​DHCS Stakeholder News - October 13, 2023

​​Top News

Governor Names New DHCS Chief Operating Officer for Programs (COOP)

On October 10, Governor Newsom announced the appointment of Chris Riesen as DHCS' new COOP, effective October 16. As part of the Directorate, Chris will provide leadership of Enterprise Data and Information Management, Enterprise Technology Services, and Program Operations. The COOP position expands the Director's Office to increase capacity to manage the growth and increased complexity of DHCS' programs, as well as to better support work/life balance. This position will support Erika Sperbeck's work as Chief Deputy Director for Policy and Program Support, leading Department operations and program integrity functions. Since July 2018, Chris has served as DHCS' Deputy Director for Enterprise Technology Services and Chief Information Officer.

​Medi-Cal Renewals Update

DHCS today published the August 2023 Medi-Cal continuous coverage unwinding eligibility measures data on the Medi-Cal Enrollment and Renewal Data webpage. The August dashboard includes data on Medi-Cal enrollment, applications in progress, redeterminations, and disenrollments. The data also include demographic details for all redetermination measures, along with the top reasons for disenrollments. 

Medi-Medi Plans Available During Medicare Open Enrollment

During the upcoming Medicare open enrollment period (October 15 through December 7), Medicare-Medi-Cal Plans (Medi-Medi Plans) are available for enrollment in twelve counties (Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara currently, as well as five new counties – Fresno, Kings, Madera, Sacramento, and Tulare – beginning on January 1, 2024). Medi-Medi Plans combine Medicare and Medi-Cal benefits and Medicare prescription drug benefits into one plan.

Approximately 45 percent of dually eligible members are enrolled in some type of Medicare Advantage plan. Enrollment in Medi-Medi Plans as of July 2023 is approximately 241,105 members. The benefits of Medi-Medi Plans include integrated materials, such as a single health plan card and one phone number to call for both Medicare and Medi-Cal benefits, leading to improved care coordination and support for members.

Medi-Medi Plans coordinate all benefits and services across both programs, including all Medicare-covered services, all Medi-Cal covered services, additional supplemental benefits, carved-out benefits (i.e., In-Home Supportive Services, Multipurpose Senior Services Program, Community-Based Adult Services, and dental), one care management team to coordinate care, and community supports offered by the Medi-Cal managed care plan.
 

Program Updates

Additional Continuous Coverage Unwinding Flexibilities

On September 22, the federal Centers for Medicare & Medicaid Services approved DHCS' request for two flexibilities that leverage existing regulations to help streamline the processing of annual Medi-Cal eligibility renewals and ease burdens on county program administrators and Medi-Cal members. The first flexibility waives the requirement for Medi-Cal members to sign and return a renewal packet that had already been submitted if counties receive verification of missing information after the packet was mailed. The second flexibility allows the use of the explanation submitted by the member within the renewal packet as sufficient verification for a successful redetermination, eliminating the need for additional supporting documentation. These flexibilities will streamline the renewal process for Medi-Cal members, especially individuals experiencing homelessness and elderly or disabled populations. Additionally, the flexibilities will ease burdens to provide additional paperwork or documentation and reduce procedural terminations during the continuous coverage unwinding period.

The flexibilities will continue throughout the unwinding period. DHCS issued Medi-Cal Eligibility Division Information Letter (MEDIL) I 23-49 to provide counties with immediate guidance on operationalizing these flexibilities.

Memoranda of Understandings Between Managed Care Plans and Third-Party Entities

DHCS this week released an All Plan Letter (APL), two Behavioral Health Information Notices (BHIN), and associated Memoranda of Understandings (MOU) templates for Medi-Cal managed care plans (MCP) required by the 2024 MCP contract to execute MOUs with certain third-party entities to ensure member care is coordinated and members have access to community-based resources to support whole-person care. The MOUs are intended to be effective vehicles to clarify roles and responsibilities among parties and support local engagement, care coordination, information exchange, mutual accountability, and transparency.

The MOU templates include a base template, which contains general provisions required to be included in all MOUs, and a set of bespoke templates tailored for programs or services administered by third-party entities that contain the required general MOU provisions and program-specific provisions. The bespoke templates are for MCPs to enter into MOUs with third-party entities with whom MCPs must make a good faith effort to execute by January 1, 2024, and include: local governmental agencies, such as county behavioral health departments for specialty mental health care and substance use disorder services; other local programs and services, including social services; child welfare departments; Regional Centers; In-Home Supportive Services programs; and Women, Infants, and Children Supplemental Nutrition Programs. DHCS will release additional required MOU templates for use by MCPs and third-party entities as they are finalized, including those required to be executed on July 1, 2024, and January 1, 2025. Additional information and copies of the MOU templates are available on the DHCS MOU webpage.

Medicare and Medi-Cal Dental Benefits

On October 11, DHCS released a new fact sheet for dental providers regarding dental benefits for dual eligible (Medicare and Medi-Cal) members. The fact sheet provides information about dental benefits that both Medicare and Medi-Cal offer and how providers can bill for dental services provided to members. Medicare, the primary payer for dual eligible patients, does not cover most dental care. Medi-Cal covers a variety of dental benefits administered by Medi-Cal dental providers. A dual eligible patient may also receive dental benefits through their Medicare Advantage plan. For dental services covered by Original Medicare or a Medicare Advantage plan, the services must be billed to Original Medicare or the Medicare Advantage plan first.

