​​​​DHCS Stakeholder News - January 6, 2023​

Top News

Five Plans to Serve Medi-Cal Managed Care Members Un​der Agreement

On December 30, DHCS and five commercial health plans – Blue Cross of California Partnership Plan (“Anthem"), Blue Shield of California Promise Health Plan, CHG Foundation d.b.a. Community Health Group Partnership Plan, Health Net Community Solutions, Inc. and Molina Healthcare of California – announced an agreement to deliver Medi-Cal services to Medi-Cal managed care members in 21 counties across the state starting in January 2024. RFP #20-10029 for the Medi-Cal MCPs was cancelled. 

The state's top priority is to ensure that Medi-Cal members have access to managed care plans that provide high-quality and timely care and are focused on delivering on the State's transformations that are designed to move the health system to become person-centered, equity-focused, and data-driven. To bring certainty for members, providers and plans, the state used its authority to work directly with the plans to re-chart our partnership and move with confidence and speed toward the implementation of the changes we want to see. As part of this agreement, Medi-Cal managed care plans will be held to new standards of care and greater accountability, helping ensure Medi-Cal members have the care and support they need to live healthier, more fulfilling lives.  

Doula Provider Applications Now Accepted

Effective January 1, 2023, DHCS added doula services throughout pregnancy, childbirth, and postpartum period as a Medi-Cal benefit. Updates to the Provider Application and Validation for Enrollment (PAVE) portal have been completed, and doulas may now access PAVE and submit their Medi-Cal enrollment application.

DHCS has created a self-paced video demonstration, Introduction to PAVE for Doula Providers, specifically for doula providers who are accessing PAVE for the first time. On January 10 at 10 a.m., DHCS will also host a virtual live session (advance registration required) to demonstrate how to use the PAVE portal. In addition, DHCS created a webpage, Medi-Cal: Doulas – Training as Medi-Cal Providers, that hosts different trainings for doulas regarding Medi-Cal. Additional trainings will be added as they become available.

New Programs and Initiatives Launching in 2023

The below Medi-Cal initiatives launched on January 1, 2023, further advancing the Medi-Cal program to be more comprehensive, coordinated, and person-centered—and ultimately leading to improved health outcomes for Medi-Cal members. 

  • CalAIM Population Health Management (PHM) Program: Medi-Cal managed care plans (MCPs) began implementing the PHM Program, a cornerstone of CalAIM. The PHM Program establishes a cohesive, statewide approach that ensures all Medi-Cal members have access to a comprehensive program that leads to longer and healthier lives, improved health outcomes, and health equity. The updated PHM Policy Guide and new Frequently Asked Questions (FAQs) are available on the DHCS CalAIM PHM webpage.
  • Enhanced Care Management (ECM) Expanded to Long-Term Care Populations of Focus:  MCPs launched the next phase of the ECM implementation, specifically for the long-term care population: adults living in the community and at risk for LTC institutionalization and adult nursing facility residents transitioning to the community. ECM is a Medi-Cal benefit that addresses the clinical and non-clinical needs of high-need, high-cost individuals through the coordination of services and comprehensive care management. ECM is part of the broader PHM Program through which MCPs will offer care management interventions at different levels of intensity based on member need, with ECM as the highest intensity level. For more information, please visit the ECM and Community Supports webpage. The updated ECM Policy Guide, ECM Implementation Timeline & Updated Populations of Focus, and ECM Model of Care Template Addendum II are now available on the DHCS CalAIM ECM and Community Supports webpage.
  • Cal MediConnect (CMC) transition to Medicare Medi-Cal (Medi-Medi) Plans: Medi-Medi plans were launched in seven counties, and CMC members were automatically transitioned to Medi-Medi Plans in those counties. Medi-Medi Plans provide comprehensive care to individuals dually eligible for Medicare and Medi-Cal. DHCS also transitioned the Medi-Cal pharmacy benefit for these members to Medi-Cal Rx. Medi-Medi Plans will coordinate benefits and services across both Medicare and Medi-Cal including Part D drug coverage. Medi-Cal Rx will resume the role as the Medi-Cal pharmacy benefits administrator for non-Medicare prescription drug coverage. Post-implementation review monitoring will continue for several weeks.​
  • Long-Term Care Carve-in to Medi-Cal Managed Care: Under CalAIM, Medi-Cal MCPs will cover and coordinate institutional Long-Term Care in all counties in 2023 in a phased approach by facility type. This will provide a LTC resident with access to coordinated and integrated care within Medi-Cal managed care and make coverage consistent across California. All MCPs are now responsible for the full LTC benefit at skilled nursing facilities, including both freestanding and hospital-based SNFs. The January 2023 transition does not apply to Intermediate Care Facilities for Developmentally Disabled or Subacute Facilities.   

