Xov xwm tshaj plaws

Tus Thawj Fwm Tsav Saib Xyuas Lub Npe Tshiab DHCS Tus Thawj Saib Xyuas Kev Ua Haujlwm rau Cov Haujlwm (COOP)

On October 10, Governor Newsom announced the appointment of Chris Riesen as DHCS’ new COOP, effective October 16. As part of the Directorate, Chris will provide leadership of Enterprise Data and Information Management, Enterprise Technology Services, and Program Operations. The COOP position expands the Director’s Office to increase capacity to manage the growth and increased complexity of DHCS’ programs, as well as to better support work/life balance. This position will support Erika Sperbeck’s work as Chief Deputy Director for Policy and Program Support, leading Department operations and program integrity functions. Since July 2018, Chris has served as DHCS’ Deputy Director for Enterprise Technology Services and Chief Information Officer.

Medi-Cal Hloov Kho Tshiab

DHCS today published the August 2023 Medi-Cal continuous coverage unwinding eligibility measures data on the Medi-Cal Enrollment and Renewal Data webpage. The August dashboard includes data on Medi-Cal enrollment, applications in progress, redeterminations, and disenrollments. The data also include demographic details for all redetermination measures, along with the top reasons for disenrollments. 

Medi-Medi Plans muaj nyob rau hauv Medicare Qhib Sau Npe

During the upcoming Medicare open enrollment period (October 15 through December 7), Medicare-Medi-Cal Plans (Medi-Medi Plans) are available for enrollment in twelve counties (Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara currently, as well as five new counties – Fresno, Kings, Madera, Sacramento, and Tulare – beginning on January 1, 2024). Medi-Medi Plans combine Medicare and Medi-Cal benefits and Medicare prescription drug benefits into one plan.

Approximately 45 percent of dually eligible members are enrolled in some type of Medicare Advantage plan. Enrollment in Medi-Medi Plans as of July 2023 is approximately 241,105 members. The benefits of Medi-Medi Plans include integrated materials, such as a single health plan card and one phone number to call for both Medicare and Medi-Cal benefits, leading to improved care coordination and support for members.

Medi-Medi Plans coordinate all benefits and services across both programs, including all Medicare-covered services, all Medi-Cal covered services, additional supplemental benefits, carved-out benefits (i.e., In-Home Supportive Services, Multipurpose Senior Services Program, Community-Based Adult Services, and dental), one care management team to coordinate care, and community supports offered by the Medi-Cal managed care plan.

Kev hloov kho tshiab

Ntxiv Nruam Kev Pabcuam Unwinding Flexibilities

On September 22, the federal Centers for Medicare & Medicaid Services approved DHCS’ request for two flexibilities that leverage existing regulations to help streamline the processing of annual Medi-Cal eligibility renewals and ease burdens on county program administrators and Medi-Cal members. The first flexibility waives the requirement for Medi-Cal members to sign and return a renewal packet that had already been submitted if counties receive verification of missing information after the packet was mailed. The second flexibility allows the use of the explanation submitted by the member within the renewal packet as sufficient verification for a successful redetermination, eliminating the need for additional supporting documentation. These flexibilities will streamline the renewal process for Medi-Cal members, especially individuals experiencing homelessness and elderly or disabled populations. Additionally, the flexibilities will ease burdens to provide additional paperwork or documentation and reduce procedural terminations during the continuous coverage unwinding period.

The flexibilities will continue throughout the unwinding period. DHCS issued Medi-Cal Eligibility Division Information Letter (MEDIL) I 23-49 to provide counties with immediate guidance on operationalizing these flexibilities.

Memoranda ntawm kev nkag siab ntawm Cov Kev Npaj Kho Mob thiab Cov Neeg Thib Peb

DHCS this week released an All Plan Letter (APL), two Behavioral Health Information Notices (BHIN), and associated Memoranda of Understandings (MOU) templates for Medi-Cal managed care plans (MCP) required by the 2024 MCP contract to execute MOUs with certain third-party entities to ensure member care is coordinated and members have access to community-based resources to support whole-person care. The MOUs are intended to be effective vehicles to clarify roles and responsibilities among parties and support local engagement, care coordination, information exchange, mutual accountability, and transparency.

