December 22, 2023 - Stakeholder News
Top News
School Based Behavioral Health Fee Schedule Announced
DHCS posted the rates for the Children and Youth Behavioral Health Initiative (CYBHI) statewide multi-payer fee schedule. As part of Governor Newsom's
Master Plan for Kids' Mental Health and the CYBHI, DHCS, in collaboration with the Department of Managed Health Care and the California Department of Insurance, is expanding access to school-based (or school-linked) outpatient behavioral health services for students.
The
fee schedule establishes the minimum rates at which Medi-Cal managed care plans (MCPs) must reimburse local educational agencies (LEAs) and school-linked providers for the provision of behavioral health services to a student under the age of 26 at a school site. School sites could include on-campus, off-campus, and mobile clinic locations. The fee schedule outlines the appropriate billing codes, rates, and provider types for each service type billable as part of the CYBHI fee schedule program. Note: The fee schedule is pending approval of a State Plan Amendment by the federal Centers for Medicare and Medicaid Services (CMS) and is subject to change.
DHCS is phasing in the fee schedule starting in January 2024, when the
first cohort of 47 LEAs (announced on December 1, 2023) will go live. The second cohort will go-live in July 2024 and the third cohort in January 2025. Under state law, Medi-Cal MCPs, Medi-Cal Fee-for-Service (FFS), commercial health plans, and disability insurers (collectively referred to as MCPs) are obligated to reimburse eligible school-linked providers, including LEAs and community-based providers contracted by or affiliated with designated by the LEA.
Please visit the
CYBHI fee schedule webpage to learn more.
Program Updates
Medi-Cal Targeted Provider Rate Increase Approved
On December 19, 2023, CMS approved State Plan Amendment (SPA) 23-0035, authorizing DHCS to provide targeted rate increases for primary/general care, obstetric, doula, and non-specialty mental health services effective January 1, 2024. Pursuant to Assembly Bill (AB) 118 (Chapter 42, Statutes of 2023), DHCS increased rates for targeted services to no less than 87.5 percent of the Medicare rate, inclusive of eliminating AB 97 provider payment reductions and incorporating applicable Proposition 56 supplemental payments into the base rate.
For more information, including the 2024 Targeted Rate Increase Fee Schedule and approved SPA 23-0035, please visit the
Medi-Cal Targeted Provider Rate Increase webpage.
Hospital Quality Assurance Fee (HQAF) Program VIII Approved On December 15, 2023, and December 19, 2023, CMS approved the HQAF SPA 23-0007, SPA 23-0008, and broad-based and uniformity tax waiver letter, respectively, authorizing the HQAF VIII program supplemental payments to be made to California private hospitals up to the aggregate upper payment limit for the period of January 1, 2023, through December 31, 2024.
The HQAF program was established in 2009 with the aim of improving hospital reimbursement for services provided to Medi-Cal members. For services provided during calendar years 2023 and 2024, the HQAF program is estimated to provide private hospitals with approximately $21 billion in federally matched supplemental payments for inpatient and outpatient services and increased capitation payments to managed care plans. In addition, the program generates funding for children's health care coverage and public hospital grants.
DHCS will publish on its website information related to the HQAF VIII program, including the SPA, Fee and Payment model, and other pertinent information. HQAF VIII will continue to provide much needed funding and enhance Medi-Cal beneficiaries' access to health care throughout California. To learn more about the program, please visit the
HQAF website, and please e-mail questions to
HQAF@dhcs.ca.gov.
New Resources for Medi-Medi Plan Outreach
DHCS released two new Sign-Language YouTube videos for members dually eligible for Medicare and Medi-Cal. Both videos are sign language interpretations: “
Joining a Medi-Medi Plan" is in American Sign Language and “
Inscibirse a un Plan de Medi-Medi" is in Mexican Sign Language.
Californians in twelve counties are eligible to enroll in Medicare-Medi-Cal Plans (Medi-Medi Plans), a type of Medicare Advantage plan in California that is only available to dual-eligible members. Medi-Medi Plans provide more comprehensive care to individuals dually eligible for Medicare and Medi-Cal, and benefits in both programs are coordinated by one managed care organization (MCO). In 2024, Medi-Medi Plans are available in the following counties: Fresno, Kings, Los Angeles, Madera, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Mateo, Santa Clara, and Tulare.
Additional information is available on the
DHCS Medi-Medi Plan webpage. Providing Access and Transforming Health (PATH) Capacity and Infrastructure Transition, Expansion, and Development (CITED) Round 3 Application Coming Soon
On January 15, 2024, DHCS plans to open the
PATH CITED Round 3 application window. The PATH CITED initiative provides funding to build the capacity and infrastructure of on-the-ground partners delivering Medi-Cal
enhanced care management (ECM) benefits and community support services. The deadline to apply for CITED Round 3 funding is currently scheduled for February 15, 2024.
On December 18, 2023, DHCS published the PATH CITED Round 3
application outline to help prospective applicants prepare the resources and information required to complete their application. The CITED Round 3 application window is expected to open on January 15, 2024, for 30 days. 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.
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 extended to December 26)
- 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 extended to December 26)
DHCS is also hiring for our human resources, auditing, health policy, information technology, and other teams. For more information, please visit the
CalCareers website.
In Case You Missed It
CORRECTED LINK: DHCS 2023 Legislative Summary Report
On December 15, DHCS released the
2023 Legislative Summary report. This report provides a summary of chaptered and vetoed legislation for all significant bills the Department analyzed and engaged with during the first year of the 2023-2024 legislative session. Please note, this report does not represent a complete listing of bills the Department followed, nor any bills that did not make it to the Governor's desk.
DHCS Awards $150 Million to Support Mental Health Programs for Youth and Young Adults
On December 21, DHCS awarded $150 million to 262 organizations to support wellness and build resilience of children, youth, and young adults.
The awards, funded as part of the
CYBHI Evidence-based Practices (EBP) and Community-defined Evidence Practices (CDEP) Grant Program, focus on equity and centering efforts around youth and young adult voices, strengths, needs, priorities, and experiences, especially for those most at risk. They also drive transformative systems change and use ongoing learnings as the basis for change and improvement in outcomes for children and youth. DHCS posted the full list of grantees for
Round Two: Trauma Informed Programs and Practices and
Round Four: Youth Driven Programs.
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.
