OR ITS
SYMPTOMS- AND THAT NEEDS-
ACCEPTABLE STANDARDS OF
MEDICINE AS DEFINED BY OUR
VARIOUS HEALTHCARE PROVIDERS-
IN ANY OF THOSE CIRCUMSTANCES
OF YOUR CONDITION PRODUCES
DEBILITATING SYMPTOMS OR SIDE
EFFECTS. AND IT'S ALSO
CONSIDERED MEDICALLY NECESSARY
TO TREAT THOSE. HOWEVER IN
CALIFORNIA MEDIC HOUSE
BEHAVIORAL HEALTH SYSTEM HAS
LONG- MISUSE THE TERM MEDICAL
NECESSITY I THINK WE'VE BEEN
UNCOVERING THE THROUGH THE
KALLIKRATIS SAYS QUITE
SIGNIFICANTLY- AND INSTEAD IT
TENDS TO USE THE TERM TO DEFINE
THE BENEFIT OR SCOPE OF
SERVICES PROVIDED BY THE
COUNTIES. ARE WHO DO SPECIALTY
MENTAL HEALTH FIRST IS THE
MEDICARE MANAGED CARE PLANS TO
PROVIDE NON SPECIALTY MENTAL
HEALTH OR MILD TO MODERATE
MENTAL HEALTH SERVICES. FROM
THIS ALSO OFTEN IS AT ODDS WITH
THE WAY WE USE THE TERM
ELSEWHERE AND HEALTH CARE AND
CAN BE DEFINED IN THE STATE
PLAN PROVIDER MAY EUROPE- OTHER
DH CS GUIDANCE- AS DONE THROUGH
THE PHYSICAL HEALTH BENEFITS-
THIS HAS CREATED A LOT OF
CONFUSING- CONFUSION SORRY. AND
MISINTERPRETATION OVER THE
YEARS OFTEN LEADING TO
RESTRICTED ACCESS- BUT ALSO TO
DIS ALLOWANCES OF CLAIMS FOR
SPECIAL THE MENTAL HEALTH AND
SUBSTANCE USE DISORDER SERVICES
I'M THAT WERE OFTENTIMES NOT
FOUNDED BASED ON- THE SERVICES
AS BEING NEEDED FOR THAT
BENEFICIARY- A FEW EXAMPLES- TO
JUST NOTE. ON THE LIST OF
DIAGNOSES AND STATE REGULATIONS
FOR EXAMPLE ARE OUTDATED THEY
DON'T DEFINE MEDICAL NECESSITY
IN A WAY THAT **** IN SHAPE OR
FORM- THEY DON'T ALSO UP
APPROPRIATELY DEFINE AND DIVIDE
THE SYSTEM OF RESPONSIBILITY AS
MANY OF THE DIAGNOSES LISTED-
CAN CURRENTLY AND- ARE
CURRENTLY AND SHOULD BE SERVED
IN BOTH OF DELIVERY SYSTEMS.
ANOTHER EXAMPLE IS THAT A
PROVIDER SHOULD BE ABLE TO BILL
FOR SERVICES OUT WHILE
DETERMINING A DIAGNOSIS ASDONE
IN PHYSICAL HEALTH AND WE HAVE
HAD CONVERSATIONS WITH CMS
AROUND THIS VERY SPECIFIC ITEM
HOWEVER HISTORICAL BARRIERS IN
CALIFORNIA HAVE PREVENTED SOME
OF THESE TYPES OF PRACTICES. OF
FROM PEOPLE BEING ABLE. TO
ACCESS BEHAVIORAL HEALTH
SERVICES. HE BELIEVES WE- BE
MORE FOCUSED BUT- THE IS A- FOR
PROVIDING BEHAVIORAL HEALTH
SERVICES- AND WHAT SERVICES CAN
BE PROVIDED BASED ON CLINICAL
DETERMINATION- SUCH AS SERVICES
THAT ARE MEDICALLY NECESSARY AS
I OUTLINED AT THE BEGINNING.
I'M SO THE KEY CHANGES THAT WE
ARE PROPOSING WITHOUT IN CALAIS
ARE CLEAR FIND THE DIVISION OF
RESPONSIBILITY BETWEEN THE
MANAGED CARE PLANS. AND THE
MENTAL HEALTH PLANS FOR
SPECIALTY MENTAL HEALTH
ENSURING ACCESS FOR CHILDREN
WITH THE EXPERIENCE OF TRAUMA
HOMELESSNESS. AND THOSE IN THE
CHILD WELFARE SYSTEM. CLEAR
FIND EARLY AND PERIODIC
SCREENING DIAGNOSTIC AND
TREATMENT FOR WHAT'S KNOWN AS
THE PSTG SERVICES AND
EXPECTATIONS. ESPECIALLY WITH
OUR COUNTY PARTNERS. ENSURING
BENEFICIARIES CAN ACCESS
TREATMENT SERVICES WHILE THEY
ARE BEING ASSESSED FOR A
DIAGNOSIS IN BOTH SPECIALTY
MENTAL HEALTH. AND SUBSTANCE
USE DISORDER SERVICES.
IMPLEMENTING STANDARDIZED
SCREENING IN TRANSITION TOOLS
TO ENSURE BENEFICIARIES GET THE
NEEDED CARE QUICKLY AND
RELIABLY. IMPLEMENTING A NO
WRONG DOOR IN TREATMENT OF CO
OCCURRING DISORDERS AS OFTEN
EXISTS ON THE PHYSICAL HEALTH
SIDE AND SHOULD BE IMPLEMENTED
AND ALLOWED WITH IN THE
BEHAVIORAL HEALTH SPACES BOB.
WE ALSO HAVE SOME IMPROVE IN
THE- DRUG MEDI CAL ORGANIZED
DELIVERY SYSTEM OR WHAT'S KNOWN
AS THE MC OF YES- AS WELL AS
STREAMLINING DOCUMENTATION
REQUIREMENTS TO ALIGN WITH
MEDICAL CARE I'M IN REDUCING
THE HEAVY BURDEN THAT WE HAVE
PLACED ON BEHAVIOR HEALTH
PROVIDERS IN CALIFORNIA. I DH
CS HAD ROBUST STAKEHOLDER
PROCESS EASIER- TO BET MANY OF
THESE MAJOR POLICY DECISIONS-
INCLUDING MEDICAL NECESSITY-
AND THAT IS WHAT IS ULTIMATELY
WITHIN THE UPDATED CALLIE IN
PROPOSAL BEFORE YOU- A FEW
NOTES A GIVEN THE INITIAL
CALLIN TRAILER BILL WOULD BE
EFFECTIVE IN JULY OF TWENTY
ONE- WHEN DH CS IN CMS ARE
STILL NEGOTIATING. THE WAIVERS
AND VARIOUS STATE PLAN
AMENDMENTS AS NECESSARY THE ACS
BELIEVES IT NEEDS ARE
SUFFICIENT FLEXIBILITY TO
ACCOUNT FOR CALLIN DETAILS AND
LIMITATIONS THAT MAY ARISE IN
THE COMING MONTHS. ARE THERE%
FOR THE TRAILER BILL ALLOWS DH
CS TO PROPOSE CAL IN POLICIES
AND PER- PROPOSALS TO CMS AND
WEBER STATE PLAN AMENDMENTS
CONTRACT CHANGES INTO PUBLISHED
GUIDANCE THROUGH I'M
INFORMATION NOTICES TO ALLOW
FOR EFFICIENT IMPLEMENTATION.
THAT SAID DH CS RECOGNIZES THE
LEDGES STRUCTURES OF
SUBSTANTIAL ROLE IN SETTING
POLICY FOR THE MEDICARE PROGRAM
AS A RESULT THE H. C. A. R. AT
DCS PRIORITIZED ESTABLISHING
THE GENERAL STATUTORY FRAMEWORK
FOR CALLIN- AND LEGISLATING THE
PRINCIPLE CONCEPTS AND GOALS IN
THE TRAILER BILL. THAT WOULD
GUIDE DH CS NEGOTIATIONS AND
IMPLEMENTATION IN ADDITION ARE
THE CALENDAR THE BILL
CONTEMPLATES ONGOING AND
EXTENSIVE STAKEHOLDER
CONSULTATION INCLUDING OF
COURSE WITH THE LEGISLATURE
WHICH WOULD INFORM THE EVENTUAL
POLICY DETAILS IN
IMPLEMENTATION. D. H. YES IS
VERY OPEN TO SUBSEQUENT
LEGISLATION TO CODIFY THOSE
DETAILS POST APPROVAL ABBY AS
WE HAVE DONE IN MANY WAIVERS
PRIOR TO THIS- IN FOR EXAMPLE
HAVE NO CONCERNS WITH INSURING.
EVSC T. PROTECTIONS FOR TO ALL
ARE IN STATE LAW IN THIS. OUR
ON THIS ITEM. THANK YOU VERY
MUCH WE'RE GOING AND MOVE ON
TO- KOREA. WE'LL TAKE QUESTIONS
AT LAST WILL HAVE QUESTIONS
AFTER EACH PANEL SO. THANK YOU
AN THANK YOU DOCTOR WHAT A
KOREAN SHEET WITH THE L. A. L.
TO START OFF WE JUST WANNA
MAKES AN OVER ARCHING COMMENT
THAT RELATES TO THE ISSUE ON
THIS PANEL BUT ALSO SOME OF THE
OTHER CALLIN PROPOSALS THAT ARE
GOING TO BE DISCUSSED LATER ON
IN THE IN THE HEARING. AND
WHICH ARE RAISED IN IN THE
AGENDA- FOR THE HEARING AS
WELL- WE WANT TO SORT OF
ACKNOWLEDGE THAT THE
WILLINGNESS THAT THE
ADMINISTRATION JUST EXPRESSED
IN IN WORKING WITH THE
LEGISLATURE- IN DEVELOPING
DETAILS RELATED TO THE KILLING
PROPOSAL. HOWEVER THAT THE AND
THE PROPOSED TRAILER BILL
LANGUAGE FOR CALAMP INCLUDING
SEVERAL BEHAVIORAL CHANGES
DELEGATES THE ABILITY TO SHAPE
DETAILS ON THESE PROPOSALS TO
THE ADMINISTRATION TO A
SIGNIFICANT DEGREE- AND SHOULD
THE LEGISLATURE WISH TO HAVE
MORE OF A ROLE IN THE
DEVELOPMENT OF THESE PROPOSALS-
FOR EXAMPLE PROVIDING MORE
INPUT ON SPECIFIC CHANGES TO-
MEDICAL NECESSITY CRITERIA IT
MAY WISH TO EXPLORE REFINEMENTS
TO THE- PROPOSED TRAILER BILL
TO ENSURE THAT IT HAS MORE IN
PLACE SORT OF IN THE- IN THE
PROCESS- SPEAK. TO MEDICAL.
SPECIFICALLY WE HAVE HEARD
ANECDOTALLY THAT THAT CURRENTLY
THE DETERMINATION PROCESS- FOR
WHICH DELIVERY SYSTEM A
BENEFICIARY SHOULD ACCESS
SERVICES FROM YOU KNOW THE AT
MANAGED CARE OR THE COUNTY. ON
CAN BE SORT OF CARRIED OUT AND
CONSISTENTLY- WHICH YOU KNOW
COULD RESULT IN BENEFICIARIES-
BEING UNABLE TO ACCESS NEEDED
SERVICES ON TIME YOU KNOW THIS
IS ESPECIALLY TRUE FOR
BENEFICIARIES UNDER AGE TWENTY
ONE GIVEN THAT THE CRITERIA FOR
ACCESSING SERVICES FROM THE
COUNTY FOR YOUTH ARE- DIFFERENT
THAN THEY ARE FOR ADULTS-
ADOPTING STANDARDIZED.
SCREENING AND TRANSITIONS TOOLS
FOR COUNTIES IN MANAGED CARE
PLANS AS PROPOSED UNDER THE
MEDICAL NECESSITY REFORMS COULD
COULD HELP SORT OF MAKE THIS
PROCESS MORE MORE CONSISTENT-
HOWEVER IN PRACTICE THERE'S
STILL IS GOING TO NEED TO BE
SIGNIFICANT COORDINATION
BETWEEN. COUNTIES IN MANAGED
CARE PLANS TO ENSURE THAT YOU
KNOW THESE TOOLS RESULT IN MORE
CONSISTENCY OF CARE FOR
BENEFICIARIES- THE PROPOSED
REVISIONS TO MEDICAL NECESSITY
ALSO HAVE THE POTENTIAL TO.
IMPROVE ACCESS TO BEHAVIOR
HEALTH SERVICES AND INCREASE
THE AMOUNT OF BEHAVIORAL HEALTH
SERVICES OFFERED- BECAUSE
BENEFICIARIES WOULD BE ABLE TO-
RECEIVE SERVICES EARLIER FOR
EXAMPLE IF THEY DIDN'T- HAVE A
DIAGNOSIS YET- AND YOU KNOW THE
FACT THAT COUNTIES WOULD HAVE
SORT OF ACCESS TO ADDITIONAL
FEDERAL FUNDING- FOR EXAMPLE BY
HAVING FEWER OF THEIR CLAIMS
FOR. BEHAVIOR HEALTH SERVICES
DISALLOWED DUE TO YOU KNOW
ADMINISTRATIVE HURDLES- AND
ACCESSING ADDITIONAL FEDERAL
FUNDING COULD HELP FREE UP
COUNTY FUNDS TO MAKE FURTHER
INVESTMENTS IN. EXPANDING
BEHAVIOR HEALTH TREATMENT
CAPACITY- REGARDING THE FISCAL
IMPACT OF THIS PROPOSAL YOU
KNOW WE FIND THAT A COUPLE OF
IMPACTS THAT GO IN DIFFERENT
DIRECTIONS ARE ARE POSSIBLE-
WHICH ON NET MAKES YOU KNOW THE
MAGNITUDE OF THE FISCAL IMPACT
ON CERTAIN- IF THESE REVISIONS
RESULT IN INCREASED UTILIZATION
OF BEHAVIOR HEALTH SERVICES-
THEY WOULD INCREASE COUNTY
COSTS AND POTENTIALLY STATE
COSTS FOR THOSE BENEFICIARIES.
IN THE COUNTY BEHAVIORAL HEALTH
SYSTEM THAT THE STATE PROVIDES
THE NON FEDERAL SHARE OF COSTS
FOR. HOWEVER IF THEY RESULT IN
COUNTY'S ACCESSING FEDERAL
FUNDS FOR SERVICES THAT ARE
ALREADY BEING PROVIDED- WHICH
WE HAVE HEARD MAY BE THE CASE-
THEY WOULD RESULT IN SAVINGS
WHICH WOULD. IN TURN FREE UP
FUNDING TO SORT OF EXPAND
BEHAVIORAL HEALTH TREATMENT
CAPACITY- IN ADDITION YOU KNOW
THE NO WRONG DOOR POLICY UNDER
THIS UNDER THIS PROPOSAL TO.
ALLOW FOR BENEFICIARIES TO-
RECEIVE SERVICES THAT ARE
ELIGIBLE FOR FEDERAL
REIMBURSEMENT- EVEN IF THEY
ULTIMATELY GET REFERRED TO THE
OTHER SORT OF DELIVERY SYSTEM
BE IT WHETHER IT BE IN MANAGED
CARE IN THE COUNTY- YOU KNOW
COULD INCREASE GENERAL FUND
COSTS IF IT RESULTS IN- MORE
BENEFICIARIES ACCESSING
SERVICES FROM THEIR MANAGED
CARE PLAN FOR EXAMPLE- YOU KNOW
THAT THAT'S- THAT'S ALL THE
COMMENTS THAT THE L. A. O. HAS-
FOR THIS PANEL HAPPY HAPPY TO
PROVIDE FURTHER. ASSISTANCE
WHERE. NEEDED THANK YOU FOR
MUCH- SO. ASSUME AT THAT POINT
THAT MARK NEWTON DOESN'T ANY
COMMENTS OR WE PUT YOUR
COMMENTS TOGETHER FOR THIS
PANEL. THAT'S CORRECT I'LL BE
SPEAKING VALLEY OFFICER SHE
THANK YOU VERY MUCH SO WE'LL GO
AHEAD AND MOVE ON TO A RYAN
QUESTS PLEASE. GOOD AFTERNOON
SKEWS ME BUT AFTER INSURANCE
WORK ORDER AND ARAMBULA MY NAME
IS DR REHNQUIST I AM THE
BEHAVIOR HEALTH DIRECTOR FOR
SACRAMENTO COUNTY AND I'LL BE
SPEAKING ON BEHALF OF THE
COUNTY BURKE. HE BROUGHT HEALTH
RECORDS TODAY. OVERALL THE
STATE'S KELLERMAN ISSUE GIVE
OFFERS THE OPPORTUNITY FOR A
COMPREHENSIVE LARGE LARGE SCALE
REFORM THE COUNTY BEHAVIORAL
HEALTH SYSTEM FROM THE INSIDE
OUT. THE COUNTIES ARE GRATEFUL
TO THE ADMINISTRATION FOR
PUTTING FORWARD THAT PROPOSALS
WE WILL DISCUSS WITH YOU TODAY.
THESE PROPOSALS HAVE BEEN
DEVELOPED IN CLOSE
COLLABORATION WITH STAKEHOLDERS
INTERESTED IN IMPROVING THE
QUALITY ACCESSIBILITY AND
EQUITY OF OUR SPECIALLY
BEHAVIORAL HEALTH SYSTEM IN
CALIFORNIA. INCLUDING C. DHEA
AND ITS MEMBERS. CURRENT
CALIFORNIA LAWS RELATING TO
MEDICAL NECESSITY
DETERMINATIONS FOR SPECIALLY
MENTAL HEALTH IN A CD SERVICES
WERE STRUCTURED IN A WAY THAT
IT WAS THAT. THAT WAS
UNNECESSARILY RESTRICTIVE IN
OVERTIME THIS IS RESULTING IN
SOME UNINTENDED CONSEQUENCES
THE KILLINGS SEEKS TO REMEDY.
HEBER HEALTH PROVIDERS SPEND UP
240% OF THEIR TIME DOING
PAPERWORK TO JUSTIFY BILLING
THE FEDERAL MEDICAID FUNDS AND
THAT'S TIME THAT COULD BE SPENT
PROVIDING CARE- BEHAVIOR HEALTH
DOCUMENTATION REQUIREMENTS ARE
GREATER BURDEN THAN IN OTHER.
PARTS OF OUR HEALTH CARE
SYSTEM. AND TO A LARGE EXTENT
EITHER SELF IMPOSED CALIFORNIA
BURNS RAN INTO OUR REGULATIONS
THAT WE END UP HAVING TO AUDIT
TO. WHEN WE END UP HAVING TO
ADD IT TO THEM BECAUSE THEY'RE
IN OUR REGULATIONS. FOR EXAMPLE
THE CURRENT SPECIALLY MENTAL
HEALTH MEDICAL NECESSITY
CRITERIA HOW BAD TO FEDERAL AND
STATE AUDIT DENIALS. OF
LEGITIMATE SPECIALTY MENTAL
HEALTH SERVICES. IS SPECIALNEEDS LEGITIMATE SERVICES WERE
DENIED BECAUSE THE
DOCUMENTATION. DIDN'T MAKE THE
TECHNICAL. THAT ISN'T QUITE
TECHNICALLY MEET THE
REQUIREMENTS. OVER TIME- COUNTY
SEVEN TRAINS THROUGH AUDIT
DISALLOWANCE IS TO EITHER
DISCONTINUE CERTAIN SERVICES OR
USE NON MEDICAID FUNDS TO FILL
IN THE GAPS FOR SERVICES TO
MEDICARE BENEFICIARIES WHICH IN
FACT SHOULD HAVE BEEN BILLABLE
WITH THE FEDERAL MATCH LEAVING
FEDERAL DOLLARS ON THE TABLE
AND OF COURSE WE THINK WE
SHOULD BE BRINGING AS MUCH
FEDERAL REVENUE AND WHERE STATE
INCOMES AS POSSIBLE. THIS IS
ALSO MASKED THE ACTUAL SERVICE
LEVELS PROVIDED BY COUNTIES TO
MEDICARE BENEFICIARIES
PARTICULARLY AMONG CHILDREN
WHICH IS CONCERNING FROM A
PUBLIC POLICY AND-
ACCOUNTABILITY PERSPECTIVE.
BECAUSE THERE'S SO MUCH OF OUR
PAYMENT BECAUSE SO MUCH OF OUR
PAYMENT RULES ARE BUILT INTO A
FEDERAL WAIVER. COUNTIES ALSO
BEAR SIGNIFICANT LIABILITY FOR
FEDERAL AND STATE FINANCIAL
AUDITS AND PENALTIES ASSOCIATED
WITH THIS DOCUMENTATION. MOST
RECENTLY THE OFFICE OF THE
INSPECTOR GENERAL AUDITED THE
CALIFORNIA ESPECIALLY MENTAL
HEALTH PROGRAMMING DISALLOWED A
HUNDRED AND EIGHTY MILLION
DOLLARS WORTH OF CLAIMS MAINLY
ON THE BASIS THAT MEDICAL
NECESSITY HAD NOT BEEN.
DOCUMENTED TO THE EXACTING
STANDARD. STANDARDS OF THIS OF
THE SELF IMPOSED REQUIREMENTS.
THIS LEVEL OF FINANCIAL RISK
HAS UNFORTUNATELY MEANT THAT
COUNTIES TO THE MINISTER OUR
SERVICES WITH IN ABUNDANCE OF
CAUTION. FOR WHICH SERVICES WE
BELIEVE MAY BE PLAYABLE AND
THOSE COUNTIES WITH MULTIPLE OR
REPEATED STATE AND FEDERAL DIS
ALLOWANCES WILL OFTEN SELF
DISALLOW CLAIMS FROM PROVIDERS
SIMPLY TO AVOID THE RISK. THIS
PROCESS DOES NOT HELP TO
IMPROVE THE QUALITY AND
OUTCOMES INSTEAD SEARCHED
ORIENT ARE STAFFED WORDS
COMPLAINTS. RATHER THAN.
FOCUSING ON CLIENTS. LOWERS
MORALE AND CAUSE TALENTED STAFF
TO LEAVE OUR RATES THE FOCUS
SHOULD BE MORE ON THE
INDIVIDUAL NEEDING CARE RATHER
THAN ON PAPERWORK- FOR EXAMPLE
THERE'S AN OVER RELIANCE ON THE
DIAGNOSIS IS A KEY ELEMENT OF
REGULATORY COMPLIANCE. SO THE
INITIAL FOCUS WITH OUR CLIENTS
HIS BANNED LINE DOING A LENGTHY
THOROUGH ASSESSMENT UP FRONT
WHICH FRANKLY CAN SERVE AS A
BARRIER TO CARE ESPECIALLY WHEN
PROVIDERS AT TIMES HAVE A
NARROW WINDOW IN WHICH TO
ENGAGE INDIVIDUALS. INTO OUR
SERVICES. WHEN SOMEONE SEEKING
HELP THEY'RE NOT NECESSARILY
WANTING TO TELL THEIR WHOLE
LIFE STORY TO A STRANGER THEY
WANT SOMEONE TO HELP THEM WITH
THEIR WITH THEIR DISTRESSED SO
THIS CREATES A BARRIER TO
DEVELOPING A RELATIONSHIP.
THANK THIS IS WILL BE CONTINUE
TO BE IMPORTANT COMPONENT BUT
WE SHOULD BE ABLE TO BILL FOR
OTHER SERVICES PRIOR TO THE
DIAGNOSIS. OUR HOPE IS THAT
BEHAVIOR HELP DOCUMENTATION TO
SPEECH AND SHIFT TO A FOCUS ON
THE PROBLEM LIST. JUST LIKE
OTHER PHYSICAL HEALTH CARE
PROVIDERS WHO. WOULD LIKE A
PROVIDERS SHOULD BE ABLE FOCUS
ON SERVICE DELIVERY AND
PROVIDING THE SERVICES NEEDED.
WHEN WHERE AND HOW IT'S
CLINICALLY APPROPRIATE. RATHER
THAN RESTRICTED BY PROVIDERS
WHO ARE CONCERNED ABOUT WHAT
ADDRESSED. BUT EVEN PRIOR TO
THE PANDEMIC- CLINICIANS FELT
THE NEED TO PROVIDE A DIAGNOSIS
FOR A CHILD RAN COUNTER TO OUR
UNDERSTANDING OF CHILDREN'S
UNIQUE MENTAL HEALTH NEEDS.
EPISD CHEATING TYLER. NOW IT'S
EVEN MORE IMPORTANT TO ENSURE
THAT CHILDREN CAN REALLY
ACCESSIBLE RANGE OF SPECIALTY
MEDICAL. RESCUE SERVICES IN THE
RAPTURE OR COUNTY BEHAVIORAL.
WE BELIEVE THAT IN DOING SO
THESE CHANGES WERE WILL BETTER
ALIGN WITH. PTSD T. BENEFIT.
CAN YOU BEHAVIORAL HEALTH OF
ALL PARTNER WITH RISKY TO
DEEPEN OUR COMMITMENT OPEN
POLICY DISCUSSION MENTAL HEALTH
IN THIS UNIQUE. ALL CHILD WELL
INVOLVED SHOW THE CHILDREN
EXTRA HOMELESSNESS WE BELIEVE
THAT GIVEN THE EXISTING STRONG
PARTNERSHIPS BETWEEN COUNTY
BEHAVIORAL HEALTH AND CHILD
WELFARE AGENCIES AND INHERENTLY
TRAUMATIC EXPERIENCE REMOVAL
FROM THE WHOLE. IN ADDITION TO
EXPERIENCES OF ABUSE AND
NEGLECT WE NEED TO ENSURE OF
LOCAL ARE GOING TO BE HERE
HEALTH CASE MANAGEMENT AND A
FULL ARRAY OF SERVICES TO
PREVENT IN A MILITARY. MENTAL
HEALTH AND ASKING S. U. D.
RISKS ASSOCIATED WITH
POSTTRAUMATIC WORKS. FINALLY
THE STATE IN COORDINATION WITH
COUNTIES IN MANAGED CARE PLANS
WILL DEVELOP A SET OF STANDARD
A SCREENING IN TRANSITION
TOWARDS. WHICH WE EXPECT TO
ENSURE GREATER CONSISTENCY IN
OUR INAPPROPRIATELY SCREEN
BENEFICIARIES INTO BETWEEN
SPECIALTY AND NON SPECIALTY
SERVICES. IN KEEPING WITH THESE
GOALS AS THE STATE CONTINUES TO
DEVELOP RESPONSE POLICY
RECOMMENDATIONS WE WOULD ASK
THE ADMINISTRATION ALSO WORK
WITH NO MEANS TO SUBSTANTIALLY
REVISED EXISTING DOCUMENTATION.
REQUIREMENTS FOR ASSESSMENT.
EVEN PLAN AND- NOTES. FROM
SPECIALLY MENTAL HEALTH AND
DRUG MEDI CAL OR TO SAYS IN OUR
TO IMPROVE OFFICIATE. THE H. D.
IS GREAT TO THE GOALS OF
COUNTING WHICH INCLUDED
PHILOSOPHICAL LEARN PRACTICE
SHIFT AWAY FROM FINANCIAL
DISALLOWANCE IS FOR MINOR
CLINICAL DOCUMENTATION CONCERNS
AND MOVE TOWARDS TRUE QUALITY
IMPROVEMENT CONSISTENT
CONSISTENT WITH A BROADER
MEDICAL PROGRAM APPROACH. THANK
THANK YOU VERY MUCH DR QUIST-
MOVING ON TO KIM LEWIS. GOOD
AFTERNOON HI THIS IS KIM LEWIS
FROM THE NATIONAL FLOOD PROGRAM
CAN YOU HEAR ME OK YES THANK
YOU HI I HAVE SOME SLIDES AND
I'M HOPING SOMEONE WILL PUT UP
BUT- LET ME KNOW. RIGHT COTTOM.
PERFECT THANK YOU- AS I SAID
I'M CAN LIFT THE NATIONAL
HEALTH CARE PROGRAM AND IT'S MY
PRIVILEGE TO BE HERE TO TALK TO
YOU ABOUT IMPROVING THE
DELIVERY OF MENTAL HEALTH
SERVICES AND MEDICARE
SPECIFICALLY I'M GONNA FOCUS MY
COMMENTS TODAY ON THE
DEPARTMENT'S CAL IMPROPRIETIES
ON BEHAVIOR HEALTH MEDICAL
NECESSITY AND RELATED CHANGES
AS WELL AS- THE PROPOSED
TRAILER BILL TO AMEND THE STATE
LINE ACHIEVED. A PROPOSAL- NEXT
LIVE. JUST BY WAY OF BACKGROUND
I AM THIS OUR OFFICES- HAS WAS
FOUNDED IN NINETEEN SIXTY NINE-
TO PROTECT AND ADVANCE THE
RIGHTS OF LOW INCOME AND
UNDERSERVED INDIVIDUALS AND
HEALTH CARE AREA- WE ADVOCATE
TO EDUCATE LITIGATE THE FEDERAL
AND STATE LEVELS TO ADVANCE
HEALTH CARE RIGHTS IN
CALIFORNIA ACROSS THE COUNTRY.
AND WE HAVE THREE OFFICES IN
CALIFORNIA WASHINGTON DC AND
NORTH CAROLINA. NEXT SLIDE. I
WANT TO TALK JUST FOR A MOMENT
ABOUT THE IMPORTANCE OF THE PST
T. AND I KNOW THAT'S BEEN
MENTIONED BY J. C. AND OTHERS-
WE TALK ABOUT MEDICAL NECESSITY
AND MENTAL HEALTH SERVICES WE
HAVE TO KEEP FRONT CENTER THE
MEDICAID ENTITLEMENT FOR
CHILDREN YOUTH UNDER AGE TWENTY
ONE THE EARLY PERIODIC
SCREENING DIAGNOSTIC AND
TREATMENT SERVICES. THE STATE'S
REQUIRED TO PROVIDE. I'M NOT
GONNA GET INTO ALL THE DETAILS
OF THE PST T. BUT IT'S
IMPORTANT TO UNDERSTAND THAT.
THIS IS A ROBUST BENEFIT ON THE
MEDICAID BENEFITS BROADER THE
MEDICAID BENEFITS FOR ADULTS
AND IT'S DESIGNED TO ASSURE.
THAT CHILDREN RECEIVE EARLY
DETECTION AND CARE SO THAT
HEALTH PROBLEMS ARE BURDENS ARE
IDENTIFIED EARLY AND TREATED AS
EARLY AS POSSIBLE. YC P. STT
CRITICAL TO THE GOALS. ARE THE
GOAL IS TO ENSURE THAT.
INDIVIDUAL CHILDREN AND YOU CAN
GET THE HEALTHCARE THEY NEED
WHEN THEY NEED IT IN OTHER
WORDS THE RIGHT CARE THE RIGHT
TIME. FOR THE- IN THE RIGHT
SETTING. THANKS LINE.
IMPORTANTLY WHEN WE TALK ABOUT
A PST T. AND I THINK JC ALLUDED
TO THIS IT'S IMPORTANT
UNDERSTAND THE MEDICAL
NECESSITY IS BUILT INTO THE
FEDERAL LAW SO THERE ARE THE
REQUIREMENT THAT CHILDREN UNDER
TWENTY ONE IN THE STATUTE ARE
ENTITLED TO MEDICALLY NECESSARY
CARE THAT IS NECESSARY CARE
DIAGNOSTIC SERVICES TREATMENT
AND OTHER MEASURES TO CORRECT
OR AMELIORATE. WHAT THE WHAT IT
SAYS IS DEFECTS AND PHYSICAL
AND MENTAL ILLNESSES AND
CONDITIONS AND THOSE AREN'T ANY
DISCOVERED BY SCREENING- ARE
AND WHETHER OR NOT THOSE
SERVICES ARE ALREADY COVERED IN
THE STATE PLAN. THE NEXT SLIDE.
IN TERMS OF UNDERSTANDING YOU
KNOW WHERE WE ARE CURRENTLY
THEIR HUSBAND LEGISLATION
PASSED IN CALIFORNIA IN TWENTY
EIGHTEEN I SPECIFICALLY SB
TWELVE EIGHTY SEVEN WHICH
CODIFIES THE REQUIREMENTS IN
STATE LAW THE LEGISLATION
REQUIRES THE DEPARTMENT TO
IMPLEMENT AND MAKE SPECIFIC
THESE PROVISIONS BY ALL COUNTY-LETTER SIMILAR INSTRUCTIONS
UNTIL THERE ARE NEW REGULATIONS
THAT ARE ADOPTED. ON THOSE
REGULATIONS ARE SUPPOSED TO BE
ADOPTED BY JULY ONE TWENTY
TWENTY TWO- THOSE UPDATED
REGULATIONS ARE REALLY
NECESSARY TO REMEDY THE
CONFUSION OUTDATED STATE
REGULATIONS THAT EXIST TODAY.
THAT LEGISLATION ALSO REQUIRE
THE DEPARTMENT ITS CONTRACTORS
TO UPDATE EVIDENCE OF COVERAGE
DOCUMENT HANDBOOKS AND
NECESSARY MATERIALS TO ENSURE
THAT THE MEDICAL NECESSITY
STANDARD THAT'S NOW IN-
EMBEDDED IN THE STATE LAW TO
COMPLY WITH THAT FEDERALLY PST
T. STANDARD. IS ACTUALLY
REFLECTED IN ALL OF THESE
MATERIALS. NEXT SLIDE. SO I
WANT TO TALK A LITTLE BIT MORE
ABOUT CALLING HIM SPECIFICALLY
AND WHAT'S IMPORTANT ABOUT
WHAT'S IN IT WE CERTAINLY FIRST
OF ALL I WANT TO SAY STRONG
SUPPORT THE IMPORTANT GOAL THE
CALENDAR OF THE KALYAN CHANGES
TO IMPROVE ACCESS TO SPECIALTY
MENTAL SERVICES FOR BOTH
CHILDREN AND ADULTS INCLUDING
WHERE THERE'S A CO OCCURRING
SUBSTANCE USE DISORDER THIS
BILL SPECIFIC IMPORTANT
PROPOSED IMPROVEMENTS THAT SOME
ABILITY TO INCLUDE REQUIRING
STANDARDIZED DELIVERY SYSTEM
SCREENING TOOL TO BE USED BY
MANAGED CARE PLANS IN MENTAL
HEALTH PLANS. TO DETERMINE
WHICH DELIVERY SYSTEM IS
RESPONSIBLE TO SERVE THE
BENEFICIARY ALSO IMPLEMENTING A
NO WRONG DOOR POLICY TO ENSURE
BENEFICIARIES RECEIVE MEDICALLY
NECESSARY SERVICES INCLUDING
SCREENING ASSESSMENT AND
TREATMENT REGARDLESS OF THE
DELIVERY SYSTEM WHERE THE SEA
CARE. ELIMINATING A REQUIREMENT
TO HAVE A DIAGNOSIS TO ACCESS
MENTAL HEALTH SERVICES FOR A
MENTAL ILLNESS OR CONDITION
INCLUDING SPECIALTY MENTAL
SERVICES. WELL THIS IS TRUE
TODAY IT'S NOT CLEAR AND SOME
IN SOME CASES A TIME LIMITED
REQUIREMENTS. STREAMLINING
MENTAL HEALTH DOCUMENTATION
REQUIREMENTS IMPOSED BY PLANS
IN COUNTY'S AGAIN THERE NEEDS
TO BE STATEWIDE CONSISTENCY ON
THIS AND I THINK THAT IS PART
OF THE GOAL OF KILLING. AND
THEN CLARIFYING THAT CHILDREN
AND YOUTH UNDER AGE TWENTY ONE
CAN GET SPECIALTY MENTAL HEALTH
SERVICES REGARDLESS OF THE
IMPAIRMENT LEVEL. THIS IS BEEN
A LONG STANDING CONCERN OF OURS
THAT HIS IMPAIRMENT LEVELS HAVE
BEEN MISAPPLIED TO LIMIT ACCESS
TO CERTAIN SPECIALTY MENTAL
HEALTH SERVICES. WHERE WE
BELIEVE MEDICAL NECESSITY
SHOULD BE THE ONLY STANDARD OR
CRITERIA TO GET THOSE SERVICES.
