DHCS Stakeholder News - September 1, 2023
Top News
Medi-Cal Managed Care Plan Contracts Go-Live
DHCS today provided “go-live" decisions to all Medi-Cal managed care plans (MCPs) scheduled to assume operations on January 1, 2024, under the new MCP contract that requires all MCPs to advance health equity, quality, access, accountability, and transparency. These new contracts will serve approximately 99 percent of all Medi-Cal members. This change is part of California's transformation of Medi-Cal to ensure members can access the care they need to live healthier lives.
The go-live decisions are based upon DHCS' assessment of the MCPs' Operational Readiness key deliverables, including network adequacy, delegation oversight, continuity of care, and certain California Advancing and Innovating Medi-Cal (CalAIM) components. Also, DHCS conducted deep dive go-live assessments for the following five MCPs identified as high-priority due to the size and complexity of their expansion to additional counties or the number of members they will serve, as well as being new to providing Medi-Cal managed care services: Kaiser Foundation Health Plan (expansion), Anthem Blue Cross (expansion), Partnership HealthPlan of California (expansion), Community Health Plan of Imperial Valley (new), as well as Molina Healthcare, which is a delegate to Health Net in Los Angeles County and will take on 50 percent of the membership (~500,000 lives) currently assigned to Health Net.
Also, on August 23, the federal Centers for Medicare & Medicaid Services (CMS) approved an amendment to the CalAIM Section 1115 demonstration, allowing the state to implement county-based model changes in its Medi-Cal managed care program and effectuate County Organized Health Systems (COHS) and Single-Plan models in non-rural counties. Additionally, CMS approved the 1915(b) waiver amendment on July 26 to allow California to effectuate COHS or Single Plan models in rural counties.
DHCS anticipates that approximately 1.2 million members will need to transition to a new MCP on January 1. Approximately 243,000 members will receive an enrollment packet to choose a MCP in the county in which they reside. Approximately 420,000 members will transition because of the county plan model change, the majority of whom will not need to choose a plan, but will be notified of their enrollment in a plan operating in the county. Additionally in Los Angeles County, approximately 500,000 members will be notified and transitioned from Health Net to Molina.
In counties where MCP changes are occurring, members will receive transition notices explaining to them what is changing, if they need to make a plan choice, their continuity of care protections, and other important information. Depending upon the county and the change occurring, members may receive 90-day, 60-day, and 30-day notices. In some counties where a member must select a plan, a choice packet will be sent with the 60-day notice. DHCS is developing webpages and materials targeted specifically to Medi-Cal members and providers that will offer more information, scheduled for posting in mid-September.
More information about how to choose a plan is available at www.healthcareoptions.dhcs.ca.gov or by calling (800) 430-4263. Members may also contact the Office of the Ombudsman at (888) 452-8609 or MMCDOmbudsmanOffice@dhcs.ca.gov if they need additional help connecting with their plan to make a continuity of care request, obtain advice if they do not agree with their treatment or services, or ask general questions about their plan, provider, or Medi-Cal.
DHCS continues transition planning and outreach activities to help ensure a smooth transition for affected members and is clearly communicating the impact to members, providers, MCPs, and other stakeholders. The 2024 MCP Transition Policy Guide was published in June 2023 and will continue to be updated in the coming months. In addition, several stakeholder webinars and stakeholder update meetings continue to provide current information about the transition status.
Additional Federal Waiver Flexibilities Approved
On August 25, DHCS received approval from CMS of two requests for temporary federal waiver authority. On August 29, CMS expanded one existing flexibility to help streamline the processing of annual Medi-Cal redeterminations and ease burdens on county program administrators and Medi-Cal members. These flexibilities will simplify the renewal processing for Medi-Cal members, especially vulnerable populations, and alleviate burdens to provide additional paperwork or documentation during the continuous coverage unwinding period.
- Suspend the Requirement to Apply for Certain Other Benefits. DHCS will temporarily suspend the requirement of Medi-Cal applicants or members to apply for certain additional benefits, such as unemployment, annuities, pensions, retirement, and disability, for which they may be entitled, minimizing procedural terminations for individuals who would otherwise be eligible. This waiver is effective on August 1 and will remain in place through the end of the 12-month unwinding period in May 2024.
- Stable Income Renewal Waiver Flexibility. DHCS will temporarily allow the Medi-Cal redetermination income determination to be completed through ex parte without requesting additional income information or documentation for Medi-Cal members with only Title II or other stable sources of income. Examples of other stable income include pension, retirement (i.e., annuities, deferred compensation), disability payments (i.e., permanent worker's compensation or private sources), alimony or child support payments, fixed distributions of dividends or interest, and non-retirement related fixed annuities. This waiver is effective on August 1 and will remain in place through the end of the 12-month unwinding period in May 2024.
