CalAIM Rate Setting Review and Methodology

To develop a comprehensive rate-setting strategy for Behavioral Health services in San Mateo County, focusing on Mental Health Outpatient Services and Substance Use Disorder (SUD) Outpatient and 24-hour Residential treatment services. The strategy aims to ensure fair reimbursement aligned with productivity and local economic conditions while maintaining operational sustainability. The rate methodology should encompass the entire BHRS delivery system rather than the current siloed practice that separates MH and SUD services.

One year into the implementation of CalAIM, San Mateo County Behavioral Health and Recovery Services (BHRS) needs to re-examine its provider rate strategy. BHRS’s current provider rates for Outpatient Services for both Mental Health (MH) and Substance Use Disorder (SUD) are reimbursed at a reduced percentage of the CalAIM rates set by the Department of Health Care Services (DHCS). The Mental Health Outpatient services rates are 65% of the County rate. The 24-hour SUD Residential services are set using various methods, ranging from 65% to 225% of the County rate. As BHRS provides services through county-operated clinics and contracted providers any rate setting methodology must consider the needs of both groups. BHRS needs a comprehensive review of rates and methodologies to determine how best to support all services and venues.