AND THEN FINALLY OPENING ACCESS
TO SPECIALTY MEDICAL SERVICES
FOR CHILDREN AND YOUTH
EXPERIENCING TRAUMA. AS
EVIDENCED BY ADVERSE CHILDHOOD
EXPERIENCES AND THOSE
IDENTIFIED THROUGH TRAUMA
SCREENING IS CRITICALLY
IMPORTANT AS WE ALL KNOW TRUMP
HAS A PROFOUND IMPACT ON THE
HEALTH OF MENTAL HEALTH. AND
ACES ARE OFTEN FREQUENTLY
EXPERIENCED BY COMMUNITIES OF
COLOR. NEXT TIME. WELL IN TERMS
OF PLAN RESPONSIBILITY- THE
CALUMET ICAL ASSESS CITY NEEDS
SOME CLARIFICATION. SO THERE
THERE NEEDS TO BE CLEAR PLAN
RESPONSIBILITY AROUND- WHO IS
RESPONSIBLE PROVIDE MENTAL
SERVICES YOU KNOW THERE'S THIS
WRONG NO WRONG DOOR- BUT BUILT
INTO THIS PROPOSAL BUT IT'S NOT
EXACTLY CLEAR CAN BENEFIT YOU
SIMPLY CHOOSE WHICH STORE THEY
WANT TO GO TO A CAN THEY GET
THE SERVICES THEY NEED WHEN
THEY DON'T HAVE THE SAME LEVEL
OF BENEFIT OR THE SAME TYPES OF
SERVICES. AND THEN CHILDREN IN
USE EXPANDING ACCESS TO MENTAL
ESPECIALLY MENTAL HEALTH
SERVICES BASED ON CIRCUMSTANCES
CAN BE SELECTIVE SO WHAT IS THE
MANAGED CARE PLANS AGAIN
RESPONSIBILITY WITH RESPECT TO
THESE CHILDREN AND YOUTH TO
MAKE MOUNT DIRECTLY TO
SPECIALTY MENTAL HEALTH.
SECONDLY THE ONGOING ACCESS IS
STILL AN ISSUE FOR US- WE KNOW
THAT UPS CITY COMPLIANCE IS
REALLY STILL IS A MAJOR
CONCERN. AND THAT THE
PENETRATION RATES IN CALIFORNIA
ARE VERY LOW FOR SPECIALTY
MENTAL HEALTH ACCESS. AND SO WE
WANT TO MAKE SURE THAT KIDS CAN
GET ACCESS TO THE SERVICES THAT
THEY NEED. NOT JUST IN THE
CHILD WELFARE SYSTEM OR THOSE
EXPERIENCING HOMELESS BUT ALSO
JUVENILE JUSTICE KIDS KIDS AT
RISK. OF COMING INTO THOSE
SYSTEMS. SO WHAT OF THE
CAPACITIES OF THE SYSTEM HAS
CURRENTLY TO MEET THOSE ONGOING
NEEDS AND WHEN WE'RE EXPANDING.
THIS ACCESS HOW IS THAT ACTORS
SPEND ASSETS TAXES GOING TO BE
MET. AND THEN THE CLINICAL
GUIDANCE THERE'S NO
APPROPRIATE- SORT OF GUIDANCE
BILL. EXISTS OR SHOWS UP WHAT
OF THE CLINICAL GUIDELINES WILL
BE USER STANDARDS I. NEXT SLIDE
SO JUST A FEW COMMENTS ON THE
TRAILER BILL ITSELF- WE DO NOT
SUPPORT- HAVING TAKING THE
MEDICAL NECESSITY OUT OF THE
STATE STATUTE WE FOUGHT HARD TO
GET THOSE CHANGES IN AND THE
EFFORTS TO NOT CHANGE THAT
LEGISLATION AND PUT THAT
CONTROL DIRECTLY IN THE HANDS
OF THE DEPARTMENT IS NOT ONE
THAT WE THINK IS THE BEST
PRACTICE OR OR PROPRIOCEPTION
TO TAKE- IS CERTAINLY THE
LANGUAGE IN. ALSO IN CAL AND
THAT SAYS THIS CAN BE CHANGED
BASED ON YOU KNOW ALL MEDICAL
NECESSITY DETERMINATIONS
SCREENINGS AND ASSESSMENTS AND
DOCUMENTATION REQUIREMENTS. ARE
GOING TO BE SIMPLY DECIDED
THROUGH TERMS AND CONDITIONS OF
A WAIVER WHICH HAPPENS TO BE.
THOSE THOSE CONDITIONS A HAPPEN
BEHIND CLOSED DOORS IN
NEGOTIATIONS BETWEEN CMS AND
THE DEPARTMENT AND WE DON'T
THINK THAT. THAT IS ENOUGH
TRANSPARENCY AND WE THINK THAT
THESE REALLY ARE ARE CHANGES
THAT NEED TO BE EMBEDDED IN THE
STATUTES ITSELF. ON NEXT LIVE
TO OUR FINALLY A WRECK.
SPECIFIC TO THIS AREA. IS THAT
WE THINK WE SHOULD MAINTAIN THE
MEDICAL NECESSITY DEFINITIONS
IN THE STATUTE AS REQUIRED.
DESCRIBE THE CALLIN CHANGES
THAT CHASE YOU TALKED ABOUT
EARLIER AS DELIVERY SYSTEM
CRITERIA NOT AS MEDICAL
NECESSITY BECAUSE IT HAS ITS
OWN MEETING MEDICAL NECESSITY.
CLARIFY THAT THE PSTG
OBLIGATIONS APPLY TO SCREENING
ASSESSMENT MEDICAL NECESSITY.
AS TODAY. CLARIFY THAT NO ROCK
WHAT ARE THOSE NO WRONG DOOR
REQUIREMENTS IN STATE LAW SO
HOW WILL WE KNOW WHICH IS WHICH
SYSTEM SOMEBODY NEEDS TO GO TO
WHEN WILL THEY NOW WAIT WHAT
THAT SYSTEM IS. AND THEN
CLARIFYING AGAIN THAT THE
DIAGNOSIS SHOULD NOT BE
REQUIRED WE THINK THAT SHOULD
BE IN THE STATUTE THAT IS NOT
REQUIRED BY EITHER MANAGED CARE
PLANS MEDICAL PLANS OR FEE FOR
SERVICE. AND THEN CLARIFYING
THAT EXPERIENCING TRAUMA IS A
CONDITION THAT QUALIFIES THE
CHILD USED TO RECEIVE
BEHAVIORAL HEALTH SERVICES
REGARDLESS OF WHETHER THEY'RE
ALREADY INVOLVED IN CHILD
WELFARE. OR EXPERIENCING
HOMELESSNESS THAT'S REALLY
IMPORTANT. AND THEN FINALLY
CLARIFYING THAT ROLE OF THE
MANAGED CARE PLANS. WHEN
THEY'RE GOING TO EXPLODE WE'RE
EXPANDING MANTA CAL- SERVICES
BEHAVIOR HEALTH DELIVERY SYSTEM
SERVICES AND THE MANAGED CARE
PLANS STILL HAVE AN OBLIGATION
TO THIS POPULATION. WELL I HAVE
SOME RESOURCES I'VE ALSO
PROVIDED AND HAPPEN TO TAKE ANY
QUESTIONS THANK YOU. GREAT
THANK YOU VERY MUCH- WE'LL GO
AHEAD AND MOVE ON TO CHRIS
STONER MERTZ PLEASE. GOOD
AFTERNOON TEARS ARAMBULA AND
WOOD THANK YOU SO MUCH FOR
HAVING US TODAY I'M CHRIS
STONER MERTZ THE CEO OF THE
CALIFORNIA ALLIANCE. WITH CHILD
AND FAMILY SERVICES.
REPRESENTING HUNDRED FIFTY
NATIONALLY ACCREDITED
ORGANIZATIONS PROVIDING
BEHAVIORAL HEALTH AND OTHER
SERVICES TO CHILDREN YOUTH AND
FAMILIES THROUGHOUT CALIFORNIA.
WE'RE IN AGREEMENT WITH MANY OF
THE POINTS THAT MS LEWIS HAS
MAINTAINED ALL TRY TO HER COME.
TO BRING SOME. TO HOW THE
TRAILER BILL LANG IN FACT THAT.
PROVIDING DIRECT SERVICE TO
FUND. WHAT IS IT REALLY TO
BETTER SO. WASTE SUPPORT THE
WORK THAT DH. IN THE COUNTY
WORK CREW. HAVE DONE A WORKING
ENSURE THAT MATTER THIS
CRITERIA. FEDERAL ASPEN TO MAN.
FOR CHILDREN YOUTH I THINK WE
ALL THE HAPPY. IN OUR CAL WORK
BIRDS ACTUALLY- TO SEE THAT-
LEADERSHIP. ROLES WERE
PARTICULAR PLEASED WITH THE
EMPHASIS ON RECORD AND MUST
ADDRESS CHILDREN MENTAL AND SO.
USE AND ONLY. ARE EVEN BEFORE
THERE IS. DIAGNOSE IN A RECORD
THAT EXPOSE. JUST TRY. IS A CAN.
THAT SHOULD ACT TO BE MIRACLE
SERVICES. SO THAT THERE'S NO
DISCREPANCY IN DEFINITION FOR
THE IMPLEMENTATION OF OUR-
GREAT. IT WOULD SIMILAR
SIMILARLY RECOMMEND THE
LEGISLATURE REJECT ANY
AMENDMENTS OUTLINED TO BE OUT
TO WORK. FOURTEEN FIVE A NINE
POINT FIVE THE FORWARD THAT
SEEK TO A ROAD REQUIREMENTS
INTENSE HEAT FOUR EIGHTY SEVEN
THAT WAS A LONG. IN TERMS OF
THE ROCK NO WRONG DOOR
APPROACH- AGAIN. WE BOUGHT THE
YOU DEPARTMENTS WORK ON THIS-
AND WE THINK THAT THAT REALLY
HELPS IT WILL HELP TO INCREASE
ACCESS TO SERVICES WHICH MOBILE
REFORMS. WE SIMILARLY AGREE FOR
THE FAT CARE ACT CRITERIA
SHOULD BE OUTLINED IN STATE
LAW. FROM WE ALSO THAT IT'S
IMPORTANT TO UNDERSTAND THAT
WHILE THE INTENT OF NO
WRONGDOING PROVES VERY POSITIVE
REALITY IS THAT THE- THE
DELIVERY SYSTEMS CAPABILITIES
ARE VERY DIFFERENT.
PARTICULARLY AS THEY RELATE TO
CHILDREN WITH LONG FOR EXAMPLE
MANAGED CARE PLANS FIVE THAT
CAN BE USED TO BILL FOR
SERVICES FOR CHILDREN. WHILE
MENTAL HEALTH PLANS. HAVE
THIRTEEN OR MORE. THIS IS
REFLECTED OF THE DIFF IN ACCESS
SERVICE. TWENTY DELIVERY SYSTEM
SETTINGS. WHAT MADE IT EASY ON
PAPER TO TRANSITION BENEFICIARY
FROM WHEN WE SYSTEM TO ANOTHER
REALITY IS THAT THIS CAN BE
VERY DIFFICULT OPPONENTS ON THE
GROUND. THERE ALSO EXISTS
LIMITS. REGARDING WHERE
SERVICES MAY BE PROVIDED TO YOU.
WITH SCHOOL BASED MENTAL HEALTH
SERVICES THESE ARE OFTEN
LIMITED. FOR YOUTH RECEIVING
SERVICES M. C. P.'S WE SEE THIS
AS AN ACCESS ISSUE AND WHILE
THERE'S AN EFFORT IN THIS
YEAR'S BUDGET PROPOSAL TO
PROVIDE OPPORTUNITIES TO
INCREASE USER ENGAGEMENT IN
SCHOOL BASED NONPROFIT THERE
CAREER SPOKESWOMAN MEANS THE-
AND OTHER SERVICES OUTSIDE OF
CLINICS SETTING. AND SEE THINGS.
IF WE WANT TO TRULY. NOT ON NO
WRONG DOOR ACCESS TO SERVE.
PLACE BUSINESS CONSIDERATION.
FINALLY AS IT RELATES TO THE
SCREENINGS ASSESSMENTS AND
DOCUMENTATION REQUIREMENTS FOR
ONLINE ALL- WOULD LIKE TO SEEK
CLARIFICATION FEDERAL AND PSTG
APPLICATION OBLIGATIONS WHY
WHEN DETERMINING SCREENING AND
ASSESSMENT INDIVIDUAL YOUR
WHOLE SERVICES. AND ONE THAT
KNOWS OR CAN BE USED TO ROADS.
YES THE TEAM AND THE FOR ACCESS
TO SERVICES. WE BELIEVE IT'S
IMPERATIVE THAT IS DH CS
DEVELOPS THESE TOOLS WERE
STAKEHOLDER PROCESSES WITH THE
GOAL OF ADMINISTRATIVE
SIMPLIFICATION AND ACCESS TO
CARE BEACH RISING FORCE MANY OF
YOU HAVE HEARD. TIME AND TIME
AGAIN TESTIMONY REGARDING
ADMINISTRATIVE BURDENS OF AUDIT
DISALLOWANCE ISN'T I'M GOING
PEOPLE WORK AT THE MAN'S IS
MUCH AS A 50% OF PROVIDERS
NINE. MR CHRIS SPOKE TO BETTER
EARLIER. IN STRONG AGREEMENT
WITH IS RECONCILED
RECOMMENDATIONS. WE ALSO
ENCOURAGE A STATEWIDE APPROACH
TO DOCUMENTATION STANDARDS THAT
ENSURE SERVICE PROVIDERS
WORKING ACROSS COUNTIES IN
SYSTEM. STANDARDS AND
REQUIREMENTS. SHE PROPOSING TO
STAY. AND STANDARDIZE TO
REQUIREMENTS. G. H. C. S. MAS
ALSO NOT JUST IT'S AND TO WHAT
EXISTS IN STATE LAW OR TERMS
AND CONDITIONS BUT THE- CURRENT
EXISTING CONTRACTUAL AGREEMENTS
WHICH MEANS STATE COUNTIES ARE
DIRECTED PROVIDERS. RESULT IN
LIMITING ACCESS TO SERVICES
RANGE OF HOW MHP LINE. WELL
THAT ACCESS TO SERVICES WHAT
STAFF ARE ALLOWED TO PROVIDE
SERVICES IN ATTENTIONAL
PROCESSES ALL. NINETY TWO
COUNTY- WELL WE KNOW THAT THESE
CHANGES WERE MADE TO MOVE
THROUGH THE CALENDAR PRESS LAST
WEEK URGED G. H. YES MORE
LEGISLATORS TO IDENTIFY THOSE
AREAS SUCH AS STANDARDIZING
DOCUMENTATION REQUIREMENTS THAT
CAN BE DONE. RIGHT NOW WE CAN
BE WORKING ON THOSE RIGHT NOW
OUR CHILDREN USED TO SERVE OUR
FULL ATTENTION AT THIS CRITICAL
TIME IN THE PROGRAM AND
DEMOCRATS. AS THEY CONTINUE TO
SUFFER INCREASES IN MENTAL
HEALTH AND SUBSTANCE USE CRISES
AND DISPROPORTIONATELY HIGH
RATES. HELLO THANK YOU SO MUCH.
THANK YOU VERY MUCH AND WE'LL
MOVE ON TO OUR FINAL PANELIST
ON THIS PANEL- CONNIE PICASSO.
CAN YOU HEAR ME OK YES THANK
YOU YES OKAY. SO MISTER CHAIR
NUMBERS MY NAME IS COUNTY
COUNCIL AND I'M A LICENSED
MARRIAGE AND FAMILY THERAPIST
AND SEIU MEMBER ANTHONY CLARKE
COUNTY BEHAVIORAL HEALTH
SERVICES. I HAVE FOURTEEN YEARS
OF EXPERIENCE WORKING IN
BEHAVIORAL HEALTH ASSESSING
SCREENING PATIENTS WITH MILD TO
MODERATE OR SERIOUS MENTAL
HEALTH NEEDS AND REFERRING TO
THE CRITICAL MENTAL HEALTH
SERVICES ACROSS THE COUNTY. AND
I AM HERE TODAY TO SHARE FTA IN
SUPPORT OF THE PROPOSED POLICY
CHANGE FROM THE DIAGNOSIS
SPECIFIC CRITERIA INTO A
MEDICAL NECESSITY CRITERIA.
THIS POLICY CHANGE WOULD ALLOW
US TO MATCH THE REALITY TO THE
EXPERIENCE ON THE FIELD WITH
THE ACTUAL DIAGNOSIS. AND
EVENTUALLY PERMITTED TO TREAT
OUR PATIENTS HOLISTICALLY FOR A
BROAD RANGE OF NEEDED TO HEAR
REAL HEALTH SERVICES. NOW THE
CURRENT RULES ARE. DAIRY AND
THEY PREVENTED FROM REFERRING
OUR PATIENTS TO ALL THE
SERVICES THEY NEED BECAUSE THE
CURRENT ROLE SIMPLY REVOLVE
AROUND WHETHER A DIAGNOSIS IS
SPRING REIMBURSABLE OR NOT. SO
ESSENTIALLY I'M HERE TODAY TO
SHARE WITH YOU MY PROFESSIONAL
VIEW ON THIS. BECAUSE DAY IN
DAY OUT A SCREEN AND REFER
CHILDREN YOUTH AND ADULTS FOR
URGING PRICE SAYS MENTAL HEALTH
SERVICES OR SOMETIMES STANDARD
SPECIALTY CARE. AND THE REALITY
IS THAT WITHIN OUR COMMUNITY
ACROSS THE STATE WE'VE BEEN
AFFECTED BY COOLEY NINETEEN AT.
SEVENTEEN LEVELS ESPECIALLY IN
SANTA CLARA COUNTY NOW. THAT
APPLIES WITH OUR PHYSICAL
HEALTH BUT ALSO OR MENTAL
HEALTH. IN RETURN THE SEEN AN
INCREASE IN DEMAND FOR
BEHAVIORAL HEALTH SERVICES.
ALTHOUGH THE INFRASTRUCTURE IS
NOT THERE TO SUPPORT IT- BUT WE
ARE SAYING THAT ALL THESE
EXPERIENCES WITH GRIEF
ISOLATION LOSS OF INCOME AND
SOMETIMES THE FEAR OF
TRIGGERING MENTAL HEALTH
CONDITIONS OR EXACERBATING
EXISTING ONES IS VERY MUCH
THERE. MANY PEOPLE ARE ALSO
FACING INCREASED LEVELS OF
ALCOHOL AND DRUG USE INSOMNIA
PANIC ATTACKS AND SUICIDAL
IDEATION. AMONG SOUTH PARK. NOW
COUNTY WORKERS ARE SPECIALLY
EQUIPPED TO HANDLE COMPLEX
CASES MY FEES AND YET WE ARE
NOT PROVIDED THE ABILITY TO USE
THAT EXPERTISE IN A WAY THAT
WILL BENEFIT OUR COMMUNITY.
UNFORTUNATELY I CAN RECALL TOO
MANY INSTANCES WHERE MEMBERS OF
OUR COMMUNITY HAPPENED TOLD
THEY DO NOT QUALIFY FOR THAT
THE CABLE HEALTH SERVICES THEY
DESPERATELY NEED. AND THESE
COMMUNITY MEMBERS ALL TOO OFTEN
BELONG TO ALREADY HIGHLY
PORTABLE SUBGROUPS. WHICH OUR
CHILDREN AND YOUTH ON THE
AUTISM SPECTRUM. SENIOR
CITIZENS SUFFERING PRIMARILY
FROM DEMENTIA WITH SECONDARY
BEHAVIORAL HEALTH SYMPTOMS SUCH
AS DEPRESSION ANXIETY OR
PARANOIA. AND ANYONE WITH A
SIGNIFICANT SUBSTANCE USE
DISORDER WHICH IS THE PRIMARY
IN RELATION TO THEIR THINKING
ABOUT HEALTH CONCERNS. SO EVEN
THOUGH OUR COUNTY WORKERS LIKE
MYSELF HALF THE CLINICAL
EXPERTISE TO SCREEN AFTER HER
COMMUNITY MEMBERS INTO A RANGE
OF BEHAVIORAL HEALTH SERVICES.
OUR WORK IS ALL DONE IN VAIN IF
COMMUNITY MEMBERS ARE
ULTIMATELY LOCKED BY INADEQUATE
YET IMPERMEABLE REIMBURSEMENT
RULES. SO MAKING POLICY CHANGE
TO A MEDICAL NECESSITY CRITERIA
WHILE AT THE SAME TIME MAKING
PAYMENT REFORM AND FOUNDED
REIMBURSEMENT POSSIBLE WILL
ALLOW BEHAVIORAL HEALTH WORKERS
TO ASSESS AND TREAT PATIENTS
FOR ALL OF THEIR DISORDERS
WITHOUT FEAR OF NOT HAPPY HE
MEANT SOURCE. THIS WOULD ALSO
OPEN OPPORTUNITY FOR US TO
FINALLY JAILED UP ARGUE NINETY
HERE BILL HEALTHCARE STAFFING
AND WORKFORCE. THAT HAS BEEN
VERY LIMITED AND I THANK YOU
FOR ALLOWING ME TO SHARE THIS
EXPERIENCE. THANK YOU VERY MUCH
THE NOTE THAT WE HAVE- SOME
ADDITIONAL COMMITTEE MEMBERS
HERE- ANY COMMENTS OR ANYTHING
FOR. AND DO WE HAVE ANY
QUESTIONS FOR PANELISTS I KNOW
I DO BUT- ANY QUESTIONS FROM
THIS WALDRON. I'M JUST BRIEFLY-
AND I DON'T KNOW HOW TO ADDRESS
IT TO MAYBE- WHOEVER COULD
ANSWER IT- YOU KNOW WE TALK
ABOUT. THE VULNERABLE
COMMUNITIES AND- THE COMPLEX
MEDICAL CONDITIONS AS WELL AS-
WE HAD IN THE GROWING NUMBER OF
JUSTICE INVOLVED POPULATIONS.
WHO HAVE SIGNIFICANT CLINICAL
NEEDS THAT ARE NOT BEING MET.
IN THE IN CARCERAL- SITUATIONS-
YOU KNOW THE UNITED STATES
UNLIKE OTHER SOME OTHER
COUNTRIES- WHEN PEOPLE GO
INSIDE THEY ACTUALLY ARE TAKEN
OFF THE HEALTHCARE SYSTEM THAT
THEY WOULD HAVE BEEN ON. AND
THEN UPON REENTRY THEY HAVE TO
BE REALLY- SIGNED UP BACK INTO.
YOU KNOW IN OUR CASE MEDIC TELL.
WHEREAS IT WOULD BE MUCH MORE
BENEFICIAL TO HAVE A CONTINUITY
OF CARE. ESPECIALLY CLOSER TO
HOME THE REENTRY TIME- IS THAT
SOMETHING THAT CAN BE. LOOKED
AT IN THIS. YOU KNOW THESE
RECOMMENDATIONS OF CALLAHAM.
BECAUSE YOU KNOW WE'RE LOOKING
YOU KNOW A YEAR BEFORE REENTRY
OR AT LEAST SIX MONTHS TO GET
THE TREATMENT- WITH THE
PHYSICIAN OR THE WELL MENTAL
HEALTH SPECIALISTS THAT THEY
WOULD SEE UPON. EXITING PRISON-
WOULD MAKE A LOT OF. US GO A
LONG WAY FOR PEOPLE STAYING ON
TREATMENT WHEN THEY COME OUT.
OTHER THAN SPECIAL S. U. D. WE
SEE UP TO EIGHT TIMES OVERDOSED
US IN THE FIRST WEEK. WHEN
PEOPLE ARE RELEASED SO- IT'S
JUST I DON'T KNOW IF THAT'S
EVEN SOMETHING THAT HAS BEEN
ADDRESSED. I WOULD BE HAPPY TO
RESPOND TO THAT QUESTION THIS
IS JC COOPER WITH THE
DEPARTMENT OF HEALTH CARE
SERVICES I'M SO I ACTUALLY
WITHIN THE KELLY PROPOSAL WE DO
PROPOSE A MANDATE- THAT ALL
INDIVIDUALS. ON RELEASE FROM
PRISON INJAIL THE SCREEN FOR
MEDIC CAL AND ENROLLED IN
MEDICARE ALL OF ELIGIBLE THAT
IS ONE OF OUR PROPOSALS THAT IS
PROPOSED FOR. THE JANUARY ONE
TWENTY TWENTY THREE START DATE
JUST TO BE CLEAR IN REGARDS THE
TIMELINES OF THAT PROPOSAL IT
ALSO INCLUDES. A REQUIREMENT TO
HAVE A WARM HAND OFF AND
REFERRAL- TO. EITHER THE
MANAGED CARE PLAN AND OR COUNTY
BEHAVIORAL HEALTH PLAN I TO
CONTINUE ANY MENTAL HEALTH OR
SUBSTANCE USE DISORDER
TREATMENT THAT MAY HAVE BEEN
PROVIDED WHILE INCARCERATED-
AND WOULD ALSO NOTE THAT WE
PROPOSED AMENDMENT TO OUR DRUG
MEDI CAL ORGANIZED DELIVERY
SYSTEM. A PROPOSAL TO ALLOW FOR
SOMEONE'S PRIOR SUBSTANCE USE
ARE TO BE CONSIDERED FOR
MEDICAL NECESSITY UPON A RE
ENTRY INTO THE COMMUNITY- AS
WELL I AND SO MANY OF THOSE
COMPONENTS THAT YOU JUST
OUTLINED ARE A PART OF THE
CALENDAR. OF LARGER PROPOSALS.
GOOD THANK YOU VERY MUCH OTHER-
DOCTOR REGULAR. THANK YOU
MISTER CHAIR- I FIRST I'M GONNA
START BY- APPRECIATE
APPRECIATING DR QUESTION WORDS
WHERE HE WAS SPEAKING ABOUT HOW
BEHAVIORAL HEALTH DOCUMENTATION
HAVE BECOME BURDENSOME REMINDED
ME OF MY DAYS PRACTICING AND
THE STRUGGLE FROM THOSE OF US
WHO ARE PROVIDERS AND HOW
OFTENTIMES THOSE OF US WHO WORK
IN OUR STATE CAPITALS ARE NOT
LISTENING AND- HEARING THEM
CLEARLY I WANT YOU TO HEAR DR
QUEST YOUR WORDS WERE POWERFUL
TO ME. YOU STATED THAT YOU ARE
FOCUSING ON COMPLIANCE RATHER
THAN YOUR CLIENTS AND THAT YOUR
WISH WAS TO FOCUS ON THE
PROBLEM LIST FOR YOUR CLIENTS
HAPPY AND YOU STATED THAT THE
CALLIN PROPOSAL WHILE IT'S BEEN
IN DEVELOPMENT FOR YEARS WILL
OFFER US THESE COMPREHENSIVE
LARGE SCALE REFORMS
SPECIFICALLY DEALING WITH OUR
OVER RELIANCE ON. DIAGNOSIS O
I WANTED TO ASK TO SEE COOPER
IF I COULD BECAUSE KEN LEWIS
ALSO BROUGHT THE QUESTION UP
ABOUT DIAGNOSIS LOOKING AT
MEDICAL NECESSITY AND WHETHER
OR NOT YOU'LL NEED ONE OF THOSE
NINETEEN DIAGNOSES TO RECEIVE
TREATMENT. AS I'M READING IT
UNDER THE CALLING PROPOSAL IT
APPEARS THAT BENEFICIARIES NOW
AFTER THE PROPOSALS THAT ARE
BEING RECOMMENDED. WILL BEGIN
TO RECEIVE SERVICES EARLIER
THAN THEY CURRENTLY ARE NOW. SO
ECHOING CAN LEWIS'S QUESTIONS
CAN YOU HELP US TO CLARIFY. IS
DIAGNOSIS REQUIRED TO OBTAIN
BEHAVIORAL HEALTH SERVICES.
BEFORE RECEIVING THEM. SO
CURRENTLY WITHIN OUR SYSTEM WE
DO HAVE SOME RULES IN REGARDS
TO WHEN YOU CAN BE REIMBURSED
FOR SERVICES- IT VARIES ACROSS
ASSESSMENT VERSUS TREATMENT
HOWEVER WHAT I WOULD SAY WITHIN
THE CAL LEAN PROPOSAL WE ARE
PROPOSING THAT AN INDIVIDUAL
WOULD BE ABLE TO RECEIVE-
MENTAL HEALTH AND SUBSTANCE USE
DISORDER SERVICES WHILE THEY
ARE- YEAH. AS A POSITION IS
DETERMINING A DIAGNOSIS- AND IF
THE DIAGNOSIS IS DETERMINED THE
THIRD THAT THERE IS NO
DIAGNOSIS THAN THEY WOULD- AND
NOT HAVE A TREATMENT PLAN PUT
IN PLACE BUT WE HAVE A NUMBER
OF. YEARS IN PLACE RIGHT NOW
THAT I THINK- AS YOU HEARD
PREVIOUS PANELISTS ACTUALLY
SPEAK TO YOU ON THAT COUNTY
BEHAVIORAL HEALTH PROVIDERS
HAVE HAD TO PUT- PROCESS THESE
IN PLACE THAT ARE PROBABLY- YOU
KNOW INAPPROPRIATE IN ORDER TO
BILL AND BE REIMBURSED FOR
SERVICES FOR EXAMPLE. GIVING
SOMEONE A DIAGNOSIS IN ORDER TO
CONTINUE TO THE BILL WHEN MAYBE
THAT'S NOT APPROPRIATE- IN IN
WE HAVE IDENTIFIED SOME OF
THOSE CASES WHICH IS WHY WE
FEEL LIKE IT'S CRITICAL TO
ALLOW FOR AT A CLINICAL
PROVIDER TO ASSESS AN
INDIVIDUAL UP PRIOR TO
DIAGNOSIS AND BE REIMBURSED FOR
THE SERVICES AND WE HAD HAVE.
WE HAVE HAD CONVERSATIONS WITH
CMS THAN THEY- THE- BOTTOM
AGREE WITH THE STATE THEY SAY
ACTUALLY SO. BY MEDICAL
NECESSITY AND LAW THAT SOMEONE
SHOULD BE ABLE TO BE RECEIVING
SERVICES FROM A PROVIDER AND BE
REIMBURSED FOR THEM WHILE THE
TERMINATE DIAGNOSIS SO WE
STRONGLY SUPPORT THIS.
RECOMMENDATION IN OUR PROPOSED
CHANGES. AS A- PROVIDER I WOULD
JUST SAY THE MORE TIME YOU
SPEND TREATING OUR PATIENTS
RATHER THAN TREATING OUR CHARTS
THE BETTER OFF WE WILL. BE
DOING AS A STATE THANK YOU.
MISTER RAMOS CENTER YOU HAVE A
QUESTION. THANK YOU MR- THE
QUESTION CENTERS AROUND THE
NECESSITY AND THE PATHWAYS FOR
INDIVIDUALS AT HIGHER RISK
AROUND POTENTIALLY MENTAL
HEALTH ISSUES INCLUDING
SUICIDAL IN THE HARM THAT'S
THERE AND- BRINGING THAT TO THE
USE OF IN THE STATE OF
CALIFORNIA THAT ARE SUFFERING
FROM THE CLOVER NINETEEN AND
THE DIFFERENT THINGS THAT WE'VE
SEEN. AT OUR FOR OUR YOUTH IN
THE STATE OF CALIFORNIA SAYS
WE'RE TALKING ABOUT- THE
PATHWAYS FOR INDIVIDUALS-
SEVERELY AT RISK ARE WE
INCLUDING THAT DISCUSSION OF
THE TOPIC AND HOW WE'RE WE'RE
MOVING FORWARD IN ADDRESSING
THE MENTAL HEALTH ISSUES
PARTICULARLY SUICIDE PREVENTION
AND THE U. THAT WE KNOW ALL.
OUR SEPARATE A HIGHER RATE THAN
WE'VE SEEN BEFORE. YES I THINK
THERE'S ACTUALLY BEEN QUITE A
BIT OF WORK IN THIS SPACE THIS
IS SPECIFICALLY AROUND ENSURING
THAT- INDIVIDUALS UNDER TWENTY
ONE- THAT WE ARE ENFORCING
THEIR RIGHTS AND PROTECTIONS IN
FEDERAL LAW AROUND P. PST T. TO
ENSURE THAT. WE ARE DOING
EVERYTHING WE CAN TO- TO
PREVENT- AND TO PROVIDE EARLY
INTERVENTION SERVICES FOR BOTH
MENTAL HEALTH AND SUBSTANCE USE
DISORDER SERVICES. HISTORICALLY
THERE HAS BEEN- AS SOME
MISUNDERSTANDINGS OR SOME A
LACK OF CLARITY IN REGARDS TO
THAT REQUIREMENT HOWEVER OTHER
DEPARTMENT. HAS BEEN ENFORCING
THE REQUIREMENT ACROSS BOTH
SPECIALLY MENTAL HEALTH AND
SUBSTANCE USE. DISORDER
SERVICES AND MAYBE MORE
CONFUSION ON THE SUBSTANCE USE
HISTORICALLY THAN ON THE
SPECIALTY MENTAL HEALTH BUT-
BUT THAT IS VERY MUCH A
REQUIREMENT ACROSS OUR DELIVERY
SYSTEMS BOTH ON THE MEDICARE
MANAGED CARE PLANS. AS WELL AS
ON OUR COUNTY PARTNERS I TO
ENSURE THAT THERE'S APPROPRIATE
ACCESS TO CHILDREN INCLUDING
PREVENTATIVE SERVICES ACROSS
THE BOARD. THANK YOU VERY MUCH-
I'VE I'VE I'VE QUESTIONS A FEW
QUESTIONS SO ON MY FIRST ONE'S
GOING TO BE FOR- KIM KIM LEWIS-
MISS LEWIS YOU BEEN INVOLVED IN
MENTAL HEALTH ISSUES PERSISTS-
FOR SOMETIME ON THE ADVOCACY
SIDE. THIS IS A LACK OF CLARITY
ON WHO'S RESPONSIBLE FOR WHAT
IN THIS AREA. PARTICULARLY
INVOLVING CHILDREN'S MENTAL
HEALTH SERVICES- IS THE PROBLEM
WE HAVE IN STATE LAW STATE
REGULATION OR GUIDANCE FEDERAL
LAW. OR SOME COMBINATION. THANK
YOU FOR THE QUESTION TO GET ONE
WELL THE PROBLEM IS NOT A
FEDERAL LAW I CAN TELL YOU-
THERE'S QUITE A BIT OF CLARITY.
ABOUT THE E. P. STT OBLIGATIONS
I'M SORRY THERE'S LIKE FLASHING
GOING ON BEHIND MY HEAD I
APOLOGIZE LOOKS LIKE I'M ON
FIRE- SO. THE I THINK THE
FEDERAL IS VERY CLEAR ABOUT
OBLIGATIONS TO INTERVENE EARLY
AND OFTEN FOR CHILDREN IN TERMS
OF BOTH SCREENING. YOU KNOW
ASSESSMENT IDENTIFICATION
PREVENTION ALL THE WAY DOWN TO
THE TREATMENT SO AND IT'S A
VERY BROAD AND ROBUST
ENTITLEMENT AS I TALKED ABOUT.
