Welcome to Orange County's Drug Medi-Cal Organized Delivery System (DMC-ODS). The County Plan provides substance use disorder (SUD) treatment services for all eligible Medi-Cal beneficiaries who reside in Orange County.
Our mission is to prevent substance use and mental health disorders; when signs are present, to intervene early and appropriately; and when assessments indicate that treatment is required, to provide the right type of treatment, at the right place, by the right person/program to help individuals to achieve and maintain the highest quality of health and wellness.
As a beneficiary, your plan offers a full range of SUD treatment services to you when they are medically necessary. The County Plan requires for treatment placement decisions to follow the criteria established by the American Society of Addiction Medicine (ASAM).
You can access DMC-ODS services starting on July 1, 2018 by calling the Beneficiary Access Line at (800) 723-8641, 24 hours a day, 7 days per week. For more information about the ODS plan, call Member Services at (855) 625-4657, Monday through Friday between 8:00 AM and 6:00 PM. You don't need to do anything else. As a Medi-Cal beneficiary, you are already eligible for these services if you need them.
Levels of Care (Treatment Placement)
- Outpatient Drug Free (ODF) consists of up to nine hours a week for adults and less than six hours a week for adolescents when determined to be medically necessary. Services can be provided by a licensed professional or a certified counselor in any appropriate setting in the community.
- Intensive Outpatient Treatment (IOT) consists of a minimum of nine hours with a maximum of 19 hours a week for adults and a minimum of six hours with a maximum of 19 hours a week for adolescents when determined to be medically. Services can be provided by a certified counselor in any appropriate setting in the community.
- Residential Treatment is a non-institutional, 24-hour non-medical, short-term residential program that provides rehabilitation services when determined as medically necessary. Residential services require prior authorization by the County Plan. Each authorization for residential services can be for a maximum of 90 days for adults and 30 days for youth. Only two authorizations for residential services are allowed in a one-year-period.
- Recovery Services are important for recovery and wellness. The treatment community helps beneficiaries be empowered and prepared to manage their health and health care.
- Withdrawal Management services are offered in residential, non-institutional, non-medical withdrawal management programs that utilize a social model detox system, for a maximum of seven (7) days to help beneficiaries during the non-acute detoxification process. Acute withdrawal management services are available 24 hours a day, 7 days a week. If you are experiencing acute or severe withdrawal, go to your nearest emergency room.
- Narcotic Treatment Program/Opioid Treatment Program (NTP/OTP) services are available to adults 18 year of age and older, seven (7) days a week and are provided by licensed NTP facilities. You must be a resident of Orange County to receive NTP services at Orange County NTP sites. Occasional courtesy dosing of beneficiaries from other counties occurs on a case by case basis. Beneficiaries should contact the NTP to determine the steps needed to obtain an occasional dose outside of their county of residence.
- Medication Assisted Treatment (MAT) is the use of prescription medications, in combination with counseling and behavioral therapies. MAT services can occur in conjunction with any of the ASAM levels of care that are covered under the plan.
Services for Youth
Youth under 21 years of age may receive additional medically necessary services under Early and Periodic Screening, Diagnosis, and Treatment (EPSDT). EPSDT services include screening, vision, dental, hearing and all other medically necessary mandatory and optional services listed in federal law 42 U.S.C. 1396d(a) to correct or ameliorate defects and physical and mental illnesses and conditions identified in an EPSDT screening whether or not the services are covered for adults.
For a more complete description of the EPSDT services that are available or to have your questions answered, please call Orange County's Children, Youth and Prevention Mental Health and Recovery Services between 8:00 a.m. and 5:00 p.m. at (714) 834-5015.
Services for Pregnant and Parenting Women
In addition to the standard benefits, pregnant women can receive residential services through the last day of the month that the 60th day after delivery occurs. Services include additional support, including childcare and counseling focused on the parent-child relationship.
Services Based on Standard Practice Guidelines
The county of Orange offers services that are based on valid and reliable clinical evidence or a consensus of providers in the field. We consider the needs of our beneficiaries and adopt practice guidelines in consultation with our network of healthcare providers. Practices are reviewed and updated periodically to ensure their relevance to the clients we serve. You can review all the county's practice guidelines by clicking on the link: Practice Guidelines.
Beneficiary Informing Materials
Quality Assurance Work Plan
- Quality Assessment and Performance Improvement Program
- 2019/20 Work Plan - PDF
- 2018/19 Work Plan - PDF
Drug Medi-Cal Organized Delivery System (DMC-ODS) Implementation Plan Resources
MOU between CalOptima and Health Care Agency
- General MOU between HCA and CalOptima - PDF
- Amendment I to MOU with CalOptima
For information and resources about the Mental Health Plan, visit http://www.ochealthinfo.com/bhs/about/medi_cal