February 3, 2025

Top News

Request for Applications (RFA): Improving Behavioral Health Services Delivery

DHCS released a RFA to solicit applications to assist counties in improving their performance in the delivery of behavioral health services and the contracting for these services with outcomes, transparency, and accountability to residents. Interested participants must apply by February 24 at 4 p.m. PST. Specifically, DHCS is interested in proposals on how to:

• Develop strategies to support county executives to establish and incentivize new referral and engagement channels to county behavioral health and local system partners (such as hospitals, homeless shelters, schools, jails, and prisons) to streamline access to needed services and incentivize service providers to proactively identify and attract new participants.
• Support county behavioral health departments and their provider partners in developing and strengthening performance management systems, including the capacity to produce performance tracking, reporting, and reviews.
• Develop tools (e.g., model contracts) to build county-level system capacity in the procurement and contracting of service providers with a focus on results (notably the outcomes achieved by individuals) over process.
• Provide a toolkit for county boards of supervisors to effectively understand, review, and approve their county integrated plans and annual reports and to review all program performance on a periodic basis to support continuous improvement.

Program Updates

Now Active: Pediatric Integration for New Start Therapies and CCS Panel Authority

Medi-Cal Rx has implemented claim utilization management (UM) edits and prior authorization (PA) requirements for members 21 years of age and younger for new start drugs/products. Continuation of therapy claims will not deny with “Reject Code 75 – Prior Authorization Required" for a period of at least 60 days, but will be subject to all other claim UM edits. Medi-Cal Rx will provide at least 30 days of notice to stakeholders prior to the reinstatement of Reject Code 75 for continuation of therapy claims.

Additionally, Medi-Cal Rx has implemented the California Children's Services (CCS) Panel Authority policy for CCS Paneled Providers who are physicians or certified nurse practitioners and enrolled in Medi-Cal. CCS Panel Authority enables CCS Paneled Providers to prescribe for members 20 years of age and younger without submitting a PA request for Medi-Cal Rx covered drugs/products, with some exceptions. 

For more information about Pediatric Integration, please refer to the Pediatric Integration tab located on the Education & Outreach webpage on the Medi-Cal Rx Web Portal.

Long-Term Care (LTC) Learning Series: Managed Care Resources for LTC Providers

On December 17, DHCS hosted the final webinar of the LTC Learning Series: Managed Care Resources for LTC Providers. This session included an overview of a set of newly developed resources that provide information and helpful tips on various managed care topics, including Medi-Cal eligibility and managed care plan (MCP) enrollment, LTC authorizations, and managed care billing and payment. The resources discussed during the session are now posted and available for reference under the Key Documents section of the CalAIM LTC Carve-In Transition webpage. The session materials include the presentation slides, a captioned video recording, and a meeting transcript.

Join Our Team

DHCS is seeking a talented and motivated individual to serve as:

• Chief of the Pharmacy Benefits Division. The Chief is responsible for overseeing the development and implementation of policy, services, and coverage criteria for outpatient pharmacy services for the state's Medi-Cal program. This includes providing policy direction for Medi-Cal Rx as well as invoicing and collecting federal and state supplemental drug rebates. The Chief also leads the development of nutrition, vision care, and medical supply benefits and oversees the administration of the Medi-Cal Pharmacy and Vision Benefit programs. A licensed pharmacist is desired, but not required. Applications must be submitted by February 7.
  

DHCS is also hiring for its accounting, financial, behavioral health, disaster response, contracting, and other teams. For more information, please visit the CalCareers website.

Upcoming Stakeholder Meetings and Webinars

DHCS posts upcoming public meetings on the Calendar of Events.

Telehealth's Evolution in California: Progress, Challenges, and Opportunities

On February 6, from 12 to 1 p.m. PST, DHCS' Benefits Division will participate on a panel (advance registration required) for an important discussion on telehealth's evolution in California. Hosted by the California Health Care Foundation, in partnership with the California Telehealth Resource Center and the California Telehealth Policy Coalition, with support from the Center for Community Health and Evaluation, this webinar is intended for health system leaders, safety net providers, policymakers, health plans, and researchers. During this webinar, participants will gain a deeper understanding of existing challenges and future opportunities, explore telehealth's progress and hear about lessons learned from health care leaders, and examine steps to reach telehealth's potential to help achieve health equity.

