April 29. 2024 - Stakeholder ​Update

Top News

DHCS Celebrates Ribbon Cuttings for Behavioral Health Treatment Centers

On April 25 and 26, DHCS celebrated the addition of two new facilities that will provide lifesaving treatment for Californians with mental health and substance use disorders (SUD). Paving the Way Foundation in Los Angeles County and Center Point Drug Abuse Alternatives Center in Sonoma County are expanding behavioral health treatment and recovery options in their local communities. These are among the first of many community treatment sites supported by the Behavioral Health Continuum Infrastructure Program and are under construction now in 49 counties. Even more sites will be funded and built, thanks to recently approved Proposition 1 bonds.
 

Program Updates

New Code 1 Diagnosis Requirement for Medi-Cal Rx Claims

Effective April 30, Code 1 Diagnosis Requirement – Reject Code 80 claim utilization management (UM) edits will be implemented for members 22 years of age and older. Medi-Cal Rx will use diagnosis code(s) from the member's Medi-Cal medical record to meet the Code 1 diagnosis restriction. Code 1 drugs are subject to prescription documentation requirements, and prescribers and pharmacy providers must document the treatment diagnosis and keep that information readily available for auditing purposes. Code 1 diagnosis requirements can be met in one of four ways: provide a diagnosis with the prescription, communicate the diagnosis verbally to the pharmacy provider, submit a prior authorization request with the diagnosis, or use an acceptable diagnosis code that is on file in the Medi-Cal data system. Members 21 years of age and younger are not impacted. 

Smile, California Mobile Dental Van Tour Continues​

On May 4, the Smile, California mobile dental van tour will stop in Huntington Park. During the event, individuals will have access to various dental services, such as exams, X-rays, cleaning, and fluoride applications. More information about Medi-Cal-covered dental services is available on the Smile, California website.​
 

Join Our Team

DHCS is hiring for communications, human resources, auditing, health policy, information technology, and other teams. For more information, please visit the CalCareers website.
 

Upcoming Stakeholder Meetings and Webinars

Medi-Cal Children's Health Advisory Panel (MCHAP)

On May 1, from 10 a.m. to 2 p.m., DHCS will hold the MCHAP hybrid meeting (advance registration required). MCHAP advises DHCS on policy and operational issues that affect children in Medi-Cal. The panel consists of a 15-member advisory body whose members include recognized stakeholders and experts in their fields, medical professionals, advocates, and parent members. If you are interested in receiving information about MCHAP meetings or have general inquiries, please email MCHAP@dhcs.ca.gov. 

Consumer-Focused Stakeholder Workgroup (CFSW)

On May 3, from 10 to 11:30 a.m., DHCS will convene the CFSW, which provides stakeholders an opportunity to review and provide feedback on a variety of consumer messaging materials. The forum focuses on eligibility- and enrollment-related activities and strives to offer an open discussion on Medi-Cal policies and functionality. Meeting materials, including the meeting agenda, will be posted to the CFSW webpage no later than May 1. Please email your questions to DHCSCFSW@dhcs.ca.gov. 

Medi-Cal Dental Los Angeles Stakeholder Meeting

On May 14, from 1 to 3 p.m., DHCS will host the Medi-Cal Dental Los Angeles stakeholder meeting. DHCS will share updates and information about new and upcoming activities. The meeting also provides dental stakeholders with a forum to share input with the Medi-Cal Dental team that can help improve the delivery of oral health care services. Meeting information will be posted on the DHCS Medi-Cal Dental Los Angeles Stakeholder Meetings webpage. Additional materials will be posted on the webpage prior to the meeting or as soon as they become available. Please email your questions to dental@dhcs.ca.gov. 

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

On May 29, from 9:30 a.m. to 3 p.m., DHCS will convene the SAC/BH-SAC hybrid meeting (advance registration required). The meeting will include an update on Proposition 1 implementation. SAC provides DHCS with valuable input on ongoing California Advancing and Innovating Medi-Cal (CalAIM) implementation efforts, as well as helps DHCS further its efforts to provide high-quality, equitable care. 

BH-SAC is a broad-based body that disseminates information and receives coordinated input regarding DHCS behavioral health activities. It was created as part of the ongoing DHCS effort to integrate behavioral health with the rest of the health care system and incorporates existing groups that have advised DHCS on behavioral health topics. 

CalAIM Managed Long-Term Services and Supports (MLTSS) and Duals Integration Workgroup Meeting

On May 30 at 10 a.m., DHCS will host the CalAIM MLTSS and Duals Integration Workgroup virtual meeting (advance registration is required). The workgroup serves as a stakeholder collaboration hub for CalAIM MLTSS and integrated care for dual eligible members and allows stakeholders to provide feedback and share information about policy, operations, and strategy for upcoming changes to Medi-Cal and Medicare. 

Agenda topics include updates on the Dual Eligible Special Needs Plan (D-SNP) State Medicaid Agency Contract (SMAC) and Policy Guide, Medicare enrollment data for dual eligible members, the Default Enrollment Pilot, and the 2025 Centers for Medicare & Medicaid Services (CMS) Medicare Advantage and Part D Final Rule, as well as a presentation on Enhanced Care Management and Community Supports for dual eligible members. 

Background materials, transcripts, and video recordings of the previous workgroup meetings, along with additional information about the workgroup, are posted on the CalAIM MLTSS and Duals Integration Workgroup webpage. For questions or comments, please email info@calduals.org.​