​​DHCS Stakeholder News - January 13, 2023​

Top News

Updates to the Medi-Cal COVID-19 Public Health Emergency (PHE) and Continuous Coverage Unwinding​ Operational Plan

On January 13, DHCS updated the Medi-Cal COVID-19 PHE and Continuous Coverage Unwinding Operational Plan to incorporate policy changes as a result of the federal Consolidated Appropriations Act of 2023 enacted on December 29, 2022, and corresponding guidance released from the Centers for Medicare & Medicaid Services (CMS) in the form of a CMCS Informational Bulletin on January 5, 2023. The updated plan reflects the delinking of the continuous coverage requirement from the PHE as of April 1, 2023, setting the stage for the resumption of Medi-Cal redeterminations.

The plan is intended to inform the public about DHCS' approach to return Medi-Cal to a normal state of operations. The plan also includes additional resources, including information about the DHCS Coverage Ambassadors campaign and links to CMS guidance documents.

​​​Winter Storm Wellness Checks

California has experienced a series of devastating storms, with predicted severe weather continuing, potentially resulting in damaging winds, heavy rain, and flooding. We must double down on our communication efforts over the coming days as additional rain is expected statewide through the next several days.

Over the next three days, we ask that you focus your efforts on Wellness Checks for your populations. Please encourage others to use these resources to check on neighbors, family, and friends.

Wellness Che​cks 101s​

During inclement weather, the priority should be on ensuring people's safety in emergencies and  making it easier for them to access shelter and other resources by removing all possible barriers.

We recommend that our community partners proactively check on individuals who are older, have disabilities, are unhoused, and/or have chronic health conditions that may put them at-risk. Reach out to them to check on how they're doing and connect them to resources as necessary.

We encourage you to work with your local county and Office of Emergency Services to aid your communities. We also recommend that you and your staff become familiar with local resources that you can offer to those in need, including local shelters or warming centers.

To assist stakeholders with wellness checks, the California Health & Human Services Agency (CalHHS) developed an Emergency Resource Guide, Appendix I: Universal Wellness Checks Questionnaire that can be used when conducting wellness checks.

Emergency Preparedness Guide/Toolkit for Individuals wi​​th Disabilities

The California Office of Emergency Services (CalOES) and Department of Rehabilitation have developed an Emergency Preparedness Guide/Toolkit for Individuals with Disabilities available in multiple languages that includes information and emergency preparedness tips for individuals with specific types of disabilities.

Evacuation: Please make sure that if local officials issue evacuation orders, please evacuate.

Stay Updated: Follow CalOES and your local emergency officials for real-time updates about the storm and its threats. Sign up for local alerts at calalerts.org.

We appreciate your efforts as we work together to improve preparedness and response to disasters and emergencies.

Governor's Fiscal Year (FY) 2023-24 Proposed Budget

Governor Gavin Newsom proposed a $144.4 billion budget for DHCS programs and services in the next FY. The budget for DHCS supports vital services that reinforce the state's commitment to preserve and improve the overall health and well-being of all Californians while operating within a responsible budgetary structure. Highlights include the expansion of full scope Medi-Cal coverage to all adults regardless of immigration status beginning January 1, 2024, CalAIM justice-involved initiatives, and provider rate changes. DHCS is also proposing the Behavioral Health Community-Based Continuum (CalBH-CBC) demonstration to expand access and strengthen mental health services for Medi-Cal members living with serious mental health illness and serious emotional disturbance. Additionally, DHCS will develop an 1115 demonstration waiver to support the state's reproductive health safety net.

U.S. Department of Health and Human Services (HHS) Renews PHE

On January 11, HHS renewed the federal COVID-19 PHE for a full 90-day extension through April 11. The formal PHE declaration was posted on the HHS website. The Biden Administration has committed to providing a minimum 60-day advance notice before it ends the PHE. Please contact the DHCS Medi-Cal Eligibility Division COVID inbox at MCED.COVID@dhcs.ca.gov with any questions.

