DHCS Stakeholder News – June 23, 2023
اخبار برتر
حقوق باروری
Tomorrow marks one year since the U.S. Supreme Court overturned Roe v. Wade, ending the constitutional right to abortion services. Reproductive freedom is still a right in California, and DHCS is playing its part in ensuring access to sexual and reproductive health services under its Medi-Cal and Family Planning, Access, Care, and Treatment (Family PACT) programs.
According to a new issue brief, Implementing State-Level Policy and Operational Processes that Enhance Access to Medicaid Family Planning Program Services, California is ranked among the top states in the country in both Medicaid family planning program utilization and enrollment. The issue brief highlights DHCS’ Family PACT program, which has operated since 1997 and provides comprehensive family planning services and reproductive health services to low-income Californians. Below are examples of how DHCS is protecting the right to choose:
- DHCS به ارائه دهندگان خدمات درمانی Medi-Cal در مورد ادامه بازپرداخت هزینه سقط جنین با دارو با استفاده از رژیم درمانی فقط با میزوپروستول اطلاع داد.
- DHCS در حال اجرای برنامه پرداخت سهام و زیرساخت برای ارائه دهندگان سقط جنین کلینیک است که فقط از بودجه دولتی استفاده می کند، برای کلینیک های جامعه غیر بیمارستانی که هزینه های قابل توجهی را در ارتباط با ارائه خدمات سقط جنین به اعضای Medi-Cal متحمل می شوند. قانون بودجه 2022-23 شامل بودجه یکباره 15 میلیون دلاری در سال مالی ایالتی (SFY) 2022-23 و 15 میلیون دلار در SFY 2023-24 برای این برنامه بود.
- از اکتبر 1 ، 2022 ، برنامه Medi-Cal به مراکز بهداشتی فدرال واجد شرایط (FQHC)، کلینیک های بهداشت روستایی، تفاهم نامه خدمات بهداشتی هند و ارائه دهندگان FQHC قبیله ای با گزینه جدیدی برای بازپرداخت با نرخ حق الزحمه خدمات برای خدمات سقط جنین تحت پوشش تحت Medi-Cal شروع به بازپرداخت کرد.
- DHCS به عنوان مدیر برنامه منصوب شده توسط شهرستان لس آنجلس برای ایجاد برنامه آزمایشی Safe Haven دسترسی به سقط جنین در لس آنجلس، به منظور گسترش، دسترسی کامل به سلامت و ارتقای سلامت، به عنوان مدیر برنامه تعیین شده توسط شهرستان لس آنجلس، مبلغ 20 میلیون دلار (مجمع 179، فصل 249، اساسنامه سال 2022) (مجمع 179، فصل 249، اساسنامه سال 2022) ارائه می کند. سقط جنین، در شهرستان لس آنجلس.
Additionally, on June 8, 2023, California submitted a new demonstration project under Section 1115 of the Social Security Act, entitled California’s Reproductive Health Access Demonstration (CalRHAD), to the Centers for Medicare & Medicaid Services. The purpose of this application is to seek federal approval of a new three-year demonstration agreement to bolster California’s sexual and reproductive health delivery system, with the goal of ensuring equitable access to a broad range of sexual and reproductive health services.
Through the CalRHAD demonstration, California seeks authority to provide grants to reproductive health providers to enhance capacity and access to sexual and reproductive health services, while also promoting the sustainability of California’s reproductive health provider safety net for the benefit of individuals enrolled in Medi-Cal and other individuals who currently face barriers to access. California’s submission builds upon the state’s existing investments in reproductive health services. CalRHAD aligns with the state’s efforts to promote equitable access to comprehensive sexual and reproductive health care.
The Centers for Medicare & Medicaid Services has completed its preliminary review and found the state’s demonstration application complete in accordance with 42 Code of Federal Regulations 431.412(a). California’s application is posted on Medicaid.gov for a 30-day federal public comment period (June 16 through July 16).
