With selection of vendor, DHCS is slated to launch CalAIM Recovery Incentives Program within next 2 months

On Nov. 3rd, the California Department of Health Care Services (DHCS) announced Pear Therapeutics, Inc. will be the incentive manager vendor for the California Advancing and Innovating Medi-Cal (CalAIM) contingency management benefit, or the Recovery Incentives Program.

 

Get the latest state-specific policy intelligence for the health care sector delivered to your inbox.

 

Through the program, eligible Medi-Cal beneficiaries struggling with stimulant use will participate in a structured 24-week outpatient program where they can earn motivational incentives in the form of low-denomination gift cards, with a retail value determined per treatment episode. The program will be followed by 6 or more months of additional recovery support services. 

Individuals will receive incentives for testing negative for stimulants only, even if they test positive for other illicit drugs. California is the first state to receive approval to pursue such a program through its Medicaid program.

The announcement comes after a months-long procurement process for an incentive benefit manager. While the program was initially scheduled to begin in July, DHCS says the inability to procure an incentive manager delayed implementation. Pear Therapeutics will now be responsible for providing an incentive benefit structure for the program.

According to DHCS, the new anticipated start date of the program for participating Drug Medi-Cal Organized Delivery System (DMC-ODS) counties will be December or January 2023.

The department intends for this initial pilot program, which is scheduled to run through March 2024, to inform the eventual creation of a statewide contingency management/recovery incentive benefit through Medi-Cal (dependent on budgetary and statutory factors).

DHCS told State of Reform that the Recovery Incentives Program is a complement to substance use disorder (SUD) treatment services and other evidence-based practices for stimulant use disorders already offered by DMC-ODS providers. The program will specifically focus on stimulant use disorders.

DHCS emphasized the effectiveness of these incentives.

“Research shows that [contingency management] reinforces an individual’s positive behavior change to meet their treatment goals,” DHCS stated.

Research has shown that contingency management can successfully reduce drug use for individuals with stimulant use disorder, including methamphetamine and cocaine use disorders, as well as retain individuals in treatment for longer. 

DHCS says the incentive manager vendor will manage the electronic tracking and distribution of incentives to Medi-Cal beneficiaries who participate in the program. Pear Therapeutics will provide a centralized, electronic mechanism for calculating incentive amounts based on urine drug screen results and a predetermined algorithm. 

The vendor will also disburse incentives to program participants, track incentive payment dates and amounts over time in accordance with DHCS protocols, and provide beneficiary, payment, and programmatic data to DHCS. 

To assist with the roll out of the Recovery Incentives Program, DHCS has contracted with UCLA to develop and implement a multilevel implementation training and technical assistance program to the 24 participating counties. 

DHCS says that after completing CM training, provider organizations will be required to undertake a readiness review before being permitted to administer contingency management. This readiness review will include interactive demonstrations and site-specific implementation goals, practice entering pilot cases into the incentive tracker to demonstrate proficiency with these tools, and practice responding to preset scenarios like disputes over test results, tampered samples, and positive results for drugs other than stimulants.