I THINK ONE OF THE CHALLENGES
ARE BIFURCATED SYSTEM THAT WE
HAVE CREATED OVER MANY YEARS
INCLUDING THIS CARVE OUT OF
SPECIALTY MENTAL HEALTH HAS
CAUSED THERE TO BE A LOT OF
CONFUSION ABOUT WHO WOULDN'T
EXACTLY HOLD THE RESPONSIBILITY
FOR WHAT. AND I THINK THAT THE
MANAGED CARE PLANS CLEARLY HAVE
AN EXPANDED ROLE STARTING IN
TWENTY FOURTEEN AS A RESULT OF
THE PORTABLE CARE ACT WHICH IS
MAYBE CREATED ADDITIONAL
CONFUSION BECAUSE NOW WE HAVE
AN EXPANDED BENEFIT THAT REALLY
WAS INTENDED FOR THE ADULT
EXPANSION POPULATION TRYING TO
BE APPLIED TO KIDS. AND I THINK
WHERE WE ARE NOW IS THAT. WE
ENDED UP WITH AND AS I WAS
TALKING ABOUT IN MY TESTIMONY
AND IMPAIRMENT SORT OF FOCUS
SO. KIDS AND THERE'S ALL
THERE'S ALL STRONG
MISUNDERSTANDING THAT MILD TO
MODERATE AND IT'S OFTEN
REFERRED TO AS A MILD TO
MODERATE BENEFIT FOR EXAMPLE ON
THE MANAGED CARE PLAN SIDE.
THAT THAT IS THE ONLY BENEFIT
AVAILABLE TO CHILDREN WHICH IS
NOT TRUE. CHILDREN ARE ARE
ENTITLED TO NECESSARY SERVICES
TO CORRECT AMELIORATED
CONDITION PERIOD. AND SO
WHETHER IT'S A SPECIALTY MENTAL
HEALTH SIDE WHERE THERE'S A LOT
MORE SERVICES AVAILABLE OR
WHETHER IT'S THE MANAGED CARE
PLAN. THAT SHOULD NOT MATTER TO
A CHILD OR FAMILY IT SHOULD BE
BOTH OF YOU ARE RESPONSIBLE TO
SERVE. THE NEEDS OF MY FAMILY
OR MY CHILD AND THEREFORE
FIGURE OUT WHO HAS TO PROVIDE
WHAT. I THINK THIS IS WHY SOME
OF THE CHANGES THAT I ALLUDED
TO IN THE CALIPERS ARE HELPFUL.
IN THAT IT DOES MAKE IT MORE
CLEAR YOU KNOW A CHILD CAN GET
IN A SERVICE THAT'S AVAILABLE
EVEN IF IT'S ONLY AVAILABLE IN
THE SPECIALTY MENTAL HEALTH
SYSTEM. IF IT'S MEDICALLY
NECESSARY. WHETHER THEY HAVE A
MILD. MODERATE OR SEVERE LEVEL
OF IMPAIRMENT SO IMPAIRMENT AND
I CAN INCLUDING THEIR EXCLUDED
DIAGNOSIS SHOULD NOT. DETERMINE
THAT. ARE REGULATIONS HAVE A
LOT OF THAT EMBEDDED INTO IT
ENTITLE NINE WHICH ARE VERY
OUTDATED. AND THE MEDICAL
NECESSITY CRITERIA IN THE
REGULATIONS ARE OUTDATED. AND
THEY NEED TO BE CHANGED OR
ELIMINATED. THANK YOU THANK YOU
VERY MUCH- ANOTHER QUESTION
FOR- MISS- MISS AT THE CASTLE-
IS BECAUSE SO YOU ARE A MENTAL
HEALTH PROFESSIONAL AND YOU
WORK AT THE CENTRALIZED ENTRY
POINT FOR THOSE SEEKING
SERVICES FROM SANTA CLARA
COUNTY BEHAVIORAL HEALTH. CAN
YOU DESCRIBE WHAT HAPPENS WHEN
YOU WHEN A CALL COMES IN DO YOU
HAVE TO DETERMINE INITIALLY HOW
SERIOUS A PERSON'S. MENTAL
HEALTH CONDITION IS AND WHICH
SIDE A MEDIC CAL DELIVERS A
pMEDICAMENTS CARE THE PLAN OR
THE COUNTY OR IS THE FOCUS ON
GETTING THE PATIENT INTO CARE
IMMEDIATELY SO JUST. HOW DOES
IT WORK IN YOUR COUNTY. IN MY
COUNTY INITIALLY IT IS ABOUT
ASSESSING FOR A CRISIS RIGHT
NATIONALLY WE WANT TO GET THAT
OUT OF- OUT OF THE WAY ARE YOU
SUICIDAL HOMICIDAL. ANY ANY
MAJOR CRISIS GOING ON WE HANDLE
THAT FIRST AND FOREMOST. NOW
ONCE THAT SETTLES FREIGHT THE
NEXT QUESTION AUTOMATICALLY
GOES TO WHAT IS YOUR INSURANCE.
WHICH IS NOT VERY AT IT IT IT
WE HAVE TO DETERMINE IF IT'S
SOMETHING THAT WE USE THAT WE
CAN ACTUALLY REFER TO CAN THEY
CAN THE CLINIC THAT WE REFER TO
BILL FOR THAT. AND THE OTHER
DAY ACTUALLY GOT A CALL FROM A
STUDENTS USE THAT TWENTY YEAR
OLD. YOUNG MAN AND HE CALLED
AND HE WAS CRYING HE WAS VERY
UPSET. HE HAS PRIVATE INSURANCE.
NOW HE'S BEEN TRYING TO GET A
HOLD OF BEHAVIORAL HEALTH
SERVICES ALL THE HEROES HEALTH
SERVICES ARE PRETTY IMPACTED.
WE CAN'T REFER BECAUSE YOU HAVE
PRIVATE INSURANCE BUT WE DIDN'T
REFER TO. A MENTAL HEALTH
URGENT CARE WHICH- CAN PROVIDE
CRISIS SERVICES REGARDLESS OF
INSURANCE. AND SO THAT'S
USUALLY THE WAY IT GOES WE HAVE
TO DETERMINE INSURANCE WE HAVE
PEOPLE WHO HAVE. MEDICARE AND
BECAUSE THEY ARE PAYING OUT OF
POCKET FOR A MANAGED CARE PLAN.
WE CANNOT REFER SO THERE THERE
ARE LIMITATIONS THERE AND IF
WE- WE GET THOSE CALLS ALL THE
TIME AS WELL- MEMBERS TO CALL
AND THEY DO HAVE MEDIC HEALTHY
INTERNET TO HOLD THIRTEEN CARE
AND THEY'RE BASICALLY TOLD TO
GO AWAY NOW YOU HAVE. AN
UNCONTROLLABLE COCAINE PROBLEM
AND YOU ARE JUST USING TOO MUCH
MATH. THIS IS NOT A MENTAL
HEALTH CONDITION. RIGHT EVEN
THOUGH THEY ARE PARANOID EVEN
THOUGH THEY ARE DEPRESSED
PATIENTS ARE BEING TURNED AWAY
CONSISTENTLY. WOW. THANK YOU
APPRECIATE CRESCENTA. DR QUIST-
A COUPLE QUESTIONS FOR YOU HERE
IF YOU'RE ABLE TO. ANSWER FOR
ME FIRST OF ALL HOW DOES THE
REQUIREMENT FOR A DIAGNOSIS
AFFECT THE FINANCING OF THE
COUNTY- YOU KNOW FOR EXAMPLE
DOES IT RELATE DOESN'T RESULT
IN. WELL ACTUALLY TOLD US ABOUT
A HUNDRED AND- EIGHTY MILLION
DOLLARS I BELIEVE IN A NUMBER
OF UNREIMBURSED COSTS- IS THAT.
IS THAT IS THAT WHEN I HEARD
CORRECTLY. THAT WAS JUST ONE OF.
FORTUNATELY SO- IT IT IMPACTS
HOW WE ACTUALLY- DETERMINE. OUR
FULL DELIVERY SYSTEM OF
SERVICES SO AND THE DIAGNOSIS
RIGHT NOW IS REALLY EMBEDDED
THROUGHOUT OUR ENTIRE SYSTEM WE
CAN'T EVEN SUBMIT A CLAIM
WITHOUT A DIAGNOSIS AND THEN
WHO GROUND TYPE THING JUST A
LITTLE BIT BECAUSE- BUT- I
THINK THAT THE FORM PART IS
THAT WE DO NEED TO MAKE IT
EASIER FOR US TO BE ABLE TO-
BILL FOR. NECESSARY SERVICES
CASE MANAGEMENT. LATERAL
SERVICES TO FIGHT TO TALK TO
THEIR LOVED ONES- BUT WE NEED
TO BE ABLE. TO- YOU KNOW OF THE
STATE OF WOULD MAKE SENSE I
DON'T A FULL TWO HOUR TO DO A
ASSESSMENT RIGHT NOW BUT HAVE A
THAT'S ABOUT TO START WOULD BE
NICE FIRST TO BE ABLE TO ENROLL
THE PERSON IN THAT GROUP. AND
BE ABLE TO THAT UNTIL WE WERE
ABLE TO GET SOMEBODY THAT CAN
DO AN SS AND GET THE FLAG OF.
SO PRETTY MUCH IS THROUGHOUT
OUR ENTIRE SYSTEM. THANK YOU SO.
OF ANOTHER. SO HOW DOES THE-
YEAR C. P. RECKON. PROCESS
AFFECT. THE DEPARTMENT
FINANCING FOR EXAMPLE ARE YOU
ALWAYS HAVING TO SET ASIDE A
RESERVE. FOR CLAIMS FOR SEVERAL
YEARS AGO AS A GUARD AGAINST
AND- AN AUDIT. IN A IN A
CLAWBACK. AT DIFFERENT COUNTY
DO DIFFERENT THINGS ON THIS AND
THAT IS ONE STRATEGY THAT NEEDS
SOME COUNTIES. USE MY COUNTY
WEEK WE'RE ACTUALLY OWED MONEY
SO- I DON'T KNOW EXACTLY HOW
MUCH FREER MY BEST GUESS WOULD
BE MAYBE EIGHT OR NINE MILLION
DOLLARS PER YEAR MORE ABOUT-
SEVEN YEARS BEHIND I THINK. SO
THAT SORT OF GIVES YOU AN IDEA
THAT MONEY STUDENT COUNTY AND
ONCE IT COMES IN IT LOOKS IT
JUST LOOKS WEIRD THAT THERE'S
MONEY SHOWING UP AND THEN HOW
HOW DO WE ACTUALLY. PLAN FOR
THAT GOING FORWARD BECAUSE YOU
DON'T KNOW WE WERE NOT ABLE TO
TELL THE PUBLIC OR TELL OUR-
ELECTED OFFICIALS YOU KNOW WE
CAN WE CAN GUARANTEE THAT WILL
HAVE THE SAME AMOUNT OF MONEY.
COMING IN EACH YEAR GOING.
FORWARD AND IN ORDER TO.
DEVELOP SERVICES AND CREATE A
PROGRAM THAT'S SUSTAINABLE YOU
WANT TO KNOW THAT THE FUNDING
BEHIND THAT PROGRAM SUSTAINABLE.
THANK YOU VERY MUCH APPRECIATE
THE- QUESTIONS FOR PROBABLY JC-
SO MANY OF THE CHANGES IN
CALENDAR ARE ARE REALLY
SIGNIFICANT IMPROVEMENTS ARE
YOU HAVE SOME CONCERNS WITH-
HOW TO CHANGE THE PROPOSED FOR
ENACTMENT IN THE PROPOSED
TRAILER BILL LANGUAGE AND THE
GREEK AND THE DEGREE OF WHICH I
VIEW AS A DELEGATION OF POLICY
DECISIONS TO THE EXECUTIVE
BRANCH AND YET TO BE CONCLUDED.
DISCUSSIONS WITH THE FEDERAL
GOVERNMENT WHEN I SEE THE
PROBLEM ACTUALLY BEING IN STATE
REGULATION. WHICH DH CS COULD
CHANGE ADMINISTRATIVE PLACE-
FOR EXAMPLE ARE PREFERRED- WELL
I MEAN CAUGHT DO YOU HAVE A
COMMENT ON THAT ACTUALLY. I
MEAN- WHAT I WOULD SAY IS THAT
THE DEPARTMENT HAS GONE THROUGH
EXTENSIVE STAKEHOLDER FEEDBACK
OVER US PRETTY SIGNIFICANT
PERIOD OF TIME ON THESE
PROPOSALS. AND THEN ANYTIME OR
SUBMITTING ANYTHING TO THE
FEDERAL GOVERNMENT INCLUDING
WAIVERS STATE PLAN AMENDMENTS-
EVEN WHEN WE ISSUE AT
BEHAVIORAL HEALTH INFORMATION
NOTICES WE ALSO GO THROUGH
EXTENSIVE- A QUARTER FEEDBACK
AND COMMENT PERIODS TO REFINE
AND- THOSE PROPOSALS BEFORE
FINALIZATION- TO THE POINT MADE
EARLIER ONCE YOU DO GET THOSE
THINGS THE CMS THERE IS A LOT
OF BACK AND FORTH NEGOTIATION
TO COME INTO COMPLIANCE WITH
THOSE PIECES SO I UNDERSTAND
THE CONCERNS THERE WHICH IS.
WHY I THINK THE DEPARTMENT IS
VERY OPEN TO YOU- AFTER WE
FINALIZE. THE VARIOUS
NEGOTIATIONS AND PIECES WITH
THE FEDERAL GOVERNMENT COMING
BACKING CODIFIED THE DETAILS-
ONCE THEY ARE ARE SETTLED- INTO
INTO STATE LAW AND AS
NECESSARY- WE MAY. DIFFER
SLIGHTLY ON WHAT WE THINK
SHOULD BE AND STATE LAW VERSUS
NOT HENCE THE- REFERENCE
EARLIER- BY OTHERS IN YOUR
SEATS IS HOW OUTDATED THE
MEDICAL NECESSITY CRITERIA THAT
WE'VE BEEN USING FOR SO LONG AS
IN STATE. REGULATIONS AND HOW
THAT REALLY HAS DRIVEN SOME OF
THESE SIGNIFICANT ISSUES AND WE
FEEL LIKE WE NEED TO BE A
LITTLE BIT MORE. NIMBLE AN
ABILITY TO CHANGE WHILE STILL
RESPECTING THE RESPONSIBILITY
ABOUT THE LEGISLATURE TO INFORM
THAT AS WELL AS A STAKEHOLDERS
TO FINE TUNE THOSE POLICIES AND
SO I THINK. I WE HOPE TO WORK
WITH YOU GUYS IN REGARDS TO
FINDING THAT BALANCE- WHILE
ENSURING THAT WE CAN BE
RESPONSIVE TO OUR BENEFICIARIES.
AND ENSURE THAT THEY GET ACCESS
TO SERVICES. THANK YOU AND I.
THAT HOWEVER I WOULD I WOULD
ENCOURAGE YOU GUYS TO SPELL OUT
THE PROPOSED CHANGES IN STATUTE
ON ON ON ON SOME OF THESE
ISSUES LIKE. I GUESS I COULD
SEE- I COULD SEE. DH CS PICKING
THE PARTICULARS A PARTICULAR
SCREEN TOOL- AND AS I DON'T
THINK WE HAVE THE CLINICAL
KNOWLEDGE TO PICK A PARTICULAR
TOOL IT BUT I THINK THE
PROBLEMS IN IN REGULATIONS.
REQUIRING A DIAGNOSIS BEFORE
TREATMENT. CAN BE REIMBURSED
COULD BE OVER WRITTEN BY
STATUTE. OVER PRESCRIPTIVE. SO
THAT'S THAT'S THAT'S MY COMMENT
MY PERSPECTIVE- AND I WOULD
HOPE THAT- WE CAN CONTINUE TO
WORK ON ON ON THIS AND IN THE
FUTURE SO. RIGHT THANK YOU WITH
THAT- WILL GO AHEAD AND MOVE ON
TO OUR SECOND PANEL AND DR RAM
BELOW THEN PUT DR RANDALL IN
CHARGE. THANK YOU WE WILL NOW
MOVE ON THE PANEL TO ON
BEHAVIORAL HEALTH PAYMENT
REFORM WE WILL HAVE SIX
PRESENTERS STARTING WITH
DIRECTOR LIFE FORM. DEC
CONFIRMED LINDE LINDE THE-
TERM. COREY HOSPITAL BRIAN
QUEST AND LEON GROWTH CLARK
HARVEY LET'S BEGIN WITH
DIRECTOR LIKE BORN PLEASE. SO-
I WILL BE PROVIDING COMMENTS ON
BEHALF OF THE DEPARTMENT- AND
THEN LINDY AND OR- DIRECTOR
LIKE WERE IN A BILLABLE FOR ANY
QUESTIONS IF NECESSARY- ALSO
THE DEPARTMENT- I THINK
ACTUALLY ONE OF THE QUESTIONS-
T. TO FOR THE END OF THE LAST
PANEL I. IS VERY APPROPRIATE
FOR OF THIS PROPOSAL THAT WE
ARE TALKING ABOUT HERE SO DO
YOU SEE S. IS PROPOSING A TO
TRANSITION FROM A COST BASED
REIMBURSEMENT PAYMENT
METHODOLOGY TO YOU OF A FEW
SCHEDULES PROBABLY THE EASIEST
WAY TO DESCRIBE- THE
METHODOLOGY CHANGE- UNDER
CURRENT METHODOLOGIES ALL
REIMBURSEMENT IS LIMITED TO YOU
ACTAL COST OF PROVIDING
SERVICES- WHICH DOES NOT ALLOW
FOR VALUE BASED ARRANGEMENTS OR
INCENTIVES TO IMPROVE OUTCOMES
IN OUR BEHAVIORAL HEALTH SPACE-
AND SO THE SHIFT IN METHODLOGY
WILL ALLOW DH CS. I TO
COLLABORATE WITH OUR COUNTY
PARTNERS IN A NUMBER OF WAYS-
FIRST- ESTABLISHING RATES FOR
REIMBURSEMENT BUT ARE NOT
LIMITED TO COST INSTEAD FOCUS
ON QUALITY AND VALUE OF
SERVICES BEING PROVIDED- AS
WELL AS PROVIDING MORE
FLEXIBILITY TO COUNTIES TO
EXPLORE INNOVATIVE PROVIDER
REIMBURSEMENT ARRANGEMENTS
WHICH WE DO THINK IT'S REALLY
CRITICAL- AND SHOWN TO BE
EFFECTIVE IN OTHER PARTS OF THE
HEALTHCARE DELIVERY SYSTEM. IT
ALSO CREATES OPPORTUNITIES FOR
IMPROVED COORDINATION OF CARE-
BY SIMPLIFYING OPTIONS FOR
CONTRACTS AND PAYMENTS BETWEEN
THE MEDICARE MANAGED CARE PLANS
IN THE COUNTY. OF AND WE DO
WANT TO ALLOW FOR THOSE
RELATIONSHIPS YOU DEVELOP AND
GROW- WITHOUT LIMITING
FINANCIAL BENEFITS FOR THE
COUNTY IN REGARDS TO BEING ABLE
TO TAKE CONTRACTS FOR EXAMPLE
WITH MANAGED CARE PLANS AND BE
ABLE TO KEEP THOSE REVENUE TO
REINVEST THEM INTO THEIR THEIR
DELIVERY SYSTEM. IT ALSO OF
COURSE- AS MENTIONED IN THE
PREVIOUS PANEL REDUCES STATE
AND COUNTY ADMINISTRATIVE
BURDEN- IT ALLOWS COUNTIES TO
CLOSE THEIR ACCOUNTING RECORDS
CLOSER TO THE END OF THE FISCAL
YEAR- BY ELIMINATING THE
LENGTHY AND LABOR INTENSIVE
COSTS BASED ON IT. AS WELL AS
THE- COSTS RECONCILIATION.
PROCESS WHICH AS AND EARLIER
CAN. MANY MANY YEARS TO
COMPLETE- SO IN ORDER TO JUST.
THE APPROPRIATE PAYMENT DH CS
IS. TO TRY SPECIALTY MENTAL
HEALTH. AND A CITY SERVICES
BOTH MEDICARE AND DNC ODS JUST
TO BE CLEAR- FROM WHAT'S-
EXISTING IS CALLED HEALTHCARE
COMMON PROCEDURE CODE- CODING
SYSTEM OR WHAT WE CALL IT-
LEVEL TO CODING TO LEVEL ONE
CODING- THIS IS- PROPOSAL.
ALLOW COUNTIES TO ALSO BE
GROUPED IN NON REGIONAL PEER
GROUPS FOR RATE SETTING
PURPOSES. OF THIS WAS BASED OFF
OF EXTENSIVE BACK AND FOR THE
FACT THAT WE HAD WITH OUR
COUNTY PARTNERS IN REGARDS TO
GETTING. A TO THIS- IT ALSO
ALLOWS. FOR MORE GRANULARITY
AND DH YES RATE SETTING ON AN
EXTRA PAYMENT TO COUNTIES IF WE
DO IT THAT WAY VERSUS OTHER.
METHODS WHICH WORK X. EXPLORED.
IDEAS IS VERY COMMITTED TO
PROVIDING- EXTENSIVE TECHNICAL
ASSISTANCE TO COUNTIES DURING
THE TRANSITION- AS REFLECTED IN
OUR TELLING THE C. P. REQUEST
WE THINK THAT IS VERY IMPORTANT
TO PROVIDE THAT TA- DH CS HAS
ALSO MET. OF WITHIN YOU WILL
CONTINUE TO WORK WITH COUNTIES
TO MAKE THIS CHANGE BY- JULY
ONE OF TWENTY TWO- THROUGH THE
BEHAVIORAL HEALTH QUALITY
IMPROVEMENT PLAN. AND BY
PROVIDING TECHNICAL ASSISTANCE-
WE DO PLAN TO WORK WITH
COUNTIES TO DEVELOP MILESTONES
AND ENSURE THEY ARE ABLE TO
ACHIEVE THEM. IN ORDER TO MAKE
THIS A REALISTIC TRANSITION-
THE BUDGET- PROPOSES TO CREATE
THAT- B. H. Q. I. P. THAT WOULD
PROVIDE FUNDING TO COUNTIES TO
INCENTIVIZE SYSTEM CHANGES AND
PROCESS IMPROVEMENTS TO BE ABLE
TO ACHIEVE- BOTH PAYMENT
REFORMS. BUT ALSO REALLY
GETTING A HIGHER LEVEL OF DATA
INTO THE DEPARTMENT- THAT WOULD
ALLOW US TO EXPLORE VALUE BASED
PAYMENT ARRANGEMENTS I'D-
BETTER DATA COLLECTION
PERFORMANCE MEASUREMENT AND
ENHANCED REPORTING IN THE
FUTURE. OF OUR BEHAVIOR HEALTH
DELIVERY. SYSTEM WHICH IS
REALLY CRITICAL TO THE TO AND
AS WE CAN TO ON THE- IN THAT
AREA FOR A BIT. HEALTH A CS I
WILL CAO WITH IN. PAY TO THEM
THROUGH THE TRANSITION OF
THROUGH THE B. H. Q. I. D. ALL
COUNTIES WOULD RECEIVE A BASE
PAYMENT IN JULY OF TWENTY ONE-
THEN COUNTIES WOULD RECEIVE
ADDITIONAL INCENTIVE PAYMENTS
AS THEY MEET PERFORMANCE
METRICS. ESTABLISHED BY THE
COUNTY AND APPROVED BY DH YES
OF COURSE- SO JUST REALLY
REITERATING HERE THAT THE
BEHAVIOR OF PAYMENT REFORM IT'S
PRETTY ESSENTIAL- TO OTHER
OPPORTUNITIES THAT ARE WITHIN
CALLIN- AS WELL FOR JUST
OVERALL BEHAVIORAL HEALTH
INTEGRATION IT ALLOWS FOR
EASIER. I'M REGIONAL
CONTRACTING A DELIVERY SYSTEM
INVESTMENTS THAT WE THINK ARE
REALLY IMPORTANT TO IMPROVE ON
AND CONTINUE TO ADVANCE THE
HIGH QUALITY CONTINUE OF CARE
BEHAVIORAL HEALTH- IN MEDIGAP.
AND THIS CONCLUDES OUR COMMENTS
AT THIS TIME. THANK YOU NEXT
WE'LL HEAR WINDY HERRINGTON
DEPUTY DIRECTOR FOR HEALTH CARE
FINANCING DH CS. A SORRY JUST
TO CLARIFY THAT WILL CONCLUDE
ALL OF THE COMMENTS FOR DH YES%
PERFECT THANK YOU TO SEE NEXT
WE WILL HEAR FROM COREY HARSHA
LEGISLATIVE ANALYST OFFICE.
THANK YOU DOCTOR IN THE LAB-
REGARDING PAYMENT REFORM- WE DO
FIND THAT THESE REFORMS- HAVE
THE POTENTIAL TO AS DISCUSSED
EARLIER REDUCE THE
ADMINISTRATIVE BURDEN ON ON
COUNTIES ASSOCIATED. ACCESS THE
SAME FEDERAL FUNDS- INCLUDING
AS DISCUSSED EARLIER DUE TO A
VERY LENGTHY COST
RECONCILIATION PROCESS THAT IS
UNDERTAKEN CURRENTLY- IN
ADDITION WE ALSO AGREE THAT
THAT THE SHIFT TO NEW PROCEDURE
CODES COULD ALLOW FOR. A MORE
NUANCED LEVEL OF UPDATED
RECORDING- THAT COULD RESULT
IN. INCREASED CAPACITY TO-
IMPLEMENT YOU KNOW TRUE VALUE
BASED. PAYMENT MODELS IN IN
BEHAVIORAL HEALTH- TO BE
IMPLEMENTED SOMETIME IN THE
FUTURE- HOWEVER YOU KNOW WE
WOULD NOTE THAT THIS REFORM IS
NOT NOT FULLY SORT OF IMPLEMENT
THIS THIS SORT OF TRUE VALUE
BASED PAYMENT MODEL IN
BEHAVIORAL HEALTH YOU KNOW THE
REFORM SHOULD BE THOUGHT OF
MORE AS A- AN- INTERMEDIARY
STEP TOWARD THAT GOAL. YOU KNOW
TAKING THAT FURTHER STEP IN
ACTUALLY IMPLEMENTING VALUE
BASED CARE IN BEHAVIOR HEALTH
IS GONNA REQUIRE SIGNIFICANT
COLLABORATION BETWEEN THE STATE
AND COUNTIES TO WORK TOWARD
IMPLEMENTING FUTURE VALUE VALUE
BASED PAYMENT MODELS- AND THE
CURRENT TELLING PACKAGE-
DOESN'T DOESN'T INCLUDE A
STRATEGY FOR. HOW TO DO THAT
JUST YET- IN ADDITION YOU KNOW
WE WOULD JUST ADD THAT YOU KNOW
PAYMENT REFORM IS LIKELY GOING
TO BE A SIGNIFICANT LIFT ON THE
PART OF COUNTIES YOU KNOW AS AS
THE DEPARTMENT JUST
ACKNOWLEDGED AND- THAT COUNTIES
ME VERY AND- THEIR READINESS
FOR TRANSITIONING TO THIS NEW
FINANCING SYSTEM- AND YOU KNOW
WHILE THERE ARE RESOURCES IN
THIS BUDGET FOR YOU KNOW THE-
THE BEHAVIORAL HEALTH QUALITY
IMPROVEMENT PROGRAM TO. SUPPORT
COUNTIES IN MAKING THIS
TRANSITION- THE STATE IS STILL
GOING TO NEED TO WORK VERY
CLOSELY WITH WITH COUNTIES TO
ENSURE THAT THEY'RE READY
THEY'RE READY TO SORT OF MAKE
THIS TRANSITION- FOR EXAMPLE
YOU KNOW WE UNDERSTAND THAT.
THERE MAY BE ISSUES WITH
COUNTIES NEEDING TO PUT MORE
FUNDING INITIALLY UP FRONT DUE
TO THE NEW PAYMENT MODEL AND-
THE STATE WOULD SORT OF NEED TO
HELP HELP COUNTIES WORK THROUGH
WORK. THROUGH THOSE ISSUES- AND
AN FOR THOSE REASONS YOU KNOW
WE HAVE QUITE. ABOUT KNOW HOW
THESE. THAT THE PROPOSED JULY
TWENTY TWO TWO AND- BEACON- AND
THOSE ARE ELLIE COMMENTS THE-
HAPPY DEATH PROVIDE FURTHER
ASSIST WE NEED. THANK YOU NEXT
WE WILL HEAR FROM DOCTOR QUEST.
GOOD AFTERNOON AGAIN HI THERE I
AM REHNQUIST THE BEHAVIOR
HEALTH DIRECTOR FOR SACRAMENTO
COUNTY SPEAKING ON BEHALF OF
THAT COUNTY BEHAVIORAL HEALTH
RECORDS. ONE OF THE PRIMARY
BUILDING BLOCKS OF THE CALENDAR
INFORMATION WILL COME BY WAY OF
IN A PERFORMER AND AS A SOCIETY
BEEN- ALLUDED TO COUNTIES HAVE
LARGELY SELF. FINANCED THE NON
FEDERAL SHARE OF OUR MEDIC
HOUSE SPECIALTY MENTAL HEALTH.
AND SUBSTANCE USE DISORDER
SERVICES THROUGH THE- CP
CERTIFIED PUBLIC EXPENDITURE
PAYMENT METHODOLOGY WHICH
REQUIRES PAINSTAKINGLY DETAILED
BY THE MINUTE DOCUMENTATION OF
THE COST SERVICES THE COST OF
SERVICES. WELL THERE'S A
BENEFIT IN THAT THE CP
METHODOLOGY GUARANTEES SERVICES
WILL BE REIMBURSED AT WILL COST
THERE ARE SIGNIFICANT DRAWBACKS
WHICH WE HOPE TO ADDRESS THE
TELLING. IMAGE REFORM PROPOSAL
FIRST AS A RESULT OF THE
CURRENT RULES CHINESE IN OUR
PROVIDERS- SADDLE SADDLE.
DOCUMENTING SERVICES TO THE
MINUTE WHICH MAKES OUR COUNTY
SPECIALTY HEALTH SERVICES OUT
LIAR WHEN COMPARED WITH MANAGED
CARE OR OTHER PAIRS. TAKES TIME
AND. ATTENTION AWAY FROM THE
WRECK SERVICES. SECOND OUR
REIMBURSEMENT STRUCTURES LIMIT
INVESTMENT AND REINVESTMENT IN
OUR DELIVERY SYSTEM BECAUSE
WE'RE ONLY ALLOWED TO BILL FOR
THE CUSTOMERS. THIS LIMITATION
RESTRICTS OUR ABILITY TO USE
VALUE BASED PAYMENTS TO
INCENTIVIZE QUALITY OR TO
INVEST IN OUR WORKFORCE
INFRASTRUCTURE. IN OUR NETWORKS
OF SUBCONTRACTED WIDER. THIRD
PROCESS FOR FINAL
RECONCILIATION IS MENTIONED IN
THE IN THE LAST SESSION CAN
TAKE SIX TO TEN YEAR.
CONCILIATION MEETINGS THAT
COUNTY ONGOING FINANCIAL REST
FROM YEAR TO YEAR SOMETIMES IN
THE TENS OF MILLIONS OF DOLLARS
WHICH CHALLENGES OUR ABILITY TO
BUDGET FORECASTS AND MAKES IT
MUCH MORE DIFFICULT TO
ACCURATELY AND TRANSPARENTLY
REPORT STATEWIDE SPENDING FOR
EXTERNAL STAKEHOLDERS. AND
FINALLY. NOT COUNTIES
CONTRACTOR CONTRACTED PROVIDERS
ARE REQUIRED TO MAINTAIN
DETAILED RECORDS AND ARE
SUBJECTED TO DETAILED AUDIT
PROCESSES WHICH LEAD TO
PROVIDER BURNOUT AND DIVERT
RESOURCES AWAY FROM PATIENT
CARE AND QUALITY IMPROVEMENT IN
FAVOR OF COMPLIANCE LESS
COMPLEX THAN MINISTRY OF
BILLING REQUIREMENTS. WHAT WE
HAVE NOT LOST OUR MISSION IS
COUNTY BEHAVIORAL HEALTH PLANS
WE ARE CERTAINLY WEIGHED DOWN
BY THE DEGREE OF DOCUMENTATION
CURRENT REQUIRED THE MEETING
BEGAN TO QUESTION WHETHER
ACROSS PROCESSES WERE FOCUSED
ON THE RIGHT THINGS. JALEN
PROVIDES OUR PLANS WITH AN
OPPORTUNITY TO GRADUALLY
MODERNIZE HOW WE CAN CLAIM
MEDICARE DOLLARS AND IN TURN.
HOW WE CAN ARRANGE FOR AND PAY
FOR OUR SPECIALTY- BEHAVIORAL
HEALTH SERVICES. C. H. TWO D.
AC IS THE SHIFT FROM THE CP TO
THE I. T. TEAM. BASED
REIMBURSEMENT AS A NATIONAL
STEP TOWARDS MORE VALUE BASED
REIMBURSEMENT WHICH WILL ALLOW
OUR SYSTEM TO BETTER
INCENTIVIZE QUALITY OUTCOMES.
INCLUDING DISPARITY YEAH I
REDUCING DISPARITIES FOR
BENEFICIARIES. IN ORDER TO MAKE
THIS STUFF WE SUPPORT H. YESS
PROPOSAL OR COST US IF YOU FOR
SERVICE REIMBURSEMENT RATES
FULLY COLOR COVER THE COST OF
EACH SERVICE REACH COUNTY. WITH
A PEER GROUP. TO ENABLE SYSTEM-REINVESTMENT. CVHS PROPOSED AT
DH CS USED STATISTICAL ANALYSES
TO IDENTIFY THE MOST
APPROPRIATE POPULATION IN COST
VARIABLES IN ORDER TO GROUP
COUNTY FOR RATE SETTING
PURPOSES WE WANT TO BE COMPARED
TO OTHER COUNTIES THAT ARE
SIMILAR TO OURSELVES. THE NEEDS
WITH THESE GROUPINGS. NOW WE
ARE ALSO CAUTIOUS IN SETTING UP
OUR RATES THAT HISTORICAL COST
DATA FOR COUNTIES AND SERVICE
TYPES LIKELY DOES NOT FULLY
CAPTURE FUTURE COSTS
PARTICULARLY GIVEN THE EXPANDED
ACCESS TO BENEFITS WE
ANTICIPATE CALLING- WE
RECOMMEND. WE RECOMMEND THAT
DHS COLLABORATE WITH COUNTY IN
OUTSIDE SUBJECT MATTER EXPERTS
AS NEEDED TO DEVELOP A
COMPREHENSIVE RATE SETTING
METHODOLOGY IT CAPTURES BOTH
HISTORICAL COST DATA AS WELL AS
A SORRY IT JUST MEANT FOR THOSE
NOT ACCOUNTED FOR IN THE
CURRENT OVERLY RESTRICTIVE
PROGRAM. AREA WE MUST ALSO
EMPHASIZED THAT THE I. G. T.
PAYMENTS MUST BE MADE TIENEN.
TO COUNTIES- AS COMPANIES WILL
NEED TO SELF FINANCE THE COST
OF SERVICES UP. WHILE THE
CURRENT PLAN IS TO IMPLEMENT
BEHAVIORAL HEALTH REFORM NO
SOONER THAN JULY FIRST OF
TWENTY TWENTY TWO. YOU WOULD-
OKAY WITH THE L. A. O. WE WOULD
NOTE THAT JULY TWENTY TWENTY
TWO IS A VERY AGGRESSIVE
TIMELINE FOR THESE CHANGES.
REFER WILL REQUIRE COUNTIES AND
CONTRACTED PROVIDERS TO ADOPT
NEW MEDICAL CODING PRACTICES
AND NEW CLAIMING AND
REIMBURSEMENT PROTOCOLS AS WELL
AS A NUMBER OF THE OTHER COUNTY
REFORMS THAT WE'VE BEEN
DISCUSSING AROUND MEDICAL
NECESSITY. TENSIFT TRAINING
INFORMATION TECHNOLOGY CHANGES
TERMINATES CONTRACT PROVISIONS
IN RE ORGANIZATION WILL BE
REQUIRED BULLS COUNTY
SANDERSON. SUBCONTRACTED
BEHAVIORAL HEALTH PROVIDERS.
