April 29. 2024 – Stakeholder Update
Principales noticias
DHCS celebra el corte de cinta para los centros de tratamiento de salud conductual
On April 25 and 26, DHCS celebrated the addition of two new facilities that will provide lifesaving treatment for Californians with mental health and substance use disorders (SUD). Paving the Way Foundation in Los Angeles County and Center Point Drug Abuse Alternatives Center in Sonoma County are expanding behavioral health treatment and recovery options in their local communities. These are among the first of many community treatment sites supported by the Behavioral Health Continuum Infrastructure Program and are under construction now in 49 counties. Even more sites will be funded and built, thanks to recently approved Proposition 1 bonds.
Program Actualizaciones
Nuevo requisito de diagnóstico del Código 1 para las reclamaciones de medicamentos recetados de Medi-Cal
Effective April 30, Code 1 Diagnosis Requirement – Reject Code 80 claim utilization management (UM) edits will be implemented for members 22 years of age and older. Medi-Cal Rx will use diagnosis code(s) from the member’s Medi-Cal medical record to meet the Code 1 diagnosis restriction. Code 1 drugs are subject to prescription documentation requirements, and prescribers and pharmacy providers must document the treatment diagnosis and keep that information readily available for auditing purposes. Code 1 diagnosis requirements can be met in one of four ways: provide a diagnosis with the prescription, communicate the diagnosis verbally to the pharmacy provider, submit a prior authorization request with the diagnosis, or use an acceptable diagnosis code that is on file in the Medi-Cal data system. Members 21 years of age and younger are not impacted.
Smile, California Continúa el recorrido en camioneta dental móvil
On May 4, the Smile, California mobile dental van tour will stop in Huntington Park. During the event, individuals will have access to various dental services, such as exams, X-rays, cleaning, and fluoride applications. More information about Medi-Cal-covered dental services is available on the Smile, California website.
Únete a nuestro equipo
DHCS está contratando para equipos de comunicaciones, recursos humanos, auditoría, políticas de salud, tecnología de la información y otros. Para obtener más información, visite el sitio web de CalCareers.
Próximas reuniones de partes interesadas y seminarios web
Medi-Cal Children’s Health Advisory Panel (MCHAP)
On May 1, from 10 a.m. to 2 p.m., DHCS will hold the MCHAP hybrid meeting (advance registration required). MCHAP advises DHCS on policy and operational issues that affect children in Medi-Cal. The panel consists of a 15-member advisory body whose members include recognized stakeholders and experts in their fields, medical professionals, advocates, and parent members. If you are interested in receiving information about MCHAP meetings or have general inquiries, please email MCHAP@dhcs.ca.gov.
Grupo de Trabajo de Partes Interesadas Centrado en el Consumidor (CFSW)
On May 3, from 10 to 11:30 a.m., DHCS will convene the CFSW, which provides stakeholders an opportunity to review and provide feedback on a variety of consumer messaging materials. The forum focuses on eligibility- and enrollment-related activities and strives to offer an open discussion on Medi-Cal policies and functionality. Meeting materials, including the meeting agenda, will be posted to the CFSW webpage no later than May 1. Please email your questions to DHCSCFSW@dhcs.ca.gov.
Reunión de partes interesadas de Medi-Cal Dental Los Ángeles
El 14 de mayo, de 1 a 3 p.m., DHCS será el anfitrión de la reunión de partes interesadas de Medi-Cal Dental Los Ángeles. DHCS compartirá actualizaciones e información sobre actividades nuevas y futuras. La reunión también proporciona a las partes interesadas en el sector dental un foro para compartir información con el equipo dental de Medi-Cal que puede ayudar a mejorar la prestación de servicios de atención de la salud bucal. La información de la reunión se publicará en la página web de las Reuniones de Partes Interesadas de DHCS Medi-Cal Dental Los Ángeles. Los materiales adicionales se publicarán en la página web antes de la reunión o tan pronto como estén disponibles. Envíe sus preguntas por correo electrónico a dental@dhcs.ca.gov.
Reunión del Comité Asesor de Partes Interesadas (SAC)/Salud Conductual (BH)-SAC
On May 29, from 9:30 a.m. to 3 p.m., DHCS will convene the SAC/BH-SAC hybrid meeting (advance registration required). The meeting will include an update on Proposition 1 implementation. SAC provides DHCS with valuable input on ongoing California Advancing and Innovating Medi-Cal (CalAIM) implementation efforts, as well as helps DHCS further its efforts to provide high-quality, equitable care.
BH-SAC is a broad-based body that disseminates information and receives coordinated input regarding DHCS behavioral health activities. It was created as part of the ongoing DHCS effort to integrate behavioral health with the rest of the health care system and incorporates existing groups that have advised DHCS on behavioral health topics.
Reunión del Grupo de Trabajo de Servicios y Apoyos Administrados a Largo Plazo (MLTSS) y Integración Dual de CalAIM
On May 30 at 10 a.m., DHCS will host the CalAIM MLTSS and Duals Integration Workgroup virtual meeting (advance registration is required). The workgroup serves as a stakeholder collaboration hub for CalAIM MLTSS and integrated care for dual eligible members and allows stakeholders to provide feedback and share information about policy, operations, and strategy for upcoming changes to Medi-Cal and Medicare.
Los temas de la agenda incluyen actualizaciones sobre el Contrato de la Agencia Estatal de Medicaid (SMAC) y la Guía de Políticas del Plan de Necesidades Especiales de Doble Elegibilidad (D-SNP), los datos de inscripción en Medicare para miembros con doble elegibilidad, el Programa Piloto de Inscripción Predeterminada y la Regla Final de Medicare Advantage y la Parte D de los Centros de Servicios de Medicare y Medicaid (CMS) de 2025, así como una presentación sobre la Administración de Atención Mejorada y los Apoyos Comunitarios para los miembros con doble elegibilidad.
Los materiales de referencia, las transcripciones y las grabaciones de video de las reuniones anteriores del grupo de trabajo, junto con información adicional sobre el grupo de trabajo, se publican en la página web del Grupo de Trabajo de Integración Dual y MLTSS de CalAIM. Si tiene preguntas o comentarios, envíe un correo electrónico a info@calduals.org.