Behavioral Health Transformation Public Listening Session: Population Behavioral Health Measures

On February 10, DHCS will host a public listening session (advance registration required) on Population Behavioral Health Measures under the Behavioral Health Services Act. In March 2024, California voters passed Proposition 1, which includes the Behavioral Health Services Act and Behavioral Health Bond. During this session, which is open to the public, participants may comment on the guidance DHCS is developing and help shape the future of Population Behavioral Health Measures in California. Visit the Behavioral Health Transformation webpage for more information and additional resources. Please send your questions about Behavioral Health Transformation and/or the public listening sessions to BHTInfo@dhcs.ca.gov.

DHCS Harm Reduction Summits

DHCS collaborates with communities across the state to promote harm reduction and low-barrier, patient-centered care within California's substance use disorder treatment system. DHCS encourages substance use disorder treatment providers and staff (including social workers, peers, front desk staff, case managers, nurses, physicians, and all staff in substance use disorder treatment settings) to attend and learn about incorporating the tenets of harm reduction into substance use disorder treatment. Summits will be held in San Diego County (February 11) and Los Angeles County (February 27). Register on the event website.

Flexible Housing Subsidy Pools (“Flex Pools") Webinar: Introduction and Technical Assistance Resources

On February 11, from 1 to 2 p.m. PST, DHCS will host an all-comer webinar on Flex Pools. A Flex Pool is a locally designed model for centrally administering rental assistance, coordinating, and effectively using available housing supports resources to help people who are experiencing or at risk of homelessness enter and maintain stable long-term housing. This webinar will be of special interest to MCPs, county behavioral health providers, county government agencies, Community Supports providers, housing support providers, housing authorities, continuum of cares, and other entities engaged in supporting Medi-Cal members who are experiencing or at-risk of homelessness. The webinar will:

• Highlight the upcoming release of the Flexible Housing Subsidy Pools: Technical Assistance Resource, which defines Flex Pools; describes their key functions, benefits, and components; and provides information about roles and responsibilities for different partner organizations, including county government agencies and MCPs.
• Promote Flex Pools as an effective model for counties and MCPs to consider for administering newly available funding for rental assistance (e.g., Behavioral Health Services Act Housing Interventions and Transitional Rent).
• Introduce upcoming technical assistance to support entities in regions that have expressed interest in Flex Pools, but have not yet operationalized them, or regions that have begun developing Flex Pools.
  

Closed-Loop Referral Implementation Guidance and All-Comer Webinar for Managed Care Plans

On February 13, from 10 to 11 a.m. PST, DHCS will hold an all-comer webinar (advance registration required) to provide an overview of the Closed-Loop Referral (CLR) Implementation Guidance for MCPs. The webinar is open to the public and will be of special interest to MCPs, Enhanced Care Management and Community Supports providers, and entities making referrals to the benefit/services. The CLR Implementation Guidance outlines requirements for MCPs in implementing CLRs, including tracking, supporting, and monitoring CLRs. The member's initial referral loop is completed with a known closure reason, such as the member receiving services. These new requirements will ensure more Medi-Cal members are connected to the care they need by identifying and addressing gaps in referral paths. MCPs must implement CLR requirements by July 1, 2025. Requirements will first apply to referrals made to priority Enhanced Care Management and Community Supports services. Please send your questions about the new guidance to PHMSection@dhcs.ca.gov.

Stakeholder Advisory Committee (SAC)/Behavioral Health (BH)-SAC Meeting

On February 19, from 9:30 a.m. to 3 p.m. PST, DHCS will host the hybrid SAC/BH-SAC meeting (advance registration required for online and in-person participation) at 1700 K Street (first-floor conference room 17.1014), Sacramento. SAC provides DHCS with valuable input on ongoing California Advancing and Innovating Medi-Cal (CalAIM) implementation efforts and helps DHCS further its efforts to provide equitable access to quality care. BH-SAC provides DHCS with input regarding behavioral health activities and was created as part of the ongoing effort to integrate behavioral health with the greater health care system. For more information, please email SACinquiries@dhcs.ca.gov or BehavioralHealthSAC@dhcs.ca.gov.

