The California Advancing and Innovating Medi-Cal initiative created a once-in-a-generation opportunity to reform Behavioral Health documentation. As the Chief of Medi-Cal Behavioral Health with the California Department of Health Care Services, my CHIP focused first on removing complex and cumbersome documentation standards that far exceed the standards of other healthcare delivery systems and replacing them with efficient, effective, and impactful policies to improve the lives of those we serve. The project then produced strategies to roll out these mandatory changes statewide across all 58 counties.

The importance of this project lies in the ability to impact outcomes for beneficiaries receiving BH services as well as the staff rendering the services. The value of the clinical intervention often lies in the relationship between beneficiary and provider, so maximizing the opportunity for these discussions brings great benefit. In stripping away excessive documentation requirements, the CHIP presented the opportunity to reform how we think about substantiating clinical work. The burdensome charting thresholds drove providers to spend copious time and energy attending to documentation standards that could be better spent performing direct client care. In qualitative data analysis, the documentation burden emerged as the primary driver of staff turnover because the excessive processes yielded a loss of connection with the heart of the work. Counties and providers reported fiscal disallowances about failure to meet these rigorous standards, often discovered months or years after the service was rendered. Successfully implementing reform in this area can yield a reduction in recoupments, improvements in staff retention, and higher quality client care.