24de marzo de 2025
Principales noticias
California presenta una solicitud para ampliar el tratamiento de la enfermedad de células falciformes
On March 11, DHCS applied to CMS to participate in the groundbreaking Cell and Gene Therapy (CGT) Access Model. If accepted, DHCS will implement this multi-year initiative to expand Medi-Cal members’ access to innovative and potentially life-changing therapies for sickle cell disease (SCD), a severe genetic blood disorder that disproportionately impacts people of African descent. Gene therapy represents a groundbreaking approach to SCD. However, these therapies come with extraordinary costs, making access difficult for patients and Medicaid programs, including Medi-Cal. The CGT Access Model addresses this challenge by using a negotiated rebate system that ties payments for these treatments to patient outcomes. If the therapy does not meet expected health improvements, drug manufacturers will provide rebates to Medicaid programs, helping ensure financial sustainability while expanding access to care. If California is approved, eligible Medi-Cal members would gain access to gene therapy treatment, fertility preservation services, case management, travel assistance, and behavioral health support. CMS anticipates testing the model over an 11-year performance period. If approved, California will begin participating in this model on July 1, 2025.
Implementación de Beneficios de Prácticas Tradicionales de Cuidado de la Salud
On March 21, DHCS published Behavioral Health Information Notice (BHIN) 25-007 – Traditional Health Care Practices Benefit Implementation. This policy, the result of years of dedicated effort and advocacy from California Tribal leaders and partners, provides guidance on the implementation of the traditional health care practices benefit in the Drug Med-Cal Organized Delivery System (DMC-ODS). The federal Centers for Medicare & Medicaid Services (CMS) approved DHCS to cover traditional health care practices provided by Indian Health Care Providers (IHCP) for Medi-Cal members in DMC-ODS counties through December 31, 2026, unless extended or amended. Traditional health care practices encompass two new service types: Traditional Healer and Natural Helper services. DMC-ODS counties will cover Traditional Healer and Natural Helper services provided by IHCPs to Medi-Cal members who meet DMC-ODS access criteria. For questions about traditional health care practices or this BHIN, please email traditionalhealing@dhcs.ca.gov.
Additionally, on April 22, DHCS will present an overview of BHIN 25-007 at the Tribes and Indian Health Program Representatives meeting (advance registration required). The presentation is open to the public and will review policy guidance to support IHCPs and DMC-ODS counties in implementing this new benefit. Attendees are encouraged to submit questions in advance to traditionalhealing@dhcs.ca.gov with the subject line “Traditional Health Care Practices Implementation.”
Program Actualizaciones
Ya disponible: Materiales del seminario web sobre la guía de implementación de referencias de circuito cerrado
Effective July 1, 2025, Medi-Cal managed care plans will be required to implement Closed-Loop Referral (CLR) requirements for Enhanced Care Management (ECM) and Community Supports. CLR requirements aim to increase the number of Medi-Cal members successfully connected to these benefits and services. By improving information collection processes, managed care plans will be able to better support individual referrals and address system-level gaps in referral practices and service availability that impact members. DHCS released materials from the February 13 webinar (posted under Informational Webinars) to share more details about these requirements. In the webinar, DHCS provided:
- The Department’s goal and motivation for releasing new CLR requirements.
- Cómo los requisitos de CLR mejorarán el proceso de referencia de miembros al simplificar los esfuerzos de seguimiento, apoyo y supervisión de referencias.
- Un ejemplo de escenario de caso de uso sobre cómo los requisitos de CLR ayudarían a un miembro a recibir el apoyo comunitario de comidas médicamente adaptadas.
Comuníquese con el DHCS si tiene alguna pregunta o comentario sobre las iniciativas de Gestión de la Salud de la Población de California Advancing and Innovating Medi-Cal (CalAIM) en PHMSection@dhcs.ca.gov.
Únete a nuestro equipo
DHCS está contratando para sus equipos financieros, de recursos humanos, farmacia, salud conductual y otros. Para más información, por favor visite el sitio web de CalCareers.
Próximas reuniones de partes interesadas y seminarios web
DHCS publica las próximas reuniones públicas en el Calendario de Eventos.
Seminario web de embajadores de cobertura
El 25 de marzo, de 11 a.m. a 12 p.m. PDT, DHCS organizará un seminario sitio web de Embajadores de Cobertura (se requiere inscripción previa) para brindar información sobre Health Care Options y actualizaciones de Medi-Cal. Los embajadores de cobertura ayudan a correr la voz sobre los beneficios de Medi-Cal, la información de inscripción y los nuevos proyectos enfocados en crear una California saludable para todos. Visite el sitio web de Embajadores de Cobertura para obtener más información, o suscribir para convertir en Embajador de Cobertura y recibir actualizaciones Regular .
Reunión del grupo de trabajo de servicios y soportes gestionados a largo plazo (MLTSS) y de integración dual
On March 27, from 10 a.m. to 12 p.m. PDT, DHCS will host the CalAIM MLTSS and Duals Integration Workgroup meeting (advance registration required). The workgroup is a stakeholder collaboration hub for CalAIM MLTSS and integrated care for dual eligible members. It allows stakeholders to provide feedback and share information about policy, operations, and strategy for upcoming changes to Medi-Cal and Medicare. The meeting agenda includes updates on Medicare enrollment data for dual eligible members, the Dual Eligible Special Needs Plan (D-SNP) Dashboard, D-SNP initiatives, and the D-SNP State Medicaid Agency Contract and Policy Guide. It also includes data updates on Enhanced Care Management and Community Supports for dual eligibles and a Community Supports service spotlight presentation on select service definition updates.
More information, background materials, transcripts, and video recordings of previous workgroup meetings are posted on the CalAIM MLTSS and Duals Integration Workgroup webpage. For questions or comments, please email DHCS at info@calduals.org.
Cobertura de audífonos para niños Program (HACCP) Seminario web para proveedores médicos y profesionales de la audición
On March 27, from 12 to 1 p.m. PDT, DHCS will host the quarterly HACCP webinar for medical providers and hearing professionals. For more information and to register, please visit DHCS’ HACCP webpage. Registration information will be posted as the webinar date approaches.
Por si te lo perdiste
Ya está abierta: Solicitud de la Ronda 4 para la Transición, Expansión y Desarrollo de la Capacidad y la Infraestructura (CITED) de Proporcionar Acceso y Transformar la Salud (PATH)
On January 6, DHCS opened the PATH CITED Round 4 application window, which includes funding opportunities to support the implementation of the new transitional rent Community Support. The PATH CITED initiative provides funding to build the capacity and infrastructure of on-the-ground partners, including community-based organizations, hospitals, county agencies, Tribes, and others, to successfully participate in Medi-Cal. All organizations providing the transitional rent Community Support must do so in partnership with their county behavioral health department. To demonstrate this partnership, all CITED applicants planning to request funding to support the transitional rent Community Support must also submit a Letter of Support in collaboration with the county behavioral health department.
La fecha límite para solicitar el financiamiento de la Ronda 4 de PATH CITED es a las 11:59 p.m. PDT del 2de mayo de 2025. El documento de orientación y la solicitud están disponibles en la página web de PATH CITED. Por favor, envíe cualquier pregunta a cited@ca-path.com.