انعطافپذیریهای فدرال برای جلسات عادلانه ایالتی تأیید شد
On June 23, 2023, the Centers for Medicare & Medicaid Services (CMS) approved DHCS’ two requests for federal waiver authority under the Social Security Act to help address the volume of State Fair Hearings once the continuous coverage requirement ends. The two waiver requests extend the timeframe for Medi-Cal members to request a fair hearing from the original 90 days to 120 days, and extend the timeframe to take final administrative action on fair hearings from 90 to 120 days. Both waivers are effective retroactive to April 1, 2023. The waiver on the extended timeframe for Medi-Cal members to request a fair hearing remains effective through September 30, 2024, and the waiver for the extended timeframe for final administrative action on fair hearings will remain effective through February 28, 2025. DHCS will issue a Medi-Cal Eligibility Division Information Letter no later than June 26 with updated guidance for counties.
راهنمای سیاست گذار برنامه مراقبت مدیریت شده (MCP).
در 23 ژوئن، DHCS راهنمای خطمشی انتقال MCP 2024 را منتشر کرد که شامل خطمشی DHCS و الزامات MCP مربوط به انتقال اعضا از MCPهای Medi-Cal است که از ژانویه 1 ، 2024 اعمال میشود. نسخه اولیه راهنمای خط مشی به موارد زیر اشاره دارد:
- حفاظت از اعضای سرخپوست آمریکایی/بومی آلاسکا.
- توجه اعضا به الزامات و سیاست های ثبت نام اعضا که برای اعضای در حال انتقال و جدید قابل اعمال است.
- تداوم الزامات مراقبت برای اعضایی که به دلیل تغییرات قرارداد MCP در حال انتقال هستند، از ژانویه 1 ، 2024 قابل اجرا است.
MCPها از راهنمای خط مشی برای توسعه خط مشی ها و رویه های مورد نیاز برای اجرای انتقال اعضای Medi-Cal استفاده خواهند کرد. در حالی که MCPها مخاطبان اصلی راهنمای خط مشی هستند، DHCS پیش بینی می کند که طیف وسیعی از ذینفعان آن را در حمایت از انتقال نرم اعضا مفید می دانند. یک نامه همراه All Plan Letter (APL) نیز برای تعیین ماهیت الزام آور راهنمای خط مشی به عنوان مرجع DHCS ویژه انتقال MCP 2024 صادر خواهد شد. راهنمای خط مشی به صورت آنلاین در دسترس خواهد بود و در طول باقیمانده این سال تقویمی به روز می شود تا MCP ها را از راهنمایی های جدید و در حال توسعه مطلع کند.
به روز رسانی برنامه
بهزودی: اصلاحیههای معافیت از راه دور خدمات مبتنی بر خانه و جامعه (HCBS).
On June 26, DHCS will post on its website Medi-Cal HCBS waiver telehealth amendments for a 30-day public comment period. All comments must be received by July 26. DHCS requested and received federal approval to implement temporary operational flexibilities under different emergency authorities due to the COVID-19 public health emergency (PHE). For the state’s six HCBS waivers, flexibilities were authorized through temporary amendments that included the option for states to extend emergency flexibilities for up to six months after the end of the PHE (November 11). One of the flexibilities approved during the PHE was the ability to provide waiver services via telehealth. To align with DHCS policy and to expand access to select waiver services, when appropriate, DHCS is submitting waiver amendments for four of the state’s HCBS waivers to make telehealth a permanent option.
گزارش ماهانه بازگشایی CMS کالیفرنیا برای می 2023
On June 23, DHCS published California’s submission of the federal “Unwinding Monthly Report” for the eligibility month of May 2023 to the Centers for Medicare & Medicaid Services (CMS) as part of the continuous coverage unwinding federal requirements. The report includes California’s updated estimate of total pending applications received between March 1, 2020, and March 31, 2023, that are still in a pending status as of May 31; total May 2023 annual renewals and renewal outcomes; and total Medi-Cal fair hearings pending more than 90 days as of May 31. The report also includes a description of California’s renewal timeline and policy during the unwinding period. This report is posted to the DHCS Medi-Cal Enrollment webpage under “DHCS Continuous Coverage Unwinding Data”.
