November 3, 2023 - Stakeholder News
Top News
DHCS Awards $144 Million to Break Down Health Care Barriers
On October 31, DHCS awarded $144 million to 145 providers across California to increase their capacity to deliver quality Enhanced Care Management and Community Supports. The awards were made through Round 2 of the Providing Access and Transforming Health (PATH) Capacity and Infrastructure, Transition, Expansion, and Development (CITED) initiative. The funding awarded in Round 2 is in addition to the $207 million awarded to 139 applicants during Round 1A and Round 1B. A total of $352 million has been awarded through the PATH CITED initiative to date. Read more in our news release.
Program Updates
Medi-Cal Rx
On November 10, Phase 4, Lift 4 of the Medi-Cal Rx reinstatement will be implemented for members 22 years of age and older. Phase 4/Lift 4 will retire the transition policy for all pharmacy benefits for members 22 years of age and older (members 21 years of age and younger will not be impacted at this time). For members 22 years of age and older, Phase 4/Lift 4 will reinstate prior authorization (PA) requirements for all therapies for standard therapeutic classes 68, 86, and 87, which includes enteral nutrition products, and reinstate Brand Medically Necessary PA requirements for all claims.
Smile, California Campaign for Medi-Cal Dental Services
On November 6, the Sealants for a Healthy Smile mobile van will make a stop in Colusa County. Smile, California representatives will encourage attendees to be mindful about their oral health and will disseminate multilingual oral health educational materials and other resources. In addition, Smile, California outreach representatives will encourage members to take advantage of their dental benefits and help families with referrals to local Medi-Cal dental providers. Sealants for a Healthy Smile reminds Medi-Cal parents and guardians to schedule regular dental checkups for their children and to request that sealants be applied to their children's teeth to prevent dental decay.
DHCS Major Program Initiatives - Go-Live Dates
From California Advancing and Innovating Medi-Cal (CalAIM) to transforming the state's behavioral health programs, DHCS' initiatives provide equitable access to quality health care leading to a healthy California for all. The links below reflect DHCS' major program initiatives and anticipated go-live dates, pending readiness, and federal approvals. This information is updated as necessary.
Join Our Team
DHCS is hiring! DHCS has an opportunity for Chief of the Financial Management Division within Fiscal (final filing date (FFD) is November 15). This executive role develops policies and procedures to ensure fiscal integrity, transparency, and accountability of approximately $150 billion in annual state and federal funding for DHCS.
Additionally, DHCS has an opportunity for Behavioral Health Policy Medical Consultant II within Behavioral Health (FFD is November 27). This position provides clinical expertise and strategic advice to DHCS Behavioral Health leadership on the development and implementation of policy and initiatives designed to strengthen behavioral health care access, quality, and service delivery.
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 reflect DHCS' tremendous work to transform the state's health care system and strengthen organizational excellence.
Upcoming Stakeholder Meetings and Webinars
Providing Access and Transforming Health (PATH) Justice-Involved Program Office Hours
On November 6, DHCS will host the next PATH Justice-Involved Program virtual office hour session for Round 3 eligible agencies (advance registration required). Office hours will be held every other Monday at 12 p.m. through December 18 to assist Round 3 agencies, including supporting implementation plan submission. For more information, visit the Justice-Involved Program website.
Medi-Cal Health Enrollment Navigators Project Stakeholder Meeting
On November 6, from 1 to 2:30 pm, the DHCS Medi-Cal Health Enrollment Navigators Project will host its next quarterly stakeholder meeting. The Navigators Project team will provide updates on current activities, and guest speakers will share additional relevant information. For more information, visit the Medi-Cal Health Enrollment Navigators Project webpage.
Keep Your Community Covered: Schools and Families Webinar
On November 16, from 2 to 3 p.m., DHCS will hold a webinar on Keep Your Community Covered: Schools and Families (advance registration required). The webinar will provide school partners with important information to assist students and their families with renewing Medi-Cal coverage. The webinar will also highlight available outreach resources and best practices for engaging families with school age children.
