Program Updates
Quality Incentive Pool (QIP) Program Year 5 (PY5) Evaluation Report
On June 6, DHCS posted the QIP PY5 (calendar year 2022)
evaluation report, per Centers for Medicare & Medicaid Services requirements. QIP began in 2017 and encourages Designated Public Hospitals (DPH) and District and Municipal Public Hospitals (DMPH) to improve the quality of care to Medi-Cal members. QIP is a directed payment program under the 2020 Medicaid and Children's Health Insurance Program Final Rule; Code of Federal Regulations section 438.6(c) provides states with the flexibility to implement delivery system and provider payment initiatives under Medicaid managed care plan contracts. QIP supports the state's quality strategy by tying funding to performance on specific high-priority quality measures. The evaluation report focuses on the impact of $1.9 billion worth of payments for PY5 performance made by Medi-Cal managed care plans to participating hospitals as part of the QIP program. In PY5, largely due to the impacts of the COVID-19 public health emergency on hospitals and health systems, DHCS implemented modifications that included reducing the number of priority clinical quality measures to nine. DHCS also strengthened the requirements, compared to 2021, for hospitals to improve upon these priority and additional elective measures. The 17 DPHs and 33 DMPHs showed collective improvement on all nine measures, compared with 2021.
Children's Presumptive Eligibility (CPE) and Newborn Gateway Portals
Effective July 1, DHCS will launch provider online portals to improve access to coverage and care for new families. Through CPE, providers may grant temporary, full scope coverage to eligible applicants through an online portal. This portal replaces the Child Health and Disability Prevention (CHDP) gateway portal. The Newborn Gateway portal is for reporting the birth of a baby with linkage to Medi-Cal and the Medi-Cal Access Infant Program within 72 hours after birth or 24 hours after discharge, whichever is sooner.
All providers seeking to participate in these portals must complete certification training to become familiar with the updated portals and reporting requirements. All qualified providers participating in presumptive eligibility must use the Newborn Gateway to enroll eligible infants who are born in their facilities into coverage as of July 1.
On June 25 at 10 a.m., DHCS will host the final CPE and Newborn Gateway portal overview webinar. Registration is available through the
Medi-Cal Learning Portal. Additionally, a recording of the webinar will be available by searching for course code CNPE104RW.
CalAIM Providing Access and Transforming Health (PATH) Technical Assistance (TA) Marketplace Vendor Fair Recordings
Organizations are invited to review vendor presentations across the seven
TA Marketplace domains to learn how they can access free services designed to help providers build data capacity, contract with Medi-Cal managed care plans, scale their workforce, promote health equity, and more. On-demand resources are free, static resources made available directly through the PATH website for organizations seeking to learn more about PATH and build their understanding and capacity to successfully participate in California Advancing and Innovating Medi-Cal (CalAIM).
On-demand resources are suitable for organizations at all levels of readiness for Enhanced Care Management and/or Community Supports, including justice-involved initiatives. No application is required to access on-demand resources. The vendor fair recordings can be accessed in the PATH
On-Demand Resource Library.
PATH Capacity and Infrastructure Transition, Expansion, and Development (CITED) Round 3 Awards
On February 15, DHCS closed the PATH CITED Round 3 funding window. CITED Round 3 award announcements are scheduled for fall 2024. 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 be successful Medi-Cal providers. Visit the
PATH CITED webpage for more information.
Drug Medi-Cal Organized Delivery System (DMC-ODS) Frequently Asked Questions (FAQs)
New and revised FAQs related to
DMC-ODS program requirements pursuant to CalAIM have been posted to the CalAIM Behavioral Health Initiative
webpage. These updated and new FAQs address questions submitted during or shortly after the February 1, 2024, DMC-ODS technical assistance webinar and address several topics, including residential treatment/billing, Medications for Addicted Treatment, prior authorization, length of stay, and recovery services. Please email
BHCalAIM@dhcs.ca.gov with questions about DMC-ODS.
Join Our Team
DHCS is seeking a highly-skilled, exceptionally motivated individual to serve as:
- Chief of the Clinical Assurance Division (CAD) to serve as the principal policymaker and lead the CAD team in the implementation of utilization management for Medi-Cal fee-for-service members in partnership with DHCS' Health Care Benefits and Eligibility program. Additionally, the Chief of CAD is responsible for the administration of Treatment Authorization Requests (TARs), the TAR-free program, and post-payment utilization control of Medi-Cal benefits.
The salary range for this position is $11,435 to $13,623 per month. Possession of a medical license is desired, but not required. A salary range of $13,624 to $17,855 per month is available for candidates who are medical doctors or clinicians. (Final filing date: June 26)
DHCS is also 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
CalAIM PATH Best Practices Webinar
On June 27, from 11 a.m. to 12 p.m. PDT, DHCS will host a webinar,
Tools to Better Engage Eligible Members in CalAIM (advance registration required). The webinar is part of a biannual series of PATH Collaborative Planning and Implementation (CPI) webinars designed to highlight best practices for implementing Enhanced Care Management and Community Supports, increase providers' successful participation in CalAIM, and improve collaboration with Medi-Cal managed care plans, state and local government agencies, and others to build and deliver quality support services to Medi-Cal members. For more information, including past webinar resources and recordings, please visit the
PATH CPI webpage.
