​​DHCS Stakeholder News - June 23​, 2023​

Top News

Reproductive Rights

Tomorrow marks one year since the U.S. Supreme Court overturned Roe v. Wade, ending the constitutional right to abortion services. Reproductive freedom is still a right in California, and DHCS is playing its part in ensuring access to sexual and reproductive health services under its Medi-Cal and Family Planning, Access, Care, and Treatment (Family PACT) programs.

According to a new issue brief, Implementing State-Level Policy and Operational Processes that Enhance Access to Medicaid Family Planning Program Services, California is ranked among the top states in the country in both Medicaid family planning program utilization and enrollment. The issue brief highlights DHCS' Family PACT program, which has operated since 1997 and provides comprehensive family planning services and reproductive health services to low-income Californians. Below are examples of how DHCS is protecting the right to choose:

• DHCS informed Medi-Cal providers about continued reimbursement for medication abortion using a Misoprostol-only treatment regimen. 
  

• DHCS is implementing an Equity and Infrastructure Payments for Clinic Abortion Providers program, using only state funds, for non-hospital community clinics that incur significant costs associated with providing abortion services to Medi-Cal members. The 2022-23 Budget Act included one-time funding of $15 million in state fiscal year (SFY) 2022-23 and $15 million in SFY 2023-24 for this program.
  

• Effective October 1, 2022, the Medi-Cal program began providing Federally Qualified Health Centers (FQHC), Rural Health Clinics, Indian Health Services Memorandum of Agreement, and Tribal FQHC providers with a new option to be reimbursed at the applicable fee-for-service rate for covered abortion services under Medi-Cal.
  

• DHCS is providing a one-time appropriation of $20 million (Assembly 179, Chapter 249, Statutes of 2022), to Essential Access Health, as the program administrator designated by Los Angeles County to establish the Los Angeles County Abortion Access Safe Haven Pilot Program for the purpose of expanding and improving access to the full spectrum of sexual and reproductive health care, including abortion, in Los Angeles County.​
  

Additionally, on June 8, 2023, California submitted a new demonstration project under Section 1115 of the Social Security Act, entitled California's Reproductive Health Access Demonstration (CalRHAD), to the Centers for Medicare & Medicaid Services. The purpose of this application is to seek federal approval of a new three-year demonstration agreement to bolster California's sexual and reproductive health delivery system, with the goal of ensuring equitable access to a broad range of sexual and reproductive health services.

Through the CalRHAD demonstration, California seeks authority to provide grants to reproductive health providers to enhance capacity and access to sexual and reproductive health services, while also promoting the sustainability of California's reproductive health provider safety net for the benefit of individuals enrolled in Medi-Cal and other individuals who currently face barriers to access. California's submission builds upon the state's existing investments in reproductive health services. CalRHAD aligns with the state's efforts to promote equitable access to comprehensive sexual and reproductive health care.​

The Centers for Medicare & Medicaid Services has completed its preliminary review and found the state's demonstration application complete in accordance with 42 Code of Federal Regulations 431.412(a). California's application is posted on Medicaid.gov for a 30-day federal public comment period (June 16 through July 16).

Federal Flexibilities Approved for State Fair Hearings

On June 23, 2023, the Centers for Medicare & Medicaid Services (CMS) approved DHCS' two requests for federal waiver authority under the Social Security Act to help address the volume of State Fair Hearings once the continuous coverage requirement ends. The two waiver requests extend the timeframe for Medi-Cal members to request a fair hearing from the original 90 days to 120 days, and extend the timeframe to take final administrative action on fair hearings from 90 to 120 days. Both waivers are effective retroactive to April 1, 2023. The waiver on the extended timeframe for Medi-Cal members to request a fair hearing remains effective through September 30, 2024, and the waiver for the extended timeframe for final administrative action on fair hearings will remain effective through February 28, 2025. DHCS will issue a Medi-Cal Eligibility Division Information Letter no later than June 26 with updated guidance for counties.

Managed Care Plan (MCP) Transition Policy Guide

On June 23, DHCS released the 2024 MCP Transition Policy Guide that includes DHCS policy and MCP requirements related to member transitions of Medi-Cal MCPs that take effect on January 1, 2024. The initial release of the policy guide addresses:

• Protections for American Indian/Alaska Native members.
• Member noticing requirements and member enrollment policies applicable to transitioning and new members.
• Continuity of care requirements for members transitioning due to MCP contracting changes effective on January 1, 2024.

