Today the Center for Medicare & Medicaid Services (CMS) approved the MCO Tax federal waiver, paving the way for DHCS to move forward with implementing the MCO Tax for the authorized effective period, subject to any future changes in federal requirements concerning health care-related taxes.
Assembly Bill 119 (Chapter 13, Statutes of 2023) authorized a MCO Tax effective April 1, 2023, through December 31, 2026. The MCO Tax is estimated to provide $19.4 billion in net non-federal funding over the 3.75-year tax period. Subject to appropriation and federal approval of applicable payment and rate methodologies, MCO tax revenues will be used to support the Medi-Cal program including, but not limited to, targeted provider rate increases and other investments that advance access, quality, and equity for Medi-Cal members and promote provider participation in the Medi-Cal program.
In accordance with state law, DHCS will certify in writing days that federal approval has been received and issue notices to each MCO subject to the tax outlining the tax due for each tax period and the dates on which the installment tax payments are due. In addition, DHCS will publish on its website information related to the MCO Tax, including the approval letter, tax amounts due for each tax period, and other pertinent information. A link to the location of these resources will be provided in a future stakeholder update.
Home and Community-Based Alternatives (HCBA) Waiver Slot Increase Amendment ApprovalOn December 11, the federal Centers for Medicare & Medicaid Services (CMS) approved DHCS' amendment to the HCBA Waiver adding slot capacity to the waiver for waiver years two through five (2024 – 2027). The waiver amendment approval is effective January 1, 2024, coinciding with the start of waiver year two (January 1, 2024 – December 31, 2024). The approved waiver amendment adds 1,800 additional waiver slots for each of the remaining four waiver years for a total increase in waiver capacity of 7,200 slots during the course of the waiver term. For additional information, including the approved waiver, visit the
HCBA waiver webpage.
Home Providing Access and Transforming Health (PATH) Capacity and Infrastructure Transition, Expansion, and Development (CITED) Round 3 Application Outline Available December 18
On December 18, 2023, DHCS will publish the PATH CITED Round 3 application outline to help prospective applicants prepare the resources and information required to complete their application prior to the opening of the funding window on January 15, 2023. The CITED Round 3 application window is expected to open on the PATH CITED website for 30 days, from January 15 through February 15, 2024. The application outline is intended to be used as a planning tool and intended to “preview" the application. It is not the formal application. Applicants are still required to apply for CITED Round 3 funding using the application link on the PATH CITED website.
The PATH CITED initiative provides funding to enable the transition, expansion, and development of Enhanced Care Management (ECM) and Community Supports capacity and infrastructure. Round 3 eligible entities include community-based organizations; county, city, or local government agencies; federally qualified health centers; Medi-Cal Tribal and Designee of Indian Health Program; providers; and others as approved by DHCS. Visit the PATH CITED
website to learn more.
Medi-Cal Renewals Update
DHCS today published the October 2023 Medi-Cal continuous coverage unwinding eligibility measures data on the
Medi-Cal Enrollment and Renewal Data webpage. The October dashboard includes data on Medi-Cal enrollment, applications in progress, redeterminations, and disenrollments. The data also includes demographic details for all redetermination measures, along with the top reasons for disenrollments.
Join Our Team
DHCS is hiring. DHCS has opportunities for:
- Assistant Deputy Director for Program Operations assists in leading, planning, organizing, and directing Program Operations, which is comprised of the California Medicaid Management Information System - Operations, Clinical Assurance, Provider Enrollment, and Third-Party Liability and Recovery Divisions. (Final filing date (FFD) is December 29)
- Chief of Capitated Rates Development within Health Care Financing serves as the principal policymaker for all rate-setting activities to ensure high-quality and cost-efficient health care through DHCS' contracted Medi-Cal MCPs. (FFD is December 19)
- Chief of Fee-for-Service Rates Development within Health Care Financing develops, interprets, and issues policy on Medi-Cal reimbursement methodologies for Medi-Cal fee-for-service (FFS) non-institutional and long-term care services and provider fee programs. (FFD) is December 20)
DHCS is also hiring for our human resources, auditing, health policy, information technology, and other teams. For more information, please visit the
CalCareers website.