YEAH EFFORTS FLOW EVEN IF
COUNTY BEHAVIORAL HEALTH PLANS
TO RESPOND TO AN- COBIT
NINETEEN PANDEMIC INCREASED
DEMAND WILL PROBABLY LIKELY SEE
AN INCREASE IN DEMAND FOR
BEHAVIORAL HEALTH SERVICES FOR
ANOTHER FIVE YEARS AFTER HOGAN-
YOU JUST BEHIND. WELL WE THINK
THE ADMINISTRATION FOR THE
PROPOSAL TO HELP IMPLEMENTATION
OF CRITICAL COUNTY MOST FORM
STUDENTS- BEHAVIOR HEALTH
QUALITY IMPROVEMENT PROGRAM. IS
THIS FUNDING IS ABSOLUTELY
ESSENTIAL FOR SUCCESS WILL
SUPPORT RELATED SYSTEM REFORMS.
WE ALSO PLAN TO WORK CLOSELY
WITH DHS IN THE COMING MONTHS
TO EVALUATE WHETHER A JULY
TWENTY TWENTY TWO TO
IMPLEMENTATION DATE IS IN FACT
FEASIBLE TO DEVELOP RATES. AND
MAKE THE RELATED ADMINISTRATIVE
AND PROCESS CHANGES WHAT WE
REMAIN COMMITTED TO PAYMENT
REFORM. USE ME AS A NECESSARY
IMPROVEMENTS. OKAY THANK YOU DR
QUEST NEXT WE HAVE DOCTOR CLARK
HARVEY CEO OF THE CALIFORNIA
COUNCIL OF COMMUNITY BEHAVIORAL
HEALTH AGENCIES. PLEASE BEGIN.
THANK YOU I AM NOT GOING TO
COVER EVERYTHING FROM DEVIATION
I WANT TO THANK YOU FOR THE
OPPORTUNITY TO PROVIDE
COMMENTARY ON THE PROPOSAL MY
COLLEAGUES HAVE ALREADY
PROVIDED SOME WONDERFUL
COMMENTS ABOUT THE POTENTIAL
IMPACTS AS A RESULT OF PROPOSED
CHANGES TO OUR PAYMENT SYSTEM
AND I'M HERE TO SHARE THE
PERSPECTIVE OF BEHAVIORAL
HEALTH PROVIDERS CONTRACTED
PROVIDERS ACROSS THE STATE THAT
CVH EIGHT REPRESENT. SEVEN THE
PROVIDER AGENCIES REPRESENTED
BY EACH DAY WELCOME PLANNING
TOWARDS REFORMING THE PAYMENT
SYSTEM CALIFORNIA. FOR YEARS WE
HAVE ADVOCATED FOR SHIFT IN THE
WAY THAT THE PAYMENT SYSTEM
OPERATES AND THAT'S WE TRACK
THE PAYMENT REFORM OF FOODS AND
OTHER STATES. WE HAVE ENGAGED
IN CONSISTENT CONVERSATIONS
ABOUT WHAT FLEXIBILITY WE MIGHT
HAVE HERE IN CALIFORNIA IN
ORDER TO REDEFINE OUR FEEDBACK
AND- THAT IS WHY WE ARE STILL
HOPEFUL ABOUT WHAT COUNTING
STUDENTS FOR. WE SEE IT AS AN
OPPORTUNITY TO TRULY REIMAGINE.
THIS INCLUDING CLEANING PROCESS
IN A WAY PAYMENT METHODOLOGIES
ARE DESIGN THOUGH ASISTIR HIS
YOU KNOW FROM HOME OR FROM THE
L. A. L. YEAH THIS IS NOT A
COMPREHENSIVE. REFORM PROPOSAL
BUT IT IS A STEP IN THE RIGHT
DIRECTION FOR WHICH WE ARE
SUPPORTIVE. I THINK RELATES TO
THE SPECIFIC COMPONENTS OF THE
PROPOSAL I WILL BRIEFLY SHARE
WITH YOU THE REFLECTIONS OF OUR
MEMBER AGENCIES. SO REGARDING
THE TIMELINE ALSO CONSISTENT
WITH THE COMMENTS WITH THE
LEGAL AND FROM DR QUIST. I
THINK RELATED TO THE
IMPLEMENTATION TIMELINE. AND
JULY FIRST ONE TWENTY.
PROVIDERS THIS IS PRETTY
AMBITIOUS AS IT WILL TAKE
LONGER TO IMPLEMENT SUCH A
SIGNIFICANT SHIFT IN SUCH A
SHORT AMOUNT OF TIME. IF WE ARE
ON TRACK FOR JULY FIRST TWENTY
TWENTY TWO THEN IT WOULD SEM
THAT THE STATE WOULD TO HAVE
ALREADY READY BY JULY FIRST
TWENTY TWENTY ONE. AND STANDS
PROVIDERS AREN'T COMPLETELY
CLEAR ON HOW THE CHANGES TO THE
PAYMENT SYSTEM MORE ACTUALLY
PLAY OUT AND WE LOOK FORWARD TO
LEARNING MORE. OF COURSE
PROVIDERS ARE EXCITED ABOUT AND
SUPPORTIVE OF THE CHANGE FROM
WHAT FEELS LIKE AN ARCHAIC
LABOR INTENSIVE MINUTE BY
MINUTE BILLING REQUIREMENTS AND
WE HAD KNOWLEDGE THAT THIS
CHANGE WILL NOW MERE BUILDING
STANDARDS. THAT ARE COMMONPLACE
IN SOME OTHER GENERAL HEALTH
CARE INDUSTRY. SO WE'RE HAPPY
TO HEAR THE COMMENTS FROM
DOCTOR PUTS IN THAT PRIOR PANEL
ABOUT THE LONGSTANDING
DOCUMENTATION BURDEN THAT
EXISTS. I KNOW THE NEW PAYMENT
REFORM STRUCTURE MAY. RAISE
SOME OF THE DOCUMENTATION
BURDEN WHAT IS NOT ADDRESSED
IT'S A STANDARDIZATION ACROSS
THE FIFTY EIGHT COUNTIES. THAT
IS A VERY MUCH. WE IMPORT TO
THE US TO A THE AS PART OF
COUNTY. INCLUDE THIS AS PART
THE DISK THERE COULDN'T BE A
BETTER TIME. OVERALL WE WANT TO
ENSURE THAT THE- RISKY IN A
WELCOME MATTER. AND ARE
INCLUSIVE OF FEEDBACK WELL.
WHEN WE TALK ABOUT THE C. B.
AND NK WILL I'M CHANGES THAT
ARE REQUIRED PROVIDERS THAT
THERE MAY SOME SHORT. FOR
EXAMPLE WERE IN TO ATTEND CODE
TO BE A TO FOR SEVERAL ASKED
AND HERO HALL SERVICES. THANK
THE CPT AND AN FIX CODE DO NOT
CONTAIN CODES ADEQUATELY COVER
HERE ORDER ASIAN COORDINATION
CASE MANAGEMENT TRANSITION OF
CARE AND IN LOVE SERVICES.
CLEARLY ABOUT HOW THE CODES
WILL TRANSLATE TO THE WORK THAT
PROVIDERS NEED TO BUILD FOR IS
DESIRED. AS IT RELATES TO
REIMBURSEMENT RATES MY
COLLEAGUES ON THIS PANEL HAVE
DESCRIBED AND COMMENTED ON THE
PROSPECTIVE REIMBURSEMENT RATE
METHODOLOGY. THE PROS INCLUDE
THE OPPORTUNITY TO GENERATE
FUNDING FOR REINVESTMENT AND
VALUE BASED INCENTIVE PAYMENTS
AND ARCHIVE. WELL PROVIDERS ARE
EXCITED ABOUT THESE PROPOSED
CHANGES FOR CLARITY IS NEEDED
ABOUT THE PROCESS OF
TRANSITIONING FROM THE CURRENT
POPS UP ENFORCEMENT METHODOLOGY
TO A PAYMENT STRUCTURE THAT
SUPPORTS A RATE SETTING
STRUCTURE BASED ON ACTUAL COSTS.
SO IN THEORY. TO A NEW
STRUCTURE SHOULD BE A WIN WIN
HOWEVER THERE ARE QUESTIONS
ABOUT THE LEAN WEIGHT COUNTIES
MIGHT HAVE BEEN IMPLEMENTING
UNITS AND HOW BEST THAT WOULD
BENEFIT COMMUNITY BASED
ORGANIZATIONS. SO THE FUNDING
FOR THE STATE TO THE COUNTY AND
THE COUNTY TO THE CVS. IS
CONCERNED IT CLEAR DIRECTION
HAS NOT PROVIDED AND WE HOPE
THAT APPROPRIATE. AND THEN
TRAINING THERE IS SO MUCH
EXCITING CHANGE AND PROVIDERS
ARE JUST REALLY HUNGRY FOR IT.
I'M MORE HOPEFUL THAT
COMPREHENSIVE AND INTENSIVE
TRAINING WILL BE PROVIDED TO
HELP THESE ESSENTIAL PERSONNEL
UNDERSTAND HOW TO OPERATE IN
THIS REFORM PAYMENT SYSTEM
BETTER STATUS IS FINDING.
OVERALL THIS PROPOSAL WILL WORK
IF IT IS OPERATIONALIZE WELL
PROVIDERS LARGEST CONCERNS OR
ABOUT THE LACK OF SPECIFICITY
FOR EXAMPLE HOW THE
REIMBURSEMENT FOR THE STATE TO
THE COUNTY IS GOING TO
TRANSLATE TO PAYMENTS TO
PROVIDERS. WE BELIEVE IT'S
CRITICAL TO ENSURE WHEN PAYMENT
FLOWS DOWNHILL THAT IT MEETS
THE PROVIDER GROWTH NEEDS TO
ONLY SERVE OUR COMMUNITY. IF
THE SYSTEM IS IMPLEMENTED
CORRECTLY IT IS A GREAT
OPPORTUNITY TO MOVE BEYOND A
FOCUS ON JUST PRODUCTIVITY AND
INSTEAD FOCUS ON OUTCOMES AND
QUALITY PROVISION OF CARE WHICH
ARE CORE TENETS OF A WELL RUN
SYSTEM. AIMED AT PROVIDING THE
BEST BEHAVIORAL HEALTH CARE
CALIFORNIA. SO WE LOOK FORWARD
TO CONTINUING AGENT WITH THE
STATE AND ARE COUNTY PARKHURST
ASSETS PROPOSAL TAKE SHAPE.
THANKS. FOR LETTING US PROVIDE
OUR COMMENTS TODAY. THANK YOU
VERY MUCH- MA'AM THAT CAN GO
THIS- WE WANNA ASK ANY
QUESTIONS. TOTAL THANK YOU DR
EMIL. ONE OF THE COMPLAINTS WE
OFTEN HEAR FROM MENTAL HEALTH
PROVIDERS IN THE MEDICARE
SYSTEM IS THE AMOUNT OF TIME
THEY SPEND- TREATING THE CHART-
RATHER THAN TREATING THE
PATIENT SO HOW DID THE HOW DOES
THE DOCUMENTATION REQUIREMENTS
FOR MEDICO WE COMPARE TO OTHER
THIRD PARTY PAYORS. THANK YOU
DOCTOR. IT'S A REALLY IMPORTANT
ONE AND ONE OF OUR BIGGEST
PRIORITY THIS YEAR- BURDENSOME
PAPERWORK- REALLY DISCOURAGES
FOLKS FROM- ENGAGING IN THE
FIELD AND PROVIDING THE
TREATMENT THAT THEY STUDY FOR
SO LONG- SO THAT'S AND REALLY
IMPORTANT TO CONTINUE TO LOOK
AT- I THINK. EIGHT TO THIRD
PARTY HERE'S I'M NOT QUITE SURE
THE MECHANISMS AND HOW IT
RELATES BUT I DO KNOW THAT
YOU'RE IN CALIFORNIA SHE HAS
BEEN SO BIG THAT OUR
ASSOCIATION HAS- COMMISSION TO
STUDY AND WE FOUND THAT
COMPARED TO YOU. MASSACHUSETTS
NEW YORK- AND SOME OTHER STATES
THAT WE HAVE FIVE TIMES THE
AMOUNT OF PEOPLE. IT TAKES FIVE
TIMES AS LONG FOR CLINICIANS TO
COMPLETE THE PAPERWORK REQUIRED
IN CALIFORNIA AND WE KNOW THAT
THAT LOOKS DIFFERENT FROM
COUNTY TO COUNTY. SO FOR MEMBER
AGENCIES THAT JUST HAPPENED ONE
AGENCY IN ONE AREA THEY HAVE TO
WORK WITH THEIR COUNTY INDIA
SET OF PAPERWORK BUT FOR MANY
OF OUR PROVIDER AGENCIES THAT
HAVE- ENTITIES ACROSS SEVERAL
COUNTIES. IT LOOKS DIFFERENT IN
LA IT LOOKS DIFFERENT AND SANTA
CLARA LOOKS DIFFERENT. ON AND
ON AND ON SO THAT IS AN ISSUE
THAT CONTINUES TO PLAGUE US
THAT'S WHY WE'RE WORKING ON
LEGISLATION FOR THIS. ISSUE
THIS YEAR- AND WE REALLY DO
HOPE THAT WERE ABLE TO YOU WORK
OUR PARTNERS AT EAST. AND ARE
STEPS TO FIGURE THIS OUT. THANK
YOU VERY MUCH. FOR COSTS SO
THIS QUESTION IS- KIND OF
FOLLOW UP TO THAT AND THAT'S IS
TO- THE DEPARTMENT. SO BECAUSE
ONE OF THE PERSISTENT PROBLEMS
WE HEAR IS ABOUT THE ERROR IS
ABOUT DOCUMENTATION INVOKED THE
LACK OF FINALITY. DUE TO THE
MULTI YEAR RECONCILIATION
PROCESS. SO I DON'T NECESSARILY
SEE ANYTHING THE TRAILER BILL
LANGUAGE OF THAT ELIMINATES
DOCUMENTATION REQUIREMENTS- CAN
YOU SPEAK TO THAT- SO ACTUALLY
WITHIN THE TRAILER BILL- WE DO
HAVE SOME NOTWITHSTANDING I
REGULATION PIECES A LOT OF
THOSE HISTORICAL AND VERY
OUTDATED- DOCUMENTATION
REQUIREMENTS ARE IN THE
REGULATIONS THAT WERE PROPOSING
TO YOU- REMOVED- WITHIN THE
CALLING- TRAILER BILL SO I
THINK THAT WOULD BE ONE THING
TO NOTE. I ALSO WOULD KNOW AS
WE- EXPLORED CONVERSATIONS WITH
COUNTIES WE LEARNED THAT A LOT
OF THOSE ARE NOT WITHIN ACTUAL
ARE REGULATION OR EVEN STATE
LAW- TODAY HOWEVER HAVE BEEN
PUT IN PLACE- DUE TO PROTECTING
THEMSELVES FROM HISTORICAL
AUDIT. REPORTS OR PAY BACK ON
THAT HAS. YOU KNOW RESULTED IN
DOWNSTREAM REQUIREMENTS TO
PROVIDERS- AMY DO YOU NEED TO
PROTECT PROVIDERS AGAINST THAT
BUT IN THE MEANTIME THAT'S WHY
IT'S THAT. YOU KNOW THE
COMBINATION OF ALL THE CALIBER
PUZZLE TOGETHER BOTH MEDICAL
NECESSITY- AND PAYMENT REFORM
ARE VERY CRITICAL TO ALL GO
TOGETHER BECAUSE OF THE FACT
THAT THEY REALLY IMPACT BOTH
THE DOCUMENTATION SIDE. I'M AS
WELL AS THE EXPECTATIONS THERE
AND SO- WE WOULD WANT TO MAKE
SURE THAT AS WE START ROLLING
THESE OUT THAT COUNTIES DON'T
PUT THOSE SAME TYPES OF
REQUIREMENTS IN PLACE FROM
AUDITING- AND OTHER THINGS THAT
HAVE HAPPENED. AND THAT'S WHY
WHICH WHAT YOU JUST MISS CLARK
WAS JUST SPEAKING TO IS REALLY
WHY YOU SEE IT CHANGE FROM
COUNTY TO COUNTY TO DIFFERENT
COUNTIES HAVE PUT IN DIFFERENT
REQUIREMENTS TO DIFFERENT
PROVIDERS BASED ON THEIR
HISTORICAL FINDINGS IN AUDIT-
AND REIMBURSEMENT PIECES AND SO
WE DO NEED TO ADDRESS THAT- WE
DO MAKE SURE THAT. WE ARE NOT
I'M PUTTING THAT BURDEN ON A
DOWNSTREAM PROVIDERS- BUT DO
YOU THINK THAT IT IT HAS BEEN
PUT IN PLACE OVER MANY MANY
YEARS BECAUSE OF- THE DEED THE
AUDITING AND THE THEIR
EQUIPMENT THAT HAVE BEEN. PUT
IN PLACE ON THOSE COUNTIES AS
WELL. THANK YOU VERY MUCH.
RESEARCHER OF COURSE THANK YOU
DR WERE LIKE AND IF WE WAS
GONNA ASK OF YOU TO QUEST BUT
IT BECOMES A BIT RHETORICA
BECAUSE YOU ANSWERED IN OUR
STATEMENT. JURORS AND HOW WE
PLAN FOR THAT IT MAKES IT
AWFULLY HARD FOR US TO MAKE
SIGNIFICANT INVESTMENTS INTO
THE SYSTEM IF YOU LACK THE
CLARITY THAT'S NEEDED FROM THE
C. P. EASE. AND SO REALLY
WANTED TO DO AGAIN A LITTLE BIT
AND MAKE SURE I UNDERSTOOD IT
CORRECTLY. BECAUSE OF THE
AUDIENCE BECAUSE OF THE
RECONCILIATION PROCESS YOUR
REIMBURSEMENT CAN TAKE ANYWHERE
FROM SIX TO TEN YEARS. FOR YOU
AS A PROVIDER TO SEEK
REIMBURSEMENT IS THAT CORRECT.
THAT'S ACCURATE I THINK RIGHT
NOW. THE CARD CHECK IS IN THE
MAIL FIST YEAR THIRD FOR- MY
COUNTY. YOUR CALL THEN ABOUT
HOW REFERENCE. CHAU YOU ABILITY
TO BUDGET AND PLAN AS WELL AS
HOW IT LEADS TOWARDS PROVIDER
BURNOUT ARE POWERFUL EXAMPLES
FOR WHY THIS RECOMMENDED.
CHANGE IS NECESSARY- I WILL-
WOULD LIKE TO FOLLOW UP WITH A
QUESTION FOR THE DEPARTMENT IF
I COULD I. THAT WE IDT WERE TO
BE MADE MONTH AND THAT THERE
WOULD A TRANSIT TO. QUARTERLY
AND- JUST WANTED TO. UNDERSTAND
A LITTLE BIT MORE ABOUT THAT
AND HOW WE GET THROUGH THAT
TRANSITION. THAT WAS THAT A
RECOMMENDATION AS WE DID KIND
OF EXTENSIVE- FEEDBACK FROM
COUNTIES- WE WANTED TO MAKE
SURE THAT WE HAD A SMOOTH
TRANSITION- BUT FROM THE WAY
THAT THEY'RE PAID TO DATE- AS
WE MOVE INTO THE- THE FEE
SCHEDULE REIMBURSEMENT SCHEDULE
AND SO BY HAVING IT CURRENTLY-
GETTING A REGULAR CASH FLOW WE
WANTED TO HAVE THAT TRANSITION
BE AS SMOOTH AS POSSIBLE BY
DOING MONTHLY- AND THEN
EVENTUALLY MOVING TO A
QUARTERLY I T. T. BECAUSE OF
THE- WAY THE FUNDS. OF THE
BEHAVIORAL HEALTH CITING
CALIFORNIA- IT WOULD BE LESS
BURDENSOME FOR BOTH THE COUNTY
AND FOR THE STATE- TO
EVENTUALLY GO TO QUARTERLY BUT
THAT'S WHY WE PROPOSED TO START
WITH MONTHLY AND THEN WHEN
APPROPRIATE TRANSITION TO
QUARTERLY- TO REDUCE THAT
BURDEN ON EVERYONE BUT WHILE
ENSURING THAT TRANSITION IS AS
SMOOTH AS POSSIBLE FOR COUNTIES
WE DO KNOW THIS IS A LARGE
COMPLEX CHANGE FOR THEM- WE
WANT TO MAKE SURE THAT WE ARE
BEING THOUGHTFUL THROUGH THAT
PROCESS- WHAT WE TYPICALLY DO.
MOST IGT'S- THROUGH A QUARTERLY
OR EVEN LONGER BASIS JUST TO BE
CLEAR WE DO WANT TO BE AS
FLEXIBLE THROUGH THE TRANSITION
AS AS. POSSIBLE WE THAT I WILL-
WILL HOLD THIS. ISSUE ITEM OPEN
AS WE MOVE ON TO ISSUE. THREE
BUT WOULD ECHO THE- OF- TO
CLARK. TO MAKE THAT WE- THIS
AFFECTED SO THAT WE HAVE THE-
BENEFIT THAT ARE BEING PROMISE
FROM PROPOSAL. THANK YOU. THANK
YOU DOCTOR REGULAR WE WILL GO
AHEAD AND NOW MOVE ON TO THE
THIRD PANEL- MEDICARE MANAGED
CARE BENEFITS STANDARDIZATION-
AND WITH THE PANELISTS AND MOST
OF THE HOME YOU HAVE SEEN
ALREADY WITH THE EXCEPTION OF
THE ADDITION HERE OF DR- DR
STEWART- BUT THE LARRY SO I
SURE I BUTCHERED THAT AND I
APOLOGIZE IN ADVANCE DR SO
HOPEFULLY YOU CAN CORRECT ME
WHEN YOUR TIME COMES FOR TO
TESTIFY SO- WE'LL GO FIRST TO
THE ADMINISTRATION. THANK YOU.
I'M SO UNDER TELLING DH CS IS
PROPOSING TO STANDARDIZE THE
BENEFIT- THAT IS PROVIDED IN
MEDICAID MANAGED CARE PLANS
STATEWIDE IT'S ONE OF OUR-
GUIDING PRINCIPLES WITHIN THE
PROPOSAL ITSELF. REGARDLESS OF
WHERE THE BENEFICIARY AS COUNTY
OF RESIDENCE IS WE DO FEEL LIKE
THAT THE BENEFIT SHOULD BE THE
SAME. REGARDLESS OF THAT-
WITHIN THE MEDI CAL MANAGED
CARE PLAN SO THIS INCLUDES THE
CARVING OUT OF SPECIALTY MENTAL
HEALTH SERVICES THAT ARE
CURRENTLY PARKED IN. FOR
MEDICARE MEMBERS ENROLLED IN
KAISER IN SOLANO AND SACRAMENTO
COUNTY SO IT'S A VERY SMALL.
PORTION OF CARBON OF WITHIN
THAT THAT WAS IDENTIFIED
THROUGH EVALUATION OF
STANDARDIZING THE BENEFIT. OF
BASED ON DATA PROVIDED A FROM
KAISER TO DH CS BASED ON THEIR
CALENDAR YEAR TWO THOUSAND
NINETEEN SERVICE PERIOD- THERE
WERE APPROXIMATELY TWO HUNDRED
AND FIFTY NINE BENEFICIARIES
PER MONTH IN SACRAMENTO THAT
WERE PROVIDED SPECIALTY MENTAL
HEALTH SERVICES- BY KAISER. AND
A HUNDRED AND FIFTY THREE AND
SOLANO- THAT WERE UTILIZING
SPECIALTY MENTAL HEALTH
SERVICES THROUGH- KAISER- DH
YES IT DOES HAVE ISSUE- OR HAD
THE- GUIDE. TO K. HISTORICALLY
IN THEIR RESPONSIBILITY- THAT
OUTLINES THE CONTINUITY
REQUIREMENTS TO ENSURE THAT ALL.
MEDICARE BENEFICIARIES- WHO
MEET MEDICAL NECESSITY CRITERIA
OF COURSE OFFER SPECIALTY
MENTAL HEALTH HAVE A RIGHT TO
REQUEST THAT CONTINUITY OF CARE
OF THOSE SERVICES- AND SO- WE
WOULD ENSURE THAT THAT B. AND-
AT THROUGH THIS. AS WELL AS
THEY DO HAVE THAT THAT RIGHTS-
BENEFICIARIES WITH PRE EXISTING
I- WHO MAKE KANU CARE RICK. TO
THE COUNTY MAY HEALTH PLAN MUST
BE THE OPTION TO CONTINUE
TREATMENT FOR UP TO TWELVE
MONTHS- I WITH AN OUT OF
NETWORK MEDICARE PROVIDER- OR A
TERMINATED NETWORK PROVIDER
JUST TO BE CLEAR. I DURING THAT
CARRY THE COUNTY MENTAL HEALTH
PLAN IS. TO WORK WITH
BENEFICIARY TO TRY THEIR CARE
OF APPROPRIATE FOR WITH THE
NETWORK IF THEY CANNOT COME TO
ANY. FOR LONGER. WITH THAT
PROVIDER IF THE BENEFITS YOU'RE-
SO CHOOSES BUT- DOES HAVE A TWO
MONTH THIS IS. TO WHAT WE- IN
OUR MEDIC MANAGED PLANS- ONE OF
THE ITEMS WAS ROLE OUT FOR
PARITY. TO ENSURE I'M HEALTH-
BENEFICIARY ARE ALSO RECEIVING
THE COTTON OF CARE-
ADDITIONALLY THE- WERE RICH A
LOT. IN THOUSAND- AND ARE NOT
NEW BUT- OUT THROUGH EMPLOYMENT.
OF PROP THIRTY THEREFORE DH THE
DOES NOT BELIEVE THAT THIS
TRIGGERED A GENERAL- BACKFILL
AS COUNTIES RECEIVE REALIGNMENT.
AT PROVIDE SIR TO THESE YOU-
HOWEVER A BEGINNING INTO
THOUSAND SIX SEVEN. MINUTES
DEVELOPED IN ALLOCATE METHOD
BAY ON. FEEDBACK I WOULD THAT
THAT BASE REVENUE AMOUNT FOR
EACH COUNTY ON HIS. CAL EXPENSE.
I THE- COUNTY. USED ABOUT THE
BASE ALLOCATION METHOD ALL. AND
CLAIMS KAISER BENEFITS AND-
COUNTY BUT IT DID NOT INCLUDE
CLAIMS FOR BEEN. IN STOCK OF
COUNTY. AT KAISER BECAUSE IN.
WEREN'T IN THE- ALLOCATE METHOD
ALL BECAUSE THE LAWN HAD EIGHT
THIS POPPY AT THE- OF THE- WAS
DEVELOPED- DH CS KERR S. A
SEPARATE. OUT I WOULD HAVE TO
INCREASE. BY THREE PER EIGHT
MILLION IF THE COST HAD BEEN.
INCLUDED IN THAT INITIAL
CALCULATION. AND THIS CONCLUDES
THAT WENT FROM THE DEPARTMENT.
VERY WELL THANK YOU VERY- SEE
COREY HOW SHE CON. ON THIS SITE
PLEASE. THANK YOU THANK AFTER
WHAT I'M I'LL BE VERY VERY AND
ARE COMMENTS THIS ISSUE- WE HAD
QUESTIONS- THAT WERE ACTUALLY
JUST SORT OF ADDRESSED BY
DEPARTMENT RELAY TO SOME OF THE
RELY IMPLICATIONS OF THIS CAR
OUT OF THE CERTAIN FROM. CARE
AND SO- WE DON'T HAVE ANY OF
FURTHER CONCERNS RAISED AT THIS
APOSTLE. THANK YOU VERY MUCH-
DOCTOR. IT RING BE ABLE HEALTH
CORRECT FOR CAN. SO RECOGNIZING
THAT THE PLAN- CAL IS TO HAVE A
STEP ACROSS DIFFERENT IN WELL
I'M AS I ON THE OTHER-
INITIATIVES- VERY- HAPPY IN A
PRE FOR THE COLLABORATION
AROUND THE OTHER CAL MINISH.
ALSO APPRECIATE- RECORD LIKE
AND SOME BEACH S. H. YES STAFF
HAVE READ OUT TO A- OR IN ORDER
TO TALK US ABOUT SOME OF OUR
CONCERNS ON THIS- BUT THIS
PARTY- PROPOSAL IS A LITTLE BIT-
CONCERNING TO US- SO WANTED YOU
SOME FACTS THAT WE HAVE IN SOME
OF THE NUMBERS ARE GOING TO.
NOT COMPLETELY UP WITH THE OF
WERE SENT- IT J. C. JUST UP
FROM- BUT- THIS WAS IN FROM
THAT WE AT THE TIME. THAT WE
WERE HAVE COME WITH KAISER
AROUND THIS TRANSITION- SO JUST
TO GIVE YOU AN IDEA- SIR CAN.
CURRENTLY SERVES UPON THIRTY
FIVE. CLIENTS YEAR AND THE
INITIAL THAT WE HEARD FOR
CLIENTS THEIR WORDS AND- THE
NUMBERS YOU HEARD YES NOW WE'RE-
PER MONTH NUMBERS IN THE
NUMBERS WE RECEIVE WHERE A PRE.
I'M SO AND A COMPARISON PER
YEAR PER YEAR SO SACRAMENTO
COUNTY. SERVES APPROXIMATELY
THOUSAND CLIENTS A YEAR HI SIR.
THAT IT'S- MATH. SERIOUSLY
MENTALLY ILL AND POP WOULD
ACROSS ABOUT THOUSAND
ADDITIONAL BENEFITS YOU TO THE
COUNTY BEHAVIORAL HEALTH. THIS
WOULD BE A THIRD SIX SIX SEVEN
THANK. IN OUR- ESPECIALLY
MENTAL HEALTH SERVICES PUBLIC-
WE WOULD NEED TO- BUILD OUT
NETWORKS- IN. COSTLY AND SCARE
IMP CARE TO GIVE YOU A LITTLE
BIT OF IDEA I THAT FIGURE IT
WAS JUST NOT WILL THREE POINT
EIGHT MILLION DOLLARS THE BE
ABLE TO INCREASE. I JUST
OPENING AN OPENING ONE THIS
YEAR AND THAT'S COSTA SIX POINT
FOUR MILLION DOLLARS A YEAR AND
IT TOOK ME FIVE YEARS TO OPEN
THAT. SO I'M NOT GONNA BE ABLE
TO YOU KNOW OPEN- ANOTHER
PSYCHIATRIC HEALTH FACILITY
REALLY QUICK SO WE'RE GOING TO
HAVE TO SERVE THOSE. IMPATIENT
CONSUMERS WITHIN OUR EXISTING
FREESTANDING HOSPITALS AND SO
WE WON'T HAVE ANY FEDERAL-
REVENUE TO COME ALONG WITH THAT
SO WE'VE ALREADY BLOWN PAST
THREE POINT EIGHT MILLION
DOLLARS OUT OF THE WATER YEAH-
SO- I'M- SORRY JUST A SECOND.
SO THIS IS A THAT WAS A REALLY
BUT THIS IS A REALLY BLACK
ANALYSIS- BECAUSE TO BE HONEST
WEEK WE HAVEN'T WE DON'T HAVE A
LOT OF INFORMATION ON THIS. AT
THIS POINT FROM KAISER ROUNDING
EXACTLY WHAT THIS WOULD LOOK
LIKE BUT IN A VERY BLUNT
ANALYSIS WERE INCREASED TO.
THANK YOU FOR ASKING INCREASE
THE NUMBER RESEARCH BY THIRTY
SIX POINT SEVEN PERCENT.
SACRAMENTO WOULDN'T NEED TO
INCREASE OUR BUDGET BY THIRTY
SIX POINT SEVEN PERCENT. THIRTY
SIX POINT 7% OR BUDGET IS A
HUNDRED AND THIRTY. HUNDRED
THIRTY POINT EIGHT MILLION
DOLLARS TO BUILD OUR CAPACITY-
THIS FIGURE DOES INCLUDE SOME
FEDERAL FINANCIAL PARTICIPATION%
SO IT MAY BE CLOSER TO ABOUT A
HUNDRED MILLION DOLLARS I WANT
TO REITERATE THIS IS NOT A
PRECISE FIGURE. BUT I JUST WANT
TO ILLUSTRATE THE MAGNITUDE OF
OUR NEED IN ORDER TO. SERVE THE
BUT THE TYPE OF. NUMBERS OF
CONSUMERS THAT THAT ARE BEING
COMMUNICATED TO US- JUSTICE
CONCERNING IS THE LACK OF
RESOURCES NEEDED FOR THIS
TRANSITION. THE STATE'S
PROPOSAL WOULD ALSO ALLOW FOR
AN ADEQUATE TIME. TO PLAN FOR
CONTINUITY OF CARE OR ELEVEN
THOUSAND HUMAN BEINGS NEEDING
CARE THEY'RE COMPLEX AND
VULNERABLE BIG BENEFICIARIES
AND- THERE WAS SOME TALK ABOUT
THE CONTINUITY OF CARE
REQUIREMENTS I I'D- BE
INTERESTED IN EXPLORING THAT I
WANT TO MAKE SURE THAT WE'RE
FOLLOWING ALL THE- RULES AROUND
AT THE CONTINUITY OF. CARE-
THANK. I THINK THAT THERE ARE
SO. REQUIREMENTS RIGHT AS I
HAVEN'T. BRUSHED UP ON THIS
RECENTLY BUT I THINK THERE ARE
SOME REQUIREMENTS THAT SAY THAT
IN ORDER FOR US TO BILL
MEDICARE NOW- BECAUSE IT WOULD
HAVE TO BE WILLING TO SIGN OUR
MEDIC HEALTH CONTRACT. AND THEN
ALL THESE- REQUIREMENTS
DOCUMENTATION REQUIREMENTS
WE'VE BEEN TALKING ABOUT. A
CASE IT WOULD HAVE TO BE
WILLING TO DO THOSE
DOCUMENTATION REQUIREMENTS AND-
RIGHT. YOU CONVERSATIONS OVER
THE YEARS WITH KAISER-
COLLEAGUES- I THINK THAT THOSE-
DOCUMENTATION REQUIREMENTS
WOULD BE DIFFICULT- SO FOR ALL
THESE REASONS- IT'S VERY
DIFFICULT TO SUPPORT THIS
PROPOSAL WITHOUT RESOLUTION OUT
OF THE VARIOUS CONCERNS. BURKE
COUNTY WOULD CERTAINLY BE
WILLING TO CONSIDER RAINEY'S
KIND- BENEFICIARIES INTO OUR
BEHAVIORAL HEALTH PLAN SERVICES
WE KNOW WE WOULD BE ABLE TO
PROVIDE THEM WITH HIGH QUALITY
CARE THIS IS OUR EXPERTISE.
HOWEVER IN ORDER TO DO THAT WE
WOULD NEED ADEQUATE FUNDING
TRANSACTION PLANNING AND CARE
COORDINATION. THANK YOU. THANK
YOU VERY MUCH- DR STUART
NONSTOP THERE LET DR MAYBE CAN
CORRECT MY PRONUNCIATION OF HIS
LAST NAME SO. THANK YOU DOCTORS
WOULDN'T ARAMBULA I'M A DOCTOR
STORE BUT LAYER. REGIONAL
DIRECTOR BEHAVIORAL HEALTH AND
ADDICTION MEDICINE FOR COLLEGE
PERMANENTLY IN NORTHERN
CALIFORNIA I WORK CLOSELY WITH
OUR MEDIC CAL TEAM AS THE
PRIMARY MENTAL HEALTH
REPRESENTATIVES. AND
COLLABORATE WITH COUNTIES WHERE
A KAISER HAS A PRESENCE. BUT
BEFORE COMING TO KAISER I WAS A
PROGRAM MANAGER FOR ACUTE
SERVICES IN MARIN COUNTY MENTAL
HEALTH SO I HAVE BACKGROUND IN
WORKING WITH COUNTIES AND BEING
A PART OF THE COUNTY SYSTEM.
