Principales noticias

El Gobernador Nombra al Nuevo Director de Operaciones de Programas (COOP) del DHCS

On October 10, Governor Newsom announced the appointment of Chris Riesen as DHCS’ new COOP, effective October 16. As part of the Directorate, Chris will provide leadership of Enterprise Data and Information Management, Enterprise Technology Services, and Program Operations. The COOP position expands the Director’s Office to increase capacity to manage the growth and increased complexity of DHCS’ programs, as well as to better support work/life balance. This position will support Erika Sperbeck’s work as Chief Deputy Director for Policy and Program Support, leading Department operations and program integrity functions. Since July 2018, Chris has served as DHCS’ Deputy Director for Enterprise Technology Services and Chief Information Officer.

Actualización de renovaciones de Medi-Cal

DHCS today published the August 2023 Medi-Cal continuous coverage unwinding eligibility measures data on the Medi-Cal Enrollment and Renewal Data webpage. The August dashboard includes data on Medi-Cal enrollment, applications in progress, redeterminations, and disenrollments. The data also include demographic details for all redetermination measures, along with the top reasons for disenrollments. 

Planes Medi-Medi disponibles durante la inscripción abierta de Medicare

During the upcoming Medicare open enrollment period (October 15 through December 7), Medicare-Medi-Cal Plans (Medi-Medi Plans) are available for enrollment in twelve counties (Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara currently, as well as five new counties – Fresno, Kings, Madera, Sacramento, and Tulare – beginning on January 1, 2024). Medi-Medi Plans combine Medicare and Medi-Cal benefits and Medicare prescription drug benefits into one plan.

Approximately 45 percent of dually eligible members are enrolled in some type of Medicare Advantage plan. Enrollment in Medi-Medi Plans as of July 2023 is approximately 241,105 members. The benefits of Medi-Medi Plans include integrated materials, such as a single health plan card and one phone number to call for both Medicare and Medi-Cal benefits, leading to improved care coordination and support for members.

Los planes Medi-Medi coordinan todos los beneficios y servicios de ambos Program, incluidos todos los servicios cubiertos Medicare , todos los servicios cubiertos por Medi-Cal , beneficios suplementarios adicionales, beneficios específicos (es decir, In-Home Supportive Services, Multipurpose Senior Services Program, Community-Based Adult Services y servicios dentales), un equipo de gestión de atención para coordinar la atención y los apoyos comunitarios ofrecidos por el plan Medi-Cal Managed Care .

Program Actualizaciones

Flexibilidades adicionales de desenrollado de cobertura continua

On September 22, the federal Centers for Medicare & Medicaid Services approved DHCS’ request for two flexibilities that leverage existing regulations to help streamline the processing of annual Medi-Cal eligibility renewals and ease burdens on county program administrators and Medi-Cal members. The first flexibility waives the requirement for Medi-Cal members to sign and return a renewal packet that had already been submitted if counties receive verification of missing information after the packet was mailed. The second flexibility allows the use of the explanation submitted by the member within the renewal packet as sufficient verification for a successful redetermination, eliminating the need for additional supporting documentation. These flexibilities will streamline the renewal process for Medi-Cal members, especially individuals experiencing homelessness and elderly or disabled populations. Additionally, the flexibilities will ease burdens to provide additional paperwork or documentation and reduce procedural terminations during the continuous coverage unwinding period.

The flexibilities will continue throughout the unwinding period. DHCS issued Medi-Cal Eligibility Division Information Letter (MEDIL) I 23-49 to provide counties with immediate guidance on operationalizing these flexibilities.

Memorandos de Entendimiento entre Planes de Atención Administrada y Entidades Externas

Esta semana, DHCS publicó una Carta para Todos los Planes (APL), dos Avisos de Información sobre Salud Conductual (BHIN) y plantillas de Memorándums de Entendimiento (MOU) asociados para los planes Medi-Cal Managed Care (MCP), requeridos por el contrato MCP de 2024 para firmar MOU con ciertas entidades de terceros para garantizar que la atención de los miembros esté coordinada y que los miembros tengan acceso a recursos comunitarios para apoyar la atención integral de la persona. Los MOUs están pensados para ser vehículos eficaces para clarificar roles y responsabilidades entre las partes y apoyar la participación local, la coordinación de cuidados, el intercambio de información, la responsabilidad mutua y la transparencia.