  • Justice-Involved Pre-Release Medi-Cal Application Process: All counties are now required to implement a Pre-Release Medi-Cal Application Process as codified in Assembly Bill 133 (Chapter 143, Statutes of 2021) to ensure all eligible inmates and youth who are released from county correctional facilities (county jails) and county youth correctional facilities have Medi-Cal coverage upon release. Additional information can be found in All County Welfare Directors Letter (ACWDL) 22-27.
     
  • Statewide Medi-Cal Managed Care Enrollment for Dual Eligibles and Other Populations: Most dually eligible members not already enrolled in Medi-Cal managed care will now be enrolled in Medi-Cal plans. Medi-Cal plans provide wraparound services and coordination for dual eligible members. Medicare providers serving dual patients do NOT need to enroll in a Medi-Cal plan to continue receiving reimbursement as usual. Prior to January 2023, over 70 percent of dual-eligiblee members were already enrolled in Medi-Cal MCPs.  
     
  • CalAIM Incentive Payment Program (IPP): The IPP Program Year 2 began on January 1. From January 2022 to December 2024, the IPP provides incentive payments, totaling $1 billion, to MCPs in order to complement and expand CalAIM. The goal of IPP is to drive change at the MCP and provider level by building appropriate and sustainable capacity; investing in necessary delivery system infrastructure; bridging current silos across physical and behavioral health care service delivery; reducing health disparities and promoting health equity; achieving improvements in quality performance; and incentivizing MCP take-up of Community Supports. For more information, please visit the ECM and Community Supports webpage.

  • CalAIM Providing Access and Transforming Health (PATH): In January, DHCS will announce the organizations that have been awarded funding through the initial round (Round 1) of CalAIM PATH: CITED initiative. The PATH CITED initiative provides funding to enable the transition, expansion, and development of ECM and Community Supports capacity and infrastructure. Community-based organizations, public hospitals, county agencies, Tribes, and other community providers are eligible to apply during the CITED grants Round 2 application window in February. In January, DHCS will also launch the Technical Assistance (TA) Marketplace for applicants which will offer entities participating in CalAIM the ability to receive support and assistance. For more information on the TA Marketplace, please visit PATH website.
Several other major program initiatives coming online January 1, 2023, include:

  • Doula Services as a Medi-Cal Benefit: After working with stakeholders for more than a year to develop the benefit, DHCS will begin covering doula services in both the fee-for-service and managed care delivery systems. Doula services are aimed at preventing perinatal complications and improving health outcomes for birthing parents and infants. Services include personal support to women and families throughout a woman's pregnancy, childbirth, and postpartum experience. This includes emotional and physical support provided during pregnancy, labor, birth, and the postpartum period. Doulas will now be able to submit their Medi-Cal enrollment application through the PAVE portal, a portal designed to simplify and accelerate the Medi-Cal enrollment process. DHCS submitted State Plan Amendment 22-0002 to the Centers for Medicare & Medicaid Services (CMS) on November 7, 2022, to add doula services as a covered Medi-Cal benefit. ​
  • Dyadic Services as a Medi-Cal Benefit: Dyadic services – such as Behavioral Health Well-Child Visits, specific assessment, screening, counseling, and brief intervention services – are a set of services provided specifically to a “dyad": a child along with their parent or caregiver. Services provided to the parent or caregiver include depression screening, behavioral health assessment and interventions, screening for social drivers of health, and alcohol and drug screening, assessment, brief interventions and referral to treatment, among other services.
     
