Back to October Stakeholder Communication Update
Behavioral Health Federal Grants Update
On September 27, 2021, DHCS re-released the Crisis Care Mobile Units (CCMU) funding opportunity, which will be available through November 29, 2021. The original $205 million funding opportunity was released from July 23, 2021, through August 23, 2021, to California counties, city behavioral health agencies, joint groups of counties and/or city behavioral health agencies, and tribal entities. DHCS is currently reviewing applications from the initial funding round seeking $159 million. Eligibility requirements remain the same, and while previous applicants may apply for additional funding, DHCS will prioritize new applicants. A minimum of $46 million will be available across two tracks: 1) planning grants up to $200,000 to assess the needs of mobile crisis and non-crisis programs and to develop an action plan to address the need; and 2) implementation grants up to $1 million per CCMU team to implement a new, or expand an existing, CCMU program. All CCMU grantees are required to prioritize mobile behavioral health crisis services for individuals age 25 and younger, while also serving the broader population, and will be encouraged to support justice intervention services. Funding for this round of grantees is available from January 3, 2022, through June 30, 2025.
Both CCMU funding rounds are supported by: $55 million through the Substance Abuse Prevention and Treatment Block Grant and the Community Mental Health Services Block Grant awarded by the Substance Abuse and Mental Health Services Administration through funds appropriated from the Coronavirus Response and Relief Supplemental Appropriations Act; and $150 million included in state fiscal year 2021-22 General Funds through the Behavioral Health Continuum Infrastructure Program. For more information about the CCMU funding opportunity, please email BHRRP@dhcs.ca.gov or visit the
Behavioral Health Continuum Infrastructure Program (BHCIP) Update
On October 1, DHCS hosted a BHCIP listening session for county, Tribal, non-profit, and for-profit organizations. The listening session discussed BHCIP funding opportunities, program timelines, and available technical assistance, and provided an opportunity for eligible applicants to provide insights, including written and verbal feedback, directly to DHCS on proposed BHCIP activities.
BHCIP provides DHCS with funding to award competitive grants to qualified entities to construct, acquire, and rehabilitate real estate assets, or to invest in mobile crisis infrastructure to expand the community continuum of behavioral health treatment resources. A portion of the funding is available for increased infrastructure targeted to children and youth age 25 and younger. For more information, please email BHCIP@dhcs.ca.gov or visit the
The CalHOPE Crisis Counseling Assistance and Training Program (CCP) received federal approval to extend services, allowing the program to continue through February 9, 2022, to provide emotional support for all Californians. Each week, the
CalHOPE Connect chat feature continues to assist individuals with an average of 4,000 chats per week. CalHOPE also continues to partner with
Together for Wellness and
Juntos por Nuestro Bienestar, which feature evidence-based and community resources to help manage stress and anxiety, and offer the CalHOPE Warm Line, (800) 317-HOPE (4673). The Warm Line connects callers to other people who have persevered through struggles with stress, anxiety, and depression.
CalHOPE provided individual crisis counseling, group counseling, public education, brief education, and supportive contact services to 40,075 Californians in July and 46,961 in August. Additionally, from July 1 through September 10, CalHOPE provided CCP services to 459,146 Californians, which involved helpline contact, email responses, resource materials handed out/mailed, and mass media outreach. The most recent statistics and accomplishments are located on the
CalHOPE Impact page. Additionally, American gymnast Mary Lou Retton delivered a message identifying CalHOPE as a local sponsor of NBC Universal's coverage of the Tokyo Olympics.
Community Health Worker (CHW) Services Benefit
DHCS is adding CHW services as a preventive service in the State Plan. In order to allow for the successful launch of the CHW benefit, DHCS is adjusting the implementation date for these benefits from January 1, 2022, to July 1, 2022. Additional time is needed to work with stakeholders and health plans, review their input, incorporate their feedback into the State Plan Amendment, ensure successful system updates, seek federal approval from CMS, and allow time for plans to prepare to offer these services. CHWs are skilled and trained health educators, assist individuals with accessing health care services, and provide key linkages with other similar and related community-based resources. CHWs would render Medi-Cal covered benefits and services under the supervision of an enrolled Medi-Cal provider. These services would be available under both the fee-for-service (FFS) and managed care delivery systems. DHCS met with stakeholders on August 18 and September 17 to discuss developing the State Plan Amendment (SPA) to add CHW services as a covered benefit. More information is available on the
DHCS website, including future opportunities for stakeholders to provide input on developing the benefit.
