January 12, 2024 - Stakeholder News
Top News
CalAIM Continuous Coverage for Children Amendment Open for Public Comment
On January 12, DHCS began a 30-day public and tribal public comment period to solicit feedback on a proposed amendment to the California Advancing and Innovating Medi-Cal (CalAIM) Section 1115 demonstration related to continuous coverage for children. Comments are due by February 12.
DHCS is seeking approval from the Centers for Medicare & Medicaid Services (CMS) to include expenditure authority under Section 1115(a)(2) to receive federal matching funds to provide continuous coverage for children through the end of the month in which their 5th birthday falls, regardless of when they first enroll in Medi-Cal or the Children's Health Insurance Program (CHIP) or any changes in circumstances that would otherwise cause a loss of eligibility.
Medi-Cal and CHIP-eligible children often go through short periods of disenrollment and re-enrollment in coverage, often referred to as “churn," leading to disruptions in coverage and lapses in continuity of care. People who experience churn are more likely to delay or forego care, receive less preventive care, stop filling their prescriptions, and have more emergency department visits. One study found that among children with asthma, those experiencing gaps in coverage were more likely to have asthma-related emergency department visits, unmet health care needs, and asthma exacerbations. By providing continuous coverage to Medi-Cal and CHIP-eligible children through age 4, DHCS seeks to ensure these children can access the care they need in a timely manner and promote positive health outcomes.
Implementation of this policy is contingent upon a state determination of available General Funds in 2024-2025 and subsequent fiscal years and CMS approval. Additional information about the amendment request and how to submit public comments are available on the CalAIM 1115 Demonstration and 1915(b) Waiver webpage.
Governor Unveils Proposed 2024-25 Budget
DHCS' proposed budget supports our purpose to provide equitable access to quality health care leading to a healthy California for all. The proposed budget builds upon the Administration's previous investments and enables DHCS to continue transforming Medi-Cal and behavioral health into a system that operates more efficiently and effectively for Californians. The Governor's Budget proposes a total of $161.1 billion and 4,649.5 positions to support DHCS programs and services.
Program Updates
Providing Access and Transforming Health (PATH) Capacity and Infrastructure Transition, Expansion, and Development (CITED) Round 3 Application Opening
On January 15, DHCS will open the PATH CITED Round 3 application window. The PATH CITED initiative provides funding to build the capacity and infrastructure of on-the-ground partners, including community-based organizations, public hospitals, county agencies, tribes, and others, to successfully participate in Medi-Cal.
The deadline to apply for PATH CITED Round 3 funding is February 15, 2024. The below events will serve to assist prospective applicants:
Announcement of Equity and Practice Transformation (EPT) Payment Program
During the week of January 15, DHCS will notice more than 200 primary care practices that they were selected to participate in the EPT Provider Directed Payment Program ($650 million over five years). Practices must confirm their interest in participating by January 22. A final list of participating practices will be posted on the DHCS EPT website later this month. Payments will directly support primary care practices to address population health and health equity, as well as develop upstream models of care. Payments will be made to practices after they complete milestones related to each activity.
The Population Health Learning Center , a fiscally sponsored program of the Tides Center, will serve as the program office for the EPT Provider Directed Payment Program, working closely with DHCS, participating practices, and Medi-Cal managed care plans (MCP). All practices in the program must participate in Population Health Learning Center activities.
New Place of Service (POS) Code for Street Medicine
Effective for dates of services on or after October 1, 2023, Medi-Cal providers may use POS code 27 for street medicine, in addition to the previously announced POS codes for street medicine: 04 (homeless shelter), 15 (mobile unit), and 16 (temporary lodging). Street medicine refers to a set of health and social services developed specifically to address the unique needs and circumstances of individuals experiencing homelessness delivered directly to them in their own environment. DHCS is currently making necessary system updates to accommodate POS code 27. Any claims for street medicine services provided on or after October 1, 2023, that are denied for using POS code 27 will not need to be resubmitted and will be reprocessed automatically after system changes are updated.
For more information about billing for street medicine, please see All Plan Letter 22-023. In addition, DHCS has published information about how Hospital Presumptive Eligibility may be used for street medicine.