  • Medi-Cal Mental Health Services Screening and Transition Tools: After working with stakeholders for more than a year, DHCS finalized the standardized, statewide Adult and Youth Screening and Transition of Care Tools for Medi-Cal Mental Health Services. Under CalAIM, DHCS streamlined the mental health screening process and improving patient care by creating standardized, statewide tools to guide referrals of adult and youth members to the appropriate Medi-Cal mental health delivery system and ensure that members requiring transition between delivery systems receive timely and coordinated care. The tools are available on DHCS' Screening and Transition of Care Tools for Medi-Cal Mental Health Services webpage.
Other notable releases and upcoming transformations include:

  • Updated Telehealth Policy: DHCS is making permanent many telehealth flexibilities from the COVID-19 public health emergency (PHE), including payment parity and broad coverage for clinically appropriate telehealth services. The updated policy will be published on January 16 in the Medi-Cal Provider Manual for telehealth, which will contain guidance on consent, establishing new patients via telehealth, billing guidance for services provided via audio-only, and brief virtual communications and check-ins.  
All current flexibilities issued during the PHE will remain as long as the PHE is in effect, and most flexibilities in place during the PHE will continue after the expiration of the PHE. During the PHE, providers should consult the Medi-Cal Telehealth Provider Manual and any additional PHE guidance to guide their delivery of services. After the PHE ends, providers should consult only the Medi-Cal Telehealth Provider Manual

  • Hearing Aid Coverage for Children Program (HACCP) Eligibility Expansion: Beginning January 1, DHCS welcomes newly eligible young adults ages 18 to 20 who meet other program criteria and need coverage for their hearing aid(s) and related services to apply for HACCP enrollment. Also, effective January 1, applicants under age 21 who meet program eligibility requirements may apply to enroll in HACCP even if they have partial other health coverage for hearing aids subject to a coverage limit of $1,500 or less per year. Additional program information is available on the HACCP webpage. Families can apply to enroll for coverage through HACCP's Online Application Portal.​
     
  • Community Assistance, Recovery, and Empowerment (CARE) Act Update: DHCS is working with the California Health & Human Services Agency and the Judicial Council of California to provide consistent communication and develop trainings for CARE Act stakeholders. The CARE Act creates a new pathway to deliver mental health and substance use disorder services to the most severely impaired Californians who too often suffer in homelessness or incarceration without treatment. DHCS will launch initial training and technical assistance to county behavioral health agencies to support the implementation of the CARE Act in the spring of 2023. Seven counties will implement the program beginning October 1, 2023, and the remaining counties no later than December 1, 2024.
     
  • Mobile Crisis Services Benefit: On December 19, DHCS released BHIN 22-064  providing guidance for implementation of the Mobile Crisis Services Benefit on January 1. Mobile crisis services are a community-based intervention designed to provide de-escalation and relief to individuals experiencing a behavioral health crisis wherever they are, reducing unnecessary law enforcement involvement and emergency department utilization. Mobile crisis services are provided year-round by a multidisciplinary team of trained behavioral health professionals in the least restrictive setting. Mobile crisis services include screening, assessment, stabilization, de-escalation, follow-up, and coordination with health care services and other supports.
  • Recovery Incentives Program – California's Contingency Management (CM) Benefit: In the first quarter of 2023, DHCS will pilot Medi-Cal coverage of CM in select Drug Medi-Cal Organized Delivery System (DMC-ODS) counties through the Recovery Incentives Program. As part of CalAIM, California became the first state in the nation to receive federal approval to cover CM services for substance use disorders (SUD). CM is an evidence-based, cost-effective treatment for SUD. DHCS intends to use the pilot as a basis for informing the design and implementation of a statewide CM benefit through the DMC-ODS program, pending budgetary and statutory authority.

Program Updates

Whole Person Care (WPC) Pilot Program Final Evaluation Report

On December 23, DHCS submitted the WPC pilot program final evaluation report to CMS. The WPC pilot program was a demonstration program under California's Medi-Cal 2020 waiver that concluded on December 31, 2021. The program aimed to achieve better care, better health, and lower costs for Medi-Cal members in California while promoting the coordination of health, behavioral health, and social services in a patient-centered manner.

The final evaluation report, developed by the UCLA Center for Health Policy Research, found that the pilot programs were successful in developing diverse and appropriate infrastructure, sharing data across sectors, and implementing new data systems. Further, the pilots were successful in delivering care coordination services, resulting in improved overall member health, reduced emergency department visits, and lowered inpatient utilization. The interventions achieved through the program lowered member costs by $99 per enrollee per year. The delivery infrastructure and partnerships developed during WPC enabled the successful transition to CalAIM's ECM and Community Supports. The final evaluation report will be posted on the Medi-Cal 2020 Evaluations webpage later in January.

