BH-CONNECT Community Transition In-Reach Services – BHP Readiness Assessment

County Behavioral Health Plans (BHPs) that intend to participate in Community Transition In-Reach Services (“In-Reach Services”) are required to submit a BHP Readiness Assessment as outlined in the BHIN 25-041. Only BHPs that administer Specialty Mental Health Services (SMHS) are eligible to offer Community Transition In-Reach Services. To qualify for Community Transition In-Reach Services, a Medi-Cal member must meet SMHS access criteria. A BHP cannot access Federal Financial Participation (FFP) for In-Reach Services until the Plan is approved by the Department of Health Care Services (DHCS). 

BHPs may opt into the program by completing and submitting the BHP Readiness Assessment via DHCS’ website on or after November 25, 2025. The BHP Readiness Assessment is provided here for reference only. BHPs must submit the BHP Readiness Assessment online. Only one Readiness Assessment is required per BHP for the duration of the demonstration and must be signed by the Behavioral Health Director or their designee.

For further information on program requirements, please refer to BHIN 25-041, which includes references to the Special Terms and Conditions (STCs) and existing authorities. 

Find more information about BH-CONNECT on the DHCS website. Reach out to BH-CONNECT@dhcs.ca.gov if you have any questions.

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* 1. Updated P&Ps

Submit updated P&Ps that reflect In-Reach criteria/requirements to BH-CONNECT@dhcs.ca.gov

Community Transition In-Reach Criteria/Requirements, as specified in BHIN 25-041

1. Member Eligibility Criteria (page 3)

2. Members at risk of experiencing extended length of stay (page 4)

3. Qualifying Facilities (page 4)

4. Comprehensive Assessment and Periodic Reassessment (page 5)

5. Comprehensive Individualized Care Plan (page 6)

6. Involuntary treatment pursuant to the Lanterman-Petris-Short Act (page 7)

7. Monitor and Follow-Up (page 7)

8. Identifying and Addressing System Barriers (page 8)

9. Service Provision and Standards (page 8)
- Additive and not duplicative
- Care Coordination

10. Service Duration (page 8)
- 180 days claiming duration
- Step down to qualifying facility

11. Community Transition Teams (page 9)

12. BHP Approval of Community Transition Teams (page 10)

13. Rates and Payment Requirements Inside Qualifying Facilities (page 12)

14. Prior Authorization (page 13)

Section 1: Background Information

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* 2. BHP Name

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* 3. Name of Individual Completing BHP Readiness Assessment

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* 4. Title/Role of Individual in Completing BHP Readiness Assessment

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* 5. Email Address

Section 2: Effective Date of In-Reach Services

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* 6. Please provide the effective date that the BHP plans to commence coverage of In-Reach Services

(Note: The effective date for In-Reach Services may be no earlier than the submission date of this Readiness Assessment.)

Date

Section 3: Behavioral Health Care Continuum

Please attest that the BHP will complete the county Integrated Plan (IP) that shall 1) assess the availability of mental health and/or SUD services and housing options within the county and 2) indicate planned action steps (e.g., future service delivery/investments) based on the assessment). The IP is required by the Behavioral Health Services Act (BHSA) as outlined in the BHSA Policy Manual “Behavioral Health Care Continuum” section.

Completion and approval of the IP is required for approval of the Readiness Assessment. BHPs that opt in to In-Reach Services prior to the IP due date must attest that they will complete the IP. If all other requirements of the BHP Readiness Assessment are satisfied, DHCS will issue conditional approval for BHPs to render In-Reach Services and access FFP until the IP is completed and approved by DHCS.

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* 7. BHSA County Integrated Plan

Attest that the BHP will complete the BHSA IP that shall 1) assess the availability of mental health and/or SUD services and housing options within the county and 2) indicate planned action steps based on the assessment.

Section 4: Forthcoming Processes for Bed Tracking Data Reports

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* 8. BHPs will be required to add a bed tracking component pursuant to forthcoming guidance. This data and information will additionally serve to inform the State’s monitoring and evaluation efforts required by CMS.

Attest to track and report, on an annual basis, data and trends in the number and utilization of beds across inpatient, subacute, and residential facilities (including Institutions for Mental Diseases) in which the BHP places members.

Section 5: Additional DHCS Requirements for Evidence-Based Practices 

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* 9. Please attest that the BHP will cover and implement all of the following BH-CONNECT evidence-based practices (EBPs) as outlined in BHIN 25-009. Please note that in addition to completing this BHP Readiness Assessment, BHPs will need to complete the EBP Opt-In Process, which is available on the BH-CONNECT Opt-in landing page

Attest to launch Assertive Community Treatment (ACT) services within one year of claiming FFP for In-Reach Services.

Attest to launch Forensic Assertive Community Treatment (FACT) services within two years of claiming FFP for In-Reach Services.

Attest to launch IPS Supported Employment services within three years of claiming FFP for In-Reach Services.

Attest that the BHP will provide Peer Support Services prior to claiming for In-Reach Services.

Attest to launch Peer Support Services with Forensic Specialization within one year of claiming FFP for In-Reach Services.