AND THANK YOU FOR THE
OPPORTUNITY TO SPEAK TO THE
COMMITTEE TODAY ON THE PROPOSED.
ESPECIALLY IN FROM KAISER IN
SULAIMON SACRAMENTO. A LONG
TERM RELATIONSHIP WITH BOTH
SOLANO AND SACRAMENTO COUNTIES
APPROXIMATELY TWENTY FIVE YEARS
OF COLLABORATION IN PROVIDING
SPECIAL EMAIL HEALTH SERVICES
DRAMATIC HOW MEMBERS BOTH
ADULTS AND CHILDREN. HI THIS IS
A LEADING EDGE COLLABORATIVE
EFFORT AND PROVIDING AN
INTEGRATED MODEL OF HEALTH CARE
FOR THESE VULNERABLE MEMBERS
FOR UNDER IF YOU WILL- FOR
CAMPAIGNS THE VISION TO
INTEGRATE SERVICES FOR THEM-
OVER THE NEXT SEVERAL YEARS
WE'RE VERY PROUD OF THIS
PARTNERSHIP WITH THESE TWO
COUNTIES AND REMAIN COMMITTED
TO IT. PATIENTS IN THESE
COUNTIES ARE CURRENTLY
INTEGRATED WITHIN OUR HEALTH
SYSTEM. AND RECEIVING
INTEGRATED CARE INCLUDING
SERVICES FOR SEVERE MENTAL
HEALTH CONDITIONS WE BELIEVE
THIS IS AN IDEAL CARE MODEL
ENSURES CONSISTENT WITH THE
OVERALL DIRECTION OF CAMPAIGN.
WE CARE ABOUT OUR PATIENTS AND
NOT DISRUPTING THEIR CARE WE
NUMBER WERE SPEAKING TODAY
ABOUT THE MOST VULNERABLE OF
OUR MEDICARE MEMBERS WHO ARE
NOT ONLY LOW INCOME. BUT ALSO
SUFFERING FROM MORE SEVERE
MENTAL HEALTH CONDITIONS AND
ONLY WORSENED DURING THIS
PANDEMIC. THEY HAVE A LARGE
BILL DECLINE- CURRENTLY KAISER
PERMANENT DAY WE PROVIDE THE
FULL CONTINUUM OF MENTAL HEALTH
SERVICES FOR MEDICARE MEMBERS
IN THESE COUNTIES. ARE INTEREST
IS IN ENSURING THAT THESE
MEMBERS STRUGGLING WITH SEVERE
MENTAL ILLNESS CONTINUE TO
RECEIVE HIGH QUALITY AND TIMELY
CARE. IMAGINE YOURSELF AS A
MEMBER OF A PLANNED YOU SEE SEE
YOUR PCP. IS CONCERNED ABOUT
YOUR MENTAL HEALTH INTERVENTION
BY MENTAL HEALTH. YOUR MENTAL
HEALTH PROVIDER USE YOUR
MEDICAL RECORDS AND SEIZE THE
IMMEDIATE LIKE TRONIC REQUEST
FOR CONSULTATION. YOUR MENTAL
HEALTH PROVIDER BEGIN SEEING
YOU AND TREAT YOUR CONDITION.
YOU THEN HAVE AN EPISODE WHERE
YOUR MENTAL HEALTH.
DETERIORATES AND YOU BECOME
SERIOUSLY ILL. THEN TOLD WE'RE
SORRY BUT YOU NEED TO LEAVE OUR
CARE IMAGINE IF THAT WAS A
DIABETIC PATIENT OR SOMEONE
WITH A CARDIAC CONDITIONS ON
THIS WORSENED AND YOU WERE TOLD
THAT SUDDENLY YOU YOU HAD TO GO
ELSEWHERE FOR CARE. HOW WOULD
ANY OF US FEEL IT IS
CHALLENGING FOR ANYONE TO LEAVE
AN INTEGRATED ARE SYSTEM OF
CAREBUT IT WILL BE ESPECIALLY
CHALLENGING FOR THE SERIOUSLY
MENTALLY ILL INDIVIDUALS
ESPECIALLY IF THEY HAVE TO GO
DIDN'T PROVIDERS. TO US THIS
SEEMS COUNTER TO CALLAHAN'S
GOAL. TO PROVIDE MORE
INTEGRATED HOLISTIC CARE TO
MEDICARE MEMBERS. THIS IS
ALREADY WHAT ARE HUNDRED TWENTY
EIGHT THOUSAND MEDICARE
BENEFICIARIES AND SOLANO AND
SACRAMENTO RECEIVED. BUT WE'RE
WILLING TO WORK WITH BOTH
COUNTIES AND THE DEPARTMENT OF
HEALTH CARE SERVICES DETERMINE
HOW BEST TO TRANSITION THOSE
MEMBERS. WITH SERIOUS MENTAL
ILLNESS- INTO A NEW ARRANGEMENT
WE CONSIDER BECOMING A
SUBCONTRACTED PROVIDE THIS CARE
TO OUR MEMBERS IF THAT COULD BE
WORKED OUT- IN BRIGHTON AND
RYAN- JUST OUTLINED SOME OF THE
CHALLENGES. WE WANT TO ACT IN
THE BEST INTEREST OF OUR
MEMBERS AND PATIENCE THANK YOU
AGAIN FOR INVITING US TO BE
HERE AND I'M HAPPY TO ANSWER
ANY QUESTIONS. IN THE MEMBERS
HE CHRIS QUESTION. I'VE GOT
I'VE GOT A COUPLE IN AN FIRST
FALL DR KRISTIN DR BILL THERE
YOU ACTUALLY ANSWERED A COUPLE
QUESTIONS I WAS GOING TO ASK
BUT I'M GONNA ASK ONE THAT SAID
YOU MIGHT NOT BE EXPECTING AND
I JUST I JUST SAY IT OUT OF A
MINUTE I'M JUST CURIOUS SO. AND
THAT IS THAT AS- PATIENTS HAVE
YOU MAYBE TRANSITION BACK AND
FORTH BETWEEN. RISER IN THE
COUNTY AS FAR AS- AS FAR AS
THEIR FOR THEIR MENTAL HEALTH
SERVICES- CAN YOU DESCRIBE HOW
THE ROOM. MEDICAL RECORDS GET
THERE AND- FIRST WITH DOCTOR
QUIZ YOU KNOW HOW TO HOW DO YOU
GET RECORDS FROM KAISER AND-
AND HOW DO YOU GET RECORDS BACK
SO THAT SO THAT THE PATIENT'S.
RECORD THIS WHOLE NOT JUST
THEIR BEHAVIOR HOPE WITH THE
ENTIRE RECORD IS HOLE SO WHAT
IS THE COOPERATION LIKE BACK
AND FORTH. AS FAR AS EXCHANGE
OF RECORDS. AS WITH ANY TIME-
DOING CARE COORDINATION WE
WOULD- OBTAIN A RELEASE OF
INFORMATION FROM THE CONSUMER
AND THEN WE WOULD HAVE THAT
INFORMATION EXCHANGE. THANK YOU
I THINK WE HAVE GOOD
CONVERSATIONS AND I THINK IT IS
AN ONGOING- RELATIONSHIP
BUILDING EXERCISE THAT I THINK
MANY PEOPLE I THINK EVERYBODY
THAT WORKS IN BEHAVIORAL
HEALTH- NOT. RECOGNIZES IT AS
SOMETHING THAT'S PART OF THE
JOB IS WE HAVE TO CONTINUE TO
MAINTAIN OUR RELATIONSHIPS WITH
OUR WITH OUR OTHER. SERVICE
PROVIDERS THAT ARE THAT ARE
HELPING THE CONSUMERS THAT WE
SERVE. SO THE YOUR- IT'S
ADEQUATE THE EXCHANGE OF
INFORMATION. YOU'RE GETTING
WHICH WITH YOU'RE GETTING WHAT
YOU NEED WHAT YOU NEED FROM
EACH OTHER. YEAH I THINK SO. I
MEAN WE HAVE CHALLENGES THAT
BUT THAT'S PART OF THE JOB IS
WORKING. ON THANK YOU- AND I
GUESS THE QUESTION ACTUALLY DID
HAVE A QUESTION SO AS A DOCTOR
WILL THERE TALKED ABOUT. THAT
KIZER MIGHT BE OPEN TO A
SUBCONTRACTING SO ARE THERE
ACTUALLY DISCUSSIONS HAPPENING.
BETWEEN THE COUNTIES ABOUT A
CONTRACTING ARRANGEMENTS THAT
WOULD ALLOW KAISER TO CONTINUE
TO TREAT. A AND SEE THEIR-
THERE THE PAGE OR THE PATIENTS-
SEE ACTUALLY CONTINUES EITHER
KAISER MENTAL HEALTH PROVIDERS
OF THEIR ANY DISCUSSIONS GOING
ON NOW. I THINK WE NEED TO HAVE
LOTS OF CONVERSATIONS ABOUT
THAT I DON'T FEEL LIKE WE'VE
HAD ENOUGH CONVERSATIONS. YEAH
OKAY GREAT THANK YOU THANK YOU-
I GOT A QUESTION FOR THE-
QUESTION COMMENTS FOR THE
ADMINISTRATION IS ONE OF THE
THEMES OF CALAMUS BETTER
INTEGRATING CARE AND I
UNDERSTAND THE DEPARTMENTS TO
ALIGN BENEFITS ACROSS VARIOUS
MANAGED CARE MODELS- BUT MOVING
PEOPLE OUT OF AN EXISTING
INTEGRATED CARE DELIVERY SYSTEM
IN FURTHERANCE OF THE GOAL OF
STREAMLINING BENEFITS IS GOING
TO BE DISRUPTIVE WE'VE WE'VE
KIND OF ALREADY HEARD THAT- TO
THE ONGOING INTEGRATED CARE
KIND CARE KAISER MEMBERS WITH
SEVERE MENTAL ILLNESSES- AND
THAT HAS THAT CREATE SUCH.
CONCERNS FOR ME WE'RE WE'RE
GOING TO HAVE A DISCUSSION
LATER ON THE AGENDA ON A FULL
INTEGRATION PLAN AND THIS SEEMS
TO BE COUNTER TO THAT DO YOU
HAVE A RESPONSE TO THAT. I CAN
UNDERSTAND- THE SENTIMENT OF
YOUR COMMENTS IS AS WHAT I
WOULD SAY I THINK- THAT WE WANT
TO ENSURE THAT THE APPROPRIATE
OVERSIGHT IS TAKING PLACE IN
REGARDS TO THE SPECIAL THE
MENTAL HEALTH SERVICES THAT ARE
BEING PROVIDED CURRENTLY- BY
KAISER- THE ULTIMATELY DID
RECOMMEND. A FOR THE
STREAMLINING OF THE SERVICES
ACROSS ALL THE MEDICARE MANAGED
CARE PLANS- AND AS NOTED
PREVIOUSLY- THE- SACRAMENTO
YEAH THE COUNTY SACRAMENTO CAN
FULLY CONTRACT BACK AND ACT
CONTINUE TO HAVE THOSE
BENEFICIARIES BEING SERVICES
PROVIDED BY KAISER- THROUGH A
CONTRACTUAL. RELATIONSHIP OF
FOR THEM TO CONTINUE IN THE
COUNTY WOULD BE RESPONSIBLE
JUST AS THEY ARE WITH ANY OTHER
I'M CONTRACTED PROVIDER TO OVER
OVERSEE THAT RELATIONSHIP. I'M
SIMILAR TO WHAT WE HAVE IN
OTHER AREAS WHERE I COUNTIES
HAVE PARTNERED WITH- MANAGED
CARE PLANS TO PROVIDE SERVICES
THAT ARE OTHERWISE
RESPONSIBILITY- AT THAT OF THE
COUNTY- SO UNDERSTAND THE
COMMENTS THAT YOU ARE MAKING
HOWEVER- THE PROPOSAL CURRENTLY
AT THIS TIME IS TO STANDARDIZE
THE MEDICARE BENEFIT- WITHIN
MANAGED CARE. THANK YOU. MY
RECOLLECTION- FROM MEDICAL LSS
RATIO DISCUSSIONS- SEVERAL
YEARS AGO THAT KAISER OPERATES
A MEDIC CAL- AT A LOSS SO WHILE
THE DEPARTMENT IS ASSUMING
SAVINGS FROM THIS PROPOSAL BY
SHIFTING THE BENEFIT BACK TO
THE COUNTIES IT'S REALLY JUST
REDUCING THE AMOUNT OF A LOSS-
THE ELASTIC KAISER EXPERIENCES
AND SHIFTING THE COST TO THESE
TWO COUNTIES AM I WRONG ABOUT
THAT. WELL I THINK WHAT I WOULD
SAY IS YOU CAN'T NECESSARILY
CORRELATE SIZERS REPORTED
LOSSES IN MEDIC HOUSE WITH A
BIG LEAD TO THESE TO A VERY
SMALL PORTIONS- THE BENEFIT AND
LIVES THAT- ARE BEING REPORTED
HERE TODAY I THINK YOU WOULD
HAVE TO HAVE A LOT MORE
ANALYTICS AND IN REGARDS TO
THAT CORRELATION- IN ORDER TO
DRAW THAT CONCLUSION. SO ARE WE
GOING TO HAVE TO FUND THESE TWO
COUNTIES IF WE RETURN THE
BENEFIT TO THE COUNTIES BECAUSE
OF WHAT PROP THIRTY REQUIRES-
SO. AS WE STATED IN OUR AND OUR
COMMENTS ARE SOLANO ACTUALLY-
HAD ACCOUNTED FOR IT IN IN THE
NUMBERS THAT THEY PROVIDED US
IN THE TWO THOUSAND SIXTEEN
SEVENTEEN. BASE ADJUSTMENTS AND
SO- WE ACTUALLY ARE CURRENTLY
PAYING US SOLANO AFFORD THESE
SERVICES AND TECHNICALLY PAYING
KAISER- FOR THESE SERVICES
WITHIN. THEIR CAPITATION RATE
IN- FOR THE PURPOSES OF
SACRAMENTO WHICH IS THE ONE OUT
LIAR. I'M SACRAMENTO HAD NOT
REPORTED THESE LIVES AT THAT
ARE CURRENTLY BEING COVERED BY
KAISER IN TWO THOUSAND SIXTEEN
SEVENTEEN AND SO THAT
ADJUSTMENT WASN'T MADE- WE DID
GO BACK AND LOOK AT THAT IS
ABOUT THREE POINT EIGHT MILLION
THAT WOULD HAVE BEEN- OTHERWISE
PROVIDED. TO YOU SACRAMENTO IF
THAT INFORMATION HAD BEEN
REPORTED IN REGARDS TO THEIR-
REALIGNMENT AND WE ARE- AS
BRIAN MENTIONED. HAVING
CONVERSATIONS WITH THEM IN
REGARDS TO. THOSE DIFFERENCES
WE ALSO HAVE AT. KAISER HAS
REPORTED DIFFERENT NUMBERS TO
US VERSUS THE NUMBERS THAT HAVE
BEEN REPORTED TO THE COUNTY. IN
REGARDS TO THE NUMBER OF WIVES
SERVED- AND WE BELIEVE THAT'S
BECAUSE MAYBE YOU ARE ALL
MENTAL HEALTH SERVICES OVER
INCLUDED VERSES JUST SPECIALTY
MENTAL HEALTH SERVICES- BUT WE
ARE CONTINUE TO HAVE
CONVERSATIONS WITH BOTH- KAISER
AS WELL AS- THE COUNTY OF
SACRAMENTO TO. RECTIFY THOSE
DISCREPANCIES. THANK YOU AND
THEN THE FINAL QUESTION WOULD
BE. CAN THE CHANGES BE MADE TO
GRANDFATHER IN EXISTING
PATIENTS WHO ARE RECEIVING
MENTAL HEALTH SERVICES FROM
KAISER PROVIDERS. SO THE CHANGE.
ONLY AFFECTS NEW ENROLLMENT.
THAT WOULD BE A LITTLE BIT
CHALLENGING WOULD HAVE TO TAKE
YOUR THAT UNDER CONSIDERATION I
THINK ONE OF THE BIGGEST
CONCERNS IS THAT WE CURRENTLY
AREN'T GETTING THE- LEVEL OF
INFORMATION AND CRITERION
OVERSIGHT ON THE SPECIALTY
MENTAL HEALTH COMPONENT WITHIN
THE CARS ARE CONTRACT. BECAUSE
OF THAT CONTRACT IS DIRECTLY
WITH THE DEPARTMENT VERSES
THROUGH THE COUNTY WHERE THAT
COULD HAPPEN SO THERE'S A
NUMBER OF THINGS THAT WOULD
HAVE TO HAPPEN FOR. US TO
CONSIDER- THOSE PIECES HOWEVER-
HAPPY TO CONSIDER AND DO THAT
ANALYTICS. THANK YOU VERY MUCH.
I'D LIKE TO THANK THE PANEL
THREE AS WE MOVE ON THE PANEL
FOR ON THE DRUG MEDI CAL
ORGANIZED DELIVERY SYSTEM WE
WILL HAVE FIVE SPEAKERS THREE
FROM THE DEPARTMENT OF HEALTH
CARE SERVICES DIRECTOR LIKE
BORN TRACY COOPER AND CALLIE
PFEIFFER. FOLLOWED BY VERONICA
KELLY AND CULBERT SAID NELLA IF
WE CAN PLEASE BEGIN WITH THE H.
THE US. THANK YOU AND I WILL
PROVIDE ALL OF OUR OPENING
COMMENTS FOR THE DEPARTMENT OF
HEALTH CARE SERVICES AND THEN-
DR PIPER AND A DOCTOR LIKE
WORKING GIVE BILLABLE FOR
QUESTIONS AS NECESSARY. I'M SO
WITHIN THE CALLIE PROPOSAL- IN
REGARDS TO BE. A DRUG- BUT THE
AND CO DS PROGRAM- DCS IS
PUTTING FORWARD A NUMBER OF
PROPOSALS REALLY IN ALIGNMENT
WITH OUR LEARNING FROM THE
FIRST. FEW YEARS OF DNC ODS-
MANY OF THE PROPOSES OF
INCLUDE- ELIMINATING THE TO YOU
OF STATE ANNUAL LIMIT FOR
RESIDENTIAL TREATMENT.
CLARIFYING THE REQUIREMENTS FOR
RECOVERY SERVICES REQUIRING ALL
FACILITIES TO OFFER AND
REFERRED TO MEDICATION ASSISTED
TREATMENT- I'M ADDING ADDING
EARLY INTERVENTION SERVICES FOR
YOUTHS UNDER TWENTY ONE- ADDING
CULTURALLY DEFINED SERVICES AND
NATURAL HEALERS AS A BENEFIT
FOR INDIAN HEALTH CARE
PROVIDERS- AS WELL AS EXPLORING
THE IMPLEMENTATION OF
CONTINGENCY MANAGEMENT. ARE
CLEAR FINE PROVIDER TYPE OF THE
TREATMENT OF PRIOR TO
DIAGNOSIS. AND TREATMENT A POST
INCARCERATION AS MENTIONED
PREVIOUSLY IN THIS- INFORMATION
HEARING. AS WELL AS A VARIETY
OF OTHER TECHNICAL UPDATES TO
DMCA YES. I'M DO YOU SEE AS
AIMS TO DESIGN A COHESIVE PLAN
TO ADDRESS BENEFICIARY
SUBSTANCE USE DISORDER- IT
NEEDS ACROSS THE CONTINUUM- AND
ENSURE THAT ALL MEDICARE
BENEFICIARIES. RECEIVE
COORDINATED SERVICES- ENTER
COMMOTE LONG TERM RECOVERY SO
WE ARE VERY SUPPORTIVE OF THESE
PIECES AND MANY OF THEM WHAT
WERE PUT FORWARD- IN OUR TWELVE
MONTH EXTENSION TO CMS AND ARE
CURRENTLY BEING. CONSIDERED BY
CMS FOR INCORPORATION INTO THE
DNC ODS OUT WAIVERS OTHERS ARE
STILL BEING CONTEMPLATING IN
THE CURRENT OF RENEWAL PROCESS
THAT IS BEFORE US- ADDITIONALLY
DH CS IS- NOT PROPOSING TRAILER
BILL TO IMPLEMENT THE VARIOUS
DMC ODS CHANGES- DAC AS PER
POST. BILL LANGUAGE- REALLY
JUST INCLUDE SECTION TWO. OF
THE AS A COMPOSER F K. UP WITH
THE FRAME OF THE TREE BILL
INDISTINCT MY CAR AT THIS TIME.
THANK YOU NEXT WE HAVE DR KELLY
DIRECTOR OF THE SAN BERNARDINO
COUNTY DEPARTMENT OF BEHAVIORAL
HEALTH AS WELL AS THE
PRESIDENT. OF THE COUNTY
BEHAVIORAL HEALTH DIRECTORS
ASSOCIATION THIS YEAR DIRECTOR
KELLY. THANK YOU DOCTOR WOULD
IN DOCTOR ARAMBULA AND HAPPY
PRESCRIPTION DRUG ABUSE
AWARENESS MONTH. A RECENT
ANALYSIS OF THE CDC AND CDPH
DATA BY CALIFORNIA HEALTH
POLICY STRATEGIES FOUND THAT
FATAL. DRUG RELATED OVERDOSES
IN CALIFORNIA INCREASED BY 50%
BETWEEN TWENTY SEVENTEEN AND
TWENTY TWENTY. THAT'S A MORE
SIGNIFICANT INCREASE THAT
OCCURRED IN THE ENTIRE UNITED
STATES WHAT MUCH OF THAT
INCREASE ATTRIBUTABLE TO
SYNTHETIC OPIOIDS LIKE
FENTANYL. WHICH IS A PAIN
MEDICATION FIFTY TO A HUNDRED
TIMES MORE POTENT THAN MORPHINE
WHICH IS OFTEN MIXED INTO OTHER
DRUGS INCLUDING HEROIN AS WELL
AS COCAINE AND METHAMPHETAMINE.
TO AND DEFINITELY A FACT. I CAN
ATTEST TO THIS NOT ONLY AS A
CLINICIAN BUT ALSO AS A MOTHER.
A WITH A DAUGHTER WHO HAS AND
OPIOID USE DISORDER- I REVERSED
AND OVERDOSED ON IN TWENTY
EIGHTEEN. AND MY HOME. AND THAT
WAS DUE TO FAN. SHE WAS LUCKY
THAT I WAS THERE THAT I HAD IN
OUR CAN'T CAN'T. OUR ENTIRE
FAMILY WAS LUCKY SHE IS IN
RECOVERY AND SHE SURVIVES. BUT
WHAT WE KNOW IS THE SAME
ANALYSIS FOUND THAT DEATHS
LINKED TO SYNTHETIC OPIOIDS
ROSE FIVE HUNDRED AND 41% IN
THE SAME THREE YEAR PERIOD IN
CALIFORNIA. AND THOSE OPIOID
RELATED DEATHS SPECIFICALLY
AFFECTED AND IMPACTED YOUNGER
CALIFORNIANS. COMING NINETEEN
AND SECRETARY GALI IS KNOWN TO
IDENTIFY IS AN EXCELLENT. AND
COPING AND COUNTIES HAVE SEEN
AN INCREASE IN FENTANYL RELATED
OVERDOSES SINCE THE START OF
THIS PANDEMIC. WAS REPORTED IN
SAN FRANCISCO FOR EXAMPLE THE
PANEL RELATED OVERDOSES
EXCEEDED COVERED NINETEEN
RELATED DEATHS IN TWENTY
TWENTY. THESE TRENDS MAKE
KNOWLEDGE IN ACCESS TO DRUG
TREATMENT AN URGENT PUBLIC
HEALTH MATTER. TBH DAY GREATLY
SUPPORTS THE. AMENDMENTS
PROPOSED BY DH CS. FOR EXISTING
DRUG MEDI CAL DELIVERY SYSTEM
WAIVER TERMS AND CONDITIONS AS
THIS IS A JOINT STATE COUNTY
DEMONSTRATION AND IT IS
IMPORTANT TO UPDATE THOSE TERMS
BASED ON THE EXPERIENCE OF OUR
FIRST FIVE YEARS AND THIS
NATIONALLY. PRECEDENT SETTING
EXPANSION OF RESIDENTIAL
TREATMENT AS A BENEFIT THROUGH
MEDICAID FOR EXAMPLE WE COMMEND
THE DEPARTMENT HEALTHCARE
SERVICES PROPOSAL TO INCREASE
ACCESS TO DMC YES FOR YOU. WHO
ARE AT HIGH RISK FOR SUBSTANCE
USE DISORDERS BY ADDING THE
AMERICAN SOCIETY OF ADDICTION
MEDICINE POINT FIVE. EARLY
PREVENTION. BENEFITS FOR THE
MEDICAL CLIENT WHO'S UNDER THE
AGE OF. TWENTY TWENTY ONE.
CARRIZO WORKED REALLY HARD TO
IMPROVE OUR SPECIALTY SUBSTANCE
USE DISORDER SERVICES FOR YOU
AND THE ABILITY TO OFFER
COVERAGE SERVICES TO A BROADER
POPULATION OF YOUTH WILL GO A
LONG WAY TOWARD REVERSING THE
ALARMING TRENDS THAT WE ARE NOW
CURRENTLY SEEING. IN ADDITION
WE STRONGLY BELIEVE THAT IN
ORDER TO SUPPORT A CLIENT
CENTRED LOW BARRIER APPROACH TO
ENGAGEMENT TO TREATMENT THAT-
YES DEMONSTRATION MUST ALLOW
FOR SERVICES TO BE REIMBURSABLE
EVEN IF A CLIENT CHOOSES TO
LEAVE TREATMENT BEFORE THE
COMPLETE ASSESSMENT. DIAGNOSIS
AND TREATMENT PLANNING PROCESS
HAS BEEN COMPLETED. THIS CHANGE
WOULD ALSO HELP ALIGN.
REQUIREMENTS ARE MENTAL HEALTH
SERVICES AND DMC ODS PROGRAMS
CONSISTENT WITH THE GOALS OF
CAL AIM TO MOVE COUNTIES
TOWARDS GREATER REALIGNMENT
AROUND ADMINISTRATIVE
REQUIREMENTS FOR MENTAL HEALTH
AND SUBSTANCE USE DISORDER
PROGRAMS. WE ALSO WANT TO ASK
THE STATE TO WORK TO ADVOCATE
STRONGLY AGAINST ARBITRARY
LIMITS ON REIMBURSEMENT FOR
RESIDENTIAL LENGTH OF STAY. AS
WE BELIEVE THEY SHOULD BE BASED
ON CLINICAL. OR IT WILL PRODUCE
UNINTENDED CONSEQUENCES FOR OUR
CLIENTS. RECOVERY VARIES PERSON
TO PERSON THERE IS NOTHING
MAGICAL ABOUT THIRTY DAYS SIXTY
DAYS NINETY DAYS. CBJ HAS LONG
ADVOCATED THAT THE STATE
ELIMINATE THE TWO EPISODES
LIMITATION ON REIMBURSEMENTS
FOR ADULT RESIDENTIAL TREATMENT
SERVICES THAT WAS INCLUDED IN
THE ORIGINAL DMC YES
DEMONSTRATION. AND THANK THE
DEPARTMENT FOR ADVANCING THIS
CHANGE. BUT CAUTION THAT THE
TWO EPISODE LIMIT SHOULD NOT BE
REPLACED WITH A SIMILAR ONE
SIZE FITS ALL. IN ORDER TO
PRIORITIZE COST CONTAINMENT OR
CLINICALLY APPROPRIATE CARE
PARTICULARLY WHEN SO MANY LIVES
ARE AT REST INSTEAD AS DH YES A
SUGGESTED THE STATE SHOULD
EVALUATE LENGTH OF STAY IN
RELATION TO POSITIVE TREATMENT
OUTCOMES AND FOCUS ON QUALITY
IMPROVEMENT IN TRANSITION OF
CARE TO OTHER. I RECOVERY
ORIENTED SERVICES FOR CLIENTS
FOLLOWING RESIDENTIAL
TREATMENT. FINALLY WE CURRENTLY
HAVE. THIRTY SEVEN COUNTIES
PARTICIPATING IN THE DMZ ODS
DEMONSTRATIONS AND ALTHOUGH
THOSE THESE COUNTIES DO ACCOUNT
FOR ABOUT 90% OF THE STATE'S
MEDICAID BENEFICIARY. THERE ARE
STILL TWENTY ONE COUNTIES WHO
ARE NOT YET ABLE TO OFFER THE
MORE ROBUST CONTAINMENT CARE.
ACCORDING TO TMZ- YES MOST OF
THESE ARE RURAL COUNTIES SMALL
COUNTIES. WHERE THEY HAVE SMALL
POPULATIONS GEOGRAPHY WORKFORCE
SHORTAGE AREAS AND LACK OF
ECONOMIES OF SCALE THAT MAKE IT
MORE CHALLENGING TO DELIVER
EVEN HOSPITAL LEVEL CARE. MUCH
LESS SPECIALIZED AS YOU THESE
SERVICES MANY OF THESE COUNTIES
ALSO HAVE RELATIVELY HIGH PER
CAPITA RATES OF OVERDOSE
DEATHS. CALIFORNIA'S RURAL
COUNTIES UNDERSTAND THE VALUE
IN ADOPTING THE MANAGED CARE
QUALITY STANDARDS OF THE DMZ OF
YES AND IN SECURING ADDITIONAL
FEDERAL FUNDING TO EXPAND AS
YOU SERVICES. BUT MANY CASES
THEY ARE NOT IN A POSITION TO
TAKE ON ADDITIONAL FISCAL RISK
AND LACK OF NEW RESOURCES FOR
WORKFORCE DEVELOPMENT. OR
INNOVATIVE SOLUTIONS FOR THE
UNIQUE CHALLENGES THAT RURAL
HEALTH CARE. SERVICE DELIVERING
COUNTER WE BELIEVE THAT IN
ORDER FOR US TO GET TO FULL
ADOPTION OF THE DRUG MEDI CAL
ORGANIZED DELIVERY SYSTEM
BENEFIT CALIFORNIA MUST
CONSIDER. ALLOCATING DEDICATED
ON GOING FUNDING TO HELP
SUPPORT CAPACITY BUILDING. IN
THESE REMAINING COUNTIES TO
BUILD UP THE FULL ARRAY AND DMC
YES. THANK YOU. NEXT WE HAVE A
CULBERTSON OUR CEO OF TARZANA
TREATMENT CENTERS. IF YOU BEGIN
SIR YOU SHOULD SHOW UP ON
CAMERA. OPERATOR IS HE HAVING
TECHNICAL DIFFICULTIES.
SEE THE
WORD HELLO YES IS THE ANSWER.
THANK YOU. WE ARE READY FOR
YOUR TESTIMONY MR SIMILAR. IT
APPEARS WE'RE HAVING SOME
TECHNICAL DIFFICULTIES. CAN WE
TRY AND CONNECT AGAIN WITH
ALBERT SIMILAR. WHILE WE WAIT
FOR HIM TO RECONNECT I WILL
BRING IT BACK UP AND SEE IF
THERE ARE ANY MEMBER QUESTIONS
WE WILL BEGIN WITH
ASSEMBLYMEMBER RAMOS FOLLOWED
BY DOCTOR WITH. EUROPE WAS THE
CHAIR. OF THE COUPLE QUESTIONS-
ON ON THIS AND CERTAINLY
LOOKING AT THE- THE
RESIDENTIAL. TREATMENT
EXTENSION FROM THE LOOKS LIKE
THE THIRTY DAY EXTENSION NINETY
DAYS BUT GOING TOWARDS A- MORE
OF A MEDICALLY. NECESSARY
MINNIS SAYS CITY IN A TWELVE
MONTH PERIOD VERSUS TRYING TO-
PUT ALL THOSE INTO AN AREA AND
CERTAINLY WE SEE. WHERE THAT
COULD BENEFIT- AND LOOKING AT.
DIFFERENT RESOURCES THAT ARE
AVAILABLE FOR- THOSE THAT ARE
IN OUR COMMUNITY- FOR LONGER
TERM TREATMENT AND- THOSE. THAT
ARE HERE BOTH CHAIRS KNOW THAT
WE'VE BEEN OUT SPOKEN AS FAR AS
TRYING TO GET MORE RESOURCES
LONGER TERM RESOURCES IN NINETY
DAYS AND NINETY DAYS PLUS. FOR
THESE TYPES OF THINGS AND BEING
ABLE TO SEE HERE IN THE FIVE
YEAR PLAN. THAT WE'RE MOVING
TOWARDS HOPEFULLY LOOKING AT A
TWELVE MONTH PERIOD BASED ON-
THE TREATMENT OF MEDICALLY
NECESSITY- THAT'S THERE. AND
THEN THE NEXT QUESTION IS
RESIDENTIAL LONG TERM.
TREATMENT AND THE NEXT QUESTION
WOULD BE I'M NOT SURE WHO COULD
PICK IT UP I WAS THINKING THAT
HOPING SOMEONE WOULD BRING IT
UP IN THEIR PRESENTATION. IS A
TRIBAL SERVICES THAT SOME
HIGHLIGHTED HERE- IN OUR IN OUR
PACKET. AND IT TALKS ABOUT
PROVIDING THE ALLOWANCE- FOR-
TREATMENT CULTURALLY TREATMENT
AS FAR AS THE DIFFERENT- PLANTS
AND DIFFERENT THINGS THAT ARE
THERE. I WAS PERSONALLY
INVOLVED IN- RIVERSIDE-
SEMOLINA COUNTY INDIAN HEALTH
AS FAR AS IDENTIFYING THE
PLANTS. THAT WERE THEN USED FOR
THOSE THAT WERE BEING
PRESCRIBED I'M SORRY I WONDER
IF SOMEONE COULD SPEAK A LITTLE
BIT MORE TO THAT- MISTER CHAIR
THROUGH THE CHAIR IF SOMEONE
CAN'T THEN WE WOULD REQUEST
THAT INFORMATION. COMING TO OUR
OFFICE. AND THEN A FOLLOW UP
WITH THE RESIDENTIAL TREATMENT
AND THE THINGS THAT WE'RE
SEEING IN THE FIVE YEAR PLAN.
HOW DOES THAT INCLUDE- THE
TRIBAL COMMUNITIES AND IS
TALKING ABOUT HERE WORKING WITH
IHS. SO IS IT THE INDIAN HEALTH
SERVICES FROM THE FAIR- RECKON-
TRIBES CAN. END UP- URBAN
CLINICS- HERE IN THE OF. SO HOW
ARE WE- GAUGING THAT DISCUSSION
AND MOVING FORWARD TO MAKE SURE
THAT THE- TRIBAL COMMUNITIES.
IN THE STATE OF CALIFORNIA ARE
PART OF THE EQUATION AND PART
OF THE BODY THAT'S GETTING.
THESE RESOURCES THAT WE'RE
TALKING ABOUT. IF WE COULD HAVE
J. C. COOPER AS WELL AS DR
CALLIE ANSWERED THE- QUESTIONS
FROM ASSEMBLY MEMBER ON THIS
PLACE. I'M ACTUALLY GOING TO
TURN IT OVER TO YOU I DR PIPER
TO RESPOND. GREENTOWN THANK YOU
FOR THE QUESTION I'M ANOTHER
ISSUE IS THAT WHAT WE'RE ASKING
FOR IN TERMS OF TRIBAL
PROVIDERS BUT WE ARE IN
NEGOTIATION WITH THEM ASK ABOUT
WHETHER WE CAN EXPAND OUR
BENEFITS INCLUDE- CULTURALLY
DEFINED CARE BECAUSE WE KNOW
THERE'S A LOT OF EVIDENCE THAT
WHEN. THAT MUSICAL RETREAT THEN
AND I'LL FRIEDMAN IS PROVIDED
BY PEOPLE FROM THE SAME CULTURE
WHO UNDERSTAND THAT PERSON'S
WALK OF LIFE AND ALSO LOOK AT
SPECIFIC PRACTICES IN THE
NATIVE AMERICAN COMMUNITIES
THAT HAVE BEEN PROVEN
EFFECTIVE- AGAIN THIS IS A
PROPOSAL ON WORLD- I'M PLANNING
TO WORK WITHIN THE FIFTY IF WE
CAN AT. BENEFIT PLAN AND
HEALTHCARE. FOR THE REST OF THE
QUESTION RESIDENTS I DID AT THE
THAT DOCTOR CAN SAID WE REASON
WHEN THEY- THAT CHANGE THAT WE
TO MAKE SURE THAT. PEOPLE ARE
THE THAT MEDICALLY NOT. AND NOT-
ARBITRARY DEFINE NUMBER THAT
THAT THE YEAR BECAUSE THEY HAD
SOME. NICE SHE MENTIONED THAT.