The MOU templates include a base template, which contains general provisions required to be included in all MOUs, and a set of bespoke templates tailored for programs or services administered by third-party entities that contain the required general MOU provisions and program-specific provisions. The bespoke templates are for MCPs to enter into MOUs with third-party entities with whom MCPs must make a good faith effort to execute by January 1, 2024, and include: local governmental agencies, such as county behavioral health departments for specialty mental health care and substance use disorder services; other local programs and services, including social services; child welfare departments; Regional Centers; In-Home Supportive Services programs; and Women, Infants, and Children Supplemental Nutrition Programs. DHCS will release additional required MOU templates for use by MCPs and third-party entities as they are finalized, including those required to be executed on July 1, 2024, and January 1, 2025. Additional information and copies of the MOU templates are available on the DHCS MOU webpage.

Medicare thiab Medi-Cal Dental Benefits

On October 11, DHCS released a new fact sheet for dental providers regarding dental benefits for dual eligible (Medicare and Medi-Cal) members. The fact sheet provides information about dental benefits that both Medicare and Medi-Cal offer and how providers can bill for dental services provided to members. Medicare, the primary payer for dual eligible patients, does not cover most dental care. Medi-Cal covers a variety of dental benefits administered by Medi-Cal dental providers. A dual eligible patient may also receive dental benefits through their Medicare Advantage plan. For dental services covered by Original Medicare or a Medicare Advantage plan, the services must be billed to Original Medicare or the Medicare Advantage plan first.

Medi-Cal Rx

On October 13, reinstatement Phase 3/Lift 3 will reinstate Quantity Restriction Edits for members 22 years of age and older. Quantity Limit restrictions will be applied to all (new and continuing) pharmacy claims. Some commonly prescribed Code I medications on the Medi-Cal Rx Contract Drugs List (CDL) have quantity limits based on the U.S. Food and Drug Administration-approved or clinically sound dosing guidelines. Claims may reject if billed incorrectly.

Also, a 30-day countdown alert was released on October 10 for the final reinstatement action. On November 10, implementation of Phase 4/Lift 4 of reinstatement will retire the transition policy for all pharmacy benefits for members 22 years of age and older; reinstate prior authorization (PA) requirements for all therapies for standard therapeutic classes 68, 86, and 87, which includes enteral nutrition products; reinstate utilization management claim edits for Reject Code 80 – Diagnosis Code Submitted Does Not Meet Drug Coverage Criteria; and reinstate Brand Medically Necessary PA requirements for all claims.

Txog rau lub Kaum Hli 17, txhua tus neeg koom nrog Medi-Cal Rx uas DHCS tau koom tes nrog yuav tau txais kev sib txuas lus Advancing Medi-Cal Rx, uas tshaj tawm tias qhov kawg ntawm kev siv zog rov qab rau cov neeg laus thiab tsis muaj kev hloov pauv rau cov menyuam yaus txog xyoo 2024. Cov neeg koom tes suav nrog Cov Kev Npaj Kho Mob Hauv Zos ntawm California, California Association of Health Plans, California Health Association, Medi-Cal managed care plan pharmacy directors, California Children's Hospital Association, Children's Specialty Care Coalition, Children's Regional Integrated Service System, California Medical Association, California Retailers Association, National Association of Chain Drug Stores, California Pharmacists Association, California Primary Care Association, California Behavioral Health Directions Association, California Association of Medical Product Suppliers, thiab Hemophilia Council of California.

Koom nrog peb pab neeg

DHCS tab tom ntiav rau peb cov nyiaj txiag, tib neeg cov peev txheej, kev cai lij choj, kev tshuaj xyuas, txoj cai tswjfwm kev noj qab haus huv, thiab pab pawg xov xwm thev naus laus zis. Yog xav paub ntxiv, thov mus saib hauv CalCareers lub vev xaib.