- Expansion of Asset Requirement Waiver. On March 29, 2023, CMS approved DHCS' request to waive the asset requirement for Medi-Cal redeterminations beginning on March 1, 2023, until California's implementation of the asset elimination on January 1, 2024. On August 29, CMS expanded this flexibility to allow California to also waive the asset requirement to Medi-Cal members reporting a change in circumstance after the continuous coverage unwinding redetermination is complete. This waiver preserves the effective date of March 1 and will remain in place through the end of the 12-month unwinding period in May 2024.
Assisted Living Waiver (ALW) Renewal 30-Day Public Comment Period
On September 5, DHCS will post the 2024 Assisted Living Waiver (ALW) renewal application to DHCS' website for a 30-day public comment period, prior to submitting the final version to CMS. All comments must be received by October 5. The ALW expires on February 29, 2024. DHCS intends to renew the waiver for another five-year waiver term beginning on March 1, 2024. The ALW provides eligible Medi-Cal members with the choice to reside in an assisted living setting as an alternative to long-term placement in a nursing facility. The goal of the waiver is to facilitate the transition of institutionalized members to a less-restrictive, community-based setting, and to prevent individuals who are at imminent risk of institutionalization from being admitted.
DHCS invites interested parties to review the renewal application and comment instructions that will be posted on the DHCS ALW webpage. Please email questions or comments to ALWP.IR@dhcs.ca.gov.
Program Updates
Equity and Practice Transformation Payments
On August 30, DHCS hosted a webinar to launch the Equity and Practice Transformation (EPT) Payments Program, a one-time $700 million primary care practice transformation program initiative to advance health equity and population health and invest in upstream care models. Primary care practices and clinics, MCP partners, and other stakeholders attended the webinar to review the latest details about the Provider Directed Payment Program, a component of EPT. Program materials, including application instructions and a guidance document, are posted on the DHCS Equity and Practice Transformation Payments Program webpage. The webinar slides and recording will soon be posted to the same webpage.
DHCS intends to release more information about the program, including payment milestones, later this year. The web-based application for this program will be available soon and must be submitted by October 23, 2023, at 11:59 p.m. Please email ept@dhcs.ca.gov with any questions.
Smile, California Campaign for Medi-Cal Dental Services
To mark National Pain Awareness Month in September, Smile, California will debut the new "Don't Wait Until It Hurts to See the Dentist" fotonovela in English and Spanish to encourage regular dental visits among Medi-Cal members and minimize the need for emergency dental visits. The fotonovela will post on SmileCalifornia.org and SonrieCalifornia.org on September 1. By accessing the webpage banner, users will be directed to a fresh landing page with details about preventive dental services available through Medi-Cal. This page will include the “Don't Wait Until It Hurts to See the Dentist" full-length and social media videos, fotonovela, and other Smile, California resources.
Also, in conjunction with the Sealants for a Health Smile promotional launch, Smile Dental Services is continuing the mobile dental van tour. Upcoming stops are scheduled in underserved counties throughout California, including September 5 in Lake County, September 12 in Tehama County, and September 26 in Calaveras County.
Join Our Team
DHCS is hiring! DHCS has an immediate opening for Chief of the Population Health Management Division within Quality and Population Health Management. This executive role leads the strategy, policy, oversight, monitoring, and evaluation of population health management.
DHCS is also hiring for our fiscal, human resources, legal, auditing, health policy, and information technology teams. For more information, please visit the CalCareers website.
DHCS' purpose is to provide equitable access to quality health care leading to a healthy California for all. DHCS' goals and objectives express the tremendous work DHCS is leading to transform our health care system and strengthen our organizational excellence.
Upcoming Stakeholder Meetings and Webinars
Nursing Facility Financing Reform Webinar
On September 7, from 2 to 3 p.m., DHCS will host a virtual stakeholder webinar (advance registration required) to discuss the development of the Skilled Nursing Facility Workforce Standards Program and provide updates on other nursing facility financing reform programs authorized by Assembly Bill 186 (Chapter 46, Statutes of 2022). Stakeholder input will be accepted. Additional information is available on the Nursing Facility Financing Reform (AB 186) webpage.
CalAIM ICF/DD Carve-In Office Hours
On September 8, DHCS will host an “office hours" session (advance registration required) as part of an educational webinar series for the CalAIM intermediate care facility for developmentally disabled (ICF/DD) long-term care carve-in. The goal of the webinar series is to provide stakeholders with an understanding of the ICF/DD carve-in policy requirements and how to support all Medi-Cal MCPs that will be required to cover and coordinate institutional long-term care for members residing in an ICF/DD home beginning on January 1, 2024. The webinars and office hours sessions are open to the public.
