DHCS Stakeholder Updates – June 24, 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 txog kev txhim kho tseem ceeb ntawm DHCS cov kev pabcuam, nrog rau cov lus qhia ntsig txog COVID-19 kev noj qab haus huv rau pej xeem xwm txheej ceev.
Kev rho menyuam tawm thiab kev pab cuam tseem muaj kev nyab xeeb rau Medi-Cal cov neeg tau txais txiaj ntsig
Despite today’s U.S. Supreme Court ruling striking down the constitutional right to an abortion, Medi-Cal will continue to cover abortion services, uninterrupted, for all Medi-Cal beneficiaries. Although this decision allows states to impose restrictions or ban abortion, California has not pursued any restrictions or bans, and the ruling did not invalidate any California laws or protections that ensure access to abortion in California.
DHCS’ policies regarding how abortion services are delivered and reimbursed have not changed, nor has the Department’s commitment to providing quality care equitably, and with the goal of reducing health disparities. DHCS remains committed to offering a broad and comprehensive package of reproductive health care services, including abortion, in Medi-Cal, and without judgment or undue restrictions. Medi-Cal beneficiaries can still go to any Medi-Cal provider of their choice for abortion services, at any time and for any reason.
As a covered Medi-Cal benefit, Medi-Cal managed care plans (MCPs) must cover abortion services, including medical services and supplies incidental or preliminary to an abortion, consistent with the requirements outlined in the Medi-Cal provider manual. All MCPs must implement and maintain procedures that ensure confidentiality and access. Members may go to any provider of their choice for abortion services, at any time and for any reason, regardless of network affiliation. MCPs will offer alternatives (e.g., coverage by fee-for-service or by an out-of-network health plan) if a provider refuses to provide abortion services.
Regardless of today’s federal court ruling, DHCS will continue to ensure coverage of and access to comprehensive reproductive health care, including abortion, for Medi-Cal beneficiaries.
DHCS Leadership Change
Tus Thawj Kav Tebchaws Gavin Newsom tau xaiv Tyler Sadwith los ua Tus Lwm Thawj Coj (DD) rau DHCS Behavioral Health (BH). Sadwith tau ua tus Lwm Thawj Coj (ADD) rau BH txij thaum Lub Xya Hli 2021, thiab Ua Haujlwm DD rau BH txij thaum Lub Rau Hli 1, 2022. DD rau BH ua lub luag haujlwm tseem ceeb hauv kev siv Medi-Cal BH cov phiaj xwm tsim los kom ua tiav cov txiaj ntsig kev noj qab haus huv sib luag, ua kom muaj kev nkag mus tau zoo rau kev saib xyuas zoo, thiab pab txhawb kev tswj hwm thiab kev kho mob kev sib koom ua ke ntawm kev saib xyuas kev puas siab puas ntsws, kev saib xyuas kev siv yeeb tshuaj, thiab kev kho mob, nyob qhov twg los tau.
DHCS is recruiting for a second ADD for BH, and will begin recruiting to backfill the ADD for the Medi-Cal BH position that Sadwith is vacating. We encourage you to please share these positions with your networks widely.
Medi-Cal Rx Reinstatement of Reject Codes
Thaum Lub Rau Hli 22, Medi-Cal Rx tau tshaj tawm 30-hnub ceeb toom txog kev rov qab kho dua rau cov kws kho mob, cov kws muab kev pab, cov phiaj xwm kev kho mob, cov khw muag tshuaj, thiab lwm tus neeg koom nrog. Ob lub Rooj Sab Laj Hauv Tebchaws rau Cov Kev Pab Cuam Tshuaj Kho Mob (NCPDP) thov kom hloov kho rau kev kuaj mob thiab Kev Tshuaj Xyuas Kev Siv Tshuaj (DUR) cov cai (Tus lej tsis lees txais 80 thiab Tus lej tsis lees txais DUR NCPDP 88) yuav rov qab siv dua rau lub Xya Hli 22.
Medi-Cal Rx tsis ntev los no tau ua qhov chaw kuaj xyuas kev npaj ua haujlwm rau nws cov kev siv zog rov qab los cuam tshuam txog kev xaiv cov ntawv thov hloov kho nrog rau xaiv cov kev tso cai ua ntej uas tau raug tshem tawm ib ntus. Raws li cov ntaub ntawv thiab kev ntsuas, nws tau txiav txim siab tias Medi-Cal Rx tau npaj ua haujlwm thiab tau tshaj tawm 30-hnub ceeb toom txog kev rov ua haujlwm dua.
