DHCS Stakeholder News - June 30, 2023
Top News
DHCS Budget Act Update — Fiscal Year 2023-24
DHCS' 2023-24 budget 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. There are no reductions to Medi-Cal funding, and more than 15 million members will continue to have access to equitable, coordinated, and person-centered care to maximize their health and life trajectory. The budget highlights include:
- Investments in Medi-Cal due to a new Managed Care Organization (MCO) tax, which represents a commitment by the Newsom Administration to dedicate billions of additional dollars over multiple years to Medi-Cal that will improve access, quality, and equity for Medi-Cal members. The principles of the tax and budget investments are to: (1) drive greater Medi-Cal provider participation, especially in underserved areas and in primary and preventive care, by providing long-term certainty for provider rate increases; (2) preserve eligibility and benefit expansions in the Medi-Cal program; (3) create conditions to alleviate the disparities and inequities within Medi-Cal; and (4) maximize opportunities to draw additional federal matching funds to Medi-Cal.
In January 2024, DHCS will increase rates to at least 87.5 percent of Medicare for primary care services (inclusive of nurse practitioners and physician assistants), obstetric care services (inclusive of OB/GYN and doula services), and non-specialty mental health services. The MCO tax will begin providing $75 million annually to support graduate medical education. Additionally, it will provide one-time funds ($150 million) for the distressed hospital loan program and small and rural hospital relief ($50 million) for seismic assessment and construction. Beginning in 2025, the MCO tax will invest $2.7 billion annually in Medi-Cal to improve access and equity.
For the Governor's 2024-2025 budget, in addition to the primary care, obstetric care, and non-specialty mental health services mentioned above, DHCS will submit detailed proposals for rate increases and investments in services and supports in primary care, obstetric care, and non-specialty mental health services, specialty care services, community or hospital outpatient procedures and services, family planning services and women's health providers, hospital-based emergency and emergency physician services, ground emergency transport services, designated public hospitals, behavioral health care for members in hospital/emergency departments and institutional long-term care settings, and investments to maintain and grow the health care workforce.
- Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) Demonstration, which expands behavioral health services for Medi-Cal members living with serious mental illness and serious emotional disturbance. DHCS will submit the BH-CONNECT Demonstration proposal for federal approval this summer, with implementation beginning no sooner than January 1, 2024. A critical part of CalAIM, BH-CONNECT includes both statewide and county opt-in components to strengthen the continuum of mental health services, with a focus on children and youth, individuals experiencing or at risk of homelessness, and justice-involved individuals. BH-CONNECT also includes a new workforce initiative, and new investments totaling $2.4 billion over five years will be directed toward strengthening the pipeline of behavioral health professionals needed to staff existing and new behavioral health treatment settings as well as toward improving short-term recruitment and retention efforts in the robust, diverse behavioral health workforce.
DHCS will post 2023-24 Budget Act highlights on its website in the coming weeks.
Program Updates
Statewide Transition Plan (STP) Approval
On June 30, DHCS received final approval from the Centers for Medicare & Medicaid Services (CMS) on the STP to bring settings into compliance with federal Home and Community-Based Services (HCBS) Settings Final Rule regulations. Final approval was granted after DHCS, in partnership with the Department of Developmental Services and the California Department of Aging, worked diligently to make a series of technical changes requested by CMS to achieve final approval. DHCS will work collaboratively with CMS to identify any areas that may need strengthening with respect to the state's remediation and heightened scrutiny processes as the state implements each of the key elements of the STP.
For more information, please visit the HCBS STP webpage. Please email questions or comments to STP@dhcs.ca.gov .
Hospital Presumptive Eligibility (HPE) and Presumptive Eligibility for Pregnant Women (PE4PW): Signature Flexibilities
On June 26, DHCS published a provider newsflash with additional guidance on the HPE and PE4PW programs making signature flexibilities established during the COVID-19 public health emergency a permanent policy for Medi-Cal providers. While these programs still require in-person evaluation, providers may accept telephonic signatures, verbal consent signatures, and electronic signatures in addition to the traditional wet signature option.
Join Our Team
DHCS is hiring for 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 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
Consumer-Focused Stakeholder Workgroup (CFSW) Meeting
On July 7, from 10 to 11:30 a.m. PDT, DHCS will host the monthly CFSW meeting. The purpose of the CFSW is to provide stakeholders an opportunity to review and provide feedback on a variety of consumer messaging materials. The forum focuses on eligibility- and enrollment-related activities and strives to offer an open discussion on Medi-Cal policies and functionality. Conference line information is posted on the CFSW webpage, and meeting materials will be posted by July 5.
2024 Managed Care Plan Transition Policy Guide Webinar
On July 10 at 1 p.m. PDT, DHCS will host a webinar (advance registration required) introducing the 2024 Medi-Cal Managed Care Plan Transition Policy Guide, which includes DHCS policy and Medi-Cal managed care plan (MCP) requirements related to member transitions taking effect on January 1, 2024.
The guide addresses protections for American Indian/Alaska Native members, member noticing requirements and member enrollment policies applicable to transitioning and new members, and continuity of care requirements for members transitioning due to MCP contracting changes. It also addresses MCP requirements to ensure Medi-Cal members determined eligible to receive Enhanced Care Management (ECM) and Community Supports do not experience disruptions to their authorizations, provider relationships, or services due to the MCP transition.
Companion All Plan Letter 23-018 establishes the binding nature of the guide as the DHCS authority specific to the 2024 MCP transition. The guide will be updated throughout calendar year 2023 to keep MCPs informed of new and developing guidance.
CalAIM Population Health Management (PHM) Advisory Group July Meeting
On July 12, from 11:30 a.m. to 1 p.m. PDT, DHCS will host the PHM Advisory Group meeting (advance registration required) that will include a briefing on the policy refinements DHCS has prioritized for ECM and Community Supports in 2023 and beyond. This meeting will cover several topics, including eligibility, referrals and authorizations, provider networks, payment, market awareness, and data exchange.
DHCS established the PHM Advisory Group to provide input to support the design and implementation of the PHM Program and Service. Advisory Group members include representatives from health plans, providers, counties, state departments, consumer organizations, and other groups, and will participate in meetings to provide real-time feedback and recommendations. The meetings are open to the public. Meeting information and materials are posted on the CalAIM PHM Initiative webpage.
Hearing Aid Coverage for Children Program (HACCP) Webinar for Medical Providers and Hearing Professionals
On September 14, from 12 to 1 p.m. PDT, DHCS will host a 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.
In Case You Missed It
Statewide High-Heat Advisory
The Office of Emergency Services (Cal OES), in coordination with the National Weather Service, has issued an Extreme Heat Advisory for the state. Below is a summary of the situation:
- Moderate heat risk impacts could become more widespread across much of interior California by June 29, with minor heat risk impacts reaching the central coast and Bay Area by June 30 through July 2.
- Major heat risk impacts are possible across the Central Valley over the weekend. Daytime high temperatures will reach the triple digits, while early morning low temperatures will remain in the 60s to lower 70s.
- Sustained triple digit temperatures may cause strain to the state's power grid and may impact the operations of facilities.
- Increased runoff from snowpack melt in the Sierras may cause downriver flooding in low elevation areas, which may impact transportation.
On June 28, DHCS' Office of Tribal Affairs (OTA) issued the advisory to tribal chairpersons and tribal health clinic executive directors. The email notification included website links to public health resources from the National Weather Service, California Department of Public Health, and Cal OES, as well as cooling center information. Additionally, OTA informed groups that if they are impacted by the extreme heat event or need resources, they may contact the Tribal Emergency Preparedness and Response Program Coordinator for assistance.