MCPs will use the policy guide to develop their own policies and procedures required to implement  Medi-Cal member transitions. While MCPs are the primary audience for the policy guide, DHCS envisions that a wide range of stakeholders will find it useful in supporting smooth member transitions. A companion All Plan Letter (APL) will also be issued to establish the binding nature of the policy guide as the DHCS authority specific to the 2024 MCP transition. The policy guide will be available online and will be updated throughout the remainder of this calendar year to keep MCPs informed of new and developing guidance.

Program Updates

Coming Soon: Home and Community-Based Services (HCBS) Waiver Telehealth Amendments

On June 26, DHCS will post on its website Medi-Cal HCBS waiver telehealth amendments for a 30-day public comment period. All comments must be received by July 26. DHCS requested and received federal approval to implement temporary operational flexibilities under different emergency authorities due to the COVID-19 public health emergency (PHE). For the state's six HCBS waivers, flexibilities were authorized through temporary amendments that included the option for states to extend emergency flexibilities for up to six months after the end of the PHE (November 11). One of the flexibilities approved during the PHE was the ability to provide waiver services via telehealth. To align with DHCS policy and to expand access to select waiver services, when appropriate, DHCS is submitting waiver amendments for four of the state's HCBS waivers to make telehealth a permanent option.

California CMS Unwinding Monthly Report for May 2023

On June 23, DHCS published California's submission of the federal “Unwinding Monthly Report" for the eligibility month of May 2023 to the Centers for Medicare & Medicaid Services (CMS) as part of the continuous coverage unwinding federal requirements. The report includes California's updated estimate of total pending applications received between March 1, 2020, and March 31, 2023, that are still in a pending status as of May 31; total May 2023 annual renewals and renewal outcomes; and total Medi-Cal fair hearings pending more than 90 days as of May 31. The report also includes a description of California's renewal timeline and policy during the unwinding period. This report is posted to the DHCS Medi-Cal Enrollment webpage under “DHCS Continuous Coverage Unwinding Data".

Additional Continuous Coverage Unwinding Federal Flexibilities

On June 16, DHCS submitted additional Section 1902(e)(14)(A) federal flexibilities to CMS for approval. As California continues through the continuous coverage unwinding period, DHCS anticipates ongoing operational challenges in resuming eligibility and enrollment actions due to the unprecedented caseload of redeterminations that California must complete. The additional federal flexibilities include: 1) ex parte renewals for individuals with income at or below 100 percent of the federal poverty level; 2) suspending the requirement to apply for other benefits as a condition of eligibility; 3) suspending the requirement to obtain medical support enforcement; 4) reinstating eligibility back to the date of disenrollment for individuals redetermined eligible during the Medi-Cal 90-day cure period; and 5) completing a renewal based on available information for hard-to-reach populations. The additional flexibilities will support administrative efficiencies for local county offices and Medi-Cal members as the redetermination process continues.

Draft Member Contact and Demographic Information (MCDI) Initiative Strategy Document Released for Public Comment

On June 22, DHCS released the draft MCDI initiative strategy document for public comment. Medi-Cal member contact and demographic information are critical components of Medi-Cal's efforts to enroll members, achieve health equity, and advance population health. Currently, stakeholders face significant obstacles in their efforts to submit, collect, and use MCDI. The draft MCDI strategy provides a vision, goals, and measures of success to improve the collection, accessibility, quality, and use of MCDI, and informs the future development of more detailed policy and operational plans. ​

DHCS will accept public comments through 5 p.m. PDT on July 6 to PHMSection@dhcs.ca.gov, with the subject line, “Comments on Draft MCDI Strategy Document". In your feedback, we encourage you to identify the specific sections and page numbers for which you are providing comments.

Medi-Cal Rx

On June 23, Medi-Cal Rx Reinstatement Phase III, Lift 4 was implemented, lifting the Transition Policy for 46 Standard Therapeutic Classes (STCs). This is the fourth in a series of lifts to retire the Transition Policy by reinstating National Council for Prescription Drug Programs (NCPDP) Reject Code 75 – Prior Authorization Required. The Drug Lookup Tool Realignment is now available on the Medi-Cal Rx web portal. Drugs can be searched by drug name (brand or generic) or the entire 11-digit National Drug Code (NDC). Drug Lookup results are for drugs that are a benefit of Medi-Cal Rx.

On June 22, the Medi-Cal Rx 90-day notice of reinstatement for adult “new start" enteral nutrition products will be posted. Beginning on September 22, 2023, any new prescriptions (no prior use in the past 15 months) for an adult member (age 22 and older) for enteral nutrition products will require prior authorization (PA). Auto PA logic will be in place to automate these requests. Stakeholder communications will begin this week and continue through go-live. This will not impact adult members who are currently using enteral nutrition products. Pediatric members (age 21 and younger) will also not be impacted.