Medi-Cal Enrollment Requirements and Procedures for CBOs and LHJs Webinar
On November 17, from 10 to 11:30 a.m., DHCS will hold a public stakeholder hearing via webinar (advance registration required) to discuss the regulatory provider bulletin on Medi-Cal enrollment requirements and procedures for community-based organizations (CBO) and local health jurisdiction (LHJ) providers that offer community health worker and/or asthma preventive services. Effective January 9, 2024, CBO and LHJ providers requesting enrollment in the Medi-Cal fee-for-service program can submit their application through the Provider Application and Validation for Enrollment (PAVE) online enrollment portal.
Written comments, questions, or suggestions may be submitted during the hearing in the webinar chat. For those unable to attend, written comments must be submitted by 5 p.m. on November 17 to be considered for publication. When submitting comments in writing, please ensure that the commenter and organization/association being represented are both identified in the comments. Written comments should be submitted to DHCSPEDStakeholder@dhcs.ca.gov. Based on the public comments received, DHCS will publish the final bulletin on the Medi-Cal and DHCS websites.
CalAIM Intermediate Care Facility for the Developmentally Disabled (ICF/DD) Carve-In Billing and Payment Webinar
On November 17 at 1 p.m., DHCS will host the fourth in a series of educational webinars on the CalAIM ICF/DD carve-in (advance registration required). These webinars outline changes to the ICF/DD carve-in policy requirements. Starting on January 1, 2024, all Medi-Cal managed care plans (MCPs) will be required to cover and coordinate institutional long-term care for members residing in an ICF/DD. The webinar series will feature several topics, including ICF/DD carve-in 101, directed payment policy and payment requirements, the per diem rate, accommodation code changes, and best practices for billing and payment. ICF/DD home, Regional Center, and Medi-Cal managed care representatives are encouraged to attend. All webinars are open to the public.
If there are specific questions you would like addressed during the webinar, please submit them in advance using this registration form or by emailing them to LTCtransition@dhcs.ca.gov. Webinar materials, including recordings, and additional details about upcoming webinars are posted on the CalAIM ICF/DD Long-Term Care Carve-In webpage.
Medi-Cal Asset Elimination Webinar
On November 29, from 1:30 to 2:30 p.m., DHCS will hold a webinar on the elimination of assets for non-Modified Adjusted Gross Income (MAGI) Medi-Cal programs, effective January 1, 2024. When implemented, this initiative will eliminate the asset test for all non-MAGI programs, including long-term care and Medicare Savings Programs. The webinar will provide background information on the asset elimination, implementation planning, procedural changes, and outreach materials. More information is available on the Asset Limit Changes for Non-MAGI Medi-Cal webpage.
In Case You Missed It
Section 1115 Demonstrations: BH-CONNECT and CalAIM Transitional Rent Amendment
On October 20, DHCS submitted to Centers for Medicare & Medicaid Services (CMS) the new Section 1115 demonstration request, entitled the California Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (
BH-CONNECT) demonstration, and the
proposed amendment to the CalAIM Section 1115 demonstration related to transitional rent services.
Additionally, CMS announced that the federal public comment period will be open for
BH-CONNECT and
CalAIM transitional rent services from October 27 through November 26, 2023.
January 2024 Medi-Cal MCP Transition
As part of
Medi-Cal transformation, some MCPs are changing on January 1, 2024, and approximately 1.2 million members will have new health plan options and/or will need to transition to new MCPs. Changing MCPs will not affect Medi-Cal member coverage or benefits. Members who transition to a new MCP are receiving notices about the transition. DHCS developed several resources to support members, providers, and other stakeholders with the transition, including the
Managed Care Plan Transition Member webpage with a county “lookup" tool, links to member
notices sent by Medi-Cal about MCP changes,
frequently asked questions, and a
Contact Us page for members to learn more about health plans and provider choices. There are also transition resources for
providers and
MCPs and stakeholders. More information about the transition is available in the
2024 Managed Care Plan Transition Policy Guide and
Medi-Cal Eligibility Division Information Letter Number I 23-54.
