Tsev Chav Xov Xwm - Chaw Ua Haujlwm Sib Txuas Lus DHCS Cov Neeg Koom Tes Hloov Tshiab - Lub Ib Hlis 20, 2023​​ 

DHCS Cov Neeg Koom Tes Hloov Tshiab - Lub Ib Hlis 20, 2023​​ 

Xov xwm tshaj plaws​​ 

Tsev Kho Mob Kaw Cov Cai hauv Medi-Cal Managed Care Plan (MCP) Network​​ 

Thaum DHCS paub txog kev kaw ib lub tsev kho mob hauv Medi-Cal MCP network, Lub Chaw Haujlwm lub hom phiaj yog los tiv thaiv kev noj qab haus huv thiab kev nyob zoo ntawm cov tswv cuab Medi-Cal. DHCS xav kom Medi-Cal MCPs ua cov kauj ruam tshwj xeeb los xyuas kom meej tias cov tswv cuab uas yuav raug cuam tshuam los ntawm kev kaw tsev kho mob lossis kev tso tseg cov kev pabcuam tseem tuaj yeem nkag mus rau cov kev pabcuam kho mob uas tsim nyog.​​ 

When DHCS was notified of Madera Community Hospital’s closure, DHCS immediately began to work with CalViva Health and Anthem Blue Cross Partnership Plan to identify the impact on Medi-Cal members’ access to care. DHCS also engaged with the California Department of Public Health to transfer Medi-Cal members who required post-acute or long-term care services following hospital discharge (i.e., skilled nursing and home health care) due to the Madera Community Hospital closure.​​ 

Additionally, DHCS reached out to Madera County’s behavioral health agency about their plans to ensure continued access to services for county residents. DHCS also contacted the behavioral health agency of the surrounding counties, including Merced, Mono, Mariposa, and Fresno, to assess the impact of the closure of Madera Community Hospital on their behavioral health systems and related mitigation plans, and to ensure the provision of needed services.​​ 

Yog xav paub ntxiv, suav nrog cov peev txheej rau Medi-Cal cov tswv cuab uas muaj lus nug txog kev nkag mus saib xyuas, thov mus saib hauv DHCS lub vev xaib.​​ 

Medi-Cal MCP Kev Sau Npe rau Medicare/Medi-Cal Dual Kev Tsim Nyog​​ 

Effective January 1, 2023, members dually eligible for Medicare and Medi-Cal across the state became eligible to be mandatorily enrolled in Medi-Cal MCPs for their Medi-Cal benefits only. As a reminder to our stakeholders, this change in Medi-Cal does not change access to Medicare providers or benefits. Additionally, Medicare providers serving dual eligible patients do not need to enroll in a Medi-Cal MCP to continue receiving reimbursement. More than 70 percent of dual eligible members statewide are already enrolled in Medi-Cal MCPs—this step transfers the remaining 30 percent into Medi-Cal MCPs.​​ 

DHCS tau tshaj tawm daim ntawv qhia txog qhov tseeb thiab cov cuab yeej siv tshiab rau cov kws kho mob Medicare los piav qhia txog cov txheej txheem them nqi rau cov neeg muab kev pab rau ob tus tswv cuab uas tsim nyog tau sau npe rau hauv Medi-Cal managed care. Daim ntawv qhia no piav qhia txog cov txheej txheem them nqi hla kev uas twb muaj lawm, uas tsis hloov pauv hauv CalAIM.​​ 

Rau cov neeg mob hauv Original (fee-for-service) Medicare, tus neeg cog lus Medicare Administrative Contractor ua cov ntaub ntawv thov thawj zaug rau kev them nyiaj Medicare, thiab tom qab ntawd xa daim ntawv thov mus rau Medi-Cal MCP (lossis DHCS) rau kev them nyiaj Medi-Cal thib ob. Rau cov neeg mob uas nyob hauv Medicare Advantage (MA), tus neeg muab kev pab cuam Medicare yuav them tus nqi them thawj zaug rau txoj kev npaj MA. Cov txheej txheem them nyiaj thib ob yuav nyob ntawm seb tus neeg mob Medi-Cal MCP puas zoo ib yam lossis txawv ntawm txoj kev npaj MA. Yog xav paub ntxiv, thov mus saib lub vev xaib Statewide Medi-Cal Managed Care Enrollment for Dual Eligible Members.​​ 

Kev hloov kho tshiab​​ 

Cov tswv cuab raug xaiv rau Doula Implementation Workgroup​​ 

Thaum Lub Ib Hlis 13, DHCS tau ceeb toom rau 26 tus neeg tias lawv tau raug xaiv los koom nrog Doula Implementation Workgroup. Tsab Cai Lij Choj Senate 65 (Tshooj 449, Cov Cai Lij Choj Xyoo 2021) yuav tsum tau DHCS los tshuaj xyuas qhov kev siv ntawm cov txiaj ntsig doula uas tau muab los ntawm Medi-Cal program. Pawg neeg ua haujlwm yuav tsum tuav nws thawj lub rooj sib tham rau lub Peb Hlis 2023 thiab yuav txuas ntxiv mus txog rau lub Tsib Hlis 2025. Ib daim ntawv teev cov tswv cuab ntawm pawg ua haujlwm tau muab tso rau ntawm nplooj ntawv web doula. Cov kev pabcuam Doula tau dhau los ua kev pabcuam Medi-Cal rau lub Ib Hlis 1.​​ 