The office hours will provide a dedicated forum for DHCS and the Department of Developmental Services to engage with ICF/DD homes, Regional Centers, and Medi-Cal MCP representatives to address questions and further their understanding of the ICF/DD carve-in. This office hours session will focus on questions related to the components of the ICF/DD carve-in, including network readiness and contracting, continuity of care, authorizations, and leaves of absence and bed holds.
Office hour participants are encouraged to submit their questions or comments in advance using the registration form or by emailing LTCtransition@dhcs.ca.gov. Additional details about upcoming webinars are available on the CalAIM ICF/DD LTC Carve-In transition webpage.
Consumer-Focused Stakeholder Workgroup Meeting
On September 8, from 1:30 to 3 p.m., DHCS will virtually host the Consumer-Focused Stakeholder Workgroup meeting. More information is available on the DHCS Consumer-Focused Stakeholder Workgroup webpage. Please email questions or comments to DHCSCFSW@dhcs.ca.gov.
Providing Access and Transforming Health (PATH) Justice-Involved Program Office Hours for Round 3 Eligible Agencies
Beginning on September 11 through December 18, DHCS will host a series of PATH Justice-Involved Program virtual office hour sessions (advance registration required) for Round 3 eligible agencies. Office hours will be held every other Monday at 11:30 a.m. to provide assistance to Round 3 agencies, including supporting implementation plan submission. For more information, visit the Justice-Involved Program website.
Hearing Aid Coverage for Children Program (HACCP) Webinar for Families and Community Partners
On September 12, from 11 a.m. to 12 p.m., DHCS will host a HACCP webinar (advance registration required) to share guidance with families and communities about applying for hearing aid coverage and helping children to maximizing their HACCP benefits once enrolled. DHCS welcomes newly interested families, those who are currently participating in HACCP, and community partners supporting families and children to join this webinar for program updates, tips, and a question-and-answer session. For more information, please visit www.dhcs.ca.gov/haccp.
CYBHI EBP/CDEP Grants Program Webinar
On September 13, from 1 to 2 p.m., DHCS will virtually host a public webinar (advance registration required) on the Children and Youth Behavioral Health Initiative (CYBHI) Evidence-Based Practices (EBP) and Community-Defined Evidence Practices (CDEP) grants program. This webinar will focus on the “Round Three: Early Childhood Wraparound Services" Request for Application (RFA). DHCS will provide technical assistance by sharing responses to frequently asked questions (FAQs) about EBP/CDEP. Please email questions about the RFA to CYBHI@dhcs.ca.gov. DHCS will post the FAQs to the CYBHI EBP/CDEP grants webpage by September 11.
Doula Implementation Workgroup Meeting
On September 14, from 12 to 2 p.m., DHCS will host the Doula Implementation Workgroup meeting. Please see the agenda and Doula Services as a Medi-Cal Benefit webpage for more information. The meeting will include a report on DHCS' Birthing Care Pathway proposal and the role of doulas, and planning for future meetings. The workgroup is responsible for reviewing how to increase the availability of doula services through educational outreach programs, identifying and minimizing barriers to doula services, and addressing delays in payments and reimbursements to doulas and members.
HACCP Webinar for Medical Providers and Hearing Professionals
On September 14, from 12 to 1 p.m., DHCS will host a HACCP webinar (advance registration required) to share information with providers to help pediatric patients and their families maximize HACCP benefits. The training session will address program requirements for families to apply for coverage and the claims submission process for audiologists, otolaryngologists, physicians, and their office staff. For more information, please visit www.dhcs.ca.gov/haccp.
CalAIM: Subacute Care Facility Carve-In Webinar
On September 15 at 9:30 a.m., DHCS will virtually host the first in a series of educational webinars (advance registration required) about the CalAIM long-term care (LTC) carve-in of subacute care facilities in Medi-Cal managed care. The goal of these webinars is to provide subacute care facilities and Medi-Cal MCPs with an understanding of the carve-in to better operationalize the new benefit, including the scope of services and relevant policies (network readiness requirements, continuity of care, intersection with CalAIM, etc.), in preparation for the January 1, 2024, carve-in.
This first webinar will provide background on the carve-in, the requirements for contracting with DHCS' Subacute Contracting Unit, and implementing policy requirements. More information is posted on the CalAIM Intermediate Care Facility for Developmentally Disabled Long-Term Care Carve-In webpage. Please email questions or comments to LTCtransition@dhcs.ca.gov.
In Case You Missed It
CalAIM Demonstration Amendment Approval
On August 23, CMS approved an amendment to the CalAIM Section 1115 demonstration waiver, allowing the state to implement county-based model changes in its Medi-Cal managed care program. The amendment includes expenditure authority to limit the choice of MCPs in non-rural areas. This authority would apply in the metro, large metro, and urban counties intending to participate in the County Organized Health System or Single Plan models.