Smile, California Campaign for Medi-Cal Dental Services

During the week of June 26, a Smile, California, Smile Alert will be sent to partners, providers, and stakeholders subscribed to receive the monthly e-newsletter. The alert will feature June as Men's Health Month and the “Don't Wait Until It Hurts to See the Dentist" video to remind individuals to prevent the habit of only seeing the dentist when there is pain or an emergency. The alert will also debut a new Smile, California Men's Health Month Carousel image that is available in English and Spanish. Sign up for Smile Alerts and to stay informed about the Smile, California campaign new resources and updates.

Join Our Team

DHCS is hiring. DHCS has an immediate opening for Chief, Financial Review-Outpatient and Behavioral Health Division within the Audits & Investigation program; the filing deadline is July 6. This executive role oversees policy development and interpretation for financial reviews, audits, and appeals of outpatient and behavioral health Medi-Cal services and reimbursement claims. Specifically, the Chief is responsible for planning, organizing, and directing program operations, oversight, and policy formulation for the financial reviews and audits of Medi-Cal and other DHCS programs' outpatient and behavioral health providers and counties.

DHCS is also hiring for our communications, 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 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

California Children's Services (CCS) Monitoring and Oversight Workgroup Meeting

On June 26, from 3 to 5 p.m., DHCS will virtually host the CCS Monitoring and Oversight Workgroup meeting to develop and implement the CCS Compliance, Monitoring, and Oversight Program, a component of the California Advancing and Innovating Medi-Cal (CalAIM) initiative. CalAIM statute requires DHCS to consult with counties and other affected stakeholders to develop and implement this initiative to enhance oversight and monitoring of county administration of the CCS program.

Background materials, meeting details, and past meeting archives, along with more information about the workgroup, are posted on the CCS Compliance, Monitoring, and Oversight Program webpage. For questions or comments, please email DHCS at CCSMonitoring@dhcs.ca.gov.​

Behavioral Health Task Force (BHTF)

On June 27, from 2 to 4 p.m., the California Health & Human Services Agency's (CalHHS) BHTF will virtually host a workshop dedicated to BHTF member discussion (advance registration required). The workshop is open to the public. Also, on June 29, from 4 to 6 p.m., the BHTF will host a workshop dedicated to members of the public (advance registration required).

The diverse BHTF membership informs CalHHS' work on behavioral health issues across the state and is positioned well to elucidate connections among wide-ranging perspectives and interests related to behavioral health needs and care, ground the framing of behavioral health issues in the state, and advance innovative and coordinated work to drive progress. For questions, inquiries, or to join the BHTF listserv, email BehavioralHealthTaskForce@chhs.ca.gov.​

In Case You Missed It

Behavioral Health Continuum Infrastructure Program (BHCIP) Round 5 Grants

On June 23, DHCS issued a news release announcing awards of $430 million for projects that will increase mental health and substance use disorder treatment infrastructure in 21 counties. The awards were made under the BHCIP Round 5: Crisis and Behavioral Health Continuum grants. BHCIP is part of a broader Administration commitment to improve the state's behavioral health and long-term care continuum infrastructure. The focus of this round of BHCIP funding was determined in part by the statewide needs assessment that found significant gaps in the availability of crisis services and supported an organized continuum of crisis services to reduce emergency department visits, hospitalizations, and incarceration. The list of BHCIP Round 5: Crisis and Behavioral Health Continuum awardees is posted on the BHCIP Data Dashboard.

Behavioral Health Bridge Housing (BHBH) Program Awards

On June 23, DHCS began awarding nearly $907 million of the $1.5 billion in funding for the BHBH Program to California county behavioral health agencies. The primary focus of the BHBH Program is to help people experiencing unsheltered homelessness who also have serious behavioral health conditions, including mental health and substance use disorders, that prevent them from accessing help and moving out of homelessness. The BHBH Program helps address housing instability and homelessness by providing support through various “bridge" housing settings, including tiny homes, interim housing, rental assistance models, and assisted living settings.

Transformation of California's Mental Health Services Act

On June 20, Governor Newsom and legislative leaders proposed a $4.69 billion bond and modernization of the Mental Health Services Act for the March 2024 ballot, which together will provide California the resources needed to build 10,000 new beds across community treatment campuses and facilities to help Californians with serious mental illness and substance use disorders get the housing and care they need. Additional information can be found on the DHCS website.​