Dental Transformation Initiative (DTI)
The July 2021 payment of $2 million for Domain 1 was released on August 2, 2021. The goal of DTI's Domain 1 is to increase by 10 percentage points the statewide proportion of children through age 20 enrolled in Medi-Cal who receive a preventive dental service during a five-year period. As of August 31, the amount of Domain 2 payments issued was approximately $194.4 million, and 3,375 providers have opted in to participate. The goal of Domain 2 is to diagnose early childhood caries by utilizing caries risk assessments to treat it as a chronic disease and to introduce a model that proactively prevents and mitigates oral disease. For more information, please visit the
Drug Medi-Cal Organized Delivery System (DMC-ODS)
California's first regional DMC-ODS model began operating in seven counties on July 1, 2020, bringing the number of counties participating in the DMC-ODS to 37 and covering more than 96 percent of the Medi-Cal population. The regional model is a collaboration among seven Northern California counties and Partnership HealthPlan of California that allows access to screening, assessment, early intervention, and continuum of substance use disorder (SUD) treatment. The DMC-ODS provides a continuum of care modeled after the American Society of Addiction Medicine (ASAM) criteria for SUD treatment services.
In 2021, DHCS continues to convene webinars for interested DMC State Plan counties. Webinar topics have included individual and regional model options, Medication Assisted Treatment (MAT) access, network adequacy standards, and fiscal implications and forecasting, all to support the implementation of DMC-ODS.
As of February 1, DHCS implemented Senate Bill (SB) 823 (Chapter 781, Statutes of 2018) through
Behavioral Health Notice No.: 21-001, which requires DHCS' licensed alcohol and other drug (AOD) recovery treatment facilities to obtain at least one DHCS Level of Care (LOC) Designation and/or at least one residential ASAM LOC Certification consistent with all of its program services. DHCS has processed 1,425 total designations for AOD providers in California. Of those designations, 1,126 are active for 420 providers. More information about the DMC-ODS is available on the
DHCS also contracts with an External Quality Review Organization (EQRO) that reviews DMC-ODS counties annually regarding access, timely access, and quality of care. The information from these reviews is summarized in annual county reports. For FY 2020-21, the EQRO completed and posted 29 DMC‑ODS county reviews, including the first review of the DMC-ODS regional model. In April 2021, DHCS submitted the annual statewide technical report as well as performance improvement project reports to CMS. All EQRO reports are posted at
https://www.caleqro.com/dmc-eqro. The EQRO commenced FY 2021-22 county reviews in September. Additionally, under contract with the University of California Los Angeles, Integrated Substance Abuse Programs (UCLA ISAP), DHCS is conducting annual DMC‑ODS waiver evaluation activities to measure and monitor outcomes. The evaluation focuses on access to care, quality of care, cost, and the integration and coordination of SUD care, both within the SUD system and with medical and mental health services. The latest DMC‑ODS waiver evaluation report is posted on the
UCLA ISAP website.
Doula Services Benefit
DHCS is adding doula services to the list of Medi-Cal preventive services to improve health equity and address health disparities. In order to allow for the successful launch of this benefit, DHCS is adjusting the implementation date for this benefit from January 1, 2022, to July 1, 2022. Additional time is needed to work with stakeholders and health plans, review their input, incorporate their feedback into the State Plan Amendment, ensure successful system updates, seek federal approval from CMS, and allow time for plans to prepare to offer these services. Doula services include emotional and physical support to individuals throughout pregnancy, labor, childbirth, and the postpartum period. Pursuant to federal regulations, doula services will need to be recommended by a physician or other licensed practitioner. DHCS met with stakeholders on September 16 to discuss developing the SPA, including defining qualifications of doulas, covered services, and supervision. These services will be available in both the FFS and managed care delivery systems. More information is available on the
DHCS website, including future opportunities for stakeholders to provide input on doula services and the SPA.
HIV/AIDS Medi-Cal Waiver Program (MCWP) Renewal
On September 29, 2021, DHCS submitted the HIV/AIDS MCWP renewal application to CMS. The renewal application is posted on both the
California Department of Public Health (CDPH) websites. DHCS, in collaboration with CDPH, must renew its HIV/AIDS MCWP every five years. The current HIV/AIDS MCWP term ends on December 31, 2021. The new waiver term will be January 1, 2022, through December 31, 2026. From August 13 through September 13, DHCS posted the HIV/AIDS MCWP renewal to the
AIDS Medi-Cal Waiver Program webpage for a 30-day public comment period. CDPH received and responded to 10 comments from stakeholders, and updated the MCWP renewal application to reflect stakeholder comments.
