In a new Behavioral Health Information Notice (BHIN 22-056 The Recovery Incentives Program: California’s Contingency Management Benefit), the Department provides policy guidance for the Contingency Management (CM) program, which provides incentives as a Medi-Cal benefit to beneficiaries with stimulant use disorder. As part of the CalAIM demonstration, California became the first state in the nation to receive federal approval to cover CM services for substance use disorders as part of the Medicaid program. California’s program that offers the CM benefit is called the Recovery Incentives Program.
DHCS will pilot MediCal coverage of CM in select Drug Medi-Cal Organized Delivery System (DMC-ODS) counties between the first quarter of 2023 and March 2024. The Department intends to use the pilot as a basis for informing the design and implementation of a statewide CM benefit through the DMC-ODS program, pending budgetary and statutory authority. The Information Notice (BHIN) provides state standards for the Recovery Incentives Program and outlines the steps participating DMC-ODS counties must take to implement CM services.
Under the pilot, eligible Medi-Cal beneficiaries will participate in a structured 24-week outpatient CM service, followed by six or more months of additional treatment and recovery support services without incentives. The initial 12 weeks of CM consists of a series of incentives such as cash-equivalents (e.g., gift cards) for meeting treatment goals. CM should be offered alongside other therapeutic interventions, such as cognitive behavioral therapy and motivational interviewing. CM should never be used in place of medications for addiction treatment (MAT), but may be offered in addition to MAT for people with co-occurring stimulant and alcohol or opioid use disorders.
CM services are available to Medi-Cal beneficiaries who meet access criteria for an individualized course of SUD treatment, reside in a participating DMC-ODS county, and who receive services in non-residential levels of care operated by a DMC-ODS provider participating in the Recovery Incentives Program. Eligible beneficiaries shall be admitted into treatment through a participating provider’s routine beneficiary admission process. Consistent with other DMC-ODS programs, there is no minimum age limit for an individual to receive CM services if they meet all eligibility criteria. In addition, pregnant and parenting people with StimUD are eligible to receive CM services. Medi-Cal beneficiaries who are receiving care in residential treatment or institutional settings are ineligible for CM services until the day of discharge, when they are transitioned into outpatient care.
The Information Notice provides much more specific guidance regarding:
- Assessment
- Documentation
- Beneficiary Education/Orientation
- Treatment Incentives
- Harm Reduction
- Treatment Schedules
- Provider and Staffing Criteria
- Drug Testing Requirements
- Billing and Reimbursement, including Start-Up Funding for Providers
Oversight, Monitoring, Fidelity Reviews, and Reporting Requirements