Youth Opioid Response California 3 (YOR 3) Application

DHCS released a RFA to strengthen capacity and access to prevention, treatment, and recovery services, as well as access points to Medication-Assisted Treatment (MAT), for youth (ages 12-24) and their families. This opportunity is designed to foster the coordination and strengthening of existing multi-system networks and encourage the development of new partnerships between agencies reaching youth. Implementation grantees may receive up to $750,000 and capacity building grantees may receive up to $50,000. For more information and to apply by the January 19 deadline, please visit the YOR CA website or email YORCalifornia@ahpnet.com.

MAT and California Hub and Spoke (CA H&SS) Awards

On January 9, DHCS will award $52 million to 105 entities providing MAT services to implement the CA H&SS from January 1, 2023, to June 30, 2024. Each entity will receive between $100,000 - $1,848,000 annually to fund prevention, assessment, diagnosis, treatment, and recovery from opioid and substance use disorders. This funding opportunity will be used to further the development and implementation of regional “Hubs" (Regional Centers of Excellence in MAT) and “Spokes" (any federally approved DATA-2000 waivered prescribers who prescribe or dispense buprenorphine) to collectively enhance the opioid and substance use continuum of care. The project is funded by the State Opioid Response (SOR) III grant, awarded by the Substance Abuse and Mental Health Services Administration (SAMHSA), and is administered by Advocates for Human Potential, Inc. (AHP). For more information, please visit the MAT website.

Home and Community-Based Alternatives (HCBA) and Medi-Cal Waiver Program (MCWP) Renewals

On December 20, DHCS submitted formal responses to the CMS Request for Additional Information to reauthorize the HCBA and MCWP waivers. The current HCBA and MCWP waiver terms were set to end on December 31, 2021. On December 13, CMS approved a fifth temporary extension to allow the HCBA and MCWP waivers to continue to operate until March 26, 2023. CMS is expected to approve the HCBA and MCWP renewals in January 2023. Due to the delay in the review and approval process, CMS and the state agreed to delay the implementation date of the new HCBA and MCWP waivers to January 1, 2023, which extends the new waiver terms to the end of 2027.

The HCBA renewal includes several significant updates, including, but not limited to:

  • Increased overall waiver capacity
  • Revised minimum requirements for social worker case manager qualifications
  • Defined the role of the Circle of Support within the waiver
  • Added Assistive Technology as a waiver service, to maintain the participant's health and safety
  • Eliminated the age restriction for Respite and Habilitation Services
  • Included Pediatric Day Health Care as a provider type for facility-based Respite Services
  • Added paramedical services as an extended state plan service

The MCWP renewal includes a limited number of significant updates, including:

  • Amended waiver name
  • Revised minimum requirements for Social Worker Case Manager Qualifications
  • Modified timeline for reassessments
  • Increased cost limits
  • Updated staff-to-client ratios

Intimate Partner Violence (IPV) Screening and Referrals Survey for Medicaid Primary Care Clinicians

There is an upcoming invitation-only survey for Medicaid primary care clinicians who treated adult (18 years of age or older) Medicaid members in 2021. The Office of Evaluation and Inspections, a component of the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS), is conducting a study on challenges faced by primary care clinicians related to intimate IPV screening and referrals beginning January 9 on a rolling basis. The survey will focus on clinicians' IPV screening (which is a recommended screening by the U.S. Preventive Services Task Force, referral practices, the challenges they encounter related to these services, and potential measures that might improve the screening for IPV. The survey is voluntary, and clinicians' responses will be anonymous. Responses will be aggregated and will be used to help make recommendations to address the screening of patients experiencing IPV.

Clinicians can find more information about this federal study and FAQs on the HHS-OIG website. For questions, email IPVsurvey@oig.hhs.gov.

Join Our Team

DHCS is hiring Californians to join our fiscal, human resources, legal, auditing, health policy, and information technology teams. For more information, please visit the CalCareers website.

DHCS is dedicated to preserving and improving the overall health and well-being of all Californians. DHCS' mission is to provide the most vulnerable residents with equitable access to affordable, integrated, high-quality health care, and the Department is currently transforming the Medi-Cal program to make sure it provides the quality-focused and person-centered care Californians need to live healthier, happier lives.

