DHCS Stakeholder Updates – July 8, 2022
Nyob zoo cov neeg muaj feem xyuam,
Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tab tom muab qhov hloov tshiab no ntawm kev txhim kho tseem ceeb ntawm DHCS cov kev pabcuam.
Lub Xya Hli yog Disability Pride Month
DHCS celebrates the culture, diversity, and contributions of people with disabilities during Disability Pride Month. The Americans with Disabilities Act (ADA) was passed on July 26, 1990, prohibiting discrimination against people with disabilities, and giving rise to this important celebration. DHCS is committed to work toward a healthier California where all individuals can live with purpose and dignity and are supported and valued.
DHCS provides Californians with disabilities access to affordable, integrated, high-quality health care to preserve and support their overall health and well-being, and strives toward health equity to ensure equal opportunities for all Californians. DHCS, in collaboration with sister departments, oversees a variety of programs serving persons with disabilities, including: California Children’s Services, the Genetically Handicapped Persons Program for adults, the Home and Community-Based Alternatives Waiver, and Home and Community-Based Services for individuals with intellectual and developmental disabilities. DHCS also makes available many other resources to support persons with disabilities. DHCS will continue to support Californians with disabilities through high-quality and person-centered care.
Final Population Health Management (PHM) Strategy and Roadmap
Thaum Lub Xya Hli 5, 2022, DHCS tau tshaj tawm Txoj Cai thiab Daim Ntawv Qhia Txog Kev Ua Haujlwm PHM Kawg, uas suav nrog cov lus tawm tswv yim ntawm cov neeg koom nrog txog txhua yam ntawm PHM Framework. DHCS txaus siab rau cov lus tawm tswv yim uas cov neeg koom nrog tau muab los pab txhim kho lub zeem muag ntawm Lub Chaw Haujlwm rau PHM. Ua ib qho kev ceeb toom, DHCS yuav tshaj tawm PHM Program, uas yog lub hauv paus ntawm California Advancing and Innovating Medi-Cal (CalAIM), thaum Lub Ib Hlis Ntuj xyoo 2023. Qhov Kev Pab Cuam PHM yuav tsim kom muaj kev sib koom ua ke thoob plaws lub xeev uas ua kom txhua tus tswv cuab Medi-Cal muaj kev nkag mus rau qhov kev pab cuam uas ua rau muaj lub neej ntev dua thiab noj qab haus huv zoo dua, cov txiaj ntsig kev noj qab haus huv zoo dua, thiab kev ncaj ncees ntawm kev noj qab haus huv. Daim ntawv qhia kev npaj qhia txog cov kev pib tseem ceeb ntawm txoj cai thiab cov txheej txheem kev lav ris, txhais thiab piav qhia txog cov tswv yim thiab cov lus siv ntawm PHM, thiab qhia meej txog cov kev cai rau Medi-Cal cov phiaj xwm kev saib xyuas kev noj qab haus huv (MCPs) rau xyoo 2023 thiab 2024. Daim Ntawv Qhia Txog Txoj Cai thiab Txoj Kev Npaj Kawg ntawm PHM muaj nyob rau ntawm nplooj ntawv web ntawm DHCS CalAIM Population Health Management. Yog koj muaj lus nug dab tsi, thov xa email rau CalAIM@dhcs.ca.gov.
Dual Tsim Nyog Txoj Cai Hloov Tshiab
As a component of CalAIM, DHCS is implementing policies to promote integrated care for beneficiaries dually eligible for Medicare and Medi-Cal. Under this effort, for contract year 2023, DHCS will limit new Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) and expanded county service areas to only those D-SNPs with an ongoing affiliation with Medi-Cal MCPs. This policy, which is in line with the federal approach and in other states, is being implemented because when a county has separate health plans for Medicare and Medi-Cal benefits, there can be beneficiary and provider confusion, duplication of care managers, and more complexity for hospital and nursing home discharge planners.
This approach in 2023 will not result in any members needing to disenroll from their existing Medicare plans. To avoid Medicare provider network disruption, DHCS will continue any existing D-SNP contracts and service areas so members in existing D-SNPs will not be required to disenroll.
Having Medicare and Medi-Cal benefits managed by the same organization is an important component of CalAIM, and aligns with DHCS’ Managed Long-Term Services and Supports (MLTSS) strategy. In 2023, CalAIM policies will provide a more robust Medi-Cal managed care delivery system for dual eligible beneficiaries statewide, including: mandatory Medi-Cal managed care enrollment; Medi-Cal managed care carve-in of skilled nursing facility care; and Enhanced Care Management for populations who are at risk for long-term skilled nursing facility care, or who reside in a nursing facility and want to transition to the community. In addition, Community Supports services designed to address social drivers of health will continue to be implemented by Medi-Cal MCPs.
Children and Youth Behavioral Health Initiative (CYBHI) Thov kom Xov Xwm (RFI)
Thaum Lub Xya Hli 6, DHCS tau tshaj tawm RFI rau CYBHI, caw cov neeg muag khoom los muab cov ntaub ntawv rau DHCS los pab qhia txog kev npaj, tsim qauv, kev txhim kho, thiab kev tso tawm ntawm Behavioral Health Virtual Services platform thaum Lub Ib Hlis 2024. DHCS yuav tuav lub rooj sib tham txog cov neeg muag khoom rau lub Xya Hli 13 rau cov neeg muag khoom yav tom ntej.
Tsim los ua ib feem ntawm Txoj Cai Nyiaj Txiag xyoo 2021, CYBHI yog pob peev txheej ntau xyoo, ntau lub chaw haujlwm uas nrhiav kev rov xav txog cov txheej txheem, tsis hais tus neeg them nyiaj, uas txhawb nqa kev noj qab haus huv rau txhua tus menyuam yaus, cov hluas, thiab lawv tsev neeg hauv California. Cov kev siv zog yuav tsom mus rau kev txhawb nqa kev noj qab haus huv hauv zej zog thiab kev xav, tiv thaiv kev teeb meem kev noj qab haus huv ntawm tus cwj pwm, thiab muab cov kev pabcuam uas ncaj ncees, tsim nyog, raws sijhawm, thiab nkag tau rau cov kev xav tau kev noj qab haus huv ntawm tus cwj pwm tshiab thiab cov uas twb muaj lawm (kev noj qab haus huv ntawm lub hlwb thiab kev siv tshuaj yeeb dej cawv) rau cov menyuam yaus thiab cov hluas hnub nyoog 0-25. CYBHI muaj lub hauv paus rau kev tsom mus rau kev ncaj ncees; tsom mus rau kev siv zog nyob ib puag ncig cov menyuam yaus thiab cov hluas lub suab, lub zog, kev xav tau, qhov tseem ceeb, thiab kev paub dhau los; tsav tsheb hloov pauv cov txheej txheem; thiab siv kev kawm txuas ntxiv ua lub hauv paus rau kev hloov pauv thiab kev txhim kho hauv cov txiaj ntsig rau cov menyuam yaus thiab cov hluas.
Ib qho kev ua haujlwm ntawm CYBHI yog los tsim thiab txhawb nqa kev coj tus cwj pwm kev noj qab haus huv Virtual Services platform los txhawb kev xa cov kev pabcuam kev noj qab haus huv sib luag, tsim nyog, thiab raws sijhawm, los ntawm kev tiv thaiv mus rau kev kho mob kom rov zoo, thiab muab lub platform e-consult rau cov kws kho mob thiab thawj tus kws kho mob rau e-consult nrog cov kws kho mob tus cwj pwm.