The Hub and Spoke System

Connecting Those in Need with Treatment Options

The Hub and Spoke System (H&SS) utilizes a proven organization model to increase access to treatment options for people who suffer from poly-substance use disorders. Developed by DHCS and implemented through early MAT Projects, the California H&SS consists of 19 Hubs and numerous community health facilities.

What is the California Hub and Spoke System (CA H&SS)?

The CA H&SS is a component of the California Medication Assisted Treatment(MAT) Expansion Opioid State Targeted Response (STR) grant program, and isbeing implemented as a way to improve, expand, and increase access to MATservices throughout the state. The program will improve access to MAT services,especially in counties with the highest overdose rates. The implementation of theCA H&SS will increase the total number of physicians, physician assistants, andnurse practitioners prescribing buprenorphine, thereby increasing the availability ofMAT for patients with Opioid Use Disorder (OUD). All Hubs and Spokes must obtain, or be currently enrolled in, Drug Medi-Cal or Fee-for-Service Medi-Cal. They must also remain in good standing throughout the contract period. Each CA H&SS consists of a “Hub” and multiple “Spokes.” There are currently 19 funded Hubs in California. The project began with approximately 119 Spokes across the state.

To locate a Hub or Spoke: California Hub and Spoke Interactive Map

What is a Hub?

Existing Department of Health Care Services (DHCS) licensed Narcotic TreatmentPrograms (NTPs) or Medication Units (MUs) may serve as the Hub, and will work closely with other clinical service providers that serve as the Spokes to build a treatment network that meets community needs. Hubs shall serve as a regional resource with a broad public health mission. Patients will be able to move between the Hub and Spokes based on clinical severity. Hubs are responsible for the following:

1. Outreach;

2. Treatment Services;

3. Data Collection and Performance Measures;

4. Reports;

5. Evaluation;

6. Training;

7. Invoices; and

8. Subcontracting.

Each awarded region in California will have a Hub, serving as the specialized addiction center of expertise. Each Hub is connected to a number of Spokes, described below.

What is a Spoke?

Spokes may consist of:

  1. A federally waivered prescriber who prescribes and/or administersbuprenorphine; or
  2. One or more federally waivered prescribers and a MAT team consisting of a licensed health practitioner and/or licensed behavioral health professional to perform duties that do not require a prescribing license.

Spokes provide ongoing care for patients with milder disorders, managing both induction and maintenance, and have access to a dedicated MAT team.

The MAT team consists of one registered nurse and one licensed clinical social worker for every one hundred patients on buprenorphine under Medi-Cal.

Spokes have the ability to refer complex patients to the Hub in their region for stabilization. NTPs and MUs cannot be Spokes.