Yog xav tau kev pab lossis kev tso cai ua ntej, thov hu rau Medi-Cal Rx Lub Chaw Pabcuam Cov Neeg Siv Khoom, uas muaj 24 teev hauv ib hnub, 7 hnub hauv ib asthiv, 365 hnub hauv ib xyoos, ntawm (800) 977-2273, lossis email MediCalRxEducationOutreach@magellanhealth.com.
Hloov kho thiab ceeb toom txog txhaj tshuaj tiv thaiv COVID-19
Thaum Lub Rau Hli 22, Lub Chaw rau Medicare & Medicaid Services (CMS) tau tshaj tawm tias cov menyuam yaus hnub nyoog 6 lub hlis txog 5 xyoos uas muaj kev pov hwm Medicaid thiab Children's Health Insurance Program (CHIP) tsim nyog tau txais kev txhaj tshuaj COVID-19 yam tsis muaj kev sib koom them nqi. Yuav luag txhua tus neeg uas muaj Medicaid, CHIP, Kev Pab Them Nqi Kho Mob Yooj Yim, kev pov hwm tus kheej uas tus tswv ntiav haujlwm txhawb nqa, thiab kev pov hwm kev noj qab haus huv rau pawg neeg thiab tus kheej tuaj yeem tau txais kev txhaj tshuaj tiv thaiv COVID-19, suav nrog cov tshuaj txhawb nqa, yam tsis tas them nqi. Cov neeg uas muaj Medicare tsis them dab tsi los txhaj tshuaj tiv thaiv COVID-19, thiab tsis muaj kev them nqi sib koom, kev pov hwm sib koom, lossis kev them nqi deductible. Los ntawm DHCS' COVID-19 Uninsured Group Program, kev kuaj mob COVID-19, cov kev pabcuam ntsig txog kev kuaj mob, thiab cov kev pabcuam kho mob, suav nrog kev pw hauv tsev kho mob thiab txhua yam kev kho mob tsim nyog, muaj pub dawb rau tus neeg ntawd txog li 12 lub hlis lossis thaum kawg ntawm qhov xwm txheej ceev ntawm kev noj qab haus huv pej xeem, seb qhov twg los ua ntej. Ua ib qho kev ceeb toom, txhua tus neeg California tuaj yeem tau txais cov tshuaj tiv thaiv COVID-19 dawb.
Information about the CDC COVID-19 Vaccination Program Provider Requirements and how the COVID-19 vaccines are provided through that program at no cost to recipients is available on the CMS website and through the COVID-19 Vaccine Policies & Guidance page. Information about DHCS’ COVID-19 vaccine administration for beneficiaries and providers is posted on the DHCS’ COVID-19 Response webpage. DHCS is in the process of updating systems and policy guidance for COVID-19 vaccine administration for children under age 5 and will post the updated guidance on the DHCS COVID-19 Response webpage once finalized.
Children and Youth Behavioral Health Initiative (CYBHI) Thov kom Xov Xwm (RFI)
Lub lim tiam ntawm Lub Rau Hli 27, DHCS yuav tshaj tawm RFI rau CYBHI. Lub hom phiaj ntawm RFI yog los caw cov neeg muag khoom los tshuaj xyuas thiab teb rau qhov tsis yog RFI no, uas yuav muab cov ntaub ntawv qhia rau DHCS los qhia txog kev npaj, tsim, kev tsim kho, thiab kev tsim tawm ntawm Behavioral Health Virtual Services platform los ntawm Lub Ib Hlis 2024.
Established as part of the Budget Act of 2021, the CYBHI is a multiyear, multi-department package of investments that seeks to reimagine the systems, regardless of payer, that supports behavioral health for all California’s children, youth, and their families. Efforts will focus on promoting social and emotional well-being, preventing behavioral health challenges, and providing equitable, appropriate, timely, and accessible services for emerging and existing behavioral health (mental health and substance use) needs for children and youth ages 0-25. CYBHI is grounded in focusing on equity; centering efforts around children and youth voices, strengths, needs, priorities, and experiences; driving transformative systems change, and using ongoing learning as the basis for change and improvement in outcomes for children and youth.
