Behavioral Health Coordination

Cal MediConnect health plans will be required to provide their members access to all needed behavioral health services (mental health and substance use disorder treatment) currently covered by Medicare and Medi-Cal.

All Medicare behavioral health services will be the primary responsibility of the Cal MediConnect plans, but Medi-Cal specialty mental health services and Drug Medi-Cal will remain the responsibility of county agencies (i.e. they will be “carved out”). Cal MediConnect plans and county agencies will be required to coordinate to ensure people have seamless access to care.

Each health plan must have a Memorandum of Understanding (MOU) with its county behavioral health agencies. These MOUs outline roles and responsibilities, patient information sharing, and a “strategy for shared accountability.” Under this strategy, one quality measure each year of the demonstration relates to the plan-county coordination for behavioral health services. If the plan successfully achieves this measure, it will earn back a percent of its capitation payment and then will be required to give a portion of the funds earned back to the county as an incentive payment.

• FACT SHEET: Behavioral Health Coordination in Cal MediConnect (Sept. 5, 2012)