New Data for Chronic Conditions Experienced by Californians with Original Medicare
On January 11, DHCS published a new dataset to the Open Data Portal, entitled “Chronic Conditions Experienced by Californians with Original Medicare, 2021". The dataset contains information about the prevalence of chronic conditions among Original Medicare beneficiaries in California as well as Medicare spending and co-occurring conditions for those with each condition. The data are available for each of California's 19 geographic regions and include demographic information. The dataset includes both Medicare-only and dually eligible Medicare beneficiaries. The dataset excludes Medicare Advantage (MA) data. In December 2023, DHCS released a related summary chartbook, and held a webinar on the chartbook. The Open Data portal dataset, as well as the chartbook, were prepared by ATI Advisory for DHCS' Office of Medicare Innovation and Integration, with funding from The SCAN Foundation.
Medicare and Medi-Cal Hearing Aid Benefits Fact Sheet
DHCS released a new Audiology and Hearing Aid Benefits in Medicare and Medi-Cal fact sheet for providers. The fact sheet provides information about hearing benefits that both Medicare and Medi-Cal offer, including the ways providers can bill for hearing services provided to members. Medicare, the primary payer for dual eligible members, does not cover most hearing benefits, such as hearing aids or exams for hearing aids. However, Medicare Advantage plans often offer hearing benefits to their members, including dually eligible members. Additionally, Medicare Part A (hospital visits) covers certain hearing services that are provided in a hospital setting, such as emergency procedures. Medi-Cal covers a variety of hearing benefits administered by enrolled audiology providers. Medi-Cal is the payer of last resort, so certain services for some members must be billed to Medicare first.
Medicare Advantage (MA) Supplemental Benefits and Medi-Cal Coverage Fact Sheet
DHCS published a fact sheet detailing the supplemental benefits available in MA plans in California in 2023 and how those benefits compare with Medi-Cal benefits. Each year, MA plans, including Dual Eligible Special Needs Plans (D-SNPs), offer supplemental benefits, which are items and services that plans can cover that are not covered under Traditional Medicare. In some cases, Medi-Cal covers similar benefits, but Medi-Cal is always the payer of last resort. For more information about MA supplemental benefits offerings in California for 2023, please refer to Chartbook #4: Supplemental Benefits in Medicare Advantage Plans in California, Contract Year 2023.
PATH Collaborative Planning and Implementation (CPI) Initiative Fact Sheet
DHCS released the PATH CPI fact sheet to help providers at all stages of Enhanced Care Management (ECM) and Community Supports implementation who are interested in learning more about participating in the initiative. The fact sheet provides a comprehensive overview of participant eligibility, examples of local successes, and priority gaps and challenges. More information is available on the PATH CPI webpage.
PATH Technical Assistance (TA) Marketplace Resource
DHCS released the PATH TA Marketplace fact sheet to help eligible entities learn how free TA services can build organizational capacity to implement ECM and Community Supports. The fact sheet provides a comprehensive overview of TA recipient eligibility, service offering examples, and ways to register to receive free TA. Access the resource by visiting the PATH TA Marketplace webpage.
Join Our Team
DHCS is hiring:
- Chief of Capitated Rates Development Division within Health Care Financing serves as the principal policymaker for all rate-setting activities to ensure high-quality and cost-efficient health care through DHCS' contracted Medi-Cal MCPs. (Final filing date extended to January 30)
DHCS is also hiring for our communications, human resources, auditing, health policy, information technology, and other teams. For more information, please visit the CalCareers website.
Upcoming Stakeholder Meetings and Webinars
Long-Term Services and Support (LTSS) Data Dashboard
On January 18, from 10 to 11 a.m., DHCS will host a webinar (advance registration required) to provide an overview and demonstration of new enhancements to the LTSS Data Dashboard. On December 15, 2023, DHCS released an updated, interactive LTSS data dashboard to report utilization and demographic data by counties and Medi-Cal MCPs and to allow users to explore trends across services and subpopulations throughout California.
The LTSS data dashboard includes data from 2017 through 2022 and features 16 additional utilization measures for home health services, the California Community Transitions project, and services utilized by Californians with developmental disabilities. The dashboard will be updated biannually. Future iterations will include additional cost and quality measures, and data will demonstrate progress toward “rebalancing" LTSS away from institutional care toward home and community-based services.
Population Health Management Updated Transitional Care Services (TCS) Policy Webinar
On January 22, from 11 a.m. to 12 p.m., DHCS will host a webinar to provide an overview of recent updates to the TCS policy (advance registration required), as outlined in the Population Health Management Policy Guide. The revised policy clarifies the requirements for high-risk members by updating the definition of “high-risk groups", reaffirming DHCS' focus on maternity care and populations with behavioral health needs, emphasizing MCP oversight on facility discharge planning processes, and underscoring the importance of member engagement.
