Finance and Business Operations

With the implementation of Behavioral Health Payment Reform in 2023, DMC-ODS services are now reimbursed through a fee-for-service (FFS) model instead of being reimbursed through cost reconciliation (i.e., reconciling to the lesser of costs or changes). Under this new approach, once a claim has been approved and paid, no further reconciliations or payments are made for that claim.

This shift presents a significant opportunity for provider agencies to enhance both financial and operational efficiency by aligning service delivery with reimbursement, ensuring that appropriate, billable treatment services are provided to generate sufficient revenue to cover operational costs.

This component of Value-Based Incentives (VBI) is designed to support provider agencies in maximizing this opportunity.

• Building Performance and Risk Metrics- (1-A)

  Description	This incentive enhances provider agencies' ability to use analytical strategies to strengthen data-informed decision-making, risk management, and financial sustainability within evolving value-based reimbursement models. An optional component of this activity is funding to purchase software to support the implementation of a data dashboard. Providers must complete the functional key performance indicators (KPI) dashboard and/or KPI tracking tool to access this funding. This activity complements the Managing Financial Risk in VBR Models (1-B) activity. This activity complements the Managing Financial Risk in VBR Models (1-B) activity.
  Eligibility	Open to all contracted treatment provider agencies.
  Other Criteria	Not applicable
  Invoicing/Submission Guidelines	Submission 1: Submit the Following Deliverables by 9/10/25: Invoice Form Cohort Assessment Survey Submission 2: Submit the Following Deliverables by 10/10/25: Invoice Form Completed functional KPI performance dashboard or KPI tracking tool Submission 3: Submit the Following Deliverables by 12/10/25: Invoice Form Completed Performance Benchmarking and Gap Analysis Tool Optional: Quality Management System Funds Optional: Leadership Coaching Verification Form
  Payment	Submission 1: $5,000 Submission 2: $15,000 Submission 3: $15,000 Optional Quality Management System Funds: $20,000 Optional Leadership Coaching Participation: $5,000
• Managing Financial Risk in Value-Based Reimbursement- (1-B)

  Description	This incentive enhances provider agencies’ ability to navigate financial risk under value-based reimbursement and alternative payment models through risk-readiness assessments, stress testing, and financial strategy development. This activity complements the Building Performance and Risk Metrics activity (1-A).
  Eligibility	Open to all contracted treatment provider agencies.
  Other Criteria	Not applicable
  Invoicing/Submission Guidelines	Submission 1: Submit the Following Deliverables by 2/15/26: Invoice Form Risk and Financial Readiness Assessment Completion of Financial Stress Test Submission 2: Submit the Following Deliverables by 3/31/26: Invoice Form Contingency Planning Template Submission Optional: Leadership Coaching Engagement
  Payment	Submission 1: $15,000 Submission 2: $15,000 Optional Leadership Coaching Participation: $5,000
• Timely Submission of CalOMS Admission and Discharge Records- (1-C)

  Description	This incentive strengthens the operational performance of provider agencies by ensuring that at least 65% of California Outcomes Measurement System (CalOMS) admission and discharge records are submitted on time and are 100% complete.
  Eligibility	Open to all contracted treatment provider agencies.
  Calculation	Numerator: Number of CalOMS admission and discharge records that are both 100% complete and submitted on time. (Discharge records include administrative discharges.) Denominator: Total number of CalOMS admission and discharge records submitted, including administrative discharges.
  Invoicing/Submission Guidelines	Consult the monthly Data Quality Report (DQR) provided by SAPC’s Health Outcomes and Data Analytics (HODA) Division on the 15th of each month, which reflects the % of metrics for the prior month’s records. Required Documents: Invoice Form Applicable HODA DQR Incentive Report Deadlines: Submission 1: Q1 (July 2025 to September 2025) - Due 10/20/25 Submission 2: Q2 (October 2025 to December 2025) - Due 1/20/26 Submission 3: Q3 (January 2026 to March 2026) - Due 4/20/26
  Payment	Submission 1: Q1 $20,000 Submission 2: Q2 $20,000 Submission 3: Q3 $20,000
• Timely Claims Submissions- (1-D)

  Description	This incentive supports fiscal accountability and revenue cycle management by ensuring 100% of prior-month service claims are submitted by the 10th of each month, as monitored through supplemental claims reporting to SAPC.
  Eligibility	Open to all contracted treatment provider agencies.
  Calculation	Numerator: The number of claims submitted by the 10th of each month for services provided in the prior month. Denominator: The total number of claims submitted each month for services provided in the preceding month.
  Invoicing/Submission Guidelines	Consult the monthly Data Quality Report (DQR) provided by SAPC’s HODA Division on the 15th of each month, which reflects the % of metrics for the prior month’s records. Required Documents: Invoice Form Applicable HODA DQR Incentive Report Deadlines: Submission 1: Q1 (July 2025 to September 2025) - Due 10/20/25 Submission 2: Q2 (October 2025 to December 2025) - Due 1/20/26 Submission 3: Q3 (January 2026 to March 2026) - Due 4/20/26
  Payment	Submission 1: Q1 $20,000 Submission 2: Q2 $20,000 Submission 3: Q3 $20,000