The MOU templates include a base template, which contains general provisions required to be included in all MOUs, and a set of bespoke templates tailored for programs or services administered by third-party entities that contain the required general MOU provisions and program-specific provisions. The bespoke templates are for MCPs to enter into MOUs with third-party entities with whom MCPs must make a good faith effort to execute by January 1, 2024, and include: local governmental agencies, such as county behavioral health departments for specialty mental health care and substance use disorder services; other local programs and services, including social services; child welfare departments; Regional Centers; In-Home Supportive Services programs; and Women, Infants, and Children Supplemental Nutrition Programs. DHCS will release additional required MOU templates for use by MCPs and third-party entities as they are finalized, including those required to be executed on July 1, 2024, and January 1, 2025. Additional information and copies of the MOU templates are available on the DHCS MOU webpage.

Beneficios dentales de Medicare y Medi-Cal

On October 11, DHCS released a new fact sheet for dental providers regarding dental benefits for dual eligible (Medicare and Medi-Cal) members. The fact sheet provides information about dental benefits that both Medicare and Medi-Cal offer and how providers can bill for dental services provided to members. Medicare, the primary payer for dual eligible patients, does not cover most dental care. Medi-Cal covers a variety of dental benefits administered by Medi-Cal dental providers. A dual eligible patient may also receive dental benefits through their Medicare Advantage plan. For dental services covered by Original Medicare or a Medicare Advantage plan, the services must be billed to Original Medicare or the Medicare Advantage plan first.

Medi-Cal Rx

On October 13, reinstatement Phase 3/Lift 3 will reinstate Quantity Restriction Edits for members 22 years of age and older. Quantity Limit restrictions will be applied to all (new and continuing) pharmacy claims. Some commonly prescribed Code I medications on the Medi-Cal Rx Contract Drugs List (CDL) have quantity limits based on the U.S. Food and Drug Administration-approved or clinically sound dosing guidelines. Claims may reject if billed incorrectly.

Also, a 30-day countdown alert was released on October 10 for the final reinstatement action. On November 10, implementation of Phase 4/Lift 4 of reinstatement will retire the transition policy for all pharmacy benefits for members 22 years of age and older; reinstate prior authorization (PA) requirements for all therapies for standard therapeutic classes 68, 86, and 87, which includes enteral nutrition products; reinstate utilization management claim edits for Reject Code 80 – Diagnosis Code Submitted Does Not Meet Drug Coverage Criteria; and reinstate Brand Medically Necessary PA requirements for all claims.

Para el 17 de octubre, todas las partes interesadas de Medi-Cal Rx con las que DHCS estuvo en contacto recibieron la comunicación "Advancing Medi-Cal Rx", que anuncia el fin del esfuerzo de restablecimiento para adultos y que no habrá cambios para la población pediátrica hasta 2024. Entre las partes interesadas se incluyen Local Health Plan of California, California Association of Health Plan, California Health Association, directores de farmacias de planes de Medi-Cal Managed Care , California Children's Hospital Association, Children's Specialty Care Coalition, Children's Regional Integrated Service System, California Medical Association, California Retailers Association, National Association of Chain Drug Stores, California Pharmacists Association, California Primary Care Association, California Behavioral Health Directions Association, California Association of Medical Product Suppliers y Hemophilia Council of California.

Únete a nuestro equipo

DHCS está contratando para nuestros equipos fiscales, de recursos humanos, legales, de auditoría, de políticas de salud y de tecnología de la información. Para obtener más información, visite el sitio web de CalCareers.

DHCS’ purpose is to provide equitable access to quality health care leading to a healthy California for all. DHCS’ goals and objectives reflect DHCS’ tremendous work to transform the state’s health care system and strengthen organizational excellence.

Próximas reuniones de partes interesadas y seminarios web

Seminario web de expansión para adultos

El 18 de octubre, el DHCS celebrará el primero de dos seminarios sitio web sobre la ampliación del programa Medi-Cal para adultos (de 26 a 49 años) dirigidos a las oficinas locales del condado y otras partes interesadas. El segundo seminario sitio web está previsto provisionalmente para principios de diciembre. El seminario sitio web proporcionará información de fondo sobre la expansión, la planeación de la implementación, la notificación, la divulgación y más. La información de inscripción se publicará en el sitio web de la ampliación de la cobertura completa de Medi-Cal para adultos de 26 a 49 años. Las personas pueden inscribir en el seminario sitio web enviando un email a AdultExpansion@dhcs.ca.gov.

DHCS will implement this expansion pursuant to Senate Bill 184 (Chapter 47, Statutes of 2022) on January 1, 2024. When implemented, the expansion will provide individuals 26-49 years of age with full scope Medi-Cal benefits, regardless of citizenship or immigration status, if they meet all other Medi-Cal eligibility criteria.