Upcoming Stakeholder Meetings and Webinars

Children and Youth Behavioral Health Initiative (CYBHI) Webinars

On January 13 and 20, from 2 to 3 p.m., DHCS will virtually host webinars (advance registration required) on behalf of the CYBHI Evidence-Based and Community-Defined Evidence Practices grants program. These webinars will focus on the Round One: Parent and Caregiver Programs and Practices RFA. DHCS' intent is to provide technical assistance by sharing responses to frequently asked questions received based on themes. During the webinars, DHCS will not address any live questions. Please email questions related to the round one to CYBHI@dhcs.ca.gov. DHCS will post the FAQs to the CYBHI webpage by January 9.

CalAIM Screening and Transition of Care Tools

On January 19, from 3 to 4 p.m., DHCS will hold a webinar about the Adult and Youth Screening and Transition of Care Tools (advance registration required) for the Medi-Cal Mental Health Services initiative. This initiative is focused on implementing statewide Screening and Transition of Care Tools for both adults and individuals under age 21 for use by Medi-Cal MCPs and County Mental Health Plans (MHPs). The webinar will include an overview of the purpose of the initiative, a review of final guidance and tools, and responses to frequently asked questions. Time will be reserved at the end of the webinar for a questions and answers session. For more information, please visit the Screening and Transition of Care Tools webpage.

HACCP Provider Webinar

On January 24, from 12 to 12:50 p.m., DHCS will host a webinar session (advance registration required) to assist providers with information to help pediatric patients and their families to maximize the HACCP benefits. The training session will address the program requirements for families to apply for coverage and the claims submission process for audiologists, otolaryngologists, other physicians, and their office staff.

In Case You Missed It

Consolidated Appropriations Act of 2023 and Medi-Cal Redeterminations 

On December 29, President Biden signed into law the Consolidated Appropriations Act of 2023 (the omnibus spending bill), which has broad implications for the Medi-Cal program and in particular the resumption of Medi-Cal redeterminations. Previously, the resumption of Medi-Cal redeterminations was tied to the termination of the COVID-19 public health emergency (PHE). With the passage of this bill, the continuous coverage requirements that paused all Medi-Cal redeterminations since March 2020 would be decoupled from the PHE termination date as of April 1, 2023, setting the stage for the resumption of Medi-Cal redeterminations.

CMS will provide updated guidance to states this month on the Medicaid program.  DHCS will update the Medi-Cal COVID-19 PHE Operational Unwinding Plan and additional plan, county and provider guidance once CMS releases updated guidance.  

DHCS will work closely with all Coverage Ambassadors to share newly developed outreach materials to Medi-Cal members across California. Individuals can join the DHCS Coverage Ambassador mailing list to receive the latest information and updated toolkits as they become available. For questions, please email Ambassadors@dhcs.ca.gov.

ECM and Community Supports Early Implementation Data

On December 22, DHCS released early implementation data for ECM and Community Supports, two major CalAIM programs that launched in 2022. ECM and Community Supports were designed to support high-need Medi-Cal members and address social factors that impact their health, such as housing and nutrition. Data show the early reach of ECM and Community Supports in January through June, and highlight growing member enrollment in both programs, particularly among historically underserved populations.

Medicare Provider Billing Information for Dual Eligible Patients

DHCS published an updated fact sheet for Medicare providers to explain the provider billing process for dual eligible members enrolled in Medi-Cal managed care. This fact sheet describes the existing crossover billing process, which does not change under CalAIM. Medicare providers serving dual eligible patients do not need to enroll in a Medi-Cal managed care plan (MCP) to continue receiving reimbursement. More than 70 percent of dual eligible members statewide are already enrolled in Medi-Cal MCPs. Medicare benefits and providers do not change upon enrollment in a Medi-Cal MCP. 

For patients in Original (FFS) Medicare, the Medicare Administrative Contractor processes the primary claim for Medicare payment, and then forwards the claim to the Medi-Cal MCP (or DHCS) for secondary Medi-Cal payment. For patients in Medicare Advantage (MA), the Medicare provider bills the MA plan for primary payment. The secondary payment process may depend upon whether the patient's Medi-Cal MCP is the same or different than the MA plan. For more information, please visit the Statewide Medi-Cal Managed Care Enrollment for Dual Eligible Members webpage.

Published COVID-19 Information


 
Thank you,
Department of Health Care Services

www.dhcs.ca.gov



Last modified date: 1/6/2023 4:08 PM