DHCS’ purpose is to provide equitable access to quality health care leading to a healthy California for all. DHCS’ goals and objectives reflect DHCS’ tremendous work to transform the state’s health care system and strengthen organizational excellence.

Cov Rooj Sib Tham Cov Neeg Koom Tes thiab Webinar yuav los tom ntej

Adult Expansion Webinar

Thaum Lub Kaum Hli Ntuj hnub tim 18, DHCS yuav tuav thawj zaug ntawm ob lub rooj sib tham hauv online txog kev nthuav dav ntawm Medi-Cal cov neeg laus (hnub nyoog 26-49) rau cov chaw haujlwm hauv nroog thiab lwm cov neeg koom nrog. Lub rooj sib tham hauv online thib ob tau teem sijhawm rau thaum ntxov Lub Kaum Ob Hlis. Lub webinar yuav muab cov ntaub ntawv keeb kwm yav dhau los txog kev nthuav dav, kev npaj siv, kev ceeb toom, kev ncav cuag, thiab ntau ntxiv. Cov ntaub ntawv sau npe yuav muab tso rau ntawm nplooj ntawv web Adult Full Scope Medi-Cal Expansion uas muaj hnub nyoog 26 txog 49 xyoos. Cov tib neeg tuaj yeem sau npe rau lub rooj sib tham hauv online los ntawm kev xa email rau AdultExpansion@dhcs.ca.gov.

DHCS will implement this expansion pursuant to Senate Bill 184 (Chapter 47, Statutes of 2022) on January 1, 2024. When implemented, the expansion will provide individuals 26-49 years of age with full scope Medi-Cal benefits, regardless of citizenship or immigration status, if they meet all other Medi-Cal eligibility criteria.

Stakeholder Advisory Committee (SAC) thiab Behavioral Health-SAC (BH-SAC) Lub Rooj Sib Tham

On October 19, from 9:30 a.m. to 3:30 p.m., DHCS will host the next SAC and BH-SAC hybrid meeting (advance registration required). It will open as a joint meeting, with topics shared by SAC and BH-SAC. A BH-SAC-only meeting will be held after the joint meeting; there is no SAC-only meeting. Participants may attend in person at The California Endowment, located at 1414 K Street in downtown Sacramento, or virtually. For more information, please visit the SAC and BH-SAC webpages.

Muab Kev Nkag Mus Nkag thiab Hloov Kho Kev Noj Qab Haus Huv (PATH) Kev Ncaj Ncees-Involved Program Lub Sijhawm Ua Haujlwm

On October 23, DHCS will host the next PATH Justice-Involved Program virtual office hours session for Round 3 awardees (advance registration required). Office hours will be held every other Monday at 11:30 a.m. through December 18 to assist Round 3 agencies, including supporting implementation plan submission. For more information, visit the Justice-Involved Program website.

Kev pom zoo me me thiab tsis pub leej twg paub txog Kev Pabcuam Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv Webinar

Thaum Lub Kaum Hli Ntuj hnub tim 25, txij thaum 12 teev txog 1:30 teev tsaus ntuj, DHCS thiab California Prevention Training Center yuav tuav lub rooj sib tham hauv online txog Kev Pom Zoo Me Nyuam Yaus thiab Kev Khaws Cia Kev Noj Qab Haus Huv Kev Sib Deev (yuav tsum tau sau npe ua ntej). Daim webinar no yuav muab ib daim ntawv qhia txog cov kev cai lij choj hauv California uas cuam tshuam rau cov menyuam yaus thiab lawv txoj kev nkag mus rau kev noj qab haus huv kev sib deev zais cia thiab kev pabcuam npaj tsev neeg. Nws yuav tshuaj xyuas cov kev zam tseem ceeb rau kev zais cia, suav nrog kev tshaj tawm txog kev tsim txom menyuam yaus, thiab qhia qee qhov piv txwv ntawm cov kev coj ua zoo tshaj plaws rau kev siv hauv cov xwm txheej nyuaj. Cov neeg koom nrog yuav kawm txog cov peev txheej los txhawb kev siv cov kev cai lij choj kev pom zoo rau menyuam yaus thiab yuav muaj lub sijhawm los sim lawv tus kheej txoj kev paub los ntawm kev kawm txog cov ntaub ntawv.