PEOPLE ARE NOT ALWAYS READY.
FOR TREATMENT THE FIRST MOMENT
THE ENTERTAINMENT AND THE
CURRENT LIMIT ON TWO EPISODES
MEANS THAT IF SOMEONE.TRIES
AND THEY'RE NOT QUITE READY AND
THEY ONLY HAVE ONE DAY STAYS AT
THEIR HOME LOCKED UP FOR THREE
MEN AND WE DON'T THINK THAT'S
APPROPRIATE WE WNNA MAKE SURE
PEOPLE CAN GET THE TREATMENT
THEY NEED- BASED ON THEIR
CONDITION. RESEARCHERS A COUPLE
FOLLOW. OF MAY. UM ON AREAS
LIKE FENTANYL AND OF THE SU.
MEN HEALTH WE KNOW THE TRAVEL
CAN. ARE EXPERIENCING THEM AT A
HIGHER RATE THAN OTHER. GROUPS
IN THE STATE OF CALIFORNIA. SO
WE WANT TO MAKE SURE THAT THE
RESOURCES ARE ACTUALLY.
REACHING THE COMMUNITIES- AND
THERE'S INPUT. AND AS FAR AS
THE- THE CULTURAL ASPECT AS FAR
AS- INCLUDING OF THOSE THE
PLANTS. ARE WE WORKING WITH
TRIBAL COMMUNITIES TO IDENTIFY
THE DIFFERENT PLANTS. THAT
PEOPLE USE- THROUGHOUT THE
WHOLE STATE OF CALIFORNIA. MY
TRIBE SERRANO AND- WE A
SOUTHERN CALIFORNIA. WE WOULD
USE DIFFERENT PLANS THAN MAYBE
UP NORTH WHERE THE EUROPE
PEOPLE. ARE AT SO HOPEFULLY AND
CAN YOU- LET ME KNOW IF WE ARE
WORKING WITH THE TRAVEL
COMMUNITY IN THOSE REGIONS TO
MAKE SURE THAT. THAT THOSE
PLANS ARE ACTUALLY PROPERLY
DOCUMENTED. ABSOLUTELY WE- WE
DO NOT THINK IT'S APPROPRIATE
FOR THE EXPANSIVENESS DEFINE
TRIBAL PRACTICES AND IF WE'RE
ABLE TO MOVE FORWARD. WITH
ALLOWING NATURAL HEALERS TO BE
A MEDIC CAL THE LOCAL PROVIDERS
AND DRUG MEDI CAL BERKELEY A
LOT FOR ALLOWED TO. REMEMBER
HOPEFULLY TO FIND PRACTICES
THAT ARE NEW AND ABOVE ARE
CURRENTLY ON SALE VIA SERVICES
WOULD BE WORKING CLOSELY WITH
THE TRIBAL. COMMUNITIES. THE
FINAL PRACTICE. AND JUST ONE
FOR CLOSE IF I MAY UM. MISTER
HEARING DOCUMENT- CULTURAL
PRACTICE FOR TRIBAL AND URBAN
CLINICS- AND URBAN CLINICS- AND
THEN THE DRIVE ARE YOU TALKING
ABOUT. THE TRIBAL- CLINICS ON
THE RESERVATION- FUNDED THROUGH
IHS ARE WE TALKING OF A
DIFFERENT TYPE OF FUNDING
STREAM OR MECHANISM. SO WHEN
WE'RE LOOKING AT DRUG MEDI CAL
ORGANIZED DELIVERY SYSTEM WE
WANT TO BE INCLUSIVE OF BOTH
THE URBAN INDIAN COMMUNITIES
SANDY- TRIBAL COMMUNITIES
BECAUSE THEIR NEEDS ARE
DIFFERENT. SO WE WOULDN'T WANT
TO BE WITH. OKAY SO- IF WE CAN
WE CAN STAY UPDATED ON ON HOW
THOSE DIALOGUE AND HOW THAT
CONVERSATION IS MOVING FORWARD-
THROUGH OUR OFFICE TO THE
CHAIRS. I WOULD DEEPLY
APPRECIATE THAT THANK YOU
MISTER. DOCTOR WHAT YES ALSO
THIS QUESTION- LA OUR DA-
DEPARTMENT- FOR BOTH IF YOU
WANT TO COMMENT SO THE DRUG
MEDI CAL ORGANIZED DELIVERY
SYSTEM MODEL IS A COUNTY OPT IN
MODEL SO WHEN THE STATE MAKES
CHANGES TO THE SCOPE OF
SERVICES PROVIDED IN IN THIS
MODEL- ARE ARE THOSE COUNTIES
THERE THE STATE COSTS ARE
COUNTY CROSS. I CAN THINK OF.
THE CARD THANK YOU DOCTOR WOULD
ACCORDING TO IT THE ONLY- WE
UNDERSTAND THAT- UNDER THE ODS
MODEL AND HISTORICALLY- THOSE
ODS SERVICES WHICH WERE
ORIGINALLY PART OF THE STATE
PLAN DM C. SUITE OF SERVICES
OFFERED ARE CURRENTLY PAID FOR-
WITH- STATE GENERAL FUND AND
SO. WE DO HAVE QUESTIONS ABOUT
THE PROPOSED REVISIONS TO THE
RESIDENTIAL TREATMENT SERVICES
WHICH ARE- YOU KNOW PART OF
THAT SORT OF ORIGINAL SUI AND
WHETHER OR NOT. THEY WOULD SORT
F BE A STATE APPLICATION TO
FIND THE NON FEDERAL SHARE
ASSOCIATED WITH- AND INCREASING
UTILIZATION OF THOSE SERVICES-
DUE TO THESE PROPOSED ODS
CHANGES- IN REGARDS TO SORT OF
THE OTHER ODS CHANGES- WE
UNDERSTAND THAT THEY PERTAIN-
THE DATE THEY ALL SORT OF
PERTAINS TO- SERVICES FOR WHICH
THE COUNTIES- YOU KNOW. BY THAT
THE NON FEDERAL SHARE COSTS NOW.
BUT HAPPY TO- TICKET TO THE- OF
HAVE FOR THE COMING. THE
COMMENTS ARE PRO IN THE THAT IT
DOES VERY BASED ON THE-
BENEFITS YEARS IT CODE AND
SERVICES PROVIDED IN DMC IDEAS
SO IT IS A COMBINATION OF BOTH.
COUNTY FUNDED STATE FUNDED AND
OF COURSE FEDERAL FUNDED- AND
SO THISIS ONE THING TO NOTE
THERE AND WE DO NOT FEEL LIKE
THAT PROPOSED CHANGES- INDIAN
CODIS AROUND THE RESIDENTIAL
TREATMENT TRIGGER ON ANY
ADDITIONAL COSTS JUST TO BE
CLEAR IT'S REALLY AROUND
CLARIFYING- HOW THE SERVICES
CAN BE PROVIDED- TO
BENEFICIARIES IN RESTRICTING
NOT ACCESS AND THEREFORE. WE
ARE NOT. PROPOSING OR ASSUMING
ANY INCREASE AT GENERAL FUND
COSTS AT THIS TIME. AND IF I
COULD ADD THAT WE DO AT THE- TO
RUN DAY DOWN THAT THE NUMBER OF
BENEFICIARIES WHO ARE CAN THINK
THAT THE SYSTEM. THAN TWO TIMES
QUITE SMALL SO. THAT'S WHY
WE'RE NOT AKIN TO SITTING THERE
WOULD BE AN INCREASE BECAUSE-
OBVIOUSLY WE WANT TO MAKE SURE
THE SERVICE IS AVAILABLE FOR
THOSE IN NEED MORE HAN TWO
EPISODES BUT THE VOLUME WOULD
BE VERY SMALL AND- NOT THAT
THAT. THANK YOU. THANK YOU IN
BEFORE WE OUT- THIS PANEL I
WANTED TO TAKE A MOMENT TO
THANK DR KELLY FOR HER QUICK
ACTION AND THINKING ON OUR FEET
WITH MARTIN IN TWENTY EIGHTEEN
THAT IS A POWERFUL STORY AND
REMINDER FOR SO MANY OF US JUST
APPRECIATE YOUR COURAGE FOR
SHARING THAT STORY WITH US HERE
TODAY. HELLO THANK PANEL FOR
AND- PASS IT OFF TO DOT ORG.
THANK YOU DR RAM YOU ARE FIFTH
PANEL IS ON WHETHER THE
DEPARTMENT OF HEALTH CARE
SERVICES. SHOULD HAVE THE
AUTHORITY TO PURSUE A FEDERAL
WAIVER OF WHAT IS KNOWN AS THE
IMD EXCLUSION FOR MENTAL HEALTH
SERVICES. ANALYSTS AGAIN WOULD
BE THE- THE ADMINISTRATION. MR
DR QUIST STEVEN KITE- WHO'S THE
CHIEF OPERATING OFFICER FOR
NAMI CALIFORNIA. AND CHAD
COSTELLO WITH THE PUBLIC POLICY
DIRECTOR FOR THE CALIFORNIA
SYSTEM CESSATION OF SOCIAL
REHABILITATION AGENCIES. SO
FIRST OFF THE ADMINISTRATION
PLEASE. THANK YOU I'M STILL AS
INDICATED IN THE CALLIN
PROPOSAL THE FEDERAL GOVERNMENT
HAS DEVELOPED AN OPPORTUNITY
FOR STATES TO RECEIVE FEDERAL
FUNDING FOR INSTITUTIONAL
SERVICES PROVIDED TO
POPULATIONS WITH SERIOUS MENTAL
ILLNESS AND SERIOUS EMOTIONAL
DISTURBANCE- ALSO KNOWN AS S.
MY S. ET I'M SIMILAR TO THE
FLEXIBILITY AS THE STATE HAS
SECURED THROUGH THE DRUG MEDI
CAL ORGANIZED DELIVERY SYSTEM
THAT WE WERE JUST REFERRING TO.
ARE VERY SIMILAR THIRTY- THAT
WE ARE DRYING DOWN FEDERAL
FUNDS FOR THOSE I. ANTI
SERVICES OUT THERE AS WELL I
JUST TO MAKE SURE THAT PEOPLE
ARE GETTING THE CORRELATION
BETWEEN THE TWO FEDERAL FUNDING
OPPORTUNITIES ON THE ACS
PROPOSES TO ASSESS COUNTY
INTERESTED IN PURSUING THE
WAIVER OPPORTUNITY- AS AS LONG
AS THE SYSTEMS ARE OUR POSITION
TO ACHIEVE AT THE REQUIRED
GOALS AND OUTCOMES- THERE ARE
EXTENSIVE AS CMS REQUIREMENTS
THAT HAVE TO BE FULFILLED IN
ORDER TO. IMPLEMENT THIS WAIVER
AND WE WOULD WORK CLOSELY WITH
THOSE COUNTIES TO ENSURE THAT
THEY CAN MEET THAT OBLIGATION
WHICH ONE OF THEM INCLUDES
BUILDING OUT A FULL CONTINUUM
OF CARE- TO BENEFICIARIES
INCLUDING COMMUNITY BASED
SERVICES- AND MAKING SURE
PEOPLE HAVE APPROPRIATE STEP
DOWN TO THE LEAST RESTRICTIVE
SETTING POSSIBLE- I WOULD NOTE
AS SIMILAR WITH THE M. C. O. D.
S. COUNTIES WOULD BE. HAVE TO
VOLUNTARILY OPT IN TO
PARTICIPATE- IN ORDER FOR IT TO
CONTINUE TO BE BUDGET NEUTRAL
SIMILAR TO- TNC ODS
ADDITIONALLY- DH CS PROPOSES TO
HIRE CONSULTANTS- TO WORK IT'S
WITHIN OUR PROPOSED CAROLINE A
B. C. P. THAT'S CURRENTLY
PENDING FOR A REVIEW AS WELL
I'M TO WORK WITH THE ACS AND
INTERESTED COUNTIES TO DO A
VERY REAL BUS A GAP ANALYSIS ON
A CAPACITY ANALYSIS. TO ENSURE
THAT WE CAN MEET THE
REQUIREMENTS- THAT CMS HAS PUT
FORWARD IN THE WAY BURKE-
PROPOSAL- AND WE WOULD NEED TO
DO THAT PRIOR TO SUBMITTING OUR
PROPOSAL TO CMS OF COURSE- I
WOULD JUST HIGHLIGHT- THAT THIS
ONE HUNDRED FIFTEEN. DOLLAR UP-
ALSO BE THE LEDGE. FOR CONSIDER-
AROUND THE BEHAVIORAL HEALTH
TO. INFRASTRUCTURE PROPOSED-
WOULD. ARE INSURED WE CAN-
CONTINUE TO BUILD OUT TO THE
COMMUNITY OF AN OUTPATIENT
SERVICES AT NECESSARY.
UNDERSCORES THE DEPARTMENT'S
COMMITMENT TO BUILDING OUT OF
THOSE NECESSARY SERVICES WHICH
WE THINK IS REALLY CRITICAL TO
HAVE PRIOR TO MOVING FORWARD
WITH. AN AYE IN THE WAIVER
REQUEST TO THE FEDERAL
GOVERNMENT WE NEED TO ENSURE
THAT BENEFICIARIES WILL HAVE
ADEQUATE ACCESS TO YOU I'M
COMMITTEE BASIN OUTPATIENT
SERVICES- AND TO BE ABLE TO
TRANSITION SMOOTHLY FROM AND I
AM THESE DAYS- INTO- THE LOWEST
LEVEL POSSIBLE AND TO BE ABLE
TO CONTINUE TO. OCCUR RECEIVE
SERVICES IN THE COMMUNITY I TO
BE ABLE TO PREVENT HOPEFULLY A
FUTURE- IDEAS. AS WELL. AS THE
REQUIREMENTS ARE QUITE
SUBSTANTIAL IN REGARDS TO CMS
REQUEST SO THE DEPARTMENT DOES-
ANTICIPATE IT WILL TAKE AT
LEAST A YEAR TO BUILD THIS
PROPOSAL. ARE WORKING VERY
CLOSELY WITH OUR COUNTY
PARTNERS STAKEHOLDERS. AS WELL-
AND DH CS WOULD BE REQUIRED AS
A CMS CURRENTLY REQUIRES THAT
WITHIN ALL OF THEIR PIECES TO
INCLUDE AN EVALUATION- SINCE IT
WOULD BE REQUIRED TO BE IN A
LOVING FIFTEEN DEMONSTRATION
THERE ARE MANDATORY. OF
CRITERIA THAT WE DO HAVE TO
MEET HE WOULD WORK WITH CMS.
REGARDING THOSE ITEMS. AND
LASTLY DH CS I'M HAS GENERAL
AUTHORITY UNDER EXISTING LAW-
AS NOTATED- TO BE ABLE TO
SUBMIT A REQUEST OF THIS IS
KIND HOWEVER. DCS IS PROPOSING
TRAILER BILL LANGUAGE TO SEEK
FEDERAL APPROVAL FOR ON THE
MENTAL HEALTH I AM THE WAIVER
AS A COMPONENT OF CALLIN. AND
THIS CONCLUDES THE COMMENTS
FROM THE DEPARTMENT. GREAT
THANK YOU VERY MUCH. MR SHIDA.
THANK YOU THANK YOU DOCTOR
WOULD- CAN'T AFFORD SORT OF GET
INTO THE DISCUSSION OF THE
SPECIFIC- MERITS OF THE
PROPOSAL JUST WANNA SORT OF
REITERATE THE COMMENTS HE MADE
EARLIER ON BEFORE WE STARTED
THIS THIS HEARING ON JUST SORT
OF THE- YOU KNOW THAT- YOU KNOW
WHAT ABOUT WHETHER OR NOT THE
YOU KNOW IF THE LEGISLATURE
WOULD WANT TO SORT OF HAVE MORE
INPUT IN IN SORT OF THE PROCESS
OF. OF- PURSUING THESE THESE
COUNTY PROPOSALS THAT COULD
COULD COULD SORT OF CONSIDER
REVISIONS TO THE TO THE TRAILER
BILL ACCORDINGLY IN ORDER TO
ANSWER SORT OF ENSURE THAT IT
HAS MORE INPUT IN THE IN THE
PROCESS- REGARDING REGARDING
THE SPECIFIC WAIVER OPORTUNITY
YOU KNOW WE DO FIND THAT THIS
REPRESENTS A SIGNIFICANT POLICY
CHOICE ON THE PART OF THE
LEGISLATURE- YOU KNOW THAT THAT
THE ADMINISTRATION YOU KNOW IN
CHOOSING TO PURSUE THIS THIS
PROPOSAL- GOT GOT SOME FEEDBACK
FROM STAKEHOLDERS STAKEHOLDERS
WEIGHING THE PROS AND CONS OF
THE- OF THE PROPOSAL AND
ELECTED TO MOVE FORWARD AND-
ACCORDINGLY YOU KNOW THE
LEGISLATURE MAY WISH TO. YOU
KNOW SORT OF CONDUCT ITS OWN
WEIGHING UP THE PROS AND CONS
OF THIS PROPOSAL- AND- IN ITS
CONSIDERATION OF WHETHER OR NOT
TO MOVE FORWARD WITH IT- WE DO
FIND THE DECISION TO PURSUE
THIS WAIVER REPRESENTS A
SIGNIFICANT OPPORTUNITY TO
ACCESS ADDITIONAL FEDERAL
FUNDING FUNDING WHICH IN
CONCEPT COULD FREE UP COUNTY
FUNDS TO FURTHER EXPAND
BEHAVIORAL HEALTH SERVICE
CAPACITY INCLUDING- INCLUDING
AND WITHIN THE COMMUNITY- YOU
KNOW AS NOTED BY THE
ADMINISTRATION YOU KNOW IN
ORDER TO GAIN WAIVER APPROVAL
FOR THIS PROJECT YOU KNOW THE
STATE'S GONNA NEED TO MEET. A
LIST OF FEDERAL REQUIREMENTS
YOU KNOW INCLUDING REQUIREMENTS
TO MAINTAINING A CERTAIN
COMMITMENT TO SUPPORTING
BEHAVIOR HEALTH SERVICES IN THE
COMMUNITY- AND WHETHER THE
STATE IS IN A GOOD POSITION
ACROSS THE BOARD TO MEET THOSE
REQUIREMENTS IS SORT OF UNCLEAR
AT THE MOMENT- AS AS NOTED
PREVIOUSLY YOU KNOW TEACH THE
S. IS INDICATED THAT IT'S
PLANNING TO NO CONTRACT TO
CONDUCT A GAP ANALYSIS LATER
THIS YEAR. I'M WHICH CUTTING
CONCEPTS SHEDS LIGHT ON WHAT
THE STATE'S CURRENT CAPACITY
FOR COMMUNITY BEHAVIOR HEALTH
SERVICES IS AND IN TURN YOU
KNOW REVEAL ANY. DEFICIENCIES
THAT THE STATE WILL NEED TO
ENTER PRESS IN ORDER TO GET
WAIVER- AND ALSO WASN'T. BY THE
TO. THERE A PROPOSED FOR SEVEN
HUNDRED FIFTY MILLION- TO
ACQUIRE. HEALTH THE LEASE WHICH
SPENT MAY HELP DEMONSTRATE. THE
STATE'S COMMITMENT TO COMMUNITY
BEHAVIORAL HEALTH FOR THE
PURPOSES OF THIS WAIVER- YOU
KNOW BUT GIVEN. I'M CONSIDERING
ALL THESE THINGS YOU KNOW THAT.
THE ADMINISTRATION IS STILL
SORT OF NOT GET. POST A
COMPREHENSIVE STRATEGY FOR SORT
OF HOW TO GAIN WAIVER APPROVAL
FOR THIS- ADDITIONAL FEDERAL
FUNDING- AND THOSE ARE SORT OF
VALUES COMMENTS ON THIS ISSUE
AND THEN. HAPPY TO CORRECT
FURTHER ASSISTANCE WHERE
NECESSARY. THANK YOU VERY MUCH
MOVING ON TO DR QUIST. GIVE ME
A C. H. D. A IS IN STRONG
SUPPORT OF THE STATE'S
COMMITMENT UNDER CALLING TO
PURSUE AN SMI S. C. D.
DEMONSTRATION WAIVER TO SECURE
ADDITIONAL FEDERAL
REIMBURSEMENT FOR ACUTE
INPATIENT PSYCHIATRIC SERVICES.
AS MENTIONED FEDERAL LAW
PROHIBITS MEDICAID
REIMBURSEMENT OR MENTAL HEALTH
SERVICES DELIVERED IN MOST
FACILITIES WITH MORE THAN
SIXTEEN BEDS. THESE LARGE
FACILITIES ARE NAMED
INSTITUTIONS FOR MENTAL DISEASE
I AM HE'S AND SPENDS
RESIDENTIAL TREATMENT
FACILITIES IN PSYCHIATRIC
HOSPITALS AS WELL AS OTHERS.
I'M REGARDLESS OF THIS
EXCLUSION- MEDICARE ALL. IT
ACCOUNT MANDATES COVERAGE FOR
INPATIENT PSYCHIATRIC BENEFITS
BUT THEN WE'RE NOT ABLE TO
ACTUALLY GET REIMBURSED FOR
SOME OF THE SOME OF THOSE-
HOSPITALIZATIONS- WHEN WE WERE
HERE IN SACRAMENTO COUNTY FOR
EXAMPLE- WE PRETTY MUCH HAVE
PREDOMINATELY ONLY ARE
FREESTANDING PSYCHIATRIC
HOSPITALS EXCEPT FOR THE THREE
SIXTEEN BED PSYCHIATRIC HELP
FACILITIES THAT THE COUNTY HAS-
HAS CREATED HAVE CREATED. SO WE
SITE THAT WERE REALLY STUCK
WITH THESE LARGE FREESTANDING
PSYCHIATRIC HOSPITALS SO AGAIN
WHILE IS MANDATES COVERAGE FOR
THESE IMPATIENT BENEFITS WE'RE
NOT ABLE TO GET FEDERAL REVENUE.
I'M CURRENTLY THE COUNTY OF
SACRAMENTO SPENDS ITS ENTIRE
NINETEEN NINETY ONE REALIGNMENT
ALLOCATION AND THEN SOME ON
BEES I AM PLEASED BECAUSE WE
DON'T HAVE ACCESS TO. THE RIGHT
KIND OF FACILITIES. THE SMI SED
DEMONSTRATION WAIVER OFFERS AN
UNPRECEDENTED OPPORTUNITY FOR
CALIFORNIA TO SECURE THAT
ADDITIONAL FEDERAL
REIMBURSEMENT. IN EXCHANGE WE
HAVE THE OPPORTUNITY GRAPH-
DEMONSTRATION WHICH WOULD
COMPEL BOTH THE STATE AND
COUNTIES TO INVEST IN THE
EXPANSION OF COMMUNITY BASED
MENTAL HEALTH SERVICES AS WAS
BEING DISCUSSED AROUND
OPPORTUNITIES. TO STEP DOWN
FROM THOSE STILL NEEDS. AS
DISCUSSED IN THIS HEARING YEARS
OF THE K. YEARS OF BEING CAPPED
AT. THAT THE COST OF SERVICES
FOR MEDICARE BENEFICIARIES
SHOULD HAVE SIGNIFICANTLY
RESTRICTED OUR ABILITY TO
INVEST IN THE DELIVERY SYSTEM.
I ALSO WOULD LIKE TO SAY COUNTY
BEHAVIORAL HEALTH PLANS ARE IN
STRONG SUPPORT OF THE STATE'S
PROPOSED SEVEN HUNDRED FIFTY
MILLION DOLLAR INVESTMENT IN
THE CONTINUING COMMUNITY
BEHAVIOR HEALTH FACILITIES TO
IMPLEMENT THIS DEMONSTRATION
PROJECT. APPLICATION AS GOOD AS
CALIFORNIANS CONTINUE TO
GRAPPLE WITH THE IMPACTS OF CO
IN NINETEEN AND DEMING THERE
HAS NEVER BEEN A MORE CRITICAL
TIME TO STRENGTHEN THE STATE'S
CONTINUUM OF CARE FOR
BEHAVIORAL HEALTH CONDITION-
SHARE JUST BRIEFLY WHAT SOME
LOCAL IMPACT WOULD BE HERE IN
SACRAMENTO COUNTY- WE LIKE I
SAID WE SPEND A SIGNIFICANT
AMOUNT OF MONEY ON THESE. I AM
THE EXCLUDED FACILITIES AND A
VERY CONSERVATIVE VERY
CONSERVATIVE ESTIMATE MIGHT BE
THAT WE WOULD BE ABLE TO WITH
FEDERAL REVENUE TO BE ABLE TO
FREE UP. AND TWELVE MILLION
DOLLARS WORTH OF- REALIGNMENT
FUNDS THAT WE COULD THEN
REINVEST BACK INTO OUR
BEHAVIORAL HEALTH CONTINUUM
TWELVE MILLION DOLLARS WOULD BE
ABLE TO BUY ME ROUGHLY. FIFTEEN
HUNDRED OUT PATIENTS LOTS AND
NOT WORK AND SIX HUNDRED
ADDITIONAL OFFICE HE WILL
SERVICE PARTNERSHIPS LOTS IT
WOULDN'T REALLY BE ABLE TO-
WILL BE REINVESTED M. FURTHER
BROADEN OUR OUTPATIENT.
CONTINUUM OF SERVICES THANK YOU.
THANK YOU VERY MUCH- MOVING ON
TO MR KITE. HELLO I'M STEVEN
TYPE CHIEF OPERATING OFFICER AT
THE NATIONAL ALLIANCE ON MENTAL
ILLNESS CALIFORNIA CHAIRS WOULD
AND ARAMBULA AND MEMBERS THANK
YOU FOR THE OPPORTUNITY TO
SPEAK WITH YOU TODAY. NOT ONLY
HAS LONG BEEN ADVOCATING FOR
THE I AM DEEP WAVER ROM THE
NATIONAL LEVEL TO THE STATE ON
DOWN TO OUR ACCOUNT WE'RE
GRATEFUL THAT THE
ADMINISTRATION HAS LISTENED TO
US AND PROVIDED THE FLEXIBILITY
FOR STATES TO IMPROVE ACCESS TO
CONTINUITY OF CARE FOR A LOT.
AS MANY OF YOU KNOW. INSTITUTE
OF MEDICINE THAT THE AND MENTAL
DISEASE R. NINETY. IS A
FACILITY SUCH AS A HOSPITAL
NURSING FACILITY OR OTHER
INSTITUTION OF MORE THAN
SIXTEEN BEDS. THAT PROVIDES
DIAGNOSIS TREATMENT OR CARE OF
PEOPLE WITH MENTAL ILLNESSES.
SO WHAT IS THE EXCLUSION SINCE
NINETEEN SIXTY FIVE THE FEDERAL
GOVERNMENT HAS PROHIBITED
MEDICAID PAYMENT FOR SERVICES
PROVIDED TO PATIENTS BETWEEN
THE AGES OF TWENTY ONE SIXTY
FIVE NINETY. LET'S POLICY IS
THE ONLY PART OF THE MEDICAID
PROGRAM THAT DOES NOT PAY FOR
MEDICALLY NECESSARY CARE SIMPLY
BECAUSE THE TYPE OF ILLNESS YOU
TREAT. I'M CALIFORNIA BELIEVES
THAT THE APPLICATION AND I AM
THE ROLE MOST DRAMATICALLY
AFFECTS PEOPLE SUFFERING FROM
SCHIZOPHRENIA AND OTHER SERIOUS
MENTAL ILLNESSES. BECAUSE THESE
PEOPLE TEND TO FALL WITHIN THE
TWENTY ONE TO SIXTY FIVE YEAR
OLD AGE GROUP AND AS SUCH ARE
DENIED FEDERAL FINANCIAL
PARTICIPATION IN THEIR
TREATMENTS. THE I AM THE ROLE
IS DISCRIMINATORY. AND WORKS
AGAINST THE PROVISION OF
NECESSARY HEALTH CARE FOR YOUNG
AND MIDDLE AGED ADULTS WITH
SERIOUS MENTAL. CREATING A
WHOLE THE CONTINUITY OF CARE AT
THIS CRITICAL LEVEL. THE IMPACT
OF THIS EXPLOSION S. CLEAR
APPROXIMATELY ONE EIGHT VISITS
TO HOSPITAL EMERGENCY ROOMS
INVOLVED MENTAL HEALTH OR
SUBSTANCE USE CONDITIONS ARE
EMERGENCY DEPARTMENTS ARE OFTEN
NOT EQUIPPED TO HELP PEOPLE
EXPERIENCING A MENTAL HEALTH
CRISIS. EMERGENCY DEPARTMENT
STAFF OFTEN HAD NO PLACE TO
SEND A PERSONAL CRISIS BECAUSE
OF THE LIMITED NUMBER OF
INPATIENT PSYCHIATRIC BEDS IN
THE U. S. WHICH IS DECREASED
SIGNIFICANTLY SINCE NINETEEN
FIFTY. BECAUSE THERE ARE OFTEN
NO CONDITION BEDS AVAILABLE.
PEOPLE CRISIS OR AUTHOR FROM
EMERGENCY DEPARTMENTS. LEFT TO
DEAL WITH THEIR ILLNESSES ON
THEIR OWN OR TRANSFER TO A FAR
AWAY COUNTY. AND ALSO THEN WHEN
PEOPLE DON'T GET THE TREATMENT
THEY NEED WHEN THEY NEED IT
THEY CAN END UP IN JAIL OR ON
THE STREETS OR IN A
CONFRONTATION WITH LAW
ENFORCEMENT LEADING TO WORSE
OUTCOMES FOR THE PERSON.
GREATER PAIN FOR THEIR LOVED
ONES AND A HIGHER COST TO THE
STATE. AS WELL AS THE FEDERAL
GOVERNMENT. THIS IS LITERALLY
LIFE AND DEATH FOR OUR FAMILY.
SO WHAT IS THE WAIVER IN
NOVEMBER TWO THOUSAND EIGHTEEN
CMS ISSUED NEW GUIDANCE THAT
INVITED STATES TO APPLY FOR
SECTION ELEVEN FIFTEEN WAIVER.
OF FEDERAL ANTI CAN EXCLUSION
FOR SERVICES WITH ADULTS OR
ADULTS WITH SERIOUS MENTAL
ILLNESS REST OF MIND. OR
CHILDREN WITH SERIOUS EMOTIONAL
DISTURBANCE OR ASKING THE
PURPOSE OF THIS DEMONSTRATION
IS TO TEST WHETHER INCREASING
ACCESS TO ACUTE INPATIENT
PSYCHIATRIC CARE. ONE REDUCES
RESILIENCE ON OUR I'M SORRY
REDUCES RELIANCE ON EMERGENCY
ROOMS AND TO IMPROVE
CONNECTIONS OUTPATIENT
COMMUNITY TREATMENT. THE WAIVER
WOULD ALLOW STATES TO RECEIVE
FEDERAL FINANCIAL PARTICIPATION
FOR SERVICES PROVIDED TO THE
MEDICAID BENEFICIARIES DURING
SHORT TERM STAYS FOR CUTE CARE
AND PSYCHIATRIC HOSPITALS OR
RESIDENTIAL TREATMENT SETTINGS
THAT QUALIFIES ID'S. IN
MEETINGS IN CALLS BUT NOT A
CALIFORNIA HAS HAD WITH OUR
MEMBERS THE QUESTION WE GET
ASKED THE MOST IS WHAT IS GOING
ON WITH THE I AM DEEP WAVER AND
WHY HASN'T THE STATE LIFE OF
THIS YET. SO I CAN SAY THAT ON
THE CALIFORNIA WAS OVERJOYED
WHEN THE DEPARTMENT OF HEALTH
CARE SERVICES ANNOUNCED THAT AS
PART OF THE STATE'S KELLY
PROPOSAL. INTENDED TO APPLY FOR
THIS WAY FOR. OUR OFFICIAL
STATE ON THE WAY TO. IS THAT
PEOPLE WITH MENTAL ILLNESS
SHOULD HAVE TO FULL RANGE
TREATMENT. OPTIONS PSYCHIATRIC
CARE CAN BE AN ESSENTIAL
COMPONENT SOME PEOPLE ST.
UPDATING I AM THE EXPLOSION TO
ALLOW FOR SHORT TERM STAYS IN
PSYCHIATRIC HOSPITALS. HELP
STRENGTHEN THE MENTAL HEALTH
SYSTEM AND PROVIDES PEOPLE WHO
RELY ON MEDICAID WITH MORE
TREATMENT OPTIONS. ADDITIONALLY
THE GOALS AND MILESTONES THE
WAIVER ALIGNED WITH NON THESE
PRINCIPLES. THESE GOALS AND
MILESTONES- THAT SITS REQUIRED
TO MEET UNDER THE SWAY BAR
PROVIDE ASSURANCE THAT WE
AREN'T RETURNING TO THE DARK
DAYS OF MASS
INSTITUTIONALIZATION AND FOR
ST. SOME OF THESE CALLS INCLUDE
REDUCE UTILIZATION REDUCED
PREVENTABLE READMISSIONS
IMPROVED AVAILABILITY OF CRISIS
STABILIZATION SERVICES. IMPROVE
ACCESS TO COMMUNITY BASED
SERVICES AND. IMPROVE CARE
COORDINATION. SOME OF THE MILES.
INCLUDE OVERSIGHT WHICH
INCLUDES PROCESS TRANSITION
PLANNING. HOUSING AND BETTER
INTEGRATION WITH PREVENTION
SERVICES. AND WE'VE SEEN SOME
SIGNS OF SUCCESS TODAY CMS HAS
APPROVED THE I AND E. WEBER FOR
MENTAL HEALTH AND JUST ONE
STATE VERMONT AND FOR SUBSTANCE
USE DISORDER IN SEVENTEEN
STATES WHERE IT'S ALREADY
IMPROVING OUTCOMES FOR
BENEFICIARIES FOR EXAMPLE THE
STATE OF VIRGINIA HAS SHOWN IN
ITS EARLY RESULTS THE I. N. D.
S. U. D. RIVER. ACTUALLY 39%
DECREASE OPIOID RELATED
EMERGENCY ROOM VISITS AND I 31%
DECREASE AND SUBSTANCE USE
RELATED ER VISITS OVERALL. SOME
CLOSING. THIS OPPORTUNITY
OFFERS HOPE TO MANY OF OUR
MEMBERS WHO HAVE BEEN DESPERATE
FOR MORE TREATMENT OPTIONS FOR
THEMSELVES NUMBER ONE. NOT ONLY
STRONGLY URGES THE STATE TO USE
THIS FLEXIBILITY FROM CMS TO
IMPROVE CARE FOR PEOPLE WITH
MENTAL HEALTH CONDITIONS THANK
YOU. THANK YOU VERY MUCH MR
KITE- MOVING ONTO CHAD COSTELLO.
