LA County Department of Public Health - Substance Abuse Prevention and Control

SAPC Home / Providers / Payment Reform / Incentives Initiative

The Los Angeles County Department of Public Health’s Bureau of Substance Abuse Prevention and Control (SAPC) designed an Incentive payment structure to begin to move the specialty SUD system to a more outcomes- and value-based reimbursement structure for specialty substance use disorder (SUD) systems. This will require defining performance metrics that are designed to incentivize outcome-focused services that translate to value-based and better care. Metrics are outlined for Workforce Development, Reaching the 95% (R95), Medications for Addiction Treatment (MAT), Optimizing Care Coordination, and Enhancing Data Reporting.

WORKFORCE DEVELOPMENT: RECRUITMENT, RETENTION & TRAINING
Meet SUD COUNSELORS CERTIFIED (1a)
Metric: 50% of all SUD Counselors providing direct services employed agency-wide by March 2025 according to the NACT data. Calculation: Numerator is # Certified SUD Counselors divided by ALL SUD Counselors delivering direct services according to NACT. Providers are required to maintain NACT accuracy monthly. Consult Data Quality Report (DQR) provided monthly by SAPC’s HODA Division. Submit final DQR as verification for incentive with Invoice.
- - Incentives Invoice
    Due 03/31/25
Meet LPHA-to-SUD Counselor Ratio (1b)
Metric: The agency-wide ratio for LPHA-to-SUD Counselor ratio is at least 1:12 (i.e., 1 LPHA for every 12 SUD Counselors). Calculation example: 38 SUD Counselors and 2 LPHAs (38/12=3.17 would be rounded up to 4), means that at least 4 LPHAs are needed to meet this deliverable. Data obtained through NACT. Providers are required to maintain NACT accuracy monthly. Consult Data Quality Report (DQR) provided monthly by SAPC's HODA Division. Submit final DQR as verification for incentive with Invoice.
- - Incentives Invoice
    Due 03/31/25
Meet Registered Counselors Minimum Wage Floor $23/hour (1c)
Metric: All employed SUD registered counselors are offered a minimum wage floor of $23 per hour. Submit verification with Invoice by 3/31/25.
- - Incentives Invoice
    Due 03/31/25
ACCESS TO CARE: REACHING THE 95%
Meet specified “R95 Champion” Criteria (2a)
Metric: Completion of Capacity Building- R95 Admission Policy Approved (2-A), R95 Discharge Policy Approved (2-B), AND one other full R95 Lower Barrier to Care Category (Service Design or Bi-Directional Referrals for Harm Reduction or suite of Admission/Discharge Agreements and Training) to which your agency is eligible. Consult R95 Champion Criteria page to determine which categories your agency is eligible to based on prior Year 1 (FY 23-24) participation.
- - Incentives Invoice
    Due 03/31/25
MEDICATIONS FOR ADDICTION TREATMENT (MAT)
Meet MAT Education/Services for Opioid Use Disorder (OUD) in Non-OTP settings (3a)
Metric: At least 25% of patients with OUD served in non-OTP settings receive MAT education and/or Medication Services that include MAT. Calculation: Numerator is applicable MAT/Medication Service Code and/or H2010M (MAT Education). Denominator is patients with OUD (F11*) diagnosis. Consult Incentive Metrics Package for applicable service codes. Consult Data Quality Report (DQR) provided monthly by SAPC's HODA Division. Submit final DQR as verification for Incentive with Invoice.
- - Incentives Invoice
    Due 03/31/25
Meet MAT Education/Services for Alcohol Use Disorder (AUD) (3b)
Metric: Claims of at least 15% of patients’ agency-wide AUD either receive MAT education and/or Medication Services that include MAT. Calculation: Numerator is applicable MAT/Medication Service Code and/or H2010M (MAT Education). Denominator is patients with AUD (F10*) diagnosis. Consult Incentive Metrics Package for applicable service codes. Consult Data Quality Report (DQR) provided monthly by SAPC’s HODA Division. Submit final DQR as verification for incentive with Invoice.
- - Incentives Invoice
    Due 03/31/25
Meet Agency-wide Naloxone Distribution (3c)
Metric: At least 50% of patients served agency-wide receive naloxone by prescription or via distribution documented in the record. Calculation: Numerator is # of patients that received naloxone at a given agency. Denominator is total # patients served. Consult Data Quality Report (DQR) provided monthly by SAPC’s HODA Division. Submit final DQR as verification for Incentive with Invoice.
- - Incentives Invoice
    Due 03/31/25
OPTIMIZING CARE COORDINATION
Signed Release of Information (4a)
Metric: At least 75% of patients served agency-wide have a signed ROI form to share with internal (other SUD) or external entities (e.g., physical or mental health) by 3/31/25 as verified through Primary and Secondary Provider use of the Sage PCNX File Attach form for uploading ROI “File Type” with ROI Internal or ROI External “Document Type”. Calculation: Numerator is # of patients with a signed ROI uploaded. Providers can utilize the “Provider File Attach Report” to retrieve total ROIs to determine this number of signed ROI. Denominator is total # patients served based on the site-specific admission form. Submit Section of Provider File Attach Report with total counts for Incentive with Invoice by 3/31/25.
- - Incentives Invoice
    Due 03/31/25
30-Day Post Discharge Level of Care (LOC) Referrals (4b)
Metric: At least 30% of patients within a given agency are referred and admitted to another level of care (LOC) of SUD care within 30 days of discharge by 3/31/25. Calculation: Numerator is # of patients referred and admitted to other level of care within 30 days of discharge. Denominator is total # patients discharged. Consult Data Quality Report (DQR) provided monthly by SAPC’s HODA Division. Submit section of final DQR as verification for incentive with Invoice.
- Incentives Invoice
  Due 03/31/25
ENHANCING DATA REPORTING
Meet Timely Submission of CalOMS Admission and Discharge Records (5a)
Metric: At least 45% of California Outcomes Measurement System Treatment (CalOMS) admission and discharge records agency-wide are submitted timely and are 100% complete. Calculation: Numerator is # of CalOMS admission and discharge records with 100% completed and timely. Denominator is total # of all CalOMS admission and discharge records submitted. Consult Data Quality Report (DQR) provided monthly by SAPC’s HODA Division. Submit section of final DQR as verification for incentive with Invoice.
- - Incentives Invoice
    Due 03/31/25
Interim Fiscal Report Submission (5b)
Metric: Agencies provide early interim fiscal reports on quarterly basis with final submission by 3/31/25. Requires submission of both the completed DMC Fiscal Reporting Tool-FY 20XX-XX (5b) and Incentives Invoice to SAPC-Finance@ph.lacounty.gov. For guidance on how to complete the DMC Fiscal Reporting Tool, please refer to the October 2024 Fiscal Reporting Training Recording and PowerPoint. See below for reporting periods and submission due dates.
Quarterly Submission Reporting Periods
- - Q1: July 2024 – September 2024
    Due 11/25/24
  - Q2: October 2024 – December 2024
    Due 01/31/25
  - Q3: January 2025 – March 2025
    Due 03/31/25
  - Q4: April 2025 – June 2025 - further guidance will be provided
  - Incentives Invoice - Due: As indicated above

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Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.