The workgroup consists of doulas, health care providers, consumer and community advocates, health plans, county representatives, and other stakeholders with experience in doula care. The workgroup will provide input on ensuring that doula services are available to Medi-Cal members who are eligible for and want doula services; minimizing barriers and delays in payments to a Medi-Cal doula or in reimbursement to Medi-Cal members for doula services received; and making recommendations for outreach efforts so that all Medi-Cal members within the eligible and other target populations are aware of the option to use doula services. Workgroup recommendations will also help inform a report to the Legislature to reduce any identified barriers.​​ 

Medi-Cal Rx​​ 

On January 20, prior authorization (PA) requirements will be reinstated for 39 additional drug classes for new start medications for members age 22 and older. “New starts” are defined as new therapies or medications not previously prescribed to the member during the 15-month lookback period. Historical claims data and PAs will be used to review for grandfathering. New start prescriptions for members age 21 and younger within these 39 drug classes will not be subject to PA reinstatement. On December 20, 2022, a 30-day notice was posted, and weekly reinstatement updates are posted every Friday on the Medi-Cal Rx website.​​ 

Smile, California Kev Sib Tw rau Medi-Cal Dental Services​​ 

Ib daim ntawv ceeb toom txog kev luag nyav ntawm Smile, California yuav raug xa mus rau lub lim tiam ntawm lub Ib Hlis 23 rau cov neeg koom tes, cov neeg muab kev pabcuam, thiab cov neeg koom tes uas tau sau npe kom tau txais tsab ntawv xov xwm txhua hli uas muaj cov yeeb yaj kiab thib peb ntawm cov yeeb yaj kiab pov thawj ntawm cov neeg muab kev pabcuam thiab tseem yuav txhawb nqa kev nthuav qhia PowerPoint tshiab uas muaj ob hom lus (lus Askiv thiab lus Mev) uas muaj nyob rau ntawm SmileCalifornia.org. Cov neeg tau txais Smile Alert kuj tseem yuav raug ceeb toom kom txhawb cov tswv cuab Medi-Cal kom tiv thaiv lawv cov hniav thoob plaws hauv ib xyoos los ntawm kev mus ntsib kws kho hniav tsis tu ncua hauv xyoo 2023. Sau npe rau peb qhov Kev Ceeb Toom Txog Kev Luag Ntxhi kom paub txog kev sib tw ntawm Smile, California, cov peev txheej tshiab, thiab cov hloov tshiab.​​  

Koom nrog peb pab neeg​​ 

DHCS tab tom nrhiav neeg ua haujlwm! DHCS muaj qhov chaw ua haujlwm tam sim ntawd rau Tus Pabcuam Tshwj Xeeb rau Tus Thawj Coj. Txoj haujlwm no muab kev txhawb nqa kev tswj hwm rau cov teeb meem tseem ceeb tshaj plaws, rhiab heev, thiab zais cia ntawm lub chaw haujlwm lossis qhov kev pab cuam.​​ 

DHCS is also 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 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.​​ 

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

 Hais​​ ng Aid Coverage for Children Program (HACCP) Webinar for Providers​​ 

Thaum Lub Ib Hlis 24, thaum 12 txog 12:50 teev tsaus ntuj, DHCS yuav tuav lub rooj sib tham hauv webinar los pab cov kws kho mob (yuav tsum tau sau npe ua ntej) nrog cov ntaub ntawv los pab cov neeg mob menyuam yaus thiab lawv tsev neeg kom tau txais txiaj ntsig HACCP ntau tshaj plaws. Kev cob qhia yuav hais txog cov kev xav tau ntawm cov tsev neeg los thov kev pab them nqi thiab cov txheej txheem xa ntawv thov rau audiologists, otolaryngologists, kws kho mob, thiab lawv cov neeg ua haujlwm hauv chaw ua haujlwm.​​ 

Muab Kev Nkag Mus Nkag thiab Hloov Kho Kev Noj Qab Haus Huv (PATH) Kev Ncaj Ncees-Involved Round 2 Funding Webinar​​ 

Overview Webinar for Behavioral Health Administration Integration Concept Paper​​ 

On January 26, from 3 to 4 p.m., DHCS will host a webinar to provide an overview of the concept paper for CalAIM Behavioral Health Administrative Integration (advance registration required). The webinar will include an overview of the initiative’s framework and goals, the phased approach for implementation between now and fiscal year 2027-28, and DHCS’ proposal for ongoing stakeholder engagement and technical assistance. For more information, visit the CalAIM Behavioral Health Initiative webpage.​​ 

California Children’s Services (CCS) Monitoring and Oversight Workgroup Webinar​​ 