IT'S. GOOD AFTERNOON CHAIRS
WOODEN ARAMBULA MEMBERS OF THE
MIDEAST AND THANK YOU FOR
ALLOWING ME TO ALL THE
PERSPECTIVE CALIFORNIA
ASSOCIATION SOCIAL
REHABILITATION AGENCIES KASRA
ONE OF THOSE ARTICLES THAT
CONTAIN WITHIN THE CALIBRATION
OF CALLING ON PARTNERS
HEALTHCARE SERVICES TO APPLY TO
CMS FOR WAIVER TO THE IDEA
EXCLUSION RAIN CHECK OURSELVES
AND THE PUBLIC POLICY DIRECTOR
CANCER WHICH IS COMPRISED OF
TWENTY FIVE MEMBER
ORGANIZATIONS THROUGHOUT THE
STATE PROVIDE SERVICES OF THE
CALIFORNIA'S PUBLIC HEALTH
SYSTEM. FOUNDED IN NINETEEN
SIXTY NINE IS THE CALIFORNIA
HALFWAY HOUSE ASSOCIATION
CANCER HAS A RICH HISTORY OF
PROVIDING PERSON CENTERED
RECOVERY AND REHABILITATION
FOCUSED VOLUNTARY COMMITTEE
BASED ALTERNATIVES TO LOTS OF
VOLUNTARY TREATMENT AS AN
ASSOCIATION CANCERS BUT OF ALL
THE COUNTY STAKEHOLDER PROCESS
AND IT'S BEEN A PRESS FOR THE
ADMINISTRATION DEPARTMENT
WANTED TO LIST THEM ON FROM THE
SUCCESSFUL CALPERS TO THE
MEDICAL SYSTEM WE ARE EXCITED
ABOUT THE PROMISE OF MANY OF
THE MULTITUDE PROPOSALS WITHIN
THE CALIFORNIA SHOULD HOLD FOR
THE BEHAVIORAL HEALTH CARE
PHYSICAL HEALTH CARE SYSTEMS
AND THOSE WE SERVE. SO PLEASE
DO NOT TAKE THE FOLLOWING
GETTING A CATION OF A LACK OF
SUPPORT FOR THE OVERALL COUNTY
NEVER WAS A LACK OF ADMIRATION
TREMENDOUS WORK DEPARTMENT
STAFF HAVE DONE AND THEN
APPRECIATION FOR THE WORK THAT
THEY WILL HAVE TO DO. TO BRING.
IT SUCCESS. HAVING SAID THAT.
CANCER IS STRONGLY. TO ANY TO
UNDO THE PROHIBITION AGAINST
YOU MEDICAID. TO FOUR CATEGORY
FACILITIES IN THIS IS A TEACH
FOR HELICES. OTHER THERE IS A
PEACE. LAST COUNT- OPPOSE. THE
EXPLOSION. THE FEDERAL DOT ROOM.
X. OF I. AS A IMPORTANT BULWARK
AGAINST. THE SEE AS THE-
CONSERVING FOR PUBLIC MENTAL
HEALTH SYSTEMS FROM OTHER
SYSTEMS. WITH INVOLUNTARY
INPATIENT CARE UNLESS YOU'RE
SERIOUS PHYSICAL CONSEQUENCES
THAT MAKE DOING SO
UNATTRACTIVE. WHY IS THIS.
FIRST THE SIGNIFICANT
GRAVITATIONAL PULL OF POLITICAL
EXPEDIENCY MANY TIMES MAKES IT
EASIER TO OPEN NINETY TYPE
FACILITY. OR UTILIZE EXISTING
LICENSED FACILITIES. I HAD THE
PRIVILEGE OF BEING INVOLVED IN
A FEW PROTRACTED MESSY EFFORTS
TO LOCATE THE LOTTERY PROGRAM
TO COMMUNITIES. IT TAKES
POLITICAL COURAGE TO STAND UP
TO PASSIONATELY UPSET
CONSTITUENTS. LEVEL COURAGE AS
FAR LESS LIKELY TO MANIFEST
ITSELF WHEN IT EASIER TO
LOCATE. I AM DETECTED SO IT CAN
BE OPENED. IN THE FINANCIAL
MARKETS CAP. SO THIS IS WHAT
MANY ADVOCATES DEMANDING OR
LEAST SEEM TO BE TO- GOING TO
MAKE LISTINGS WHICH YOU ARE
AWARE AND IN THE PUBLIC ARE
UNAWARE OF OTHER TREATMENT
OPTIONS COULD SHOULD BE OFFERED.
THESE ARE FAMILY MEMBERS
DISCIPLINE IT RELIEVES HELP AND
ACCESS TO CARE RESIDENTS. IN
THIS INTERVIEW TO ME ACCESS TO
LAWCENTER AFRICA SLOWS.
CASUALLY SAID MUCH OF WHAT IS
INTRODUCED IN MAN FOR I AM THE
TYPE THAT COULD BE ADDRESSED
LESS RESTRICTIVE.
REHABILITATION FOCUSED ACTUALLY
COMMUNITY BASED ALTERNATIVES.
SUCH AS THOSE OUTLINED WELFARE
INSTITUTIONS CODE SECTION FIFTY
SIX FIFTY SIX SEVENTY. TWO
FIFTY SIX SEVENTY SIX- THE
APPLICATION FOR A POTENTIAL
ACCEPTANCE OF THE NINETY
EXCLUSION WAIVER WOULD MARK AN
IMPORTANT AND WE'LL GET IT
REGRETTABLE DEPARTURE FOR
CALIFORNIA'S FORTY PLUS YEAR
COMMITMENT. TOWARD DEVELOPING
VOLUNTARY KEENLY BASED
ALTERNATIVES TO HOSPITAL
INSTITUTIONAL CARE SETTINGS AS
ORIGINALLY EXPRESSED A
CALIFORNIA'S COMMITTEE
RESIDENTIAL TREATMENT SYSTEM
HAPPENED NINETEEN SEVENTY
SEVEN. I AM THESE ARE ALMOST
ALWAYS LEFT THE SAUDIS. ISSUES
AND IDEAS ARE ALMOST NEVER
THERE VOLUNTARILY. INDIVIDUALS
FIND THEMSELVES IN NINETY
SETTING AS PART OF A LONG TERM
INVOLUNTARY. HOLDS SOME KIND
SUGGEST CONSERVATORSHIP. I AM
THESE ARE NOT BAY. THEIR
COMMUNITY LOCATED EVERY
FACILITY OR PROGRAM IS LOCATED
THE COMMUNITY. THAT'S A POLICY
HOSPITALS LOCATED COMMITTEE OF
NORWALK WITH THOSE WHO RECEIVED
SERVICES THERE ARE NOT IN ANY
WAY PARK LACK OF THE COMMUNITY
ARE LAW. OFFICE BUILDINGS ARE
DESIGNED. HAVE THE STILL HERE
WITH THEIR PATIENTS NO MATTER
WHERE THEY HAPPEN TO LOOK AT IT.
THE ANYWAY FOR APPLICATION
WOULD FLY IN THE FACE THE
SUPREME COURT'S NOT NINETY
NINE. ON VERSUS ELSIE. WHICH
ESSENTIALLY THAT ENDED WITH
THIS HAVE THE TO LIVE IN
COMMUNITY RATHER THAN
INSTITUTIONS LAST WEEK. THE
PROPOSAL APPLICATION MAKES NO
SENSE OF THE LARGER CALLIN YOU
SHOULD. AS A MEMBER OF THE
CALENDAR HERE HEALTH WORKER I
WAS AT THE SESSION BACK IN
TWENTY TO SEE THAT REQUIRE FOR
NINETY EXCLUSION WAS NAY PART
OF CAL. NATALIE OF MY
ORGANIZATIONS UP JUST OR-
BECAUSE OF A WE KNOW OF THE
CONTEXT DOUBLES KALANK. I WAS
RELIEVED THAT THROUGH OF
RECEIVING FEEDBACK FROM OPEN.
IT SEEMS HIGHEST VERSION WEBER
THE DRAW CAL ONLY BE SURPRISE
AGAIN WHEN IT MADE A REAL IN
THE TWO TWENTY ONE. REPLIES
COUNTY WHICH BRINGS ME. BEFORE
YOU HEAR. THE I. NIECES OR
WHATEVER MAKES LITTLE. AS
LITTLE SISTERS. BACK TWENTY
TWO. YEARS NO OTHER ELEMENT.
RELY AND I AM HAVE TO BE. JUST
PROPOSAL. THE WAIVER OF.
REQUIRED SO. ASAP OF THE FIFTY
LABOR VEHICLE US THE RIGHT OF
CALLIN IN NINETEEN. BE WHERE.
MEETING REQUIREMENTS BY C. TO
LEGALLY. TO MATCH. SEARCH OF
THE PROPOSAL TO APPLY FOR
NINETY STUDENT WAIVER CONTAINS
IN THE CALENDAR SHOULD HAVE
SHOULD BE. IS IT I NEED IN
ORDER TO TRACK FOR THE BUT
SHALL BUSINESS BIT LATE
CALENDAR. MOREOVER THE
ELIMINATION IS PART IT THE OVER
USE THE BALL CARE. CALIFORNIA
BACKWARD NOT FORWARDS ONLY
UNDER MY HERE'S A EFFORT TO
HELP WITHIN OUR OF ALL KING
BASED. IN THE OF ALL. TO THE
MORAL LEGAL AND CLOSE STATES
STEP OF MAINSTREAM. THANK YOU
FOR YOUR TIME. THANK YOU VERY
MUCH- I APPRECIATE ALL THE ALL
THE PANELS HERE IN I THINK WE
HAVE SOME- PLEASE. GO DR RANGAN.
THANK YOU MIGHT QUESTIONS TODAY
WILL BE FOR THE I. TO- HAVE A
STINK ABOUT IN THE ONE THE
FEDERAL GOVERNMENT HASN'T OF
CALIFORNIA'S I AM THE WAY FOR
WOULD YOU LIKE THAT THE
INCREASE IN FEDERAL TO RESULT
IN MORE I AM DE QUE. FOR WILL
IT FREE OF COUNTY FOR FROM CA
BASED CARE CENTER WHAT I'M
ASKING IS LISTEN HELP US MOVE
AWAY FROM MORE AND CARE AND
TOWARDS MORE AND BETTER CAN YOU
BASED. THANK YOU FOR THAT
QUESTION SO I THINK ONE OF THE
THINGS THAT I WOULD HIGHLIGHT
IS. IN ORDER FOR A COUNTY TO
EVEN BE ABLE TO- BE AVAILABLE
TO USE THE I AM THE WAIVER TO
OPT IN AND SUBMIT THE
APPLICATION TO GO LIVE. THEY
WOULD HAVE TO DEMONSTRATE THAT
THEY HAVE ADEQUATE ACCESS TO
OUR COMMUNITY BASED AND
OUTPATIENT SERVICES TO ENSURE
THAT THERE IS A CONTINUUM. THE
GOAL OF THE I AND B. WAIVER IS
TO ACTUALLY- OVER TIME BUILD
OUT THAT CONTINUUM REDUCE THE I
AM THE LENGTH OF STAY- BY
ENSURING THAT THERE IS
APPROPRIATE- COMMUNITY BASED
SERVICES AVAILABLE- WE WOULD
MAKE. VERY CLEAR AND I JUST
WANT TO MAKE SURE EVERYONE
UNDERSTANDS THE DEPARTMENT IS
NOT INTENDING TO INCREASE THE
NUMBER OF PEOPLE. WHO ARE ABLE
TO- GET I AM THE SERVICES-
HOWEVER WE DO KNOW THAT THERE
IS A ROLL UP FOR SOME I AM THE
SERVICES BUT IN THAT BEHAVIORAL
HEALTH SPACE AND SPECIFICALLY
THE SPECIAL. TEAM MENTAL HEALTH
SPACE BUT WE WANT TO BUILD OUT
THE CONTINUUM OF SERVICES-
INCLUDING THE OUT PATIENT- AND
COMMUNITY BASED SERVICES AND
HAVE THAT FULL CONTINUUM. WE
ALSO PLAN ON REALLY ADDRESSING
SOME OF THE COMPLEXITIES
WITHIN. OUR PROGRAM AROUND THE
JUSTICE INVOLVED IN ENSURING
THAT THERE ARE ADEQUATE
SERVICES BOTH FROM A RE ENTRY
AND A DIVERSION POINT IF- MADE
AVAILABLE. TO INDIVIDUALS WITH
THIS I AM THE WAY BURKE- AND
IT'S FAR GREATER THAN JUST
DRYING DOWN FEDERAL FUNDS THAT
WE DO ANTICIPATE AND EXPECT THE
COUNTIES THAT PARTICIPATE- IN
THIS I. ANTI WOULD REINVEST ANY
OF THOSE FEDERAL FUNDS INTO
ARGENTINE YOU'D- GROWTH IN.
REGARDS TO EVIDENCE BASED
MODELS ON THE OUT PATIENT FRONT
I'M AN ADDITIONAL. SERVICES IN
THE COMMUNITY. OKAY THANK YOU-
CYBER COUPLE OF QUESTIONS- AND
SO COULD BE ARGUED THE IN DR-
SO I'M CURIOUS WHY WHAT IT HAVE
TO DO DIFFERENT IN ORDER THE
STATE TO SEE CAN I AM THE
WAIVER FOR MENTAL MENTAL HEALTH
SERVICES SO ARE THERE SPECIFIC
ADDITIONAL SERVICES THAT HAVE
TO BE AVAILABLE IN REGIONS OF
THE STATE. FOR EXAMPLE. I COULD
GO TO. EITHER YOU J. C. OR DR
QUIST I DO YOU NEED ME TO
REPEAT IT. YES PLEASE SO WHAT
WILL COUNTIES HAVE TO DO
DIFFERENTLY IN ORDER FOR THE
STATE TO SEE CAN I AM THE
WAIVER FOR MENTAL HEALTH
SERVICES. SO REALLY THERE'S
GOING TO BE A NUMBER OF
REQUIREMENTS THAT I MAY WANT TO
KICK IT KELLY IN REGARDS
BECAUSE I DON'T HAVE THE FULL
LIST OF ALL. THE REQUIRED. BUT
THERE SEEM AS DOES HAVE A LIVE
OF. BOTH PRIME FORTY. THEY
HAVE TO REDUCE I AM I AM
DEALING OF STAY TO- HELLO
AMOUNT OF STAY. BY HAVING THE
FALCONS OF. OUTPATIENT
COMMUNITY SERVICE- THEY ALL ARE
GOING TO HAVE RICK. OR QUALITY
IN IN THE SO ADDITIONAL
OVERSIGHT REQUIRE. THEY HAVE TO
TAKE IN THE TO THOSE SERVICES
I'M BUT LET ME PASS AND SEE-
DOCTOR FOR HOW ADDITION D. AND-
TO- SOME OF THEIR- WITH IN THE
FEDERAL. A WAIVER THE THEY
WOULD HAVE TO MEET IN ORDER TO.
DRAW THOSE. THANK RIGHT THANK
YOU AND GAVE THE YES ON THE
GOVERNMENT WAS IN CAT JEFF BIG
IT MANY IN PLACE TO MAKE SURE
THAT THIS IS NOT DRAW FACING
COUNTY MORE AMBITIOUS OF THAT
THEY WE WOULD HAVE TO DENNIS AT
STATE AND PROTECT COUNTY
WOULDN'T A DEMO THAT THERE
REALLY UP FULL COMMUNITY BASED-
CAN OF IN THE THERE IS RIGOROUS.
ARE THEY GETTING HELP FACILITY
AND THEN. THEY'LL TAKE BETTER-
CRISIS RESIDENTS EITHER. THAT
ARE. ACCEPTING OUR LOW LEVELS
OF CARE OFTEN. TO KEEP IN MIND
IT TAKES SEVENTEEN COULD BE
CONSIDERED AND I AM DAVID NOT
THAT. IN PRIDE. WE WILL BE
WORKING WITH COUNTY TO MAKE
SURE THE THIS SO THAT'S PROMISE
ARTICLE WHICH IS ENSURE THAT IF
SOME SHOWS A THE PMR. TO AND
ACUTE CRISIS. THE ANSWER IS NO
TO DISCHARGE HOME OR GO TO JAIL
THAT THERE THAT ABOUT THEY'LL
SOME NEEDS LEVEL OF CARE
DISABLE IF THE- OR TO DO REAL-
COURTNEY FOR THE INTENSE OUT.
I'M DOCTOR QUIT THEY ALSO HAVE
SOME- ADDITIONAL. THE
PROSPECTUS. SACRAMENTO HAS
EXPRESSED INTEREST IN THE
PROGRAM. THANK YOU VERY MUCH
APPRECIATED- THIS WAS SAY THANK
YOU AGAIN TO- PANEL FIVE. OF
FOR THEIR- THEIR TESTIMONY
TODAY AND WITH THAT WE WERE GO
AHEAD AND MOVE ON TO OUR SIX
PANEL. DOCTOR RANDY WILL TAKE
OVER FROM HERE. FOUR SIX PANEL
WE WILL BE ADDRESSING THE
PROPOSED INTEGRATION OF
SPECIALTY MENTAL HEALTH AND
SUBSTANCE USE DISORDER
SERVICES. WE WILL HAVE THREE
SPEAKERS DIRECTOR LIKE PORN GZ
COOPER AND DR KELLY PLEASE
BEGIN. SO DO YOU SEE S. IS
PROPOSING ADMINISTRATIVE
INTEGRATION OF THOSE SPECIALTY
MENTAL HEALTH AND SUBSTANCE USE
DISORDER SERVICES INTO ONE BIG
HELP MANAGED CARE PROGRAM- THIS
PROPOSED THAT PROPOSAL IS
DISTINCT FROM THE FULL
INTEGRATION PLAN WE HAVE HAD A
NUMBER OF QUESTIONS REGARDING
THAT WE DO TRY TO SEPARATE THIS
IS AROUND- INTEGRATION OF BOTH
MENTAL HEALTH AND SUBSTANCE USE
DISORDER SERVICES NOT
NECESSARILY. THE FULL
INTEGRATION WHICH I KNOW WE
WILL GET TO LATER- WHICH TALKS
ABOUT INTEGRATING PHYSICAL
HEALTH BEHAVIORAL HEALTH AND
ORAL- INTO A COMPREHENSIVE
MANAGED CARE PLAN SO SEPARATING
THOSE TWO- APPROXIMATELY HALF
OF THE INDIVIDUALS WITH SERIOUS
MENTAL HEALTH. ILLNESS HAVE CO
OCCURRING SUBSTANCE USE
DISORDER SERVICES OR NEEDS- AND
THESE INDIVIDUALS ARE TRULY
BENEFIT FROM INTEGRATED MENTAL
HEALTH AN STD I TREATMENT. THE
STATE COVERS A MEDIC CAL AS YOU
DEON SPECIALTY MENTAL HEALTH
SERVICES THROUGH SEPARATE
COUNTY CONTRACTS TODAY- WHICH
MAKES IT DIFFICULT FOR COUNTIES
AND CONTRACTED PROVIDERS TO
OFFER INTEGRATED TREATMENT
INDIVIDUALS WITH CO OCCURRING
DISORDERS. OF FOR EXAMPLE
COUNTIES ARE SUBJECT TO USE-
TWO SEPARATE ANNUAL QUALITY
ASSESSMENT A SEPARATE PAYMENT-
POST PAYMENT CHART AUDITS AS
WELL AS ALL OF THE
ADMINISTRATIVE REQUIREMENTS
WITHIN THEIR CONTRACTS
SEPARATING BETWEEN THE GOP
INCLUDING SEPARATE
REIMBURSEMENT COST REPORTING
METHODOLOGIES THAT WERE
MENTIONED EARLIER IN THIS IN
THIS HEARING. I'M JUST TO
HIGHLIGHT SOME OF THE
COMPLEXITIES- IN MANY OF OUR
COUNTIES HAVE ADMINISTRATIVELY
AT THE LOCAL LEVEL- YOU KNOW
INTEGRATED- BUT WE STILL OLD
THEM ACCOUNTABLE TO TWO
SEPARATE CONTRACTS AND
REQUIREMENTS THAT THEY HAVE
ESSENTIALLY HAD TO STAY
SEPARATE FOR THE PURPOSES. OF
MEETING STATE AND FEDERAL
REQUIREMENTS AS CURRENTLY- IN
THEIR CONTRACTS IN ORDER TO
COMPLY WITH THE SEPARATE
PROCESS EASE OF PROVIDERS
OFFERING INTEGRATED TREATMENT
TO A MEDICARE BENEFICIARY MUST
DOCUMENT AS YOU D. TREATMENT
SERVICES FOR EXAMPLE SEPARATE.
FROM A MENTAL HEALTH TREATMENT
SERVICE- WHICH WE REALLY. FEEL
IS REALLY UNNECESSARY AND IF WE
HAVE BETTER INTO CARE. DELIVERY
SYSTEM WE DO THINK IT WOULD
GREATLY BENEFIT ARE BETTER- I
WOULD NOTE ARE CURRENTLY COUNTY
TO PROVIDE IN ADMINISTER THESE
BENEFITS UNDER A SINGLE
CONTRACT WITH THE DEPARTMENT
HEALTHCARE SERVICES ALL ARE ARE
SEPARATE- THE GOAL OF THIS
PROPOSAL IS TO INTEGRATE- THOSE
SERVICES UNDER ONE. COUNTY
PROGRAM WITH ONE COUNTY
CONTRACT WITH THE DEPARTMENT OF
HEALTH CARE SERVICES- AND I
THINK THAT'S AN IMPORTANT PIECE
TO IT TO NOTATE HERE- WE DO
ANTICIPATE THIS EFFORT WILL-
IMPROVE OUTCOMES FOR
BENEFICIARIES TO CORD NEEDED
TREATMENT ACROSS THE CONTINUUM
OF CARE- I MAKING IT EASIER FOR
PROVIDERS TO OFFER. INTEGRATED
CARE. ADDITIONALLY YOU- AN
ADDITIONAL KIND OF GOAL AND
BENEFIT WOULD BE TO REDUCE THE
ADMINISTRATIVE AND FISCAL
BURDENS FOR THE COUNTIES
PROVIDERS AND STATE THAT IS.
SOMETHING THAT WOULD BE A
BENEFIT HEREBY REDUCING THE
NUMBER OF CONTRACTS AS AS
MENTIONED AB IS BOB- ALTHOUGH
DACA'S COULD ACCOMPLISH-
ADMINISTRATIVELY WE DO PREFER
TO INCLUDE THE THIS IN THE
CALENDAR FOR THE BILL. TO
CLEARLY SIGNAL THE FUTURE
REQUIREMENT FOR COMBINED COUNTY
CONTRACTS- INTO EXPRESSLY
ACKNOWLEDGE AND REQUIRE- OF THE
ASSOCIATED PLANNING ACTIVITIES
AND COUNTY UP CONSULTATION
DURING THE UPCOMING CAL IN
TERM- WITH THE WORK. INVOLVED
INTEGRATE THE TWO CONTRACTS IT
IS QUITE SUBSTANTIAL JUST TO BE
CLEAR IN REGARDS TO- THEM BEING
VERY SEPARATE TODAY- SO DH CS
DOES BELIEVE THIS WORK WE NEED
TO BE DONE OVER THE FIVE YEARS
OF THE CURRENT WAVE BURKE- AND
THAT'S WHERE WE WOULD FOCUS
WORKING WITH THEIR COUNTIES. ON
THOSE BUILDING BLOCKS OF
INTEGRATION I TO DO IT OVER
TIME SO IT'S NOT OVERWHELMING
FOR THE COUNTY TO MOVE INTO A
SINGLE INTEGRATED CONTRACT- AND
THEN IN THE NEXT- WAIVER PERIOD
STARTING IN TWENTY TWENTY SEVEN
IS WHEN WE WOULD EXECUTE- THE
FIRST SINGLE CONTRACT WITH
COUNTIES TO PROVIDE BOTH.
SPECIALTY MENTAL HEALTH AND A
CD SERVICES IN A COMBINED
CONTRACTS- SO THIS WILL
CONCLUDE- THE COMMENTS FROM THE
DEPARTMENT HOW. HAPPY TO ANSWER
QUESTIONS WITH THAT. DOT KELLY.
THANK YOU DOCTOR ON DR WOULDN'T
AND RUNNING KELLY THE
HEALTHCARE FOR SAN YOU KNOW IN
THE PRESIDENT C. B. H. T. F. K.
B. EVER HOPEFULLY WE STRONG
SUPPORT THE DEPARTMENT'S
PROPOSAL TO INTEGRATE OUR
MENTAL HEALTH AND SUBSTANCE USE
DISORDER PLANS AND WHILE WE
OFTEN DISCUSS THE DESIRE TO SEE
GREAT GREATER CLINICAL
INTEGRATION OF PHYSICAL ON HERE
HOW WE STILL ARE NOT AT A POINT
WHERE WE HAVE REAL INTEGRATION
BETWEEN MENTAL HEALTH AND
SUBSTANCE USE DISORDER
SERVICES. TODAY COUNTIES IN OUR
CONTRACTED COMMUNITY BASED
PROVIDERS WHO WISH TO PROVIDE
CLINICALLY INTEGRATED SERVICES
TO INDIVIDUALS WHO HAVE CO
OCCURRING SUBSTANCE USE AND
MENTAL HEALTH DISORDER AFTER DO
SO WHILE MAINTAINING REALLY
STRICT COMPLIANCE TO THE STATE
SETS A REGULATORY REQUIREMENTS
THAT'S TO SEPARATISTS US MEANT
TO SEPARATE TREATMENT PLANS TO
SELL CLAIMS TO DIFFERENT
STOPPING PATTERNS AND MULTIPLE
PROGRAM INSIGHT CERTIFICATION
OR LICENSURE. AND SO FOR THOSE
BENEFICIARIES WITH CO OCCURRING
MENTAL. HEALTH AND SUBSTANCE
USE DISORDERS. PROVIDERS MUST
DO THE WHAT CAN BE. THE CLIENTS
MENTAL ILLNESS OR THEIR S. U.
D. WILL BE THEIR PRIMARY
DIAGNOSIS FOR THE PURPOSE OF
DOCUMENTATION STANDARDS
NECESSARY TO AVOID THIS
ALLOWANCES AND TO SECURE
REIMBURSEMENT. OPERATIONALLY
FOR COUNTY BEHAVIORAL HEALTH
SERVICES WE MUST ALSO STAND UP
DISTINCT DATA COLLECTION
COMPLIANCE REVIEW AND NETWORK
ADEQUACY COMPLIANCE STRUCTURES.
SO KEEPING WITH THE OVERALL
THEMES ACCOUNT AIMS BEHAVIORAL
HEALTH REFORMS WE ARE SO
LOOKINGFORWARD TO THE
RESTRUCTURING OF OUR RULES AND
PROCESSES TO BE FAR MORE
EFFECTIVE. MODERN AND TO REMOVE
THESE OUTDATED SERVICE BARRIERS
WHICH DO NOT MAKE SENSE FOR
PROVIDERS. AND THEY DON'T MAKE
SENSE MOST IMPORTANTLY FOR
MEDICARE BENEFICIARIES WHO ARE
THE PEOPLE THAT WE SERVE. AND
ALTHOUGH THESE CHANGES ARE LONG
OVERDUE AS JC JUST STATED
REMOVING THE ARTIFICIAL
ADMINISTRATIVE WALL WE PUT UP
BETWEEN. SPECIALLY MENTAL
HEALTH AND S. U. D. WILL TAKE
TIME. THE GOAL OF CAL AIM IS TO
TRANSITION- COUNTY BEHAVIORAL
HEALTH PLANS TO A SINGLE COUNTY
BEHAVIORAL HEALTH CONTRACT BY
TWENTY TWENTY SEVEN AND THIS
EFFORT MUST BE COORDINATED WITH
OTHER CAL INITIATIVES. IN ORDER
TO FOR EXAMPLE CREATE A SINGLE
STANDARDIZED AND INTEGRATED
SCREENING TOOL. TO DEVELOP AN
INTEGRATED ASSESSMENT AND A
LINE REQUIREMENTS FOR CLINICAL
DOCUMENTATION WHICH IS ARE VERY
DIFFERNT NOW TO ALLOW
PROVIDERS TO USE A SIMPLIFIED
CLIENT CENTERED PROBLEM LAST
RATHER THAN A COMPLIANCE CENTER
TREATMENT PLAN. SO WE KNOW SOME
CHANGES WILL BE STRAIGHT
FORWARD CURRENTLY SOME COUNTIES
HAVE ALREADY INTEGRATED
BENEFICIARY LINES ALTHOUGH THEY
MUST OBSERVE A DISTINCT
DOCUMENTATION STANDARDS. I
COUNTIES WILL ALSO WELCOME
PERFORMING A SINGLE ANNUAL
EXTERNAL QUALITY REVIEW
ORGANIZATION COMPLIANCE REVIEW
RATHER THAN THE TWO THAT WE
CURRENTLY HAVE. OVER THOSE
PLANS LIKE MINE AND SAMPOERNA
DINO COUNTY WE'VE ALREADY LAID
SOME SIGNIFICANT GROUNDWORK FOR
THIS SHIFT BY. DEVELOPING
WORKAROUNDS TO SUPPORT GREATER
CLINICAL INTEGRATION AND WE'RE
HOPING DHS WILL WORK WITH US TO
ALLOW FOR AN EARLIER PHASED IN
APPROACH. BECAUSE OF THE
SIGNIFICANT CO OCCURRING MENTAL
HEALTH AND SUBSTANCE USE
DISORDER SERVICES OUR AIM IS
NOT TO JUST DO THE
ADMINISTRATIVE INTEGRATION
ASSEMBLY STREAMLINE OUR OWN
BURDEN AS PLANS AND PROVIDERS.
BUT TO REALLY DESIGN THIS
ADMINISTRATIVE INTEGRATION INTO
A WAY THAT WILL. COMPEL MORE
CLINICALLY INTEGRATED MENTAL
HEALTH AND SUBSTANCE USE TO
SERVICES AT THE PROVIDER LEVEL
AND HOPE THAT. THE STATE WILL
APPROACH THIS EFFORT. WITH IN
MIND BECAUSE ONE OF. IN NEED
PRESENTS TO ME AS A CLINICIAN.
I SHOULD BE ABLE TO HELP THEM
WITH THEIR SCHIZOPHRENIA. AND
THEIR HEROIN ADDICTION USING
ONE CHART. ONE METHOD OF
ASSESSING ONE CLINIC SITE AND
ONE CLINICIAN THANK YOU. THANK
YOU DR KELLY WILL BRING IT.
BACK UP FOR ANY MEMBER
QUESTIONS THAT WE MAY. QUESTION
I'M GOING TO THIS WITH ONE WITH
WHERE YOU AND OFF DR IF I COULD
BECAUSE I AGREE WITH YOU THIS
IS NOT AN SIMPLY TO EMIGRATE.
BUT US TO FIGURE OUT HOW WE CAN
HELP AND SORRY HOPING YOU COULD
COMMENT ABOUT WHAT REAL
INTEGRATION WOULD LOOK LIKE FOR
A PATIENT AS COMPARED TO WHERE
THE WORLD IS TODAY IN TERMS OF
THE CLINICAL INTEGRATION WITH
WHICH YOU WERE JUST SPEAKING
ABOUT. SO CLINICALLY WOULD BE
GREAT IF OUR PATIENTS TO COME
JUST TO OUR ONE SITE AND
RECEIVE THEIR MENTAL HEALTH AND
ADDICTION SERVICES THAT WE CAN.
FREELY WRITE IN THEIR CHART
THAT THEY HAVE LIKE A JUST
STATED AS AN EXAMPLE
SCHIZOPHRENIA. AND
METHAMPHETAMINE ABUSE AND THAT
WE COULD TREAT WHICHEVER WAS
THE ISSUE OF THAT DAY CURRENTLY
WE CANNOT DO THAT CURRENTLY
WHEN A PATIENT COMES IN WHO HAS
SCHIZOPHRENIA I SEE THEM IN MY
MENTAL HEALTH CLINIC. AND THEN
I WILL MAKE SURE THEY HAVE AN
APPOINTMENT IN MY SUBSTANCE USE
DISORDER CLINIC A DIFFERENT DAY
THEY WILL GET THAT SERVICE TWO
DIFFERENT CHARTS. WE STILL HAVE
TO HAVE A RELEASE OF
INFORMATION FOR MY TO
CLINICIANS WHO ARE EMPLOYED BY
THE SAME ENTITY TO LOOK AT EACH
OTHER'S CHART. SO IF WE HAD A
MORE INTEGRATED SYSTEM AND I
WILL SAY THAT WE HAVE- AND-
DONE SOME. PILOT PROGRAMS HERE
IN SAN BENITO COUNTY WHETHER
INLAND EMPIRE HEALTH PLAN OR
MANAGED CARE PLAN WE TRIED
PUTTING ON A- MENTAL HEALTH
CLINICIAN AND AN ADDICTION
COUNSELOR IN PRIMARY CARE. CAN
WORK SO WELL WE PUT THE PRIMARY
CARE NURSE IN OUR CLINIC AND
IT'S BEEN VERY EFFECTIVE WE'VE
SEEN A SIGNIFICANT REDUCTION.
IN THE COMORBIDITIES OF OUR
CLIENTS SPECIFICALLY REDUCTIONS
AND THEIR A. ONE C. LEVEL FOR
THOSE WHO HAVE DIABETES WHICH
IS A BIG PORTION OF OUR
PRODUCTS WE'VE SEEN A DECREASE
IN EMERGENCY DEPARTMENT VISITS.
AND A DECREASE IN PSYCHIATRIC
INPAIENT VISITS THAT JUST
TELLS US OUR DATA TELLS US THAT
IS THE MOST EFFECTIVE WAY. ARE
MENTAL HEALTH AND ADDICTION
DOCK- PATIENTS OFTENTIMES FEEL
SAFER COMING TOGETHER SERVICES
AT OUR CLINICS SO BEING ABLE TO
COORDINATE THAT INTO ONE CLINIC
PURSES TWO. THAT ARE OVERSEEN
BY THE SAME ENTITY MAKES A LOT
OF SENSE ADDITIONALLY- IF WE
HAVE A GREAT CLINICAL PICTURE
THAT SHOULD MAKE THE
ADMINISTRATIVE PIECE MUCH
EASIER AND FAR. LESS BURDENSOME
THAN IT IS FOR ALL OF US. THANK
YOU DR KING FOR VISION WITH THE
WE WILL HOLD ISSUES. OPEN AND
MOVE ON TO A SEVEN. THANK YOU
VERY DR RAMYA THE NEXT. PANEL
IS DISCUSSING BEHAVIORAL HEALTH
REGIONAL CONTRACTING. AND OB
TWO SPEAKERS ESSENTIALLY- THE
ADMINISTRATION- AND- THIS
COOPER I ASSUME AND THEN-
MICHELLE CABRERA THE EXECUTIVE
DIRECTOR OF ACCOUNTING COUNTY
BEHAVIORAL HEALTH DIRECTORS
ASSOCIATION. SO PLEASE WHENEVER
YOU'RE READY MISS COOPER. THANK
YOU I'M SO GIVEN THE- DIVERSE
THE INSIDES OF COUNTIES ACROSS
THE STATE OF CALIFORNIA ON THIS
PER PER PROPOSALS REALLY
LOOKING AT HOW WE CAN PROVIDE
AN INSURER- WE ARE CLEAR WITH-
OUR ABILITY TO BE FLEXIBLE WITH
OUR COUNTY PARTNERS IN AND
ALLOW FOR REGIONAL CONTRACTING.
OF EXISTING A LAW AUTHORIZES
COUNTIES TO DEVELOP REGIONAL
APPROACH IS TO ADMINISTER AND
DELIVER A SPECIALTY MENTAL
HEALTH AND SUBSTANCE USE
DISORDERS TODAY- AND YOU SEE
THIS IS REALLY JUST ENCOURAGING
COUNTIES THROUGH THE CLIPERS
YOU DEVELOP REGIONAL APPROACH
IS TO ADMINISTER AND DELIVER ON
THESE SERVICES AND MEDICARE OUT
WHEN APPROPRIATE AT AND WHERE
BENEFICIAL FOR THOSE COUNTY IS.