Medi-Cal Rx

On October 13, reinstatement Phase 3/Lift 3 will reinstate Quantity Restriction Edits for members 22 years of age and older. Quantity Limit restrictions will be applied to all (new and continuing) pharmacy claims. Some commonly prescribed Code I medications on the Medi-Cal Rx Contract Drugs List (CDL) have quantity limits based on the U.S. Food and Drug Administration-approved or clinically sound dosing guidelines. Claims may reject if billed incorrectly.

Also, a 30-day countdown alert was released on October 10 for the final reinstatement action. On November 10, implementation of Phase 4/Lift 4 of reinstatement will retire the transition policy for all pharmacy benefits for members 22 years of age and older; reinstate prior authorization (PA) requirements for all therapies for standard therapeutic classes 68, 86, and 87, which includes enteral nutrition products; reinstate utilization management claim edits for Reject Code 80 – Diagnosis Code Submitted Does Not Meet Drug Coverage Criteria; and reinstate Brand Medically Necessary PA requirements for all claims.

By October 17, all Medi-Cal Rx stakeholders that DHCS has been engaging with will have been presented the Advancing Medi-Cal Rx communication, which announces the end of reinstatement effort for adults and no changes for the pediatric population until 2024. Stakeholders include Local Health Plans of California, California Association of Health Plans, California Health Association, Medi-Cal managed care plan pharmacy directors, California Children's Hospital Association, Children's Specialty Care Coalition, Children's Regional Integrated Service System, California Medical Association, California Retailers Association, National Association of Chain Drug Stores, California Pharmacists Association, California Primary Care Association, California Behavioral Health Directions Association, California Association of Medical Product Suppliers, and Hemophilia Council of California.
 

Join Our Team

DHCS is 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 reflect DHCS' tremendous work to transform the state's health care system and strengthen organizational excellence.

Upcoming Stakeholder Meetings and Webinars

Adult Expansion Webinar

On October 18, DHCS will hold the first of two webinars on the Medi-Cal adult (ages 26-49) expansion for local county offices and other stakeholders. The second webinar is tentatively scheduled for early December. The webinar will provide background information about the expansion, implementation planning, noticing, outreach, and more. Registration information will be posted on the Ages 26 through 49 Adult Full Scope Medi-Cal Expansion webpage. Individuals may register for the webinar by emailing AdultExpansion@dhcs.ca.gov.

DHCS will implement this expansion pursuant to Senate Bill 184 (Chapter 47, Statutes of 2022) on January 1, 2024. When implemented, the expansion will provide individuals 26-49 years of age with full scope Medi-Cal benefits, regardless of citizenship or immigration status, if they meet all other Medi-Cal eligibility criteria.

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

On October 19, from 9:30 a.m. to 3:30 p.m., DHCS will host the next SAC and BH-SAC hybrid meeting (advance registration required). It will open as a joint meeting, with topics shared by SAC and BH-SAC. A BH-SAC-only meeting will be held after the joint meeting; there is no SAC-only meeting. Participants may attend in person at The California Endowment, located at 1414 K Street in downtown Sacramento, or virtually. For more information, please visit the SAC and BH-SAC webpages.

Providing Access and Transforming Health (PATH) Justice-Involved Program Office Hours

On October 23, DHCS will host the next PATH Justice-Involved Program virtual office hours session for Round 3 awardees (advance registration required). Office hours will be held every other Monday at 11:30 a.m. through December 18 to assist Round 3 agencies, including supporting implementation plan submission. For more information, visit the Justice-Involved Program website.

Minor Consent and Confidentiality for Sexual Health Services Webinar

On October 25, from 12 to 1:30 p.m., DHCS and the California Prevention Training Center will host a Minor Consent and Confidentiality for Sexual Health Services webinar (advanced registration required). This webinar will provide an overview of the California laws that impact minors and their access to confidential sexual health and family planning services. It will review important exceptions to confidentiality, including mandated child abuse reporting, and share some examples of best practices for implementation in difficult situations. Participants will learn about resources to support implementation of minor consent laws and be given an opportunity to test their own knowledge through case studies.
 
For those unable to attend the live webinar, a transcript and recording of the webinar, along with additional resources, will be made available on the Family PACT website.

PATH Collaborative Planning and Implementation (CPI) Best Practices Webinar

On October 27, from 10 to 11 a.m., DHCS will host a statewide webinar, entitled Enhanced Care Management (ECM) and Community Supports Provider Peer Support and Contracting Self-Assessment (advance registration required). This virtual session is the first in a series of biannual best practices webinars designed to highlight best practices for implementing ECM and Community Supports, increase providers' successful participation in California Advancing and Innovating Medi-Cal (CalAIM), and improve collaboration with MCPs, state and local government agencies, and others to build and deliver quality support services to Medi-Cal members. For more information and to register, please visit the PATH CPI webpage.