Principales noticias
Volver a la actualización de comunicaciones con las partes interesadas de febrero de 2022
Actualización de la Solicitud de Propuesta (RFP) del Plan de Atención Administrada
On February 9, DHCS released a RFP for its commercial Medi-Cal managed care plan (MCP) contractors that will redefine how care is delivered to more than 12 million Californians. The RFP raises the state’s expectations of MCPs in the Medi-Cal program through a new and strengthened contract that will apply to all plans. This unprecedented Medi-Cal plan procurement, when implemented, will transform health care delivery for Californians enrolled in Medi-Cal managed care.
DHCS está buscando socios de MCP comprometidos con el avance de la equidad, la calidad, el acceso, la responsabilidad y la transparencia para reducir las disparidades de salud y mejorar los resultados de la atención médica para los miembros de Medi-Cal. Los MCP seleccionados se comprometerán a cumplir requisitos nuevos y mejorados para garantizar que los miembros tengan acceso a los servicios de atención médica adecuados cuando sea necesario, incluidos los servicios sociales, los apoyos y los servicios de administración de la atención que son fundamentales para impulsar mejoras en la salud de la población y la equidad en la salud. A través del proceso de RFP, el DHCS está mejorando su supervisión de los socios del plan y sus subcontratistas para garantizar una mayor transparencia y responsabilidad.
The RFP procurement is part of a larger set of state investments in the health and well-being of all Californians that includes CalAIM. Proposals from MCPs are due on April 11, 2022. DHCS will award contracts by fall 2022, and new contracts are scheduled to begin on January 1, 2024.
On February 15, DHCS hosted an all-comers webinar for members, advocates, providers, health plans, and other stakeholders to share how DHCS will leverage the MCP RFP and managed care contracts to further DHCS’ goals to enhance how care is delivered to Medi-Cal members.
On February 24, DHCS will host a voluntary pre-proposal web conference from 1 – 2:30 p.m. specifically for the MCP procurement and the RFP released on February 9; Register for the RFP web conference
Visite la página web de adquisiciones de MCP para obtener más información. Visit the RFP webpage to view the RFP.
Actualización de la implementación de Medi-Cal Rx
On January 1, DHCS transitioned the Medi-Cal pharmacy benefit of more than 14 million Medi-Cal members to a single delivery system, a change that will benefit members and result in substantial savings. As is the case with any large project, some implementation issues were to be expected, and DHCS’ vendor, Magellan, is addressing those as quickly as possible. DHCS is also ensuring that providers are kept updated, and that relevant information is communicated to them via e-mail blasts, provider newsflashes, information on the DHCS and Medi-Cal Rx websites, and direct provider outreach. Our actions are designed to ensure that Medi-Cal members can get the prescription drugs they need when they need them. For questions or comments related to Medi-Cal Rx, please email RxCarveOut@dhcs.ca.gov.
Actualización de California Avanzando e Innovando Medi-Cal (CalAIM)
On December 29, 2021, DHCS received approval of the CalAIM Section 1115 Demonstration, CalAIM Section 1915(b) waiver, and Medi-Cal State Plan Amendments from the federal Centers for Medicare & Medicaid Services (CMS). These approvals provide the authority to launch CalAIM, a long-term commitment to transform and strengthen Medi-Cal – the cornerstone of California’s health care system.
CalAIM shifts Medi-Cal to a population health approach, prioritizing prevention, addressing social drivers of health, and transforming services for communities who historically have been under-resourced and faced structural racism in the health care system. CalAIM is a bold transformation, putting people’s needs at the center of care and setting the pace for transformation of the entire health care sector.
On January 14, DHCS hosted a webinar to provide an overview of the recently approved CalAIM Section 1115 Demonstration and 1915(b) waiver. View the January 14 CalAIM Section 1115 demonstration 1915(b) waiver presentation.
Programa de incentivos para la vacunación contra el COVID-19 de Medi-Cal
El DHCS está asignando hasta $350 millones para incentivar los esfuerzos de vacunación contra el COVID-19 en el sistema de prestación de atención administrada de Medi-Cal desde el 1de septiembre de 2021hasta el 28de febrero de 2022. Los MCP de Medi-Cal son elegibles para recibir pagos de incentivos por actividades diseñadas para cerrar las brechas de vacunación con sus miembros inscritos y para abordar las disparidades en la aceptación de la vacuna para grupos específicos de edad y raza/etnia. Los MCP pueden ganar hasta $50 millones por lograr medidas de proceso específicas y $200 millones por medidas de resultados, con $100 millones disponibles para que los MCP los utilicen para incentivos directos a los miembros.
Effective September 1, 2021, all 25 full-service MCPs and one population-specific health plan were approved for participation in the program. The first outcome ascertainment period ended on October 31. Between September 1 and October 31, all plans reported improvement in all three intermediate outcome measures and all seven vaccine uptake outcome measures. Statewide, the target for Measure 3 was exceeded, improving the percentage of primary care providers in MCP networks providing COVID-19 vaccine in their office from 49.3 percent to 56.8 percent. In addition, almost one-third of the gap in COVID-19 vaccination rates between the Medi-Cal and overall California populations ages 12-25 was closed, and almost one-third of the gap in COVID-19 vaccination rates between the overall Medi-Cal population and both the Black/African American and American Indian/Alaska Native Medi-Cal populations was closed. Vaccination rates continued to improve through the second outcome ascertainment date of January 2, 2022, but statewide did not meet DHCS’ goal of closing two-thirds of the gap for any of the seven vaccine update outcome measures. January 2 data for the three intermediate outcome measures are being compiled.