Ib qho kev ua haujlwm ntawm CYBHI yog los tsim thiab tsav kev coj noj coj ua ntawm Kev Noj Qab Haus Huv Virtual Kev Pabcuam platform rau txhua tus menyuam yaus, hluas, thiab tsev neeg hauv California. Nws yuav txhawb nqa 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 coj tus cwj pwm.
Muab Kev Nkag Mus thiab Hloov Kho Kev Noj Qab Haus Huv (PATH) Webinar
Thaum Lub Rau Hli 29, DHCS yuav tuav lub rooj sib tham hauv web los muab cov neeg muaj feem txaus siab nrog cov ncauj lus qhia ntxaws txog cov kev pib hauv qab no: Kev Npaj Ua Haujlwm thiab Kev Ua Haujlwm; Peev thiab Infrastructure Transition, Expansion, thiab Development (CITED); thiab Technical Assistance Marketplace. Lub webinar tseem yuav ua qhov chaw los teb cov lus nug dav dav los ntawm cov neeg muaj feem cuam tshuam txog PATH kev pib. Cov neeg muaj feem txaus siab raug txhawb kom xa cov lus nug ua ntej mus rau 1115path@dhcs.ca.gov. Cov neeg tuaj koom kuj yuav muaj sijhawm los nug cov lus nug. Yuav tsum sau npe ua ntej.
PATH yog ib qho kev pib tsib xyoos los tsim thiab nthuav dav lub peev xwm thiab kev tsim kho vaj tse hauv nroog, nroog, thiab lwm lub koomhaum tseemfwv thiab lub nroog thiab cov chaw pabcuam hauv zej zog, suav nrog cov tsev kho mob pej xeem, cov koom haum hauv zej zog, pab pawg neeg thiab cov neeg sawv cev ntawm Indian cov kev pabcuam kev noj qab haus huv, thiab lwm yam kom ua tiav hauv kev xa cov Kev Pabcuam Kev Noj Qab Haus Huv, Kev Pabcuam Hauv Zej Zog, thiab kev pabcuam kev ncaj ncees raws li CalAIM.
Cov Khoom Muaj Cai Txwv Hloov pauv rau Tsis-MAGI Medi-Cal
Thaum Lub Xya Hli 1, DHCS yuav siv qhov hloov pauv rau cov cuab yeej cuab tam txwv rau Non-Modified Adjusted Gross Income (Non-MAGI) Medi-Cal cov kev pab cuam. Cov kev hloov pauv no, tau tshaj tawm los ntawm Kev Sib Tham Bill 133 (Tshooj 143, Txoj Cai ntawm 2021), nce cov khoom muaj nqis rau cov kev pabcuam Non-MAGI rau $ 130,000 rau ib tus neeg thiab $ 65,000 rau txhua tus neeg ntxiv (txog li 10 tus neeg). Cov kev txwv cov cuab tam uas tau hloov kho no tau hloov pauv tag nrho cov peev txheej dhau los txwv rau cov kev pab cuam Non-MAGI Medi-Cal ($ 2,000 rau ib tus neeg thiab $ 3,000 rau ob tus neeg).
Tsis tas li ntawd, DHCS tau xa ib nqe lus 1115 zam rau qhov kev hloov pauv txoj cai no kom them rau cov tib neeg uas tsim nyog rau Pickle, Disabled Adult Child(cov menyuam), thiab Disabled Widow(ers) cov kev pab cuam, uas tseem hu ua Social Security cov nyiaj tau los ntawm pawg, thiab cia siab tias yuav tau txais kev pom zoo los ntawm CMS los ntawm Lub Xya Hli 1.
DHCS yuav tshaj tawm ib nplooj ntawv tshiab rau cov neeg tau txais txiaj ntsig zoo nyob rau lub Xya Hli 1. Nplooj ntawv no yuav suav nrog cov lus nug thiab cov lus teb uas nquag nug thiab cov ntaub ntawv hais txog cov kev pabcuam cuam tshuam los ntawm kev hloov pauv khoom vaj khoom tsev.
Tshaj tawm cov ntaub ntawv COVID-19
Additional updates will be posted on the DHCS COVID-19 Response page.