Upcoming Stakeholder Meetings and Webinars
Enhanced Care Management (ECM) and Community Supports Healthcare Common Procedure Coding System (HCPCS) Coding Guidance Webinar
On December 18, from 11 a.m. to 12 p.m., DHCS will host a
webinar to provide an overview of recent updates to the ECM and Community Supports HCPCS Coding Guidance (advance registration required). DHCS initially released guidance in 2021 that includes the HCPCS codes and modifiers that must be used to report and bill for ECM and Community Supports service encounters. This includes encounter data that ECM and Community Supports services providers submit to MCPs for claiming or invoicing, and that MCPs submit to DHCS to monitor program performance and integrity. Based on feedback submitted from stakeholders throughout the early years of ECM and Community Supports implementation, DHCS updated this guidance to increase the level of statewide data standardization and ease administrative burden.
Specifically, DHCS added new ECM and Community Supports HCPCS code/modifier combinations and codified the requirement that MCPs may not require or allow their providers to report codes or modifiers for ECM and Community Supports services beyond those defined by DHCS in the guidance. This webinar will offer MCPs, ECM and Community Supports providers, and other interested stakeholders the opportunity to learn more and ask questions about the updates made to the ECM and Community Supports HCPCS coding guidance.
Telehealth Stakeholder Advisory Group Informational Webinar
On December 19, from 10 to 11 a.m., DHCS will hold an informational webinar for the Telehealth Stakeholder Advisory Group and request feedback on updates DHCS is finalizing to the Medi-Cal Provider Manual: Telehealth related to Patient Choice of Telehealth Modality and the Right to In-Person Services. DHCS anticipates these updates will be published in Spring 2024. The updates meet the requirements established in Senate Bill 184 (Chapter 47, Statutes of 2022) and Assembly Bill 1241 (Chapter 172, Statutes of 2023). Following the webinar, DHCS will provide advisory group members with a three-week comment period. Please submit your questions and public comments via email to
Medi-Cal_telehealth@dhcs.ca.gov.
Medi-Cal Rate Increases Webinar
On December 19, DHCS will hold a webinar to share information with providers about how and when Medi-Cal rate increases, effective January 1, 2024, will be implemented in the Medi-Cal FFS and managed care delivery systems. On December 1, DHCS published the new FFS rates on the
DHCS website.
Pursuant to Welfare and Institutions Code section 14105.201, subject to federal approval, DHCS will increase FFS rates for targeted procedure codes to no less than 87.5 percent of applicable Medicare rates. DHCS will direct Medi-Cal MCPs to ensure the payments they make to network providers for the targeted procedures codes are no less than the new FFS reimbursement level. The affected services are primary care services, including those provided by physician and non-physician professionals, obstetric and doula services, and non-specialty mental health services.
In August 2023, DHCS solicited public comment on the targeted procedure code list and the FFS rate increase methodology, and in September submitted
State Plan Amendment 23-0035 to CMS. In addition, DHCS partnered closely with a MCP workgroup to develop how the new payment expectations (a directed payment arrangement) will be operationalized in the managed care delivery system. Due to the need for MCPs to update their systems and provider contracts, the increased rates will not be paid in the managed care delivery system immediately. DHCS will formally establish, through written guidance, compliance timeframes for MCPs to fully implement the increased payment levels, as applicable, on a go-forward basis as well as retroactively to January 1, 2024.
For more information about the webinar, or if you have questions or comments, please email
TargetedRateIncreases@dhcs.ca.gov.
Hearing Aid Coverage for Children Program (HACCP) Webinar for Medical Providers and Hearing Professionals
On December 19, 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.
In Case You Missed It
California Launches New Opioid Resource Website
California
launched a new, comprehensive opioid website that gives Californians a single resource for prevention, data, treatment, and support information. The website,
OPIOIDS.CA.GOV, is part of Governor Newsom's multi-pronged approach to connect Californians with information to prevent and reduce overdoses and deaths and support those struggling with substance use and addiction.
All Californians should visit
OPIOIDS.CA.GOV to learn more and help us spread awareness and save lives. Together we can make a difference in combating this crisis.
We are also interested in hearing feedback from our partners about this new resource as we continue to iterate and improve the website. Please share your thoughts or comments with us at
CommsOutreach@cdph.ca.gov.
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 transitioning to a new MCP received 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.