Program Updates

Medi-Cal Telehealth Updates 

DHCS has released several updates to the Medi-Cal Telehealth webpage that reflect DHCS' current telehealth policy:

  • Frequently Asked Questions (FAQ) page
  • Telehealth Policy Paper
  • Telehealth Research and Evaluation Plan
  • Telehealth Provider Manual (scheduled to be updated on January 13)
As reflected in the Telehealth Policy Paper, most telehealth coverage policies will be maintained after the expiration of the federally declared COVID-19 PHE.

Please email Medi-Cal Telehealth@dhcs.ca.gov with any questions or comments. 

Medi-Cal Rx Update

Beginning on January 20, the next wave of reinstatement of prior authorization (PA) will include PAs for an additional 39 therapeutic classes, followed by the remaining therapeutic classes (excluding enteral nutrition products) on February 24. At that time, PA requirements will be fully reinstated for members age 22 and older. For claims that are paying under the Transition Policy due to claim history, a provider may submit a PA before the end of the transition period, beginning on February 24. For additional details, visit the reinstatement page of the Medi-Cal Rx website. Additionally, Medi-Cal Rx began publishing a weekly newsletter (“Reinstatement Spotlight") to support stakeholder engagement and education, and to provide stakeholders with links to recently published resources and informational updates. 

Elevate Youth California (EYC) Request for Applications (RFA)

On January 16, DHCS will release another EYC RFA for community-based and Tribal organizations to build organizational capacity to implement youth social justice, mentoring, and peer support prevention programming in communities disproportionally impacted by the war on drugs. Funded by the Proposition 64 Youth Education, Prevention, Early Intervention, and Treatment Account, nearly $17 million is available, and organizations can apply for funding up to $400,000 each. For more information, visit the EYC website.

Behavioral Health Bridge Housing (BHBH)

DHCS is currently working with stakeholders to finalize the funding strategy and allowable uses for the BHBH program to address the immediate housing and treatment needs of people experiencing unsheltered homelessness and who have serious behavioral health conditions. A RFA will be released in late January 2023 to county behavioral health agencies for participation in this first round of grant program funding. For the second round of funding, a RFA will be released in spring 2023 for Tribal entities to apply for funding. For more information, please visit the BHBH website.

Application Deadline for Clinic Workforce Stabilization Retention Payments (CWSRP)

DHCS reminds all successfully registered qualified clinics to submit their CWSRP applications before the deadline. All requests for payment must be submitted no later than 5 p.m. on January 27. DHCS encourages early submissions so all applications can be validated shortly after the application submission deadline.
For application guidance, an application video tutorial, and all other supporting information, please visit the CWSRP webpage.

CalAIM Behavioral Health Administrative Integration Initiative Concept Paper

In January, DHCS will publish a concept paper on the California Advancing and Innovating Medi-Cal (CalAIM) Behavioral Health Administrative Integration initiative, which aims to consolidate Medi-Cal programs for Specialty Mental Health Services and Drug Medi-Cal or Drug Medi-Cal Organized Delivery System services into a single county-based behavioral health program by FY 2027-28. The concept paper will include an overview of the initiative's framework and goals, the phased approach for implementation between now and FY 2027-28, and DHCS' proposal for ongoing stakeholder engagement and technical assistance.

DHCS will accept stakeholder feedback on the concept paper through February 13. The concept paper will be available on the CalAIM Behavioral Health webpage.

Smile, California Campaign for Medi-Cal Dental Services

In the coming weeks, Smile, California will debut a new tri-fold brochure for new and expecting parents, entitled “Healthy Smiles from Pregnancy Through the Toddler Years". The brochure will be available in English, Spanish, Vietnamese, Chinese, and Korean, and will be available to view and download on SmileCalifornia.org

Join Our Team

DHCS is hiring! We are currently searching for a mission-driven, motivated individual to serve as the Chief of the Medi-Cal Eligibility Division. This position provides leadership, direction, and coordination of Medi-Cal and Children's Health Insurance Program eligibility policy and operations. We are also hiring a Chief of the Human Resources Division.

DHCS is also 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, and high-quality health care, and is currently transforming the Medi-Cal program to make sure it provides the care Californians need to live healthier, happier lives.

