The El Dorado County Drug Medi-Cal Organized Delivery System (DMC-ODS) is a managed care plan organized under 42 Code Federal Regulations Section 438.2 as a Prepaid Inpatient Health Plan. The plan is authorized under a pilot program initiated by the state's Medicaid administrator, the California Department of Health Care Services (DHCS), in coordination with the Center for Medicare & Medicaid Services of the U.S. Department of Health and Human Services.
The El Dorado County Health and Human Services Agency (HSAA) is authorized by the El Dorado County Board of Supervisors to administer the plan under an intergovernmental agreement with DHCS. The plan is administered by HHSA's Behavioral Health Division. The
purpose of the pilot program is to test a new, more organized and comprehensive approach to providing substance use disorder (SUD) treatment services to Medi-Cal eligible youth and adults. The goal is to demonstrate how this treatment concept improves individual health outcomes while decreasing system-wide health care costs.
Substance use disorders are often chronic, relapsing conditions of the brain that affect behavior by reinforcing compulsive drug seeking and use, despite catastrophic consequences to individuals, their families, and others around them. While some individuals may develop a substance use disorder and achieve recovery after minimal intervention over a brief time, others will succumb to an intensified and relapsing course. Approaching substance use disorders as a disease assists with framing interventions aimed at managing the condition through a model of care that provides a continuum of services tailored to an individual's needs. El Dorado County DMC-ODS provides the continuum of care modeled after the American Society of Addiction Medicine (ASAM) Criteria.
The ASAM Criteria provides outcome-oriented and results-based care in the treatment of addiction. The ASAM Criteria was created to improve the quality of and access to addiction care and is the most widely used and comprehensive set of guidelines for placement, continued stay, transfer, and discharge of patients with addiction and co-occurring conditions.
The ASAM Criteria is a single, common standard for assessing patient needs, optimizing placement, determining medical necessity, and documenting the appropriateness of reimbursement.
The ASAM Criteria provides a consensus based model of placement criteria and matches a patient's severity of SUD illness with treatment levels that run a continuum marked by five levels of care.
The principles, concepts, and criteria of the ASAM Criteria promote good stewardship of resources in the addiction, mental health, and general health care systems.
This approach is expected to provide DMC-ODS eligible enrollees with access to the care and services they need to achieve a successful and sustainable recovery and improve access to quality care by:
Expanding local networks of high quality providers through selective provider contracting;
Requiring the use of evidence-based practices in SUD treatment;
Increasing coordination with other systems of care, including physical and mental health;
Increasing local control and accountability with greater administrative oversight and;
Creating quality assurance and utilization controls to promote efficient and effective use of resources.
El Dorado County Implementation Plan:
Detailed information regarding El Dorado County's plan to implement the DMC-ODS system countywide.
California Department of Health Care Services (DHCS):
Additional information regarding state wide initiative to develop adequate substance use treatment throughout California.