Xov xwm tshaj plaws​​ 

CalAIM Kev Pabcuam Nruam rau Cov Menyuam Hloov Kho Qhib rau pej xeem tawm tswv yim​​ 

Thaum Lub Ib Hlis Ntuj Tim 12, DHCS tau pib 30-hnub rau pej xeem thiab pab pawg neeg tawm tswv yim rau kev tawm tswv yim txog kev hloov kho rau California Advancing and Innovating Medi-Cal (CalAIM) Seem 1115 ua qauv qhia ntsig txog kev pab them nqi tas mus li rau cov me nyuam. Cov lus hais yuav dhau los ntawm Lub Ob Hlis 12.​​ 

DHCS is seeking approval from the Centers for Medicare & Medicaid Services (CMS) to include expenditure authority under Section 1115(a)(2) to receive federal matching funds to provide continuous coverage for children through the end of the month in which their 5th birthday falls, regardless of when they first enroll in Medi-Cal or the Children’s Health Insurance Program (CHIP) or any changes in circumstances that would otherwise cause a loss of eligibility.​​ 

Medi-Cal and CHIP-eligible children often go through short periods of disenrollment and re-enrollment in coverage, often referred to as “churn,” leading to disruptions in coverage and lapses in continuity of care. People who experience churn are more likely to delay or forego care, receive less preventive care, stop filling their prescriptions, and have more emergency department visits. One study found that among children with asthma, those experiencing gaps in coverage were more likely to have asthma-related emergency department visits, unmet health care needs, and asthma exacerbations. By providing continuous coverage to Medi-Cal and CHIP-eligible children through age 4, DHCS seeks to ensure these children can access the care they need in a timely manner and promote positive health outcomes.​​ 

Kev ua raws li txoj cai no yog ua raws li lub xeev kev txiav txim siab ntawm Cov Nyiaj Txiag muaj nyob rau hauv 2024-2025 thiab cov nyiaj xyoo tom ntej thiab CMS kev pom zoo. Cov ntaub ntawv ntxiv txog qhov kev thov hloov kho thiab yuav ua li cas xa cov lus pom rau pej xeem muaj nyob rau ntawm CalAIM 1115 Demonstration thiab 1915(b) Waiver webpage.​​ 

Tus Thawj Kav Tebchaws Unveils Proposed 2024-25 Budget​​ 

DHCS’ proposed budget supports our purpose to provide equitable access to quality health care leading to a healthy California for all. The proposed budget builds upon the Administration’s previous investments and enables DHCS to continue transforming Medi-Cal and behavioral health into a system that operates more efficiently and effectively for Californians. The Governor’s Budget proposes a total of $161.1 billion and 4,649.5 positions to support DHCS programs and services.​​ 

Kev hloov kho tshiab​​ 

Muab Kev Nkag Mus thiab Hloov Kho Kev Noj Qab Haus Huv (PATH) Peev Xwm thiab Cov Txheej Txheem Kev Hloov Pauv, Kev nthuav dav, thiab Kev Txhim Kho (CITED) Round 3 Daim Ntawv Thov Qhib​​ 

Thaum Lub Ib Hlis 15, DHCS yuav qhib PATH CITED Round 3 daim ntawv thov qhov rai. PATH CITED teg num muab nyiaj txiag los tsim kom muaj peev xwm thiab kev tsim kho ntawm cov neeg koom tes hauv av, suav nrog cov koom haum hauv zej zog, tsev kho mob pej xeem, cov koom haum hauv nroog, pab pawg neeg, thiab lwm tus, kom koom nrog Medi-Cal kom tiav.​​ 

Hnub kawg rau kev thov rau PATH CITED Round 3 nyiaj yog Lub Ob Hlis 15, 2024. Cov xwm txheej hauv qab no yuav pab tau los pab cov neeg thov yav tom ntej:​​  

• Yuav Ua Li Cas Txhim Kho Koj Daim Ntawv Thov Nyiaj Pab Webinar Part 1: Lub Ib Hlis 16 thaum 10 teev sawv ntxov​​  
• Yuav Ua Li Cas Txhim Kho Koj Daim Ntawv Thov Nyiaj Pab Webinar Part 2: Lub Ib Hlis 23 thaum 10 teev sawv ntxov​​  
• Cov sijhawm ua haujlwm txhua lub limtiam: Lub Ib Hlis 22 txog Lub Ob Hlis 12 thaum 9 teev sawv ntxov (xaiv hnub thiab sau npe rau ntawm PATH CITED lub vev xaib).​​ 

