Mental health policies aim to improve access to quality healthcare and ensure parity by coordinating resources and services for those in need, creating incentives to improve outcomes, and promoting efficiency in care. However, California's behavioral health organizations are subject to some of the strictest ad hoc access and parity frameworks in the country.
This article will explore these requirements and discuss how a purpose-built California behavioral health EHR (electronic health record) may help ease some of the regulatory burdens for providers and boost patient care.
California Requirements for Behavioral Health and Human Services
California’s parity laws and regulatory standards for behavioral health and human services are notably complex and rigorous. They reflect the state’s commitment to making mental health care available to all.
For example, federal parity legislation, such as the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 and the Affordable Care Act (ACA) of 2010, ensures that large group health plans, individual health insurance policies, and some types of managed care plans cover mental health and substance use disorders.
Furthermore, they state that behavioral health and human services (BHHS) coverage must be no more restrictive than medical/surgical services coverage. In addition to federal laws, states can expand (though not preempt) regulations.
Some of the key aspects include:
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California Mental Health Parity Act: Also known as Senate Bill 855, this law expanded the types of diagnoses health insurance covered to include all mental health conditions, including substance use disorders. Under this act, health plans must provide coverage for the diagnosis and medically necessary treatment of these conditions. Before that, California required health plans to cover nine specified serious mental illnesses and serious emotional disturbances of a child.
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CalAIM California Advancing and Innovating Medi-Cal: This initiative aimed to upgrade California’s Medicaid program. CalAIM focuses on whole-person, comprehensive, and coordinated care, especially for populations with complex needs. CalAIM introduces support communities and enhanced care management that BHHS providers must integrate into the services provided.
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Specialty mental health services (SMHS) and drug Medi-Cal (DMC): These include regulations that govern everything from service delivery and documentation to billing practices. Detailed certification and compliance require high levels of documentation accuracy.
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Patient privacy and data security laws: California’s patient privacy laws expand federal regulations like HIPAA. The California Consumer Privacy Act (CCPA) impacts how behavioral health data is collected, shared, and stored. The Confidentiality of Medical Information Act (CMIA) requires consent, integrity of records, and reporting compliance.
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Mandatory reporting and quality measures: California requires detailed case management and reporting from substance use disorder treatment facilities, behavioral health providers, and human services organizations to monitor quality-based care measures intended to drive continuous improvement in behavioral health care, such as:
- Patient health outcomes
- Adherence to evidence-based, comprehensive treatment plans
- Inpatient readmission
- Behavioral health symptom and functioning improvement (measurement-based care)
- Patient goal attainment
- Patient experience
- Social outcomes (grade-level attainment, kindergarten readiness, crime rate, employment rate)
- Behavioral health integration with all California counties (58 county behavioral health offices plus other agencies)
- Out-of-pocket cost
- Equity in behavioral health outcomes
- Social service coordination
- Healthcare coordination/referral success
- Parity (equitable access to behavioral health care)
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Integrated care models: Regulations encourage behavioral health integration with the broader healthcare system. This integration requires compliance with additional standards and protocols to ensure timely coordinated care.
The Burdens and Consequences of Additional Compliance
Parity is an important cause, and healthcare equity should be everyone's goal in a caring profession. However, added behavioral health regulations create significant administrative, operational, and logistical burdens for organizations.
This challenge, if not mitigated, can extend deep into the heart of your operations. While designed to improve access and equity and ensure security, privacy, and quality, they often impose undue demands on behavioral health organizations.
For California service providers, some of these pain points have tangible consequences:
- Extensive and complex clinical documentation across multiple programs and agencies consumes valuable time.
- Data reporting to keep track of quality measures and program compliance can be overwhelming and may take dedicated staff.
- Compliance means staying abreast of evolving laws as CalAIM regularly introduces new requirements regarding care coordination and documentation.
- Keeping up with individual and program costs adds another level of complexity to revenue cycle management (RCM).
The Benefits of a California Behavioral Health EHR Solution
For many, compliance is not just a matter of policy adherence but an ongoing challenge that consumes a significant investment in time and money. From maintaining HIPAA compliance to ensuring the privacy of patient data, adhering to the evolving regulations and standards set forth by the government at state and federal levels demands meticulous attention to detail and fastidious record keeping.
This can be especially daunting if you have already outgrown your EMR and need an upgrade.
The cost of compliance is multifaceted. Financially, organizations must allocate funds to meet the record-keeping standards and train staff to operate EHR software competently. However, depending on the system, they may need to purchase expensive equipment like a server or hire health IT professionals to manage everything.
The good news is that a California behavioral health EHR system, purpose-built for your organization by ContinuumCloud, can significantly ease the burdens of operations, parity, and other regulations.
Cloud-Based EHR Solution With Onboarding
ContinuumCloud’s EHR solution is a cloud-based system. This means you won’t need to purchase expensive equipment and servers, hire IT consultants, or train your staff. We handle it all for you.
Clinical Care Management
ContinuumCloud’s EHR platform includes built-in assessment tools, done-for-you templates, and automated treatment plan generation. These features ensure compliance with regulatory standards while streamlining documentation.
Integrated Billing and RCM
By optimizing your existing billing processes with integrated billing, you’ll simplify coding, reduce claim errors, and speed up the revenue cycle. Specific features like eligibility verification and claims scrubbing can also reduce denials. Built-in reporting functionality streamlines cost compliance tracking to help you keep up with payment reform legislation.
Telehealth and Messaging
Secure messaging and synchronous or asynchronous telehealth enable timely and convenient care delivery. This improves the patient experience and increases patient engagement, two drivers of value-based care that are critical for reaching mandated outcomes.
Patient Portal and Self-Scheduling
Offload administrative tasks by automating patient intake, appointment setting, and appointment reminders.
Chat and Communication
ContinuumCloud offers comprehensive, secure, and integrated HIPAA-compliant messaging tools to improve collaboration and meet CalAIM’s interoperability requirements.
Surveys and Engagement
Automated surveys are digital tools for tracking patient progress. This time-saver captures valuable data for outcomes and quality improvement reporting.
Reporting and Outcomes
Prebuilt report templates and a business intelligence dashboard streamline workflows and ensure accuracy by simplifying data collection and report creation.
Tame the Red Tape With a California Behavioral Health EHR
Achieving equity and access in behavioral health care is a worthy goal. However, regulatory burdens have profound implications. They can slow the adoption of new technologies and practices, deter small practices from expanding services, and complicate collaborative efforts across different healthcare systems.
Having a highly configurable EHR solution is paramount to meeting California’s ever-increasing regulations. But it shouldn’t end there. A purpose-built EHR can help you exceed government expectations and reach organizational goals like increased productivity, a shorter revenue cycle, and more time to focus on your patients.
ContinuumCloud’s EHR system is customizable and comprehensive. Contact us today to learn more about how we can help you navigate the complex regulatory landscape, reduce administrative burden, and improve clinical care management and coordination.