Rau cov neeg uas tsis tuaj yeem koom nrog lub rooj sib tham hauv online, daim ntawv sau thiab cov ntaubntawv kaw ntawm lub rooj sib tham hauv online, nrog rau cov peev txheej ntxiv, yuav muab tso rau hauv lub vev xaib Family PACT.

PATH Collaborative Planning and Implementation (CPI) Qhov Zoo Tshaj Plaws Webinar

On October 27, from 10 to 11 a.m., DHCS will host a statewide webinar, entitled Enhanced Care Management (ECM) and Community Supports Provider Peer Support and Contracting Self-Assessment (advance registration required). This virtual session is the first in a series of biannual best practices webinars designed to highlight best practices for implementing ECM and Community Supports, increase providers’ successful participation in California Advancing and Innovating Medi-Cal (CalAIM), and improve collaboration with MCPs, state and local government agencies, and others to build and deliver quality support services to Medi-Cal members. For more information and to register, please visit the PATH CPI webpage.

Hauv Case Koj Tsis Tau Nws

California muab khoom plig ntau lab rau cov kws kho mob coj tus cwj pwm los tiv thaiv COVID-19

DHCS awarded nearly $5.2 million to 36 mental health and/or substance use disorder providers through the COVID-19 Substance Use and Mental Health Disorder Mitigation Project to support community mitigation measures that prevent the spread of COVID-19 and protect those who are at increased risk for severe illness. From September 15, 2023, through March 31, 2025, providers will receive up to $500,000 to expand services to provide education about COVID-19 testing, implement onsite COVID-19 testing, collaborate with community partners to prevent infectious disease transmission, and expand COVID-19 response services to individuals connected to the behavioral health system.

Dental Managed Care Plan Parity

As part of the CalAIM 1915(b) waiver Special Terms and Conditions, DHCS conducted a parity evaluation to assess the performance (utilization) of Sacramento County dental managed care (DMC) plans compared to the statewide dental fee-for-service (FFS) delivery system. The evaluation was based on utilization measures for calendar year 2022 in the following categories: annual dental visits, preventive dental services, and use of sealants for children and adults. Based on the evaluations, DHCS determined that none of the three DMC plans operating in Sacramento County – Access Dental Plan, Health Net Dental, and Liberty Dental Plan – met parity with statewide FFS utilization averages in all required measures. As a result, members currently enrolled in DMC plans will have the option to enroll in FFS. 

Pib txij lub Kaum Ib Hlis 2023, DHCS yuav xa cov ntawv ceeb toom rau kwv yees li 614,000 tus tswv cuab uas tam sim no tau sau npe rau hauv DMC cov phiaj xwm hauv Sacramento County kom qhia rau lawv txog lawv txoj kev xaiv los nyob nrog lawv cov phiaj xwm tam sim no lossis rho npe tawm thiab koom nrog FFS, siv tau rau lub Kaum Ob Hlis 1, 2023. Daim ntawv ceeb toom yuav muab cov ntaub ntawv qhia txog yuav ua li cas cov tswv cuab thiaj li tau txais kev pab kho hniav yog tias lawv xaiv FFS lossis lawv txoj kev xaiv los xaiv lwm txoj kev npaj DMC tsuas yog tias tus tswv cuab muaj peev xwm teeb tsa qhov teeb meem nkag mus rau kev kho mob hauv FFS. Tsis tas li ntawd xwb, txij li lub Kaum Ob Hlis 1, cov tswv cuab Medi-Cal tshiab uas tsim nyog yuav raug sau npe rau hauv FFS kho hniav. Yog xav saib cov ntaub ntawv qhia txog kev ua haujlwm ntawm FFS thiab DMC ntawm cov hniav, mus saib nplooj ntawv web ntawm Dental Data Reports.