The HIV/AIDS MCWP, authorized under section 1915(c) of the Social Security Act, provides comprehensive case management and direct care services to persons living with HIV/AIDS as an alternative to nursing facility care or hospitalization. The goals of the MCWP are to: (1) provide home and community-based services for persons with HIV who may otherwise require institutional services; (2) assist participants with HIV health management; (3) improve access to social and behavioral health support; and (4) coordinate service providers and eliminate duplication of services.
Home and Community-Based Alternatives (HCBA) Waiver Renewal
On September 29, 2021, DHCS submitted the HCBA waiver renewal application to CMS. The renewal application, and additional information, is posted on the
DHCS website. DHCS must renew its HCBA waiver every five years. The current waiver term ends on December 31, 2021; the new one will be effective from January 1, 2022, through December 31, 2026. From August 16 through September 16, DHCS posted the HCBA waiver renewal application to the
DHCS website for a 30-day public comment period. DHCS received and responded to 128 comments from 36 stakeholders, and updated the HCBA waiver renewal application to reflect stakeholder comments.
The HCBA waiver, authorized under section 1915(c) of the Social Security Act, provides long-term, community-based services and supports to Medi-Cal-eligible beneficiaries in the community setting of their choice. These services include private duty nursing, case management, and personal care services necessary to maintain the health and safety of an individual with nursing level of care needs, in a community setting instead of an institution.
Home and Community-Based Services (HCBS) Spending Plan
On September 3, 2021,
CMS notified DHCS that California's HCBS Spending Plan was granted partial approval of the initiatives proposed, with one initiative denied and additional information requested for other initiatives. On September 17, DHCS, in collaboration with sister departments,
provided CMS with the additional information requested for specific initiatives. DHCS and its partners are currently developing implementation strategies and timelines. More information will be made available to stakeholders and posted on the DHCS website in the coming weeks.
On July 12, DHCS submitted California's $4.6 billion Medicaid
HCBS Spending Plan to CMS for review and approval. The American Rescue Plan Act of 2021 (ARPA) provides states with a temporary increase in federal funds for certain HCBS Medicaid expenditures from April 1, 2021, through March 31, 2022. The HCBS plan reflects many of the investments included in the initial version released by DHCS in early June, as well as program funding included in the 2021 Budget Act. The plan will expand services for California's most vulnerable and at-risk residents through new and existing programs that will strengthen HCBS in the state's Medicaid delivery systems. These investments will also build capacity and transform critical safety net programs, as well as promote economic mobility and social stability.
Medical Interpreters Pilot (MIP) Project
Pursuant to SB 165 (Chapter 365, Statutes of 2019), DHCS is required to collaborate with stakeholders to establish a pilot at up to four sites to evaluate the provision of medical interpretation services for beneficiaries with Limited English Proficiency (LEP) enrolled in Medi-Cal managed care and FFS Medi-Cal. A primary goal of the pilot will be to determine whether providing medical interpretation services results in a reduction of disparities in access to and use of services, and quality of care, with respect to beneficiaries with LEP and beneficiaries who are proficient in English. DHCS will make available up to $5 million for the pilot project and the associated ongoing, independent evaluation to be conducted throughout the term of the pilot by California State University at San Diego's Institute for Public Health.
On August 31, DHCS announced the following selected pilot site contractors: Contra Costa County—Monterey Language Services; Los Angeles County—Language World Services, Inc.; San Diego County—Hanna Interpreting Services, L.L.C.; and San Joaquin County—J. Rivera Associates. DHCS anticipates that the pilot project will run from November 1, 2021, through September 30, 2023. For more information, visit the
Medication Therapy Management (MTM)
As part of the Governor's 2021 Budget Act, DHCS submitted
SPA 21-0028 to CMS seeking to add MTM as a payable FFS pharmacy service provided in conjunction with certain complex chronic medical conditions. On September 15, DHCS received CMS approval of this SPA, and is now working to finalize provider contracts and meet with stakeholders to obtain feedback and insights regarding the specific requirements and allowances of the MTM benefit. To participate in this program, Medi-Cal-enrolled pharmacies will be required to enter into a contract with DHCS. The contract will outline the requirements and guidelines necessary to receive reimbursement under this methodology.
Medi-Cal Rx Implementation Update
Medi-Cal Rx is scheduled to launch on January 1, 2022. Outreach and education activities have begun and will run through December, in advance of the January 1 go-live date. DHCS will send a 60-day notice to all Medi-Cal beneficiaries and a 30-day notice to all FFS beneficiaries. MCPs will also send a 30-day notice to their members as part of a broader outreach campaign. Additionally, DHCS has resumed Medi-Cal Rx stakeholder engagements and meeting schedules. For more information, please visit the
DHCS website or email RxCarveOut@dhcs.ca.gov.