پوشش مستمر اضافی انعطاف پذیری فدرال را باز می کند
در 16 ژوئن، DHCS بخش 1902(e)(14)(A) اضافی انعطافپذیریهای فدرال را برای تایید به CMS ارسال کرد. همانطور که کالیفرنیا در طول دوره بازگشایی پوشش مداوم ادامه میدهد، DHCS چالشهای عملیاتی مداوم را در از سرگیری اقدامات واجد شرایط بودن و ثبتنام به دلیل حجم بیسابقهای از تعیینهای مجدد که کالیفرنیا باید انجام دهد، پیشبینی میکند. انعطافپذیریهای اضافی فدرال شامل موارد زیر است: 1) تمدید موقت برای افرادی که درآمد کمتر از 100 درصد سطح فقر فدرال دارند. 2) تعلیق الزام درخواست برای سایر مزایا به عنوان شرط واجد شرایط بودن؛ 3) تعلیق الزام به اخذ اجرای حمایت پزشکی. 4) بازگرداندن واجد شرایط بودن به تاریخ لغو ثبت نام برای افرادی که در طول دوره درمان 90 روزه Medi-Cal واجد شرایط هستند. و 5) تکمیل یک تجدید بر اساس اطلاعات موجود برای جمعیت های صعب العبور. انعطافپذیریهای اضافی از کارآییهای اداری برای دفاتر شهرستانی محلی و اعضای Medi-Cal با ادامه روند تعیین مجدد پشتیبانی خواهد کرد.
سند راهبردی پیش نویس تماس و اطلاعات جمعیتی اعضا (MCDI) برای اظهار نظر عمومی منتشر شد
On June 22, DHCS released the draft MCDI initiative strategy document for public comment. Medi-Cal member contact and demographic information are critical components of Medi-Cal’s efforts to enroll members, achieve health equity, and advance population health. Currently, stakeholders face significant obstacles in their efforts to submit, collect, and use MCDI. The draft MCDI strategy provides a vision, goals, and measures of success to improve the collection, accessibility, quality, and use of MCDI, and informs the future development of more detailed policy and operational plans.
DHCS will accept public comments through 5 p.m. PDT on July 6 to PHMSection@dhcs.ca.gov, with the subject line, “Comments on Draft MCDI Strategy Document”. In your feedback, we encourage you to identify the specific sections and page numbers for which you are providing comments.
Medi-Cal Rx
در 23 ژوئن، Medi-Cal Rx Reinstatement Phase III، Lift 4 اجرا شد که خط مشی گذار را برای 46 کلاس درمانی استاندارد (STC) لغو کرد. این چهارمین مورد از یک سری افزایشهایی است که با بازگرداندن کد 75 شورای ملی برنامههای داروهای تجویزی (NCPDP) بازنشسته میشود - مجوز قبلی لازم است. Drug Lookup Tool Reignment اکنون در پورتال وب Medi-Cal Rx در دسترس است. داروها را می توان با نام دارو (برند یا ژنریک) یا کل کد ملی داروی 11 رقمی (NDC) جستجو کرد. نتایج Drug Lookup برای داروهایی است که از مزایای Medi-Cal Rx هستند.
On June 22, the Medi-Cal Rx 90-day notice of reinstatement for adult “new start” enteral nutrition products will be posted. Beginning on September 22, 2023, any new prescriptions (no prior use in the past 15 months) for an adult member (age 22 and older) for enteral nutrition products will require prior authorization (PA). Auto PA logic will be in place to automate these requests. Stakeholder communications will begin this week and continue through go-live. This will not impact adult members who are currently using enteral nutrition products. Pediatric members (age 21 and younger) will also not be impacted.
کمپین لبخند، کالیفرنیا برای خدمات دندانپزشکی Medi-Cal
During the week of June 26, a Smile, California, Smile Alert will be sent to partners, providers, and stakeholders subscribed to receive the monthly e-newsletter. The alert will feature June as Men’s Health Month and the “Don’t Wait Until It Hurts to See the Dentist” video to remind individuals to prevent the habit of only seeing the dentist when there is pain or an emergency. The alert will also debut a new Smile, California Men’s Health Month Carousel image that is available in English and Spanish. Sign up for Smile Alerts and to stay informed about the Smile, California campaign new resources and updates.
به تیم ما بپیوندید
DHCS is hiring. DHCS has an immediate opening for Chief, Financial Review-Outpatient and Behavioral Health Division within the Audits & Investigation program; the filing deadline is July 6. This executive role oversees policy development and interpretation for financial reviews, audits, and appeals of outpatient and behavioral health Medi-Cal services and reimbursement claims. Specifically, the Chief is responsible for planning, organizing, and directing program operations, oversight, and policy formulation for the financial reviews and audits of Medi-Cal and other DHCS programs’ outpatient and behavioral health providers and counties.
