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Getting Ready For DMC-ODS Waiver Implementation – Statewide Trainings

Participants in the CIBHS Drug Medi-Cal Organized Delivery System (DMC-ODS) waiver trainings are vocal about implementation successes, barriers and challenges.

The CIBHS DMC-ODS waiver training project hosted its first training May 1, 2016 and is on track to complete 100 trainings throughout the State by December 30, 2016.

There are several content areas including DMC-ODS Waiver Assessment and Modality of Services (MOS); American Society of Addiction Medicine Criteria (ASAM), Selective Contracting (SC); Quality Assurance Processes (QA), Medication Assisted Treatment (MAT), and Continuum of Care (COC). CIBHS utilizes trainers from UCLA, Behavioral Health Services (BHS), and independent contractors.

The trainings were hosted in Sacramento, Riverside, Los Angeles, Redding, San Bernardino, San Mateo, Contra Costa, Santa Cruz, Santa Barbara, Fresno, Yolo, Plumas, Nevada, San Francisco, San Diego, Alameda, and Bakersfield. The target audience included County Behavioral Health staff, Substance Use Disorder Providers, as well as other stakeholders.

As Program manager of the DMC-ODS training project, I’ve had the opportunity to travel the state and learn about the varying county perspectives and from SUD providers on the waiver from all implementation phases such as- Adequate Substance Use Disorder (SUD) capacity is a concern for both County Behavioral Health Staff and SUD providers; The relationship with the courts has been mentioned at almost every training. The waiver requires an ASAM assessment and has limits for length of stay and extensions. Court ordered treatment now often does not align with the waiver lengths of treatment requirements; The focus is now on the assessment driving treatment by using the ASAM; Developing the infrastructure needed to transition is an often mentioned concern. One of the evaluations stated “I understand the training material- what I am trying to understand is the massive change that is underway”; Workforce needs are a concern- wages, pay scales, recruitment/retention, bi-lingual staffing needs, new staffing patterns.

 “The DMC-ODS Waiver is being implemented on the foundation of a 45-year history of county business systems organized on a grants management model and provider operations focused primarily on self-help social model interventions. This is not a criticism. We did the best we could with the resources, science and thinking we had at the time. Now against a backdrop of fundamental changes in administrative, regulatory, financial and clinical practice set in motion by the Waiver, the field is facing the challenge of transformation from an isolated under-funded system to an essential health benefit and an essential component of health care. And we have until October 2020, when the Waiver is due for renewal, to make it all happen”. Victor Kogler, Vice President CIBHS.

The Quality Assurance Processes will be available early 2017 and shall provide counties with instructions for drafting the quality assurance plans in a manner that complies with the Code of Federal Regulation Section 438 requirements and provide guidance on the practical application of the quality assurance plans and organizational structure and operation of the quality assurance committee.

 “Quality Improvement in DMC-ODS has key elements: Organizational leadership, timely access, evidence based treatment, and a client centered, flexible care and support. Overcoming stigma and access and a message of respect for the individual are critical to support of recovery”. Rama Khalsa, PhD Director EQRO.

I asked Al Hasson, UCLA Trainer how he would answer the most frequently asked questions in the Medication Assisted Treatment workshops and he shared his favorite quote from Walter Ling MD. When do we take someone off medicine? “When someone gets a life”.

The regional concerns addressed at a training in Shasta are reflected in this quote-

“Arranging for trainings in the northern region of California can be difficult in the winter months because of the long distances programs are required to travel and problems caused by inclement weather including dangerous road conditions and possible snow.”. Liz Leslie, Shasta County.

CIBHS is looking forward to continuing training in the participating counties as well as moving into new counties in 2017. The CIBHS DMC-ODS waiver training project will work closely with the DMC-ODS Waiver Forum.

Stay tuned for our year-end report in January 2017 in which we will summarize the barriers, most frequently asked questions, and regional concerns.

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