A TO DO SO- ALSO LOOKING TO
TAKE ADVANTAGE OF A VARIETY OF
OPTIONS INCLUDING JOINT POWERS
AUTHORITY- TO OPERATE SUCH
SERVICES AND MULTI COUNTY
REGIONS POOLING RESOURCES TO
CONTRACT A WITH ADMINISTRATIVE
SERVICE ORGANIZATIONS ARE THIRD
PARTY ADMINISTRATORS- OR OTHER
ENTITIES THAT AS THEY SEE FIT-
IT REALLY LOOKING AT EVEN SOME
PARTNERSHIPS WITH LOCAL
MEDICARE MEDICARE PLANS TO
CREATE ADMINISTRATIVE
EFFICIENCIES ACROSS. MULTIPLE
COUNTIES WE HAVE HEARD FROM A
NUMBER OF- YOU KNOW BOTH MENTAL
HEALTH AND SUBSTANCE USE
DISORDER UP PLANS- THAT UPON
THE IMPLEMENTATION OF THE TWO
THOUSAND SIXTEEN I FEDERAL
FINAL RULE AROUND MANAGED CARE
UNDER THE ADMINISTRATIVE
COMPLEXITIES AND BURDENS HAVE
BEEN HARD ON SOME COUNTIES
ESPECIALLY SMALL COUNTIES- AND
BY DOING THE COMING TOGETHER TO
ADDRESS THOSE CONCERNS IT MAY
ALLEVIATE SOME OF THAT- THAT.
BOTH FISCAL PRESSURE AS WELL AS
ADMINISTRATIVE BURDEN- ON THOSE
COUNTIES AND SO JUST SHOWING
OUR SUPPORT HERE ESPECIALLY FOR
THOSE SMALL RURAL FRONTIER
COUNTIES- AND COUNTIES WHICH
YOUR POPULATION CENTERS- OF ALL
COMPLIMENTARY COMPLIMENTARY
RESOURCES THAT NEED TO BE AYE
CONSIDERING THIS OPPORTUNITY
THAT THE DEPARTMENT IS VERY
COMMITTED TO WORKING WITH THOSE
COUNTIES TO OFFER TECHNICAL
ASSISTANCE- TO HELP DEVELOP
REGIONAL CONTRACTS. AND
ESTABLISH- ANY INNOVATIVE
PARTNERSHIPS FILLED THEY AND
THAT CAN OUR CALL THIS. GREAT
THANK YOU VERY MUCH- MISS
COOPER. I AFTERNOON- ABOUT THE
AND WOOD AND MEMBERS MACHEL
EXECUTOR DIRECTOR THE COUNTY
HEALTH DIRECTOR THE- AND AS G.
LEADS. COUNTY HEALTH PLAN OUR
VERY EXCITED TO LOOK FORWARD TO
OPPORTUNITIES TO BETTER
COLLABORATE AND COORDINATE
ACROSS THE DELIVERY SYSTEM AND
IN TERMS OF THE BACK AND HEALTH
PLANS FUNCTIONS- THAT THEY ARE
CURRENTLY RESPONSIBLE FOR-
BECAUSE OF ALL OF THE PAYMENT
REFORM CHANGES THAT HAVE BEEN
DISCUSSED TO BE MEDICAL
NECESSITY CHANGES THAT FEDERAL.
COUNTY WILL NEED TO- ENTIRELY
RETOOL THE BUSINESS OPERATIONS
BEHIND HOW THEY FUNCTION AS
PLANNED AND THAT IS ON TOP OF
THE FINAL GOAL- IMPLEMENTATION
REQUIREMENTS WHICH ARE
CONTINUING TO OF ALL- WITH IN
PARTNERSHIP WITH EACH B. F. AND
FELT. THE ONE THING I WOULD SAY
IS THAT CAN BE HEALTH PLANS OF
ALL SIZES ARE EXCITED ABOUT
OPPORTUNITIES TO BETTER
LEVERAGE ECONOMIES OF SCALE
ACROSS THE STATE- TO BETTER
STANDARDIZED OPERATIONS AND
FUNCTIONS INCLUDING THROUGH
JOINT PURCHASING AS WELL AS-
EXPLORING THE OPPORTUNITY FOR-
AT A MULTI COUNTY- ELECTRONIC
HEALTH RECORD FOR EXAMPLE ALL
OF THIS IS POSSIBLE BECAUSE-
COUNTY BEHAVIORAL HEALTH HOPE
DIRECTORS. PRIOR MADE THE
STRATEGIC DECISION WITH SUPPORT
FROM- THEIR THEIR
RESPONSIBILITY FUNDAMENTAL
SERVICES BACK TO STAND UP A
JOINT POWERS AUTHORITY
CALIMESA- WHICH DOES IS DOES
CONSIST OF R. FIFTY EIGHT
COUNTY- PLANS AS WELL AS PART
OF MUNICIPAL MEMBERS THEMSELVES
WE THINK THE JOINT POWERS
AUTHORITY A LOT OF CONVERSATION
IS ALREADY MOVING FORWARD ON
THIS AND WE VERY MUCH
APPRECIATE. THE STATE OFFER OF
SUPPORT AND PARTNERSHIP AND
REALLY THE ENCOURAGEMENT. FOR
COUNTY BEHAVIORAL ALL PLAN- TO
DO MORE OF THIS CALL WORK
MOVING FORWARD- THANK YOU.
THANK YOU VERY MUCH- MOVING THE
COMMITTEE FOR OR COMMENTS FROM
THE COMMITTEE. C. NINE I JUST
WANNA SAY THANK YOU VERY MUCH
TO BOTH THE BOTH OF YOU FOR THE
INFORMATION OF THIS PARTICULAR
PANEL. AND WE WILL GO AHEAD AND
MOVE ON TO OUR EIGHTH AND FINAL
PANEL DR RUBIO. THANK YOU
DOCTOR WOULD WE ARE NOW ON OUR
PANEL ON FULL INTEGRATION PLANS
WE WILL HEAR FROM THE
DEPARTMENT OF HEALTH CARE
SERVICES AS WELL AS- COREY HOW
SHOULD I WITH THE LEGISLATIVE
ANALYST'S OFFICE. AS WELL AS
MICHELLE CABRERA PLEASE BEGIN.
RIGHT SO MY COMMENTS ON THIS
PARTICULAR PROPOSAL WILL BE
RELATIVELY SHORT I THINK GIVEN
ALL OF THE COMPREHENSIVE
PROPOSALS THAT YOU SAW WITHIN
TELLING. AS WELL AS THE
UPCOMING MANAGED CARE PLAN
PROCUREMENT YOU SAW WITHIN THE
UPDATED TELLING PROPOSAL THAT
WE HAD EXTENDED THE TIME PERIOD
FOR THE FULL INTEGRATION PLANS.
THE DEPARTMENT VERY MUCH IS
STILL VERY INTERESTED IN
EXPLORING THIS CONCEPT BUT JUST
WANTED TO NOTATE- YOU KNOW IT
IS A VERY COMPLEX- PROPOSAL AND
SO WILL TAKE TIME FOR THE
DEPARTMENT TO WORK ON- WE DO
ARE VERY INTERESTED TO TEST THE
EFFECTIVENESS. OF THIS
APPROACH- TO PROVIDE FULL
INTEGRATION OF BOTH PHYSICAL
HEALTH BEHAVIORAL HEALTH AND
POTENTIALLY ORAL HEALTH UNDER
ONE CONTRACTED INTO T. BUT AS
YOU'D IMAGINE WITH BEHAVIORAL
HEALTH BEING A REALLY AREN'T
RELYING TO COUNTIES- IT WOULD
REQUIRE BOTH VOLUNTARY
PARTICIPATION. THE COUNTY. AS
WELL AS A MANAGED CARE PLAN-
AND WE KNOW THAT THERE ARE JUST
SO MANY COMPLEXITIES TO- TO
THINK THROUGH IN REGARDS TO
THIS PROPOSAL WHICH IS REALLY
WHY. ARE YOU SEE THE PROPOSED
IMPLEMENTATION- OF TWENTY
TWENTY SEVEN WITHIN THIS
PROPOSAL- AND WOULD JUST NOTATE
THAT NO WE ARE NOT PROPOSING
TRAILER BILL LANGUAGE FOR THIS
PEACE AT THIS TIME. GIVEN THE
COMPLEXITY AND WHERE WE ARE IN
OUR CURRENT ANALYSIS WE DID NOT
THINK THAT THAT WAS APPROPRIATE
SOME. OF THAT RISK IS THE END
OF MY COMMENTS. AND HAPPY TO
ANSWER ANY QUESTIONS AT THAT
TIME. COREY HOSPITAL WITH THE
L. A. M. THANK YOU DR ARAMBULA-
ELIA WILL ALSO BE VERY BRIEF
AND OUR COMMENTS ON ON THIS
PARTICULAR PANEL- JUST SORT OF
WANT TO ECHO- YOU KNOW THAT THE
POTENTIAL BENEFITS OF THESE
PILOTS AND YOU KNOW PROVIDING A
MORE INTEGRATED HEALTH CARE
APPROACH TO MEDICARE
BENEFICIARIES- AS NOTED. BY THE
BY THE DEPARTMENT IMPLEMENTING
THESE THESE PILOTS IS GOING TO
BE A VERY COMPLEX EFFORT AND A
VERY SIGNIFICANT LEFT- YOU KNOW
GIVEN THIS WE DO FIND THAT THE
LATER- SORT OF EXTENDED TIME
FRAME FOR THIS PROPOSAL IS
REASONABLE- THE PROPOSED PILOTS
REYES A HOST OF COMPLEXITIES
HERE PARTICULARLY AROUND
REALIGNMENT IN WHICH COMPONENTS
OF THE PILOT. COUNTIES WILL PAY
FOR WHICH COMPONENTS THE STATE
WILL PAY FOR- AND AS THE STATE
WORKS TOWARDS THESE PIRATE
PILOTS YOU KNOW A VERY
COMPREHENSIVE STRATEGY IS GOING
TO BE NEEDED TO NAVIGATE THESE
ISSUES WELL RIGHT NOW THE
COUNTY PROPOSAL DOESN'T DOESN'T
INCLUDE DETAILS RELATED TO WHAT
THIS PLAN IS GOING TO BE BACK.
IN THE STATE MOVES FORWARD WITH
WITH PURSUING THESE PILOTS- THE
DETAILS ARE REALLY GOING TO
NEED TO BE FLUSHED OUT GOING
FORWARD- AND THAT'S THAT'S ON
ALL IN. THE SAME ISSUE THANK
YOU. NEXT WE WILL HEAR FROM FED
CABRERA EXITS. TO OF COUNTY
BEHAVIORAL HEALTH DIRECTORS
ASSOCIATION. GOOD AFTERNOON
AGAIN CHAIRED THE SHOCK OF IT
AT THE BEACH CA- I AM GOING TO
SPEAK ACTUALLY TO- SOME OF THE
CONCERNS THAT THE DHEA HAS WITH
THE PROPOSAL CORPORAL
INTEGRATION PLAN- THAT GO
BEYOND REALIGNING
CONSIDERATION- AND I THINK THAT
WE BELIEVE MUST BE CAREFULLY
WEIGHED OVER THE NEXT SEVERAL
YEARS AB FIVE. EIGHT AND
EXTERNAL STAKEHOLDERS IN THE
PURSUIT OF ENCOURAGING- THE
VOLUNTARY AND ESPECIALLY TO
MENTAL HEALTH AND ACTIVITY
CARVE OUT THROUGH VOLUNTARY
POOL INTEGRATION PLAN- UNDER
THIS MODEL SPECIAL BE MENTAL
HEALTH AND BEAUTY SERVICES
WOULD NO LONGER BE ADMINISTERED
BY COUNTY BEHAVIORAL HEALTH
PLAN. BUT RATHER BY AND MANAGED
CARE ENTITY THAT OPERATES THE
FULL INTEGRATION PILOT. WE
BELIEVE THAT THIS MAY CREATE
SEVERAL MAJOR PROBLEMS THAT WE
NEED TO FLESH OUT FIRST
NATIONALLY MANAGED CARE CARBON
OF SERIOUSLY MENTALLY ILL
POPULATION ARE RELATIVELY NEW
AND STILL IN THE EARLY STAGES.
WE'RE NOT AWARE OF SIGNIFICANT
STUDY ON HOW THESE EARLY CARBON
VERY IMPACTING ACCESS TO
SPECIALTY SERVICES PARTICULARLY
WITH DISPONIBLE POPULATION
WHICH- BECAUSE BE UNIQUE
DYNAMIC- THAT WHEN AND A PERSON
WITH THE- MENTALLYMENTAL
ILLNESS FAILED TO FILL BY SOME.
YEARS DON'T JUST SHOW UP ON THE
MEDICAID HEALTH PLAN OR
PROVIDER LEDGERS OUT WITH OTHER
FORMS OF MEDICAL DISEASE AN
ILLNESS BUT RATHER THESE
INDIVIDUALS END UP OUTSIDE OF
MEDICAID REIMBURSABLE SERVICES.
SUCH AS IN THE I AND B.
SERVICES BE DISTRACTED DAY OR
IN OTHER LOCKER SPENDING
PLEDGES STATE HOSPITAL IN
CORRECTIONAL FACILITIES. FOR
THESE REASONS WE BELIEVE THAT
THE FINANCIAL INCENTIVES AND
ACCOUNTABILITY ARE INCREDIBLY
DIFFICULT TO A LINE THROUGH
HEALTH PLAN INTEGRATION ALONE.
CHINESE ON THE OTHER HAND
CURRENTLY BEAR REPORT AND
INVEST. IN WHAT I'D LIKE TO
REFER TO AS THE MEDIC CAL
BOOKEND. ON THE FRONT END EARLY.
OUR IN ENGAGEMENT SERVICES. AND
ON THE BACK AND A CUTE
INCLUDING. TEND TO BE. AND I AM
DE AS AS BLACK THAT IN BETTER
NOT COVERED THROUGH MEDICAID
HOW. JOHNNY BE REAL. CURRENTLY
OPERATES UNDER A GOLD BUDGET
FOR IT BUT IF YOU HEARD TO DATE.
WE MUST HOPE TO NOW A COMPLEX
WEB OF THE AND FEDERAL WILL
THAT THE- BECAUSE OF THE
SERVICE. OUR SIX TWO REMOVE SO
MANY OF BARRIERS. IN BETTER OUT
WE NEED TO CAN WHAT GOAL ARE
AND WHAT IF THE GOAL TO THAT
THE HEALTH OUT AND LOWERING THE
WHITE COLLAR AND MORE FOR AND
GET WITH MENTAL ILLNESS IN AT
THE DEEP. LATER SO OFTEN AT THE
WITH CAPTAIN TO PHYSICAL HEALTH
CARE WE OUGHT TO LOOK AT THE OF
OUR MANAGE CARE CURRENTLY IN
MANAGE THE MILD TO MODERATE
BENEFIT. BY AND LARGE MANAGE
CARE PLANS AND HEALTH HOW DID
SHE ADMINISTRATIVE INTEGRATION
OF THAT BENEFIT BUT THESE
BENEFITS ARE OFTEN ADMINISTERED
TO A SEPARATE DELEGATED IN ANY
CITY WITH SEPARATE PROVIDER
NETWORKS. ADMINISTRATIVE AND
FISCAL INTEGRATION HAS NOT YET
RESULTED IN THE TYPE OF MENTAL
HEALTH SERVICE INTEGRATION BUT
PHYSICAL HEALTH THAT WE MIGHT
HAVE ANTICIPATED WITH THE WHOLE
LOT OF THEIR BENEFITS.
THEREFORE WE WOULD EMPHASIZE
THAT ADMINISTRATIVE INTEGRATION
AND CLINICAL INTEGRATION REALLY.
AREN'T TOO DIFFERENT ENDEAVORS.
WHY WOULDN'T OUR THAT BETTER
ALIGN FIND IN IN AND- MIGHT
HELP DRIVE QUALITY INTO. IT IS
NOT A GOOD AND- SERVING. MY AND
IT WILL BE CAN BE A CHALLENGE
PARTICULARLY IF YOU GO ON.
LOCATION FOUR MONTHS ON. STATUS.
NO CHILD BY. BOB CHOIR. PLEASE
OUT AND ENGAGEMENT ACT AS WELL
AS I AND YOU ARE NOT COVERED BY.
IT ALSO RICK FIELD BASED
SERVICES WHICH BRINGS THE
PROVIDE OUT INTO COMMUNITY TO
MEET CLIENT WHERE THEY ARE AT
RATHER THAN X. CLIENT COME INTO
FOR WHAT OF THE HOUSE CARE.
FURTHER FMI ITS BEAUTY CLIENT
ALL BASED DIDN'T BIG MONEY IN
TRYING TO ACT ALL FORMS THE
CARE YEAH I THINK BE HERE
HEALTH. THAT TIME BUT OFTEN
CLAIM MUCH MORE EXPECT WELCOME
UNLESS STATEMENT WITH THEIR
WITHIN THEIR BEHAVIOR FROM. AS
PRIMARY HOW HOME I TALKED KELLY
RESTING. WELL MAKE CAN IS HELP.
TO ADDRESS SOME OF THE- LONG
STANDING STICKING. TOWARD THE
RIVER GOAL PLAN CONCLUDED. NOT
GUARANTEE AND THERE MUST BE A
FIVE PART OF THE ANALYSIS OF
HOW BENEFICIARIES ACROSS THE
COUNTRY ARE SAFE. INTEGRATION
EXPERIMENT. THE ANALYSIS ON THE
INTEGRATION OF SERVICES
PARTICULARLY FOR INDIVIDUALS
WITH MORE SEVERE MENTAL ILLNESS
AND SUBSTANCE USE DISORDERS CAN
ALSO BE DONE WITH AN EYE TOWARD
WHAT EXISTS OUTSIDE OF THE
SPEAKING AT TODAY. UNLIKE WITH
PHYSICAL HEALTH THE EXPERIENCE
WITH THE COUNTY SAFETY NET
DEMONSTRATE THAT EVEN THOSE
WITH PRIVATE COMMERCIAL
COVERAGE CANNOT ACCESS TIMELY
AND APPROPRIATE BEHAVIORAL
HEALTH SERVICES. AS REFERENCED
BY- THE- PERSON EARLIER WITH AT
THE END YOU. KNOW SERVICES
SOMETIMES THEY'RE ONLY
AVAILABLE TO THE COUNTY
BEHAVIORAL HEALTH SAFETY NET
AND THEY'RE COMPLEMENTED WITH
NON MEDICAL SERVICES IN OTHER
WORDS IT WON'T BE AS SIMPLE AS
BUILDING A NETWORK WITH
EXISTING PROVIDERS WHO OFTEN
AREN'T WILLING. TO COME INTO
MEDICARE NETWORKS AT ALL.
FURTHER THANK YOU FOR HOLDING
TO DATE ALREADY PROVIDE- INTO
ACCESS WITH HOUSING SO SERVICES.
EDUCATION AND OTHER OUT OF HELP.
SYSTEM ANOTHER UNIT ELEMENT OF
THE B. HEALTH SAFETY NET ABOUT
IN CALIFORNIA TODAY WHICH WOULD
BE DIFFICULT TO REPLICATE R.
THE HYPER TENDERS AROUND
CLIENTS AND COMMUNITY VOICE AND
CHOICE AS WELL S AN
ORIENTATION AROUND TRAUMA
INFORMED CARE RECOVERY
PRINCIPLE. CAN EVEN CLIENTS AND
GAUGE IN INFORMING IMAGE IT'S A
PLAN THROUGH COUNTY MENTAL
HEALTH BOARDS AND COMMISSIONS
AS WELL AS WE GET TO ENGAGEMENT
IN OUR CULTURAL COMPETENCE
PLAN. TO OUR KNOWLEDGE THESE
PRACTICES ARE UNIQUE IN THE WAY
THAT THEY ARE- REQUIRED TO BE
DONE UNDER MEDIC HOUSE
SPECIALTY BECAUSE THEY'LL HELP.
AS A RESULT WE SERVE HIGHER
NUMBERS THE BENEFICIARY OF
COLOR AND HAVE ACTUALLY
SUPPORTED THE DEVELOPMENT OF
COMMUNITY DEFINED PRACTICES.
OUTSIDE OF MEDICARE
REIMBURSEMENT. ONE THE BOTH OF
CHALLENGE TO BRING MANY OF THE
SERVICES IN UNDER MEDICARE WE-
MANY ALSO BUSINESS WORK FORCED.
IN BEHAVIORAL HEALTH AND THE
AVAILABILITY OF HONEY BEES
PROVIDERS HAS REALLY MADE UP
FOR SOME OF THE SHORTCOMINGS
ACROSS THE STATE BOTH IN RURAL
AND URBAN AREAS ALIKE. COUNTIES
ALSO MANAGED PRIVATE INPATIENT
SERVICES TREATMENT FOR LPS
CONSERVATIVE. PREVENTION AND
OTHER TYPES OF EMERGENCY
DISASTER SERVICES A QUALITY
KEEPER HOPE THEIR RESEARCH IN
THE REMAINING AND SHARE ALL OF
THAT WOULD FALL OUTSIDE. OF
HEALTH MEDICAL HEALTH PLAN-
SMITH RESPONSE- FOR CBH HAS
MANY ABOUT THE AFFECT THE
PULLING TRUTH BUT THAT SHOULD
BE BEHAVIORAL HEALTH MODEL
APART TO REDISTRIBUTE ONLY
MEDICAL BENEFITS TO ANOTHER
ADMINISTRATOR DEMAND. FROM THE
BROADER CONTINUUM OF SERVICES.
LET ME BE CLEAR WE SUPPORT
GREATER EMPHASIS ON IMPROVING
BENEFICIARY ACCESS TO PRIMARY
AND OTHER CRITICAL HEALTH
SERVICES. AND TO REDUCE
PROVIDER STIGMA TOWARD
INDIVIDUAL BUT SERIOUS MENTAL
ILLNESS AND A CITY HOWEVER
WHILE THE ADMINISTRATIVE
INTEGRATION OFFERS POTENTIAL
GAME HERE IT IS IMPORTANT TO
UNDERSTAND WHETHER
BENEFICIARIES ARE BETTER
SERVED. WHEN THEY'RE CARE
PROVIDED IN THE PLAN FOR
WEATHER FRAGMENTATION. AND NEED
BEHAVIORAL HEALTH CARE NEEDS
ARE CONSIDERED WHEN THEY ARE
SAID WITHIN. A BROADER
POPULATION THANK YOU. THANK YOU
VERY MUCH. C. THAT BECAUSE THAT
OF THE POWER WILL BRING IT TO
MEMBERS FOR ANY QUESTIONS.
SEEING NONE I WILL THANK THIS
PANEL- SPECIFICALLY- MISS
CABRERA FOR YOUR COMMENTS
YOU'VE GIVEN US A LOT TO. THINK
ABOUT. WITH THAT WE WILL NOW
MOVE ON TO PUBLIC COMMENT. AND
I WILL HAND IT OVER TO DOCTOR
WOULD. THANK YOU VERY MUCH
DOCTOR REGULAR AND- BEFORE WE
ACTUALLY MOVED TO PUBLIC
COMMENT I JUST WANNA SAY THANK
YOU AGAIN TO ALL THE PANELISTS
WHO JOINED US HERE TODAY- THIS
IS OBVIOUSLY VERY COMPLICATED
TOPIC- AND THE GOALS OF
EVERYONE INVOLVED HERE IS- ARE
AMBITIOUS- WITH THE ULTIMATE
GOAL OF PROVIDING BETTER
QUALITY CARE- WHOLE PERSON.
CARE TO- TO PEOPLE WITHIN THE
MEDICAL SYSTEM SO- THIS IS THE
FIRST HEARING OF TWO WE HAVE
ANOTHER ONE NEXT WEEK- WHERE
WE'LL BE DELVING INTO- A WHOLE
DIFFERENT ARRAY OF TOPICS BUT
BUT WE DEDICATED THIS THIS FOR
FIRST ONE TO- BEHAVIORAL
HEALTH- ISSUES IN PARTICULAR-
AND SOME OF SOME AROUND
SUBSTANCE ABUSE AS WELL SO. SO
WE THANK EVERYBODY FOR THEIR
PARTICIPATION- AND YOU KNOW WE
IT'S OUR JOB TO ASK HARD
QUESTIONS SOMETIMES- AND- PART
OF OUR OVERSIGHT ROLE IN OUR IN
OUR RESPONSIBILITY TO WORK WITH
THE ADMINISTRATION ON THIS-
THIS REMINDER THAT YOU KNOW
NEARLY FOURTEEN MILLION PEOPLE
IN CALIFORNIA. RECEIVE SERVICES
TO THE MEDICARE PROGRAM ON
THAT'S AND THAT IS MORE THAN A
THIRD OF THE POPULATION AND
HALF OF THE CHILDREN IN
CALIFORNIA SO IT'S OUR DUTY TO
DO THE BEST VERY BEST WE CAN
FOR EVERYBODY INVOLVED SO- WITH
THAT- WE WILL OPEN THE LINES TO
PUBLIC COMMENT. I'LL REPEAT THE
CALL IN NUMBER FOR PUBLIC
COMMENT FOR THIS HEARING. IT IS
EIGHT SEVEN SEVEN SIX NINE TWO.
EIGHT NINE FIVE SEVEN. AND THE
ACCESS CODE IS TWO FOUR TWO.
SIX TWO THREE SEVEN. ONCE AGAIN
THAT IS EIGHT SEVEN SEVEN. SIX
NINE TWO EIGHT NINE FIVE SEVEN
AND THE ACCESS CODE IS. TWO
FOUR TWO SIX TWO THREE SEVEN WE
HAVE MEMBERS OF PUBLIC TO KEEP
THEIR COMMENTS TO TWO MINUTES
OR LESS- WE ALSO ONE OF. SAY
AGAIN THAT WE DO ACCEPT WRITTEN
COMMENTS SUBMITTED TO THE
COMMITTEE. THROUGH OUR OUR
WEBSITE- OPERATOR- IS OR ANYONE
ANYONE ON THE LINE WHO'S LIKE
TO GIVE PUBLIC COMMENT. YES WE
GO TO LINE AT NINE BUT PUBLIC
COMMENT PLEASE GO AHEAD. THANK
YOU DOCTOR WOULD END UP TARIAN
VILLEGAS'S NGT ACTS ON BEHALF
OF SEIU CALIFORNIA WE REPRESENT
THE COUNTY BEHAVIORAL HEALTH
WORKERS AND THE NUMBER OF
CONTACTED BEHAVIOR HEALTH
CLINICS- WE ARE GRATEFUL THAT
YOU BOTH HOSTED DISCONNECT
WEEKS COUNTING HEARING BECAUSE-
THEY ARE EXTREMELY INSTRUMENTAL
IN THE THIRD THE LEGISLATURE'S
ROLE IN IMPROVING THE
ADMINISTRATION ACCOUNTING
PROPOSAL. FIRST ON THE MEDICAL
NECESSITY POLICY CHANGE WE
STRONGLY SUPPORT THE PROPOSAL
AS MENTIONED BY A MEMBER CONNIE
BECAUSE BILL. ADDITIONALLY WE
LOOK FORWARD TO WORKING WITH
THE ADMINISTRATION AND OTHER
STAKEHOLDERS TO ACCOMPLISH THAT
APPROPRIATELY AND IN A WAY THAT
WILL NOT INTENTIONALLY REMOVED
MEDICALLY NECESSARY EXCEPT THE
P. STANDARD PROTECTIONS IN LAW.
ON SECOND ON PAYMENT REFORM
THIS SHIFTIN FOCUS FROM COSTA
QUALITY AND VALUE OF SERVICES
FOR BEHAVIORAL HEALTH PAYMENT
REFORM IS A STEP IN THE RIGHT
DIRECTION HOWEVER WHEN
ESTABLISHING REIMBURSEMENT
RATES FOR COUNTIES WE LIKE THE
EACH YEAR ALSO CONSIDERED THE
NUMBER AND QUALITY OF
INVESTMENT IN THE WORK FORCE
TRAINING AND INFRASTRUCTURE
NEEDED TO PROVIDE. HIGH QUALITY
SERVICES TO MANY COM NUMBERS
THESE ARE CRITICAL FACTORS THAT
WILL HELP COUNTIES EXPAND AND
MAINTAIN STRONG PROGRAMS IN THE
LONG TERM. ADDITIONALLY WOULD
LIKE TO REQUEST TO BE A
MECHANISM FOR TRANSPARENCY AND
ACCOUNTABILITY SO THE PUBLIC
CAN BETTER TRACK HOW FUNDS ARE
FLOWING THROUGH THE COUNTIES.
WE SUPPORT THE INTEGRATION OF
MENTAL HEALTH SERVICES AND STD
SERVICES ESPECIALLY IMPORTANT
FOR CLIENTS TO HAVE- OCCURRING
DISORDERS AND LASTLY THERE
SHOULD BE AN AUTOMATIC
ELIGIBILITY FOR CHILDREN AND
YOUTH START BY OUR CHILD
WELFARE SYSTEM INCLUDING PRE
DETENTION USED. TO BE SEEN
SPECIALTY MENTAL HEALTH
SERVICES AN SUV SERVICES.
INSURED CHILDREN AND YOUTH AND
THEIR FAMILIES AND THEIR
CAREGIVERS CAN ACCESS THE FULL
RANGE OF B. H. SERVICES
WORKFORCE CAPACITY MIGHT ALSO
REFLECT. ON AND BE EXPANDED. TO
INCLUDE BOTH BEHAVIORAL HEALTH
COUNTY FAST AND COUNTY PUBLIC
HEALTH NURSE. THANK YOU. THANK
YOU VERY. NEXTER CALLER. SENATE
REMINDER IN A PRESS IN THE TO
MAKE A PUBLIC- THE TO LINE
EIGHT THE NEXT COME. THE GO
AHEAD. A DOCTOR WHERE THE
DOCTOR ARAMBULA INTO MANY
MEMBERS HI GOOD AFTERNOON MY
NAME IS WENDY WAY WITH HAPPILY
SYCAMORE A COMMUNITY MENTAL
HEALTH AND SOCIAL SERVICE
ORGANIZATION BASED IN L. A.
COUNTY. ARCHITECTURE THEMSELVES
WITH THE TESTIMONY PROVIDED
EARLIER BY DOCTOR LEE UNDER
CLARK HARVEY. WE SUPPORT THE
PROPOSED SHIP. FROM CERTIFIED
PUBLIC EXPENDITURES TO INTER
GOVERNMENTAL TRANSFERS. IT WILL
BE IMPORTANT FOR DH CS TO
PROVIDE CLEAR GUIDANCE. TO THE
COUNTY IS THAT IN THE SHIFT
FROM THE P. E. I. G. P. ANY
ACCOMPANYING ACCOMPANYING
FLEXIBILITY. NEEDS TO APPLY TO
COUNTY CONTRACT PROVIDERS SO
THAT THE ENTIRE. SPECIALTY
MENTAL HEALTH. IT'S MOVING THE
BASED AND OUTCOME BASED CARE.
CONTACT PROVIDERS WITHIN THE
COUNTY NETWORK IN THE SPECIALTY
MENTAL HEALTH SYSTEM PROVIDES
SIGNIFICANT PORTION OF THE CARE
JUDY'S MEDICARE BENEFICIARIES
WHO WE ARE DISCUSSING THIS
TRANSFORMATION ENVISIONED IN
KALANK WILL LIKELY NOT BE
ACHIEVED UNLESS. WE INCLUDE ALL
THE PROVIDERS ACROSS THE
DELIVERY SYSTEM THANK YOU SO
MUCH THANK YOU VERY MUCH. THE
NEXT CALLER PLEASE. THANKS TO
GO TO LINE SIXTEEN PLEASE GO
AHEAD. TO THE CHAIRS CHAIRMAN
WOULD HAVE GERMAN ARAMBULA THIS
IS RACHAEL HAGER FOR THE
PSYCHIATRIC POSITIONS ALLIANCE
OF CALIFORNIA- THANK YOU FOR
THE OPPORTUNITY TO COMMENT
TODAY THANK YOU FOR HOLDING
THIS HEARING. HOW THERE'S A LOT
TO LIKE IN THE COUNTING
PROPOSALS ARE OF SURPRISED MR
CONCERNED- GENERALLY BUT I'D
LIKE TO SPECIFICALLY COMMENT ON
THE IMD WAIVER ISSUE- WOULD
START WITH ASSOCIATING- THE
POSITION OF SOKAYA INTERESTS
WITH THAT OF THE TESTIMONY OF
STEPHEN CREDIT NOT CALIFORNIA.
WHO DID AN EXCELLENT JOB UP
ILLUMINATING THE CONTOURS AND
PARAMETERS OF THIS ISSUE SHOULD
I INTEREST PROVIDE THE CARE FOR
PEOPLE WITH SEVERE MENTAL
ILLNESS IN THE COMMUNITY THEY
HAD MET- AT THE DOOR AND TREAT
THEM THROUGHOUT THE DURATION OF
INPATIENT STAYS AND THEY ACCESS
AND RELEASE- WHEN APPROPRIATE
FROM THOSE STATES ALSO
TREATMENT STEP DOWN FACILITIES
AND THEN AGAIN IN THE COMMUNITY
SO. ACTORS KNOWS WELLS ANYONE
YOU KNOW HOW CRITICAL AND HOW
UNDER RESOURCE IS THAT SEGMENT
OF THE CARE CONTINUUM THAT
PROVIDES THE EMERGENCY CARE FOR
MANY CONSUMERS AT A PARTICULAR
POINT IN TIME AND NOT A
PARTICULAR POINT IN THEIR
JOURNEY WITH MENTAL ILLNESS IT
IS THE LEAST RESTRICTIVE LEVEL.
OF CARE IT'S FOR. OKAY FOR NINE
WHERE. THANK YOU VERY MUCH I
THINK YOU'RE OKAY I WASN'T SURE
IF YOU'RE IF YOU'RE IF YOU
FINISH IT UP OKAY. I'M SORRY
YES I AM DONE OKAY OKAY THANK
YOU THANK YOU CUT YOUR CUT OUT
FOR A SECOND SO THANK YOU VERY
MUCH- AND NEXT BIGGER PLEASE.
THE NEXT TO GO TO LINE NINETEEN
PLEASE GO AHEAD. GOOD AFTERNOON
MR CHAIRMAN MEMBERS OF THE
THIRTY DAYS HANG ON BEHALF OF
THE CALIFORNIA STATE
ASSOCIATION OF COUNTIES- IN
INTEREST THE TIME I WANT TO
ALIGN MYSELF WITH MANY OF THE
SUPPORT OF SUPPORT WITH MANY OF
THE PROPOSALS AND CAL AIMS-
THAT THAT CALIFORNIA'S. BE
REVOKED REPRESENTATION ALSO
SUPPORT- I DO WANT TO NOTE THAT
THE FULL RFR THE SACRAMENT ALSO
LONOKE COUNTY PROPOSAL I'M
HAVING THE KAISER. THE GO BACK
THE COUNTIES OF IS CLEARLY NOT
THE COOED NEEDS A LOT-
EXAMINATION AT. THAT WE'RE- OF
CAL BECOME AIMED EFFORT OVERALL
APPRECIATE HAVING THIS HEARING
ABOUT ALL THE BEHAVIOR HEALTH
ISSUES. WITHIN CALLIN THANK YOU
THANK YOU VERY MUCH. X. BIGGER
PLEASE. OUR NEXT CALLER PLEASE.
AGAIN IF YOU WISH MAKE COMMON
YOU MAY PRESS ONE AT ZERO AT
THE TIME. AT THE TIME THERE ARE
NO COMMON THANK YOU. OKAY WELL
THANK YOU VERY MUCH IT WILL
BRING BACK ANY CLOSING COMMENTS
ARE CURRENTLY NOT SEEN NONE-
WE'LL GO AHEAD AND CLOSE THE
HEARING WIL LET DOCTOR REGULAR
BANG THE GAVEL BECAUSE HE'S GOT
IT SO FACIALLY CLOSE THE
HEARING TODAY AND WE WILL BE
BACK NEXT WEEK- FOR A SECOND
HEARING ON ON THIS- PROPOSAL SO
THANK YOU VERY MUCH. AND HAVE A
GREAT EVENING.