In Case You Missed It

California Secures Federal Approval of Flexibilities to Help Medi-Cal Members and Providers Affected by the Southern California Wildfires

In response to the Southern California wildfires, DHCS requested and received federal approval for several dozen flexibilities to prevent disruptions in health care delivery so Medi-Cal members can continue to receive needed care. Section 1135 waivers allow the U.S. Department of Health and Human Services to waive various administrative requirements to increase access to medical services during a time of national emergency. Section 1135 waiver approvals remain in effect throughout the duration of the public health emergency.

California and Sierra Vista Child & Family Services Open New Community Wellness Family Resource Center in Stanislaus County

On January 23, DHCS and Sierra Vista Child & Family Services celebrated the opening of a new facility in Stanislaus County to close gaps in mental health and substance use disorder treatment. The Community Wellness and Youth Prevention Center will provide vital behavioral health services, including restorative justice practices for youth, mental health counseling, pregnant and postpartum services, family and parent support services, and other integrated services.

DHCS awarded Sierra Vista Child & Family Services more than $4.6 million through the Behavioral Health Continuum Infrastructure Program (BHCIP), which works to ensure comprehensive behavioral health care for California's most vulnerable individuals. The facility is expected to serve 4,800 individuals annually. With approved Proposition 1 bonds, in 2025 and 2026, even more behavioral health treatment facilities will be funded and built. 

New Peer Respite Brings Vital Behavioral Health Services to Placer County

On January 29, DHCS attended Placer County's opening of a new 16-bed adult peer respite that provides a safe, supportive, and home-like environment for adults awaiting placement in residential treatment programs or exiting such programs to a lower level of care. The facility, dubbed “The Harbor," began welcoming clients today through a referral-based system managed by Placer County's substance use team. DHCS awarded Placer County nearly $400,000 through BHCIP.

California Awards $2.7 Million to Local Overdose Prevention Groups Across California

DHCS awarded $2.7 million to 15 local coalitions through the California Overdose Prevention Network (COPN), a respected statewide learning network dedicated to combating the overdose epidemic. This funding will provide sustained support for coalitions backing COPN's mission to strengthen connections within communities and provide access to knowledge, training, and resources to improve practices and create lasting change. The fifteen awarded coalitions will use this funding between January 1, 2025, and August 30, 2027, to implement strategies that address overdose prevention, treatment, and recovery. These efforts include naloxone distribution, expanded access to life-saving resources, and community education, all aimed at reducing overdose deaths and fostering long-term recovery throughout the state.

California Awards More Than $65 Million to 91 Organizations for Opioid Treatment and Recovery

DHCS awarded nearly $65.4 million to 91 organizations to strengthen the California Hub and Spoke System, a proven model designed to increase access to medications for opioid use disorder (MOUD) services statewide. This funding will enhance prevention, treatment, and recovery services throughout the state, advancing the fight against the opioid crisis and saving lives. The Hub and Spoke System consists of a network of Narcotic Treatment Programs (known as Hubs) licensed to dispense methadone and other MOUDs. These Hubs are connected to other MOUD prescribers (known as Spokes), which primarily provide various formulations of buprenorphine—a medication that reduces opioid cravings and withdrawal symptoms—and ongoing opioid use disorder and substance use disorder care and treatment.

Now Open: Providing Access and Transforming Health (PATH) Capacity and Infrastructure Transition, Expansion, and Development (CITED) Round 4 Application

On January 6, DHCS opened the PATH CITED Round 4 application window, including the 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. Nearly $158 million is available for Round 4.

All organizations interested in becoming Transitional Rent Community Support providers must do so in partnership with both the Medi-Cal MCP and their county behavioral health department. To demonstrate these partnerships, all CITED applicants planning to request funding for the Transitional Rent Community Support must submit letters of support in collaboration with their MCP and county behavioral health department. For more information about this requirement, please review the Transitional Rent Letter of Support Guidance and Transitional Rent Letter of Support Template.
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The deadline to apply for PATH CITED Round 4 funding is 11:59 p.m. PST on May 2, 2025. The guidance document and application can be found by visiting the PATH CITED webpage. Please submit questions to cited@ca-path.com.