The TCS policy for lower-risk members was also updated for 2024 and 2025 to provide member-centered transitional care support with a lighter-touch approach than the model for high-risk members. While the updated lower-risk model removes the single point of contact requirement, it does impose a clear but less staff-heavy requirement for a MCP telephonic team to be available for all transitioning members and requires follow-up with a primary or ambulatory care provider within 30 days of discharge. It also emphasizes existing requirements on hospitals regarding the discharge process. The webinar will offer interested stakeholders the opportunity to learn more and ask questions about these recent updates.
Statewide Home and Community-Based Services (HCBS) Gap Analysis and Multi-Year Roadmap Stakeholder Meeting
On January 24, from 1 p.m. to 2:30 p.m., DHCS and the California Department of Aging (CDA) will host a stakeholder meeting (advance registration required) for the ongoing statewide HCBS Gap Analysis and Multi-Year Roadmap initiatives. Speakers will provide updates and progress reports on the approach to the gap analysis as well as details regarding stakeholder engagement activities and consumer listening sessions underway as part of this work.
For more information about the projects and past meeting materials, please visit the DHCS website and CDA website. If you have any questions, please email HCBSGapAnalysis@dhcs.ca.gov.
Launching ECM for Birth Equity Populations: Webinar
On February 2, from 1:30 to 3 p.m., DHCS will host a webinar on Launching ECM for Birth Equity Populations (advance registration required) to review the vision of ECM for the birth equity population of focus (POF) and the early days of implementation. DHCS, in partnership with Medi-Cal MCPs and providers across the state, launched ECM for the birth equity POF on January 1.
This webinar will provide an overview of the design and operational guidance for the birth equity POF; give provider perspectives on how they prepared for the launch of ECM for the birth equity POF and tailored approaches to providing ECM; and offer guidance to MCPs, counties, and providers on contracting and preparing to deliver the ECM benefit to address known disparities in health and birth outcomes in racial and ethnic groups with high maternal morbidity and mortality rates.
The webinar is open to all, but will be of special interest to MCPs and providers working with birth equity populations, including counties and community-based organizations. Providers interested in learning more about ECM for the birth equity POF or about referring members may also attend. Participants are invited to submit questions by January 29 to CalAIMECMILOS@dhcs.ca.gov. Attendees will be able to ask questions during the webinar.
In Case You Missed It
Children and Youth Behavioral Health Initiative (CYBHI) Annual Report
The California Health & Human Services Agency (CalHHS) today released the CYBHI Annual Report, "Implementing the Vision," which showcases how the historic initiative is making progress in key areas, from launching trauma-informed training for educators to rolling out new digital behavioral health platforms for youth and families. In 2023, CalHHS departments, grantees, and key partners made incredible strides toward achieving the five-year initiative's goals to transform how California supports the behavioral health of children, youth, and families. Read about substantial investments to build and strengthen the behavioral health workforce, and learn about the impact of $180.5 million in grants for innovative evidence-based and community-defined practices. The CYBHI is shaping a brighter, healthier future for our children, youth, and families. Learn more by diving into the report for an in-depth look at its journey and progress.
January 2024 Medi-Cal MCP Transition
On January 1, DHCS achieved a significant milestone in its transformation of Medi-Cal with the launch of the new managed care contract and the MCP transition, under which approximately 1.2 million members gained new health plan options and/or transitioned to new MCPs (note: changing MCPs does not affect Medi-Cal member coverage or benefits). To facilitate a smooth transition between MCPs for members, DHCS created Continuity of Care protections to minimize disruptions to members' care.
DHCS developed several resources to support members, providers, and other stakeholders with the transition, including the MCP Transition Member webpage with a county “lookup" tool, links to the member notices sent by Medi-Cal about MCP changes, member frequently asked questions in all threshold languages, and a Contact Us page for members to learn more about health plan changes. There are also transition resources for providers, MCPs, and stakeholders. More information about the transition is available in the 2024 MCP Transition Policy Guide and Medi-Cal Eligibility Division Information Letter Number I 23-54.
The MCP Transition Member webpage includes resources and information to support members' transition. Members unable to resolve issues or questions after working with their MCP may contact DHCS' Office of the Ombudsman at toll-free (888) 452-8609 or by emailing MMCDOmbudsmanOffice@dhcs.ca.gov.