DHCS همچنین برای تیم های ارتباطات، مالی، منابع انسانی، حقوقی، حسابرسی، سیاست های بهداشتی و فناوری اطلاعات ما استخدام می کند. برای اطلاعات بیشتر، لطفاً به وب سایت CalCareers مراجعه کنید.
DHCS is dedicated to preserving and improving the overall health and well-being of all Californians. DHCS’ mission is to provide the most vulnerable residents with equitable access to affordable, integrated, high-quality health care, and is currently transforming the Medi-Cal program to make sure it provides the care Californians need to live healthier, happier lives.
جلسات و وبینارهای ذینفعان آینده
نشست گروه کاری نظارت و نظارت بر خدمات کودکان کالیفرنیا (CCS).
در 26 ژوئن، از ساعت 3 تا 5 بعدازظهر، DHCS عملاً میزبان نشست گروه کاری نظارت و نظارت CCS برای توسعه و اجرای برنامه انطباق، نظارت و نظارت بر CCS، جزء ابتکار پیشبرد و نوآوری Medi-Cal کالیفرنیا (CalAIM) خواهد بود. اساسنامه CalAIM DHCS را ملزم میکند تا با شهرستانها و سایر ذینفعان آسیبدیده برای توسعه و اجرای این ابتکار برای افزایش نظارت و نظارت بر مدیریت شهرستان بر برنامه CCS مشورت کند.
Background materials, meeting details, and past meeting archives, along with more information about the workgroup, are posted on the CCS Compliance, Monitoring, and Oversight Program webpage. For questions or comments, please email DHCS at CCSMonitoring@dhcs.ca.gov.
گروه ویژه سلامت رفتاری (BHTF)
On June 27, from 2 to 4 p.m., the California Health & Human Services Agency’s (CalHHS) BHTF will virtually host a workshop dedicated to BHTF member discussion (advance registration required). The workshop is open to the public. Also, on June 29, from 4 to 6 p.m., the BHTF will host a workshop dedicated to members of the public (advance registration required).
The diverse BHTF membership informs CalHHS’ work on behavioral health issues across the state and is positioned well to elucidate connections among wide-ranging perspectives and interests related to behavioral health needs and care, ground the framing of behavioral health issues in the state, and advance innovative and coordinated work to drive progress. For questions, inquiries, or to join the BHTF listserv, email BehavioralHealthTaskForce@chhs.ca.gov.
در صورتی که شما آن را از دست داده است
کمک های مالی دور 5 برنامه زیرساخت پیوسته سلامت رفتاری (BHCIP).
On June 23, DHCS issued a news release announcing awards of $430 million for projects that will increase mental health and substance use disorder treatment infrastructure in 21 counties. The awards were made under the BHCIP Round 5: Crisis and Behavioral Health Continuum grants. BHCIP is part of a broader Administration commitment to improve the state’s behavioral health and long-term care continuum infrastructure. The focus of this round of BHCIP funding was determined in part by the statewide needs assessment that found significant gaps in the availability of crisis services and supported an organized continuum of crisis services to reduce emergency department visits, hospitalizations, and incarceration. The list of BHCIP Round 5: Crisis and Behavioral Health Continuum awardees is posted on the BHCIP Data Dashboard.
جوایز برنامه مسکن پل سلامت رفتاری (BHBH).
On June 23, DHCS began awarding nearly $907 million of the $1.5 billion in funding for the BHBH Program to California county behavioral health agencies. The primary focus of the BHBH Program is to help people experiencing unsheltered homelessness who also have serious behavioral health conditions, including mental health and substance use disorders, that prevent them from accessing help and moving out of homelessness. The BHBH Program helps address housing instability and homelessness by providing support through various “bridge” housing settings, including tiny homes, interim housing, rental assistance models, and assisted living settings.
Transformation of California’s Mental Health Services Act
On June 20, Governor Newsom and legislative leaders proposed a $4.69 billion bond and modernization of the Mental Health Services Act for the March 2024 ballot, which together will provide California the resources needed to build 10,000 new beds across community treatment campuses and facilities to help Californians with serious mental illness and substance use disorders get the housing and care they need. Additional information can be found on the DHCS website.