Department hloov tshiab
Rov qab mus rau Lub Kaum Hli Ntuj Stakeholder Kev Sib Txuas Lus Hloov Tshiab
Leadership Transition
Thaum lub Cuaj Hlis 10, 2021, Tus Thawj Kav Tebchaws Gavin Newsom tau tsa Michelle Baass ua tus Thawj Coj DHCS, pib lub Cuaj Hlis 15. Baass yav dhau los ua tus Thawj Coj thiab Tus Lwm Thawj Coj ntawm Lub Chaw Haujlwm Saib Xyuas Kev Pabcuam thiab Nyiaj Txiag rau California Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv thiab Tib Neeg (CHHSA) txij li xyoo 2017. Ua ntej koom nrog CHHSA, Baass tau ua haujlwm hauv Pawg Neeg Saib Xyuas Kev Cai Lij Choj rau 13 xyoo hauv ntau lub luag haujlwm. Nws pom nws lub luag haujlwm tshiab yog txoj hauv kev los daws qhov sib npaug ntawm kev saib xyuas kev noj qab haus huv thiab qhov tsis sib xws kom txhua tus neeg hauv California muaj cib fim rau kev noj qab haus huv. Baass hloov Will Lightbourne, uas tawm ntawm kev so haujlwm xyoo 2020 los ua tus thawj coj DHCS thaum muaj kev sib kis thoob ntiaj teb.
California Advancing and Innovating Medi-Cal (CalAIM)
On October 1, Medi-Cal managed care plans (MCP) submitted their Model of Care (MOC) for Enhanced Care Management (ECM) and Community Supports (formerly called “In Lieu of Services”). These submissions include initial ECM and Community Supports provider capacity and other critical information, including organizational descriptions, key policies and procedures, and provider contract boilerplates related to the transition of the Health Homes and Whole Person Care pilot programs to the ECM and Community Supports benefits. ECM and Community Supports are scheduled to go live on January 1, 2022.
ECM and Community Supports are foundational components of CalAIM. ECM will be a whole-person, interdisciplinary approach to comprehensive care management that addresses the clinical and non-clinical needs of high-cost, high-need managed care members through systematic coordination of services that is community-based, interdisciplinary, high-touch, and person-centered. Community Supports are medically appropriate and cost-effective alternatives to services covered under the State Plan. Community Supports are optional services for MCPs to provide and optional for managed care members to access. For more information about ECM and Community Supports, please visit the DHCS website.
MCP Procurement Timeline thiab Model Changes Update
DHCS is adjusting the release date of the Medi-Cal MCP Request for Proposal (RFP) to February 2, 2022. Though the RFP was scheduled to be released at the end of 2021, this change will not affect the implementation date of January 1, 2024. Additional time is needed to address stakeholder comments received during the comment period for the draft RFP. DHCS is also timing the release of the final RFP so that it does not coincide with the winter holiday period. County Managed Care Transition to Local Plan: Letter of Intent Instructions, and notified them of their conditional approval to advance to the next stage of the assessment process. DHCS has authority to determine which, and how many, MCPs the state contracts with for Medi-Cal services in all counties. DHCS’ evaluation includes assessment of historical quality of care performance and the financial health and viability of the plan.
The conditionally approved counties must now submit an approved county ordinance to DHCS by October 10. By December 3, MCPs are required to submit to DHCS a network contracting strategy for review. A final list of counties approved to move forward with a Plan Model change, will be posted at Plan Model County Changes in early November. Final approval to implement on January 1, 2024, will be based upon MCP operational readiness and Centers for Medicare & Medicaid Services (CMS) approval.
DHCS’ determination will be guided by the best interests of Medi-Cal beneficiaries and DHCS’ goals for the Medi-Cal managed care delivery system under CalAIM: drive quality of care improvements, streamline and reduce complexity, and build upon whole-person care approaches. Additional information is available on the DHCS website.
Medi-Cal Qhov Kev Pab Cuam Tiv Thaiv Kab Mob Khaus Viv-19
DHCS is allocating up to $350 million to incentivize COVID-19 vaccination efforts in the Medi-Cal managed care delivery system from September 1, 2021, through February 28, 2022. Medi-Cal MCPs are eligible to earn incentive payments for activities that are designed to close vaccination gaps with their enrolled members, and to address vaccine uptake disparities for specific age and race/ethnicity groups. MCPs collectively may earn up to $50 million for achieving specified process measures and $200 million for outcome measures, with $100 million available for all MCPs to use for direct member incentives. DHCS will issue payment allocations upon approval of the MCP’s Vaccination Response Plan, and will assess program achievements in October 2021, January 2022, and March 2022. All 25 full-service MCPs, one population-specific health plan, and one Cal MediConnect plan submitted a Vaccination Response Plan and were approved for participation in the program. For more information, please visit the DHCS website.