Access to Care

Only about 10-15% of people who need SUD treatment access services. Among those who do not receive services, approximately 95% report either not being interested in services or not believing they need them. The Reaching the 95% (R95) initiative ensures SAPC’s specialty SUD system not only serves those already seeking help, but also actively engages the much larger group who are not.

While specific R95 activities continue through Value-Based Incentives (VBI), R95 is evolving into a broader system priority. The principles of R95 are embedded throughout SAPC’s VBI, particularly in the Access to Care focus area, which centers on reducing barriers to treatment through words, policies, and actions across the SUD system.

Treatment provider agencies interested in learning more about opportunities available through the R95 Initiative are encouraged to review the R95 Website and the R95 FY 26-27 workgroup calendar.

• MAT Education/Services for Opioid Use Disorder (OUD) in Non-OTP Settings (3-A)

  Description	At least 70% of clients with OUD in non-OTP (opioid treatment program) settings receive MAT education and/or medication services that include MAT. This incentive is designed to promote clinical quality and access to evidence-based care by ensuring clients with OUD in non-OTP (opioid treatment program) settings receive MAT education and/or medication services that include MAT.
  Eligibility	Open to Non-OTP contracted treatment provider agencies.
  Calculation	Numerator: Applicable MAT / Medication Service Code and/or H2010M (MAT Education $0) in claim. Denominator: Clients with OUD (F11) diagnosis. (Applicable MAT / Medication Service Codes are, for non-OTP settings: 90792, 99202 through 99205, 99212 through 99215, H0034, H0033, and H2010M.)
  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 reports performance of the metric for the prior month/quarter’s records. Required Documents: Invoice Form Applicable DQR incentive page(s) Deadlines: Submission 1: Q1 (July 2026 to September 2026) - Due 10/20/26 Submission 2: Q2 (October 2026 to December 2026) - Due 1/20/27 Submission 3: Q3 (January 2027 to March 2027) - Due 4/20/27
  Payment	Submission 1: Q1 $20,000 Submission 2: Q2 $20,000 Submission 3: Q3 $20,000
• MAT Education/Services for Alcohol Use Disorder (AUD) (3-B)

  Description	At least 50% of clients with AUD agency-wide receive MAT education and/or medication services that include MAT. *NOTE: Claims from OTP settings must ensure that at least 45% of patients with AUD either receive education about medications for AUD or treatment with medications for AUD in order to meet this incentive benchmark.
  Eligibility	Open to all contracted treatment provider agencies.
  Calculation	Numerator: Applicable MAT / Medication Service Code1 and/or H2010M (MAT Education $0) in claims. Denominator: Patients with AUD (F10.*) diagnosis. (Applicable MAT / Medication Service Codes are, for non-OTP settings: 90792, 99202 through 99205, 99212 through 99215, H0034, H0033, and H2010M. Applicable codes for OTP settings are H2010M and S5001AB, S5001C, S5000C, and S5001C specific to AUD medications.)
  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 reports performance of the metric for the prior month/quarter’s records. Required Documents: Invoice Form Applicable DQR incentive page(s) Deadlines: Submission 1: Q1 (July 2026 to September 2026) - Due 10/20/26 Submission 2: Q2 (October 2026 to December 2026) - Due 1/20/27 Submission 3: Q3 (January 2027 to March 2027) - Due 4/20/27
  Payment	Submission 1: Q1 $20,000 Submission 2: Q2 $20,000 Submission 3: Q3 $20,000
• Clients Referred/Admitted to Another SUD Level of Care (3-C)

  Description	At least 35% of clients are referred and admitted to another level of SUD care within 30 days of discharge. This incentive strengthens continuity of care.
  Eligibility	Open to all contracted treatment provider agencies.
  Calculation	Numerator: Number of new discharges referred and admitted to another level of SUD care within 30 days of discharge.* Denominator: Total number of new discharges each quarter.** *Any referrals/transfers to a higher or lower LOC within 30 days of discharge to another agency or within your agency ** Administrative discharges are included in the denominator but won’t be included in the numerator/no credit for the incentives.
  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 reports performance of the metric for the prior month/quarter’s records. Required Documents: Invoice Form Applicable DQR Incentive page(s) Deadlines: Submission 1: Q1 (July 2026 to August 2026) - Due 10/20/26 Submission 2: Q2 (September 2026 to November 2026) - Due 1/20/27 Submission 3: Q3 (December 2027 to February 2027) - Due 4/20/27 *Please note that September late claims will be included in Q2 due to 30-day tracking lag.
  Payment	Submission 1: Q1 $20,000 Submission 2: Q2 $20,000 Submission 3: Q3 $20,000
• Mental and Physical Health Referrals/Care Coordination (3-D)

