April 8, 2024 – Stakeholder Update
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DHCS Launches Health Equity Roadmap Initiative
DHCS publicly launched the Health Equity Roadmap initiative, an ongoing effort to inform and advance DHCS’ work to eliminate health disparities and advance health equity for Medi-Cal members. The Health Equity Roadmap initiative represents a phased process co-designed with Medi-Cal members to create a more equitable Medi-Cal system that puts member needs first. The first step in this process was a statewide listening tour, during which DHCS leaders and community partners listened to Medi-Cal members’ experiences with Medi-Cal. The information gathered from these sessions will inform the development of the DHCS Health Equity Roadmap that will guide the development and implementation of future DHCS programs to advance health equity.
After the listening sessions, DHCS will begin to identify common themes heard from members throughout the state. DHCS will work closely with Medi-Cal members, experts, advocates, providers, and stakeholders to ensure all relevant voices and experiences are included in the conversation. The Health Equity Roadmap, developed during the co-design phase, will incorporate the ideas and suggestions members shared with us to transform Medi-Cal into a more equitable health care delivery system.
For inquiries related to the Health Equity Roadmap initiative, or for ideas on how DHCS can make Medi-Cal more equitable, please email HealthEquityRoadmap@dhcs.ca.gov.
Telehealth: Sib tham sib siv Dashboard thiab Tshaj Qhia
As part of an overall initiative aimed at monitoring telehealth utilization within Medi-Cal, DHCS released the first phase of its public-facing interactive Medi-Cal Telehealth Utilization Dashboard and companion Biennial Telehealth Utilization Report. Both the dashboard and report will help DHCS take a data-driven approach to evaluating telehealth policy. DHCS’ objective is to consistently provide a range of telehealth metrics and articulate telehealth data in a public-facing format that is easy to access and understand.
DHCS anticipates publishing the dashboard and report in two phases. Phase one includes eight measure sets of medical services data related to telehealth utilization. Phase two will expand the dashboard to include data sets related to mental health, the Drug Medi-Cal Organized Delivery System, and dental care. The dashboard is anticipated to be completed with all data sets in summer 2024 and will be updated annually thereafter.
To complement the dashboard, DHCS created the report, which provides an executive summary of Medi-Cal telehealth utilization, trends, and key takeaways. The report includes telehealth utilization data from 2019 to 2022. For more information, please visit the Medi-Cal & Telehealth webpage. Please email your questions to Medi-Cal_telehealth@dhcs.ca.gov.
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Child Health and Disability Prevention (CHDP) Program Transition
Senate Bill 184 (Chapter 47, Statutes of 2022) tau tso cai DHCS los txiav tawm CHDP qhov kev pab cuam thiab kev hloov pauv mus rau lwm lub Medi-Cal kev xa khoom los ntawm Lub Xya Hli 1, 2024. Qhov kev hloov pauv no ua kom yooj yim dua thiab ua kom yooj yim rau kev xa cov kev pabcuam rau cov menyuam yaus thiab cov tub ntxhais hluas hnub nyoog qis dua 21 xyoos, ua raws li cov hom phiaj ntawm California Advancing and Innovating Medi-Cal (CalAIM) teg num. CalAIM txhim kho tus qauv kev saib xyuas thoob plaws Medi-Cal los ntawm kev sib sau cov dej num saib xyuas rau cov menyuam yaus thiab cov hluas nyob rau hauv Medi-Cal cov phiaj xwm tswj hwm kev saib xyuas (MCP).