Money Follow the Person (MFP) Supplemental Funding Application
The MFP demonstration program supports state efforts for rebalancing the state long-term services and supports system so individuals have a choice of where they live and receive services. The goals of the MFP program are to increase the use of HCBS and reduce the use of institutionally-based services, when appropriate, while strengthening the ability of Medicaid programs to provide HCBS to people who choose to transition out of institutions.
On September 23, 2020, CMS announced supplemental funding of up to $165 million for states currently operating a MFP demonstration program. Each state is eligible to receive up to $5 million in supplemental funding for planning and capacity-building activities to accelerate long-term care system transformation design and implementation, and to expand HCBS capacity. To receive a funding award, state grantees were required to submit a proposal that included a project narrative by June 30.
On July 27, CMS approved DHCS' $5 million MFP supplemental funding application to conduct a statewide gap analysis and multiyear roadmap of its HCBS and Managed Medi-Cal Long-Term Supports and Services (MLTSS) programs and networks. The CMS-approved application is available on the
Peer Specialist Certification Program
On July 22, 2021, DHCS released
Behavioral Health Information Notice 21-041 identifying the state standards for Medi-Cal peer support specialist certification programs that may be implemented by counties, or an entity representing counties, that opt in to provide these programs, according to SB 803 (Chapter 150, Statutes of 2020) requirements. This certification is required for Medi-Cal reimbursement, but does not impact peer programs with other funding sources. For questions about Medi-Cal peer support specialist certification, email Peers@dhcs.ca.gov.
On August 27, DHCS released for stakeholder feedback a draft of
SPA 21-0051, which seeks to establish peer support services as a distinct specialty mental health service, and peer support specialists as a distinct provider type.
DHCS is in the process of submitting to CMS all federal Medi-Cal waivers and State Plan Amendments required to implement the new peer support specialist benefit. Upon CMS approval, peer support specialist services could begin by July 1, 2022.
Postpartum Care Coverage
Under the provisions of ARPA, DHCS is opting to broaden the scope of Medi-Cal coverage for currently eligible and newly eligible pregnant individuals. Medi-Cal will cover the full breadth of medically necessary services, during both the pregnancy and postpartum periods, by adding ten months of coverage following the current 60-day postpartum period, for a total of 12 months. In the interest of aligning the Medi-Cal Access Program (MCAP) with the Medi-Cal postpartum care extension policies described above, DHCS submitted a Children's Health Insurance Program (CHIP) SPA,
CA-21-0032, proposing to create a Health Services Initiative (HSI) to extend the provisions allowed in ARPA to MCAP. On September 14, DHCS
received federal approval for the HSI. Under the provisions of ARPA and the HSI, individuals will maintain coverage through their pregnancy and 12-month extended postpartum coverage period regardless of income changes, citizenship, or immigration status. This policy is targeted for implementation on April 1, 2022.
Smile, California Campaign for Medi-Cal Dental Services
The statewide “Back-Tooth-School" campaign, which aimed to encourage parents and caregivers to send their children back to school with healthy smiles by scheduling a dental check-up before the start of the 2021-22 school year, concluded in September.
Smile, California developed 15 new resources and assets (translated in Spanish and some in Chinese) as part of this campaign. Fifty-six local oral health programs participated in the campaign by co-branding
Smile, California resources, sharing messaging through social media, and conducting kindergarten oral health assessment events.
Also, two new videos were posted to
SonrieCalifornia.org. The first video, entitled “How to Use the Find A Dentist Tool," is available in both
Spanish. The second video, “Healthy Children are Ready to Learn!", underscores the important role good oral health and regular dental check-ups play in school readiness. This video is also available in both
English and Spanish.
Additionally, in October,
Smile, California will partner with 185 school-based health centers, which do not offer dental treatment as a service, by providing them with a new 11x17 inch poster in English, Spanish, Mandarin, and Vietnamese. The poster will feature a 2-2-2 tip message (visit the dentist 2x a year, and brush for 2 minutes 2x a day each day) and will feature a list of the free and low-cost services provided by the Medi-Cal Dental Program. Further, in celebration of the campaign's third anniversary, five Medi-Cal dental provider testimonial videos will premiere on
Smile, California's website and social media accounts. Watch the series on
By the end of August,
SmileCalifornia.org had 19,854 new visitors, of which 14,505 clicked the “Find a Dentist" button.