Provider guide update for sobering center

Change to authorization requirement

Sobering center utilization will no longer require an authorization. Providers will just submit a claim for services that are rendered. No prior authorization or authorization will be required. For example, a member may be referred to a sobering center; providers will no longer need to request authorizations post-occurrence but will now be able to submit claims for the services. Please refer to DHCS Community Supports Policy Guide for more information and details on the Sobering Center Community Support: http://tinyurl.com/5yarxmct

Sobering centers

Sobering centers are one of the 14 Community Supports offered for Anthem Blue Cross members enrolled in Medi-Cal Managed Care in the state of California. Sobering centers are alternative destinations for members who are found to be publicly intoxicated (alcohol and/or drug) and would otherwise be transported to the emergency department or jail. Sobering centers provide these members, primarily those who are homeless or those with unstable living situations, with a safe, supportive environment to become sober.

Sobering centers provide services such as medical triage, lab testing, a temporary bed, rehydration and food service, treatment for nausea, wound and dressing changes, shower and laundry facilities, substance use education and counseling, and homeless care support services:

• When utilizing this service, a direct coordination with the county behavioral and/or public health agencies is required. Coordination will be dependent upon the member's needs.
• The service also includes screening and linkages to ongoing supportive services such as follow-up mental health and substance use disorder treatment and housing options, as appropriate.
• This service requires partnership with law enforcement, emergency personnel, and outreach teams to identify and divert members to sobering centers.
• The services provided should utilize best practices for members who are homeless and who have complex health and/or behavioral health conditions including housing first, harm reduction, progressive engagement, motivational interviewing, and trauma informed care.

To be eligible for sobering centers, members must meet all of the following to be considered for sobering centers:

• Members aged 18 and older who are intoxicated but conscious, cooperative, able to walk, nonviolent, free from any medical distress as demonstrated by utilization and scoring from an evidence-based tool such as the CIWA tool (including life threatening withdrawal symptoms or apparent underlying symptoms) and who would otherwise be transported to the emergency department or a jail or who presented at an emergency department and are appropriate to be diverted to a sobering center
• An approved screening tool or like assessments such as a CIWA must be completed.

Anthem has the right to determine eligibility through review of assessment and notes completed by the Community Supports (CS) provider upon intake. Anthem has the right to determine presumptive eligibility with certain CS Providers.

If you have any questions, reach out to your assigned Regional Program manager.