  Description	At least 30% of clients with mental or physical health conditions were referred and connected to appropriate services.
  Eligibility	Open to all contracted treatment provider agencies.
  Calculation	Numerator: The number of clients with a mental or physical health condition who were referred and connected to mental or physical health services. Denominator: Total number of clients with a mental or physical health condition. Mental health conditions are identified by the client responses on Dimension 3 of the ASAM Assessment, affirmative response to items 8.1, 8.2, 8.3, or 8.4 on the CalOMS Admission Form, and/or mental health diagnosis in the Diagnosis Form; Physical health conditions are identified by affirmative responses to items 7.1, 7.2, or 7/3 on the CalOMS Admission Form.
  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 reports performance of the metric for the prior month/quarter’s records. Required Documents: Invoice Form Applicable DQR incentive page(s) Deadlines: Submission 1: Q1 (July 2026 to September 2026) - Due 10/20/26 Submission 2: Q2 (October 2026 to December 2026) - Due 1/20/27 Submission 3: Q3 (January 2027 to March 2027) - Due 4/20/27
  Payment	Submission 1: Q1 $20,000 Submission 2: Q2 $20,000 Submission 3: Q3 $20,000
• Clients Engaged in Treatment (= or > 30 days) (3-E)

  Description	At least 60% of admissions remain engaged in treatment for 30 days or longer following admission in non-WM (Withdrawal Management) settings. This incentive promotes early engagement and continuity of care. Sustained engagement during the first 30 days is a critical indicator of treatment stabilization and is associated with improved retention and outcomes.
  Eligibility	Open to all contracted treatment provider agencies.
  Calculation	Numerator: Number of admissions that remain engaged in treatment for 30 days or longer following admission. Denominator: Total number of admissions* *Q1: new admissions and carryover records from the 4th quarter FY 2025-26; Q2-Q3: new admissions
  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 reports performance of the metric for the prior month/quarter’s records. Required Documents: Invoice form Applicable DQR incentive page(s) Deadlines: Submission 1: Q1 (July 2026 to August 2026) - Due 10/20/26 Submission 2: Q2 (September 2026 to November 2026) - Due 1/20/27 Submission 3: Q3 (December 2026 to February 2027) - Due 4/20/27 *Please note that September engagement will be included in Q2 due to 30-day engagement tracking lag.
  Payment	Submission 1: Q1 $20,000 Submission 2: Q2 $20,000 Submission 3: Q3 $20,000
• Seven-Day Follow-up after Residential Services / Residential Services – Withdrawal Management Discharge (3-F)

  Description	At least 30% of new discharges from residential care (including residential withdrawal management) receive any follow-up service in another LOC within seven (7) days after discharge. This incentive promotes care transition and continuity of care.
  Eligibility	Open to all contracted residential and/or residential withdrawal management treatment provider agencies.
  Calculation	Numerator: Number of new discharges with any follow-up service in another LOC within seven days after discharge Denominator: Total number of new discharges from residential and/or residential withdrawal management services
  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 reports performance of the metric for the prior month/quarter’s records. Required Documents: Invoice Form Applicable DQR incentive page(s) Deadlines: Submission 1: Q1 (July 2026 to September 2026) - Due 10/20/26 Submission 2: Q2 (October 2026 to December 2026) - Due 1/20/27 Submission 3: Q3 (January 2027 to March 2027) - Due 4/25/27
  Payment	Submission 1: Q1 $20,000 Submission 2: Q2 $20,000 Submission 3: Q3 $20,000
• Percent of Appointment Disposition Form Referrals with Completed Appointment Disposition (3-G)