On January 30, from 12 to 4 p.m., DHCS will host the CCS Monitoring and Oversight Workgroup meeting (advance registration required) to develop and implement the CCS Compliance, Monitoring, and Oversight Program, a component of the CalAIM initiative. The webinar will cover the Grievance Numbered Letter (NL), Training NL, Surveying NL, Memorandum of Understanding development, compliance activities, and enforcement proposal. Additional information is available on the CCS Compliance, Monitoring, and Oversight Program webpage.​​ 

CalAIM Skilled Nursing Facility (SNF) Carve-In Webinar: Yuav Ua Li Cas Medi-Cal Managed Care Pab Txhawb Cov Neeg Nyob Hauv SNF​​ 

On January 30, from 2 to 3 p.m., DHCS will virtually host the fourth in a series of public educational webinars for the SNF Carve-In (advance registration required) to support Medi-Cal MCPs and SNF providers as they implement Medi-Cal managed care coverage of SNFs statewide that began on January 1. The webinar will provide an overview of key Medi-Cal managed care benefits, services, and programs that support current SNF residents and SNF residents transitioning back to their home or community. Additional details on upcoming webinars are available on the CalAIM LTC Carve-In transition webpage.​​ 

Drug Medi-Cal Organized Delivery System (DMC-ODS) Daim Ntawv Ceeb Toom Txog Kev Noj Qab Haus Huv (BHIN) Webinar​​ 

Thaum Lub Ib Hlis Ntuj Tim 31, txij 11 teev sawv ntxov txog 12 teev tsaus ntuj, DHCS yuav tuav ib lub webinar (yuav tsum tau sau npe ua ntej) los muab cov ntsiab lus ntawm kev hloov tshiab ntsig txog DMC-ODS. Tshwj xeeb, DHCS yuav tham txog kev hloov kho tshiab rau BHIN 21-075. Cov ntaubntawv povthawj siv webinar yuav muaj. Yog xav paub ntxiv, mus saib hauv CalAIM Behavioral Health Initiative lub vev xaib. Yog xav paub ntxiv, email BHCalAIM@dhcs.ca.gov.​​ 

Lub Chaw Saib Xyuas Kev Noj Qab Haus Huv Nyiaj Txiag Kev Hloov Kho Webinar​​ 

Thaum Lub Ob Hlis 1, txij 1:30 txog 2:30 teev tsaus ntuj, DHCS yuav tuav lub rooj sib tham hauv online txog kev hloov pauv nyiaj txiag ntawm chaw saib xyuas neeg mob (yuav tsum tau sau npe ua ntej) tham txog kev tsim kho Txoj Haujlwm Txuj Ci Kev Ua Haujlwm uas tau tso cai los ntawm Assembly Bill 186 (Tshooj 46, Cov Cai ntawm xyoo 2022).  Yog xav paub ntxiv, mus saib nplooj ntawv web ntawm Nursing Facility Financing Reform (AB 186).​​ 

Hauv Case Koj Tsis Tau Nws​​ 

Daim ntawv thov Deadline rau Clinic Workforce Stabilization Retention Payments (CWSRP)​​ 

DHCS ceeb toom rau txhua lub tsev kho mob uas tau sau npe tiav lawm kom xa lawv daim ntawv thov CWSRP ua ntej hnub kawg. Txhua daim ntawv thov them nyiaj yuav tsum xa tuaj tsis pub dhau 5 teev tsaus ntuj rau lub Ib Hlis 27. DHCS txhawb kom xa daim ntawv thov ua ntej kom txhua daim ntawv thov tuaj yeem raug lees paub sai tom qab hnub kawg xa daim ntawv thov.​​ 

Yog xav tau kev qhia txog kev siv, kev qhia ua yeeb yaj kiab txog kev siv, thiab lwm yam ntaub ntawv txhawb nqa, thov mus saib CWSRP nplooj ntawv web.​​ 

Tribal Behavioral Health Crisis thiab Non-Crisis Vehicles and Vehicle-Related costs RFA​​ 

Thaum Lub Ib Hlis 11, DHCS tau tshaj tawm RFA los thov cov ntawv thov los ntawm California Tribal cov koom haum kom nthuav dav kev nkag mus rau Tribal ntsoog thiab tsis muaj teeb meem kev coj tus cwj pwm kev noj qab haus huv los ntawm kev pab nyiaj txiag. Cov nyiaj no yuav tsum tau siv tshwj xeeb rau cov tsheb thiab cov nqi tsheb uas tso cai rau kev txhim kho kev nkag mus rau kev coj tus cwj pwm kev noj qab haus huv mobile teeb meem thiab cov kev pabcuam tsis muaj teebmeem. Lub sijhawm ua haujlwm yuav yog los ntawm Lub Ob Hlis 1, 2023, txog rau Lub Rau Hli 30, 2025. Tsim nyog California Tribal cov chaw muab kev pabcuam kev noj qab haus huv tuaj yeem thov tau nyiaj txij li $50,000 txog $1,000,000. Hnub kawg rau kev thov yog Lub Ob Hlis 28.​​ 

HACCP Kev Tsim Nyog Kev nthuav dav​​ 

DHCS now welcomes (since January 1) 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.​​