Reunión del Comité Asesor de Partes Interesadas (SAC) y Salud Conductual-SAC (BH-SAC)

On October 19, from 9:30 a.m. to 3:30 p.m., DHCS will host the next SAC and BH-SAC hybrid meeting (advance registration required). It will open as a joint meeting, with topics shared by SAC and BH-SAC. A BH-SAC-only meeting will be held after the joint meeting; there is no SAC-only meeting. Participants may attend in person at The California Endowment, located at 1414 K Street in downtown Sacramento, or virtually. For more information, please visit the SAC and BH-SAC webpages.

Horario de oficina del Programa de Acceso y Transformación de la Salud (PATH, por sus siglas en inglés)

On October 23, DHCS will host the next PATH Justice-Involved Program virtual office hours session for Round 3 awardees (advance registration required). Office hours will be held every other Monday at 11:30 a.m. through December 18 to assist Round 3 agencies, including supporting implementation plan submission. For more information, visit the Justice-Involved Program website.

Seminario web sobre el consentimiento y la confidencialidad de los menores para los servicios de salud sexual

El 25 de octubre, de 12:00 a 13:30, el DHCS y el Centro de Capacitación para la Prevención de California organizarán un seminario sitio web sobre el consentimiento de menores y la confidencialidad en los servicios de salud sexual (se requiere inscripción previa). Este seminario sitio web ofrecerá una visión general de las leyes de California que afectan a los menores y su acceso a servicios confidenciales de salud sexual y planeación familiar. Se revisarán importantes excepciones a la confidencialidad, incluyendo la obligación de denunciar el abuso infantil, y se compartirán ejemplos de buenas prácticas para su implementación en situaciones difíciles. Los participantes conocerán recursos para apoyar la aplicación de las leyes de consentimiento de menores y tendrán la oportunidad de poner a prueba sus conocimientos mediante estudios de caso.

Para quienes no puedan asistir al seminario sitio web en directo, la transcripción y la grabación del mismo, junto con recursos adicionales, estarán disponibles en el sitio web de Family PACT.

Seminario web sobre las mejores prácticas de planificación e implementación colaborativa (CPI) de PATH

On October 27, from 10 to 11 a.m., DHCS will host a statewide webinar, entitled Enhanced Care Management (ECM) and Community Supports Provider Peer Support and Contracting Self-Assessment (advance registration required). This virtual session is the first in a series of biannual best practices webinars designed to highlight best practices for implementing ECM and Community Supports, increase providers’ successful participation in California Advancing and Innovating Medi-Cal (CalAIM), and improve collaboration with MCPs, state and local government agencies, and others to build and deliver quality support services to Medi-Cal members. For more information and to register, please visit the PATH CPI webpage.

Por si te lo perdiste

California otorga millones a proveedores de salud conductual para combatir el COVID-19

DHCS awarded nearly $5.2 million to 36 mental health and/or substance use disorder providers through the COVID-19 Substance Use and Mental Health Disorder Mitigation Project to support community mitigation measures that prevent the spread of COVID-19 and protect those who are at increased risk for severe illness. From September 15, 2023, through March 31, 2025, providers will receive up to $500,000 to expand services to provide education about COVID-19 testing, implement onsite COVID-19 testing, collaborate with community partners to prevent infectious disease transmission, and expand COVID-19 response services to individuals connected to the behavioral health system.

Paridad del plan de atención dental administrada

As part of the CalAIM 1915(b) waiver Special Terms and Conditions, DHCS conducted a parity evaluation to assess the performance (utilization) of Sacramento County dental managed care (DMC) plans compared to the statewide dental fee-for-service (FFS) delivery system. The evaluation was based on utilization measures for calendar year 2022 in the following categories: annual dental visits, preventive dental services, and use of sealants for children and adults. Based on the evaluations, DHCS determined that none of the three DMC plans operating in Sacramento County – Access Dental Plan, Health Net Dental, and Liberty Dental Plan – met parity with statewide FFS utilization averages in all required measures. As a result, members currently enrolled in DMC plans will have the option to enroll in FFS. 

A partir de noviembre de 2023, DHCS enviará avisos a aproximadamente 614.000 miembros actualmente inscritos en planes DMC en el condado de Sacramento para informarles de su opción de permanecer con su plan actual o dar de baja y unir a FFS, a partir del 1 de diciembre de 2023. El aviso proporcionará información sobre cómo los miembros pueden acceder a los servicios dentales si eligen el plan de pago por servicio (FFS) o su opción de elegir un plan DMC alternativo solo si el miembro puede demostrar un problema de acceso a la atención en el plan FFS. Además, a partir del 1 de diciembre, los nuevos miembros Medi-Cal que cumplan los requisitos se inscribirán automáticamente en FFS dental. Para consultar los reportes de rendimiento de DMC y FFS dental, visite la sitio web de Reportes de datos dentales.