  Description	At least 30% of referrals made by SASH/CENS/CET in the Appointment Disposition Log are completed within three (3) business days of the appointment date. Completion is defined as Appointment disposition logs that have all fields completed, including, but not limited to, referral information, appointment disposition, and rescheduled appointment date. AND Appointment dispositions that are logged within three (3) days of the appointment date This incentive focuses on strengthening provider agency operational performance.
  Eligibility	Open to all contracted treatment provider agencies.
  Calculation	Numerator: Number of completed dispositions in the appointment disposition log within three (3) business days of appointment date. Denominator: Total SASH/CENS/CET referral count to each provider agency.
  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 reports performance of the metric for the prior month/quarter’s records. Required Documents: Invoice Form Applicable DQR incentive page(s) Deadlines: Submission 1: Q1 (July 2026 to September 2026) - Due 10/20/26 Submission 2: Q2 (October 2026 to December 2026) - Due 1/20/27 Submission 3: Q3 (January 2027 to March 2027) - Due 4/25/27
  Payment	Submission 1: Q1 $20,000 Submission 2: Q2 $20,000 Submission 3: Q3 $20,000
• R95 Unique Clients Served (3-H)

  Description	Provider agency must demonstrate at least a 5% increase in the number of unique clients served compared to the previous fiscal year (FY 2025-26 vs FY 2026-27) to satisfy this activity. This incentive encourages provider agency use of meaningful data to support business decisions, focusing on measurable impact and data reporting at the agency level to understand provider agency reach and progress in reaching the 95% of people with SUD that have not been engaged in treatment.
  Eligibility	Treatment provider agencies that have been approved for all five (5) R95 policies and agreements in any fiscal year, including FY 2026-27, are eligible.
  Calculation	Numerator: (Number unique clients served July 1, 2026 - February 28, 2027) – (Number unique clients served July 1, 2025 - February 28, 2026) Denominator: number unique clients served July 1, 2025-February 28, 2026
  Invoicing/Submission Guidelines	Guidance Documents R95 Unique Clients Served activity guide R95 Unique Clients Served Submission Checklist Submit the below documents by 03/19/2027: Invoice Form KPI MSO Payment Reconciliation Report (Do not submit PHI via VBI Electronic Submission Form or unsecure email.)
  Payment	$20,000
• R95 Client-Facing Agreements (3-I)

  Description	This incentive fosters a client-centered approach by ensuring participating treatment provider agencies update their policies and patient-facing agreements to recognize SUD as a chronic medical condition that will be treated with compassion. Treatment provider agencies are expected to implement approved policies and agreements within one (1) month of SAPC approval.
  Eligibility	Open to all contracted treatment provider agencies that have not adopted all five (5) R95 policies and agreements: admission policy, discharge policy, toxicology policy, admission agreement, and toxicology agreement. Provider agencies with no R95 policies and agreements are eligible for the full payment amount. Provider agencies with some R95 policies and/or agreements are eligible for the half payment amount. Example: Adopted R95 admission and discharge policy in FY 2023-24, but have not adopted toxicology policy, toxicology agreement, or admission agreement. Provider agencies that adopted all R95 policies and agreements across previous fiscal years are ineligible for participation in FY 2026-27.
  Other Criteria	Not applicable
  Invoicing/Submission Guidelines	Guidance Documents: R95 Policies and Client-Facing Agreements Submission Checklist PDF versions of the Admission Agreements and Policies are available below for your convenience. R95 Admission Policy (pdf) R95 Discharge Policy (pdf) R95 Admission Agreement (pdf) R95 Toxicology Policy (pdf) R95 Toxicology Agreement (pdf) Submit required documents by 11/02/2026 Invoice Form For provider agencies that have not previously completed any of the below documents, submit all five. For provider agencies that previously completed any of the below policies and agreements, short of all five (5) items, submit all remaining items. R95 Admission Policy R95 Discharge Policy R95 Admission Agreement R95 Toxicology Policy R95 Toxicology Agreement Participating treatment provider agencies are to submit R95 policies and agreements, after internal review and formatting. All submissions should be in Word (.doc/.docx) file format.
  Payment	$40,000 one-time payment for all five (5) R95 policies and agreements completed in FY 2026-27 $20,000 one-time payment for one to four (1-4) remaining R95 policies and/or agreements completed in FY 2026-27