Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, and under which qualified low-income individuals receive health care services, including substance use disorder services that are delivered through the Drug Medi-Cal Treatment Program and the Drug Medi-Cal organized delivery system, subject to utilization controls. For purposes of the Drug Medi-Cal Treatment Program, existing law prescribes the maximum allowable rates for services, including individual and group rates for extensive counseling for outpatient drug-free treatment. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.

This bill would expand substance use disorder services to include contingency management services as an optional benefit under the Drug Medi-Cal organized delivery system, as specified, subject to utilization controls. The bill would require counties that administer the Drug Medi-Cal organized delivery system to submit a plan to the department that demonstrates readiness to implement contingency management services that are provided to eligible Medi-Cal beneficiaries through electronic or in-person means and to consult with stakeholders for purposes of developing that plan. The bill would require the department to review and approve the plan. The bill would require the department to issue guidance on the use of contingency management services for Medi-Cal beneficiaries who access substance use disorder services under the Drug Medi-Cal organized delivery system. The bill would provide that contingency management services are not a rebate, refund, commission preference, patronage dividend, discount, or any other gratuitous consideration. The bill would authorize the department to establish limits on the number and value of incentives available to Medi-Cal beneficiaries who receive contingency management services, and to implement these provisions by various means, including provider bulletin, without taking regulatory action. The bill would condition the implementation of these provisions to the extent permitted by federal law, the availability of federal financial participation, and the department securing federal approval. The bill would require the department to determine maximum allowable rates for contingency management services, as specified.