Finance and Business Operations

With the launch of CalAIM Behavioral Health Payment Reform in 2023, DMC-ODS services moved to a fee-for-service (FFS) reimbursement model. Under FFS, payment is based on service delivery and approved claims.

This transition creates significant opportunity for provider agencies to strengthen financial stability and operational efficiency. Success depends on aligning service delivery with reimbursement, ensuring that appropriate, billable treatment services are consistently provided, and ensuring that revenue is sufficient to support operational costs and investments to continue to improve service quality and delivery.

The Finance and Business Operations category of SAPC’s Value-Based Incentives (VBI) is designed to support provider agencies in navigating and succeeding in this payment environment.

• Timely Submission of CalOMS Admission and Discharge Records (1-A)

  Description	At least 80% of California Outcomes Measurement System (CalOMS) admission and discharge records are submitted on time and are 100% complete. This incentive strengthens provider operational performance through timely and complete data reporting.
  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. Denominator: Total number of CalOMS new 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 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
• Timely Claims Submissions (1-B)

  Description	At least 95% of prior-month service claims are submitted by the 10th of each month, as monitored through supplemental/late claims SAPC is tracking each month. This incentive supports fiscal accountability and effective revenue cycle management through timely claims submission, as monitored through supplemental/late claims SAPC is tracking each month.
  Eligibility	Open to all contracted treatment provider agencies.
  Calculation	Total number of late claims submitted after the 10th of the following month. Timely claim submission calculation will be based only on the original claims, excluding denials. For admissions at the end of each month, claims must be submitted within 35 days of a client’s admission if the admission occurs only on the last day of the month (per historical claim submission analyses). For any submission issues, including Sage, EHR-related matters, or pending authorizations, please contact SAPC’s Health Outcomes and Data Analytics (HODA) Division team and provide supporting documentation prior to the due date: hoda_caloms@ph.lacounty.gov.
  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 2026) - Due 4/20/27 *Please note that September late claims will be included in Q2.
  Payment	Submission 1: Q1 $20,000 Submission 2: Q2 $20,000 Submission 3: Q3 $20,000
• Data Aggregation – Building Performance and Risk Metrics (1-C)

  Description	This incentive supports SAPC provider agencies in strengthening their data infrastructure to operate successfully in an evolving value-based environment through planning and development of a data aggregation platform. The activity consists of tracks to support provider agencies at varying levels of readiness, from early planning through initial implementation under SAPC’s Fiscal Year 2025-26 data aggregation VBI. To support provider agencies at different stages of implementation, the incentive includes cohort options based on prior participation and implementation status.
  Eligibility	Open to all contracted treatment provider agencies, including provider agencies that participated in FY 2025-26.
  Other Criteria	Not applicable
  Invoicing/Submission Guidelines	Cohort 1 - Second Year (Advanced): Eligible if the provider agency participated in SAPC’s FY 2025-26 Data Aggregation VBI and completed Option 1 (purchase and initial implementation) Submission 1: Submit the following deliverables by 10/20/26: Invoice Form Q1 metrics reporting + QI Plan Template Addendum: Data Aggregation Implementation Update Mid-year SAPC Progress Check: Complete 11/01/26 – 1/29/2027 Required formal visit to assess progress towards full implementation Submission 2: Submit the following deliverables by 1/20/27: Invoice Form Q2 metrics reporting + QI Plan Template Submission 3: Submit the following deliverables by 3/31/27: Invoice Form Q3 metrics reporting + QI Plan Template Documentation of full implementation Addendum: Data Aggregation Implementation Closeout Summary Optional: Documentation of implementation of additional metrics Cohort 2 - Second Year (Mid-Stage): Eligible if the provider agency participated in SAPC’s FY 2025-26 Data Aggregation VBI and completed Option 2 (planning) Submission 1: Submit the following deliverables by 10/20/26: Invoice Form Documentation of software purchase and technical implementation Addendum: Data Aggregation Implementation Update Mid-year SAPC Progress Check: Complete 11/01/26 – 1/29/2027 Required formal visit to assess progress towards full implementation Submission 2: Submit the following deliverables by 3/31/27 Invoice Form Documentation of full implementation Addendum: Data Aggregation Implementation Closeout Summary Cohort 3 - New/First Year (First-time participants): Eligible if the provider agency did not participate in or did not complete all submissions for SAPC’s FY 2025-26 Data Aggregation VBI Submission 1: Submit the following deliverables by 9/30/26: Invoice Form Data Source Inventory and Baseline Metrics Tool Submission 2: Submit the following deliverables by 12/15/26 Invoice Form Data Aggregation Readiness Assessment Submission 3 (choose one): Submit the following deliverables by 3/31/27: Option 1: Purchase and initial implementation Invoice Form Documentation of purchase and initial implementation Implementation Completion Plan Option 2: Investing and Planning for Future Implementation Invoice Form Initial Implementation Plan
  Payment	Cohort 1 - Second Year (Advanced): Submission 1: $20,000 Submission 2: $15,000 Submission 3: $20,000 Optional: $5,000 one-time payment for implementation of additional metrics Cohort 2: Second Year (Mid-Stage): Submission 1: $15,000 Submission 2: $25,000 Cohort 3 - New/First Year (First-time participants): Submission 1: $15,000 Submission 2: $15,000 Submission 3: Option 1: $40,000 Option 2: $15,000