​​​​​DHCS Stakeholder News - December 23, 2022​

DHCS is providing this update of significant developments regarding DHCS programs.

Top News

Enhanced Care Management (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 drivers 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.

As California continues to strengthen its capacity to deliver ECM and Community Supports services, more members will benefit from the state's efforts to transform Medi-Cal, expand how and where members receive care, and build an equitable health care system for all. DHCS is committed to transparency and will continue to release implementation data to showcase the growing impact of ECM and Community Supports on the Medi-Cal delivery system and members statewide.

New Medicare Provider Fact Sheet for Medi-Cal Managed Care Enrollment

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 (fee-for-service (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.

Public Charge All County Welfare Directors Letter Published 

On December 22, DHCS released All County Welfare Directors Letter (ACWDL) 22-34 to inform counties of the final rule, entitled “Public Charge Ground of Inadmissibility" (2022 Final Rule), published by the U.S. Department of Homeland Security on September 9, 2022. Effective December 23, the 2022 Final Rule restores previous policies, including the exclusion of Medicaid when determining the use of public benefits, with the exception of long-term institutionalized care, and will apply to applications for visas, admission, and adjustment of status postmarked on or after the effective date. The ACWDL reminds counties that the 2022 Final Rule does not change whether individuals can apply for and receive public benefits. The public charge status of a Medi-Cal applicant or member has no impact on their eligibility for Medi-Cal benefits.

In September, an updated Public Charge Guide was posted (in 21 languages) on the California Health & Human Services Agency website to serve as a resource for individuals and families with questions about the current federal public charge policy. One can also visit the U.S. Citizenship & Immigration Services website for updated information and resources. For general questions about the final rule and public charge, a list of nonprofit organizations qualified to assist individuals is available on the California Department of Social Services website.

Program Updates

Medi-Cal Rx

The following notifications for Medi-Cal Rx reinstatement were released on December 20:

• 30-day notice for Phase 2, Wave 1
• Updated Medi-Cal approved National Drug Code list identifying those drugs impacted by the Phase 2, Wave 1 prior authorization reinstatement
• Phase 2 Frequently Asked Questions (FAQ)
• 90-day notification for Phase 3.

More information about the reinstatement plan is available on the Medi-Cal Rx reinstatement webpage.

Hearing Aid Coverage for Children Program (HACCP) Eligibility Expansion

Beginning January 1, DHCS welcomes newly eligible young adults ages 18 through 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.

Provider Manual for Doula Services Published

DHCS published the new provider manual for doula services on December 16 in advance of the benefit going live on January 1, 2023. The manual describes the policy for both FFS and managed care delivery systems that was developed in collaboration with stakeholders after more than one year of working together. State Plan Amendment 22-0002 for doula services is currently pending review with the Centers for Medicare & Medicaid Services. This benefit will help DHCS reach vulnerable populations to prevent perinatal complications and improve birth outcomes. Doula services encompass health education, advocacy, and physical, emotional, and nonmedical support provided throughout the perinatal period. For more information, please visit the Doula Services as a Medi-Cal Benefit webpage.

Coming Soon: Medi-Cal Telehealth Updates

In early January 2023, DHCS will refresh the telehealth webpage to include: an updated Telehealth Policy Paper reflecting final telehealth policies as adopted through the 2022-23 budget and related statutory changes; a Telehealth Research and Evaluation Plan; an updated FAQ page; updates to the Medi-Cal Telehealth Provider Manual; and a new page on patient consent, including model language for providers.

Current telehealth flexibilities adopted under the federal COVID-19 public health emergency (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 Telehealth Provider Manual and additional PHE guidance to direct their delivery of services. After the PHE ends, providers should consult strictly only the Medi-Cal Telehealth Provider Manual. For questions, email Medi-Cal_Telehealth@dhcs.ca.gov.

Clinic Workforce Stabilization Retention Payments (CWSRP) Applications

On December 29, DHCS will begin accepting applications for CWSRP. All qualified clinics that successfully registered by the registration deadline, December 28, will receive a link to the application and can begin submitting the required information on behalf of eligible employees.

All applications for payment must be submitted no later than 5 p.m. on January 27, 2023. DHCS encourages early submissions so all applications can be validated before the due date. DHCS anticipates issuing payments to qualified clinics in February 2023. Clinics receiving funding must issue payments to qualified employees within 60 days of receipt of funds.

An application tutorial video, application guidance, and an Excel template for submitting employee information will be posted on the CWSRP webpage by December 29.

CalHOPE Courage Award Winners

On January 4, 2023, DHCS will recognize the December CalHOPE Courage Award winners at the Sacramento Kings NBA game at the Golden 1 Center. The monthly award honors student-athletes at California colleges and universities for overcoming the stress, anxiety, and mental trauma associated with personal hardships and adversity.

Join Our Team

DHCS is hiring! We are searching for a mission-driven, motivated leader to serve as Chief of the Human Resources Division. We are also hiring a Policy Advisor for Homelessness and Housing within the Health Care Delivery Systems program. The Policy Advisor leads and coordinates the planning, development, and implementation of new homelessness and housing-related Medi-Cal policies across DHCS programs.

Additionally, 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 eligible Californians with equitable access to affordable, integrated, high-quality, health care, and is currently transforming the Medi-Cal program to make sure it provides the equity-focused and person-centered care Californians need to live healthier, happier lives.

In Case You Missed It

DHCS to Invest Millions to Tackle Youth Opioid Use

On December 20, DHCS issued a news release announcing the availability of nearly $3.4 million in grants available to help improve patient care in the areas of substance use disorder, opioid use disorder, and addiction. Organizations can apply for grants of up to $70,000. 

Application Period Closing Soon for Hospital and Skilled Nursing Facility (SNF) COVID-19 Worker Retention Payments (WRP)

The application period for the Hospital and SNF COVID-19 WRP closes at 5 p.m. on December 30. DHCS is encouraging successfully registered Covered Entities (CEs), Covered Services Employers (CSEs), Physician Group Entities (PGEs), and Independent Physicians to submit applications prior to the deadline so all applications can be validated timely.

If you are a CE, CSE, PGE, or an Independent Physician and you have not yet registered, today, December 23, is the last day to register.

For registration and application guidance, an application video tutorial, and all other supporting information, please visit the WRP webpage.​