CHDP Transition Plan tau tsim los ntawm kev koom tes nrog CHDP Program Transition Workgroup thiab nrog kev tawm tswv yim los ntawm CHDP cov neeg koom nrog thoob plaws lub xeev. Txoj kev hloov pauv khaws cia qhov kev tsim nyog tau txais kev tso npe tam sim no muaj los ntawm CHDP Gateway, cov haujlwm hauv qab CHDP Childhood Lead Poisoning Prevention Program, thiab Txoj Haujlwm Saib Xyuas Kev Noj Qab Haus Huv rau Cov Menyuam hauv Kev Pabcuam. Raws li Txoj Cai Kev Noj Qab Haus Huv thiab Kev Nyab Xeeb Ntu 124024, DHCS tau tshaj tawm hauv nws lub vev xaib ib tsab ntawv tshaj tawm uas tau lees paub tias txhua yam haujlwm uas xav tau rau kev hloov pauv tau ua tiav los ntawm Lub Peb Hlis 27, 2024.
Medi-Cal Rx
On March 29, a 30-day countdown bulletin was posted for the Code 1 Diagnosis Requirement – Reject Code 80 claim utilization management (UM) edits implementation for members 22 years of age and older. Effective April 30, 2024, Medi-Cal Rx will utilize diagnosis code(s) from the member’s Medi-Cal medical record to meet the Code I diagnosis restriction. If an acceptable diagnosis code is not found in the medical record or included at time of claim adjudication, claims submitted to Medi-Cal Rx will deny with Reject Code 80. Prescription documentation requirements apply to Code I diagnosis restricted drugs. Prescribers and pharmacy providers must document the treatment diagnosis and keep that information readily available for auditing purposes.
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DHCS is hiring for communications, human resources, auditing, health policy, information technology, and other teams. For more information, please visit the CalCareers website.
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CalAIM Muab Kev Nkag Mus thiab Hloov Kho Kev Noj Qab Haus Huv (PATH) Technical Assistance (TA) Marketplace
On April 9 and 25, from 9 to 10:30 a.m., DHCS will host virtual CalAIM PATH TA Marketplace Vendor Fairs, where vendors pitch their organization and services to potential TA Recipients and encourage utilization of the TA Marketplace. Approved TA Recipients and organizations currently contracted with or planning to contract with a Medi-Cal MCP or other eligible entity to provide Enhanced Care Management (ECM)/Community Supports are encouraged to attend. The PATH TA Marketplace is a one-stop-shop website where entities can access free TA services from curated and approved vendors. Vendor services help eligible ECM/Community Supports providers build their data capacity, strengthen cross-sector partnerships, train existing and new staff, implement linguistically responsive services, and more.
The April 9 Vendor Fair features vendors providing services in Domain 2: Community Supports and Domain 7: Workforce. Domain 2 includes TA vendors with expertise in designing, implementing, and improving one or more Medi-Cal Community Supports services. Domain 7 includes TA vendors with expertise in recruiting and retaining a well-prepared, high-performing workforce, with a particular focus on members of the frontline, clinical, and/or “lived experience” workforces.
The April 25 Vendor Fair features vendors providing services in Domain 5: Promoting Health Equity and Domain 6: Supporting Cross-Sector Partnerships. Domain 5 includes TA vendors with expertise to help TA recipients advance health equity through their implementation of ECM/Community Supports and in their work with Medi-Cal members. Domain 6 includes TA vendors with the expertise to help TA recipients successfully engage in cross-sector partnerships, including partnerships between Medi-Cal MCPs and counties.
Additionally, on April 1, DHCS opened the CalAIM PATH TA Marketplace Round 4 vendor application. Organizations interested in applying to qualify as a TA vendor can apply on the PATH TA Marketplace webpage. Applications must be submitted by 5 p.m. PDT on April 30. Approved vendors will receive PATH-funded reimbursements for TA services they provide in the TA Marketplace. For more information, please review the guidance document.