Upcoming Stakeholder Meetings and Webinars

CalAIM Population Health Management (PHM) Webinar on Transitional Care Services

On January 19, from 2:30 to 4 p.m., DHCS will host a webinar to discuss Transitional Care Services (advance registration required) under the PHM Program, a cornerstone of CalAIM. Transitional Care Services support individuals undergoing a transition from one setting or level of care to another (e.g., discharge from hospital to home) to promote continuity of care and limit service disruptions. The webinar will feature a panel discussion on emerging practices for implementing Transitional Care Services for high-risk members in 2023, and an overview of the latest requirements, including the phased implementation timeline.

CalAIM Adult and Youth Screening and Transition of Care Tools for Medi-Cal Mental Health Services Webinar

On January 19, from 3 to 4 p.m., DHCS will host a webinar (advance registration required) for stakeholders to learn about the Adult and Youth Screening and Transition of Care Tools for Medi-Cal Mental Health Services initiative, which went live on January 1. As part of CalAIM, 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 managed care plans (MCPs) and county mental health plans. 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.

Statewide Home and Community-Based Services (HCBS) Gap Analysis Webinar

On January 20, from 1 to 3 p.m., DHCS, in partnership with the California Department of Aging (CDA), will host a stakeholder engagement webinar (join at scheduled time) to present the preliminary approach for the Statewide HCBS Gap Analysis. This analysis will inform the development of a multiyear roadmap to address identified gaps in the service delivery system. DHCS' gap analysis will focus on the Medi-Cal population and services and CDA's will target aging and disability populations and services outside of Medi-Cal. This will be the first of multiple stakeholder engagement efforts. To be included on the invitation list for upcoming webinars, please email HCBSGapAnalysis@dhcs.ca.gov.

Hearing Aid Coverage for Children Program (HACCP) Webinar for Providers

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

CalAIM Behavioral Health Administration Integration Concept Paper Overview Webinar

On January 26, from 3 to 4 p.m., DHCS will host a webinar to provide an overview of the concept paper for CalAIM Behavioral Health Administrative Integration (advance registration required). The webinar will include an overview of the initiative's framework and goals, the phased approach for implementation between now and FY 2027-28, and DHCS' proposal for ongoing stakeholder engagement and technical assistance. For more information, visit the CalAIM Behavioral Health Initiative webpage.

Final Stakeholder Workgroup Meeting for Doula Policy Development

On January 26, from 1 to 3 p.m., DHCS will virtually host the last public stakeholder workgroup meeting (join webinar at scheduled time) about adding doula services as a covered Medi-Cal benefit. At the final meeting, DHCS will provide a presentation on how doulas can contract with MCPs, and will discuss plans for the next doula workgroup, which will begin in March. As required by Senate Bill 65 (Chapter 449, Statutes of 2021), the Doula Implementation Workgroup will review the implementation of the benefit.

In Case You Missed It

California Announces $52 Million Investment in Opioid Prevention and Treatment Services

On January 11, Governor Newsom issued a news release announcing that DHCS awarded $52 million to providers of Medication-Assisted Treatment (MAT) services to support the prevention, assessment, diagnosis, and treatment of opioid and substance use disorders, as well as recovery. To learn more about the California MAT Expansion project, visit the California MAT website​.

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 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.

Tribal Crisis and Non-Crisis Behavioral Health Care RFA

On January 11, DHCS released a RFA to solicit applications from California Tribal entities to expand access to Tribal crisis and non-crisis behavioral health care through the infrastructure funding. This funding must be used exclusively for vehicles and allowable vehicle-related costs to improve access to behavioral health mobile crisis and non-crisis services. The project period will be from February 1, 2023, through June 30, 2025. Eligible California Tribal entities providing behavioral health services can apply for funding ranging from $50,000 to $1,000,000.  The deadline to apply is February 13.

Medicare Provider Billing Information for Dual Eligible Patients

DHCS published an updated fact sheet and toolkit 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 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 (fee-for-service) 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 as or different than the MA plan. For more information, please visit the Statewide Medi-Cal Managed Care Enrollment for Dual Eligible Members webpage.

Hearing Aid Coverage for Children Program (HACCP) Eligibility Expansion

Effective 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.

Published COVID-19 Information

Last modified date: 1/30/2023 11:45 AM