California Children’s Services (CCS) Advisory Group Meeting
Lub Plaub Hlis 10, txij li 1 txog 4 teev tsaus ntuj, DHCS yuav tuav lub rooj sib tham CCS Pawg Pabcuam Peb Hlis. Pawg CCS Advisory Group thiab DHCS ua haujlwm hauv kev sib koom tes los xyuas kom cov menyuam yaus hauv CCS thiab Whole Child Model (WCM) kev pabcuam tau txais kev saib xyuas tsim nyog thiab sijhawm sijhawm. Cov txheej txheem txheej txheem suav nrog kev hloov kho tshiab ntawm WCM tom qab kev saib xyuas kev hloov pauv thiab nthuav dav, CCS Kev Ua Raws Cai, Kev Saib Xyuas, thiab Kev Saib Xyuas Kev Ua Haujlwm, Kev Tiv Thaiv Kev Noj Qab Haus Huv Me Me thiab Kev Tiv Thaiv Kev Xiam Oob Qhab, thiab CCS Redesign Performance Measure Quality Subcommittee. Cov ntaub ntawv ntxiv muaj nyob rau ntawm CCS Advisory Group lub vev xaib. Thov xa email rau koj cov lus nug rau CCSProgram@dhcs.ca.gov.
Doula Stakeholder Implementation Workgroup Meeting
On April 12, from 10 a.m. to 12 p.m., DHCS will host the next Doula Stakeholder Implementation Workgroup Meeting to examine implementation of the Medi-Cal doula benefit, in accordance with Senate Bill 65 and Welfare and Institutions Code section 14132.24. The meeting will be held via Zoom, with an in-person option at 1501 Capitol Avenue, Sacramento, CA 95814, Room 71.4003. The link to attend the meeting virtually along with an agenda are available on the Doula Services as a Medi-Cal Benefit webpage. Please email your questions to DoulaBenefit@dhcs.ca.gov.
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DHCS Tshaj Tawm Daim Ntawv Qhia Txog Kev Ua Haujlwm Peb Hlis ntawm ECM thiab Kev Txhawb Zej Zog
On April 4, DHCS released the latest ECM and Community Supports Quarterly Implementation Report that includes data from January 2022 through September 2023. This data release adds third quarter 2023 utilization data at the state, county, and Medi-Cal MCP levels and demographics, including ethnicity, primary language spoken, age, and sex.
The data report demonstrates the uptick in both the availability and use of Community Supports, showing significant growth in the number of counties offering these services. As of January 2024, 23 counties across California offered all 14 Community Supports, and all counties offered at least seven Community Supports. This marks a significant increase from the end of 2022, when only three counties offered all 14 Community Supports. Overall, approximately 103,000 unique Medi-Cal members used Community Supports in the first 21 months of the program, with more than 186,000 total services delivered. Additionally, the number of members served by ECM each quarter is up; in Q3 2023, approximately 86,000 members received ECM, up 28 percent from Q4 2022. The Q3 2023 total includes 6,300 members under age 21, many of whom were newly eligible for ECM in July 2023. Altogether, more than 160,000 unique Medi-Cal members across the state received ECM in the first 21 months of the benefit.
ECM and Community Supports aim to improve Medi-Cal members’ overall health and well-being by addressing both medical and social factors that can impact a person’s health, including housing assistance, meal programs, job training, and centralized coordination of care. For inquiries related to the report or to provide feedback on the data, please email CalAIMECMILOS@dhcs.ca.gov.
Mobile Medi-Cal Dental Van Ncig saib
On April 4, DHCS kicked off the second mobile dental van tour in Fresno with a press event. DHCS’ Smile, California campaign informs Medi-Cal members about preventive dental services to children and youth to enhance utilization of essential dental care and improve oral health, particularly for underserved groups. In addition to Fresno, the mobile dental van visited Pixley (April 5) and will make future stops in Hollister (April 11), Avenal (April 12), and Huntington Park (May 4).
Medi-Cal members, medical and dental providers, and community-based organizations can learn more about Medi-Cal’s covered dental services by visiting the Smile, California website, in English at SmileCalifornia.org or in Spanish at SonrieCalifornia.org. The website includes helpful resources, such as informational flyers, videos, factsheets, and the “Find-A-Dentist” tool to locate a dental provider.