Tshaj Tawm ntawm Equity and Practice Transformation (EPT) Kev Them Nyiaj​​ 

Lub lim tiam ntawm Lub Ib Hlis 15, DHCS yuav pom ntau dua 200 qhov kev saib xyuas thawj zaug uas lawv tau raug xaiv los koom nrog EPT Tus Kws Pab Tswv Yim Them Nqi Them Nqi ($ 650 lab tshaj tsib xyoos). Cov kev coj ua yuav tsum lees paub lawv qhov kev txaus siab rau kev koom tes ua ntej Lub Ib Hlis 22. Daim ntawv teev npe kawg ntawm kev koom tes yuav muab tso rau hauv DHCS EPT lub vev xaib tom qab lub hlis no. Cov nyiaj them ncaj qha yuav txhawb nqa kev saib xyuas thawj zaug los daws cov pej xeem kev noj qab haus huv thiab kev noj qab haus huv kev ncaj ncees, nrog rau tsim cov qauv kev saib xyuas sab saud. Kev them nyiaj yuav raug them rau cov kev coj ua tom qab lawv ua tiav cov ntsiab lus tseem ceeb ntsig txog txhua yam haujlwm.​​ 

Lub Chaw Kawm Kev Noj Qab Haus Huv Pej Xeem , ib qho kev txhawb nqa nyiaj txiag ntawm Tides Center, yuav ua lub luag haujlwm ua haujlwm rau EPT Tus Muab Kev Pabcuam Kev Them Nqi, ua haujlwm nrog DHCS, kev koom tes, thiab Medi-Cal cov phiaj xwm tswj hwm kev saib xyuas (MCP). Txhua qhov kev coj ua hauv qhov kev zov me nyuam yuav tsum koom nrog hauv Cov Kev Ua Haujlwm Pabcuam Kev Noj Qab Haus Huv Hauv Pej Xeem.​​ 

New Place of Service (POS) Code for Street Medicine​​ 

Siv tau rau cov hnub muab kev pabcuam rau lossis tomqab Lub Kaum Hli 1, 2023, Medi-Cal cov chaw muab kev pabcuam tuaj yeem siv POS code 27 rau cov tshuaj hauv kev, ntxiv rau cov lej POS uas tau tshaj tawm yav dhau los rau cov tshuaj hauv kev: 04 (chaw nyob tsis muaj tsev nyob), 15 (chav tsev txawb), thiab 16 (chaw nyob ib ntus). Txoj kev tshuaj yog hais txog cov kev pabcuam kev noj qab haus huv thiab kev sib raug zoo tsim tshwj xeeb los daws cov kev xav tau tshwj xeeb thiab cov xwm txheej ntawm cov tib neeg muaj kev tsis muaj tsev nyob xa ncaj qha rau lawv hauv lawv tus kheej ib puag ncig. DHCS tam sim no tab tom ua qhov tsim nyog hloov kho tshiab kom haum rau POS code 27. Txhua qhov kev thov rau cov kev pabcuam tshuaj kho mob tau muab rau lossis tom qab Lub Kaum Hli 1, 2023, uas raug txwv tsis pub siv POS code 27 yuav tsis tas yuav xa rov qab thiab yuav rov ua dua tshiab tom qab hloov kho cov txheej txheem.​​ 

Yog xav paub ntxiv txog kev them nqi kho mob, thov mus saib Daim Ntawv Cog Lus 22-023. Tsis tas li ntawd, DHCS tau tshaj tawm cov ntaub ntawv hais txog yuav ua li cas Tsev Kho Mob Presumptive Eligibility yuav raug siv rau kev kho mob.​​ 

Cov ntaub ntawv tshiab rau cov xwm txheej mob uas tau ntsib los ntawm Californians nrog Original Medicare​​ 

On January 11, DHCS published a new dataset to the Open Data Portal, entitled “Chronic Conditions Experienced by Californians with Original Medicare, 2021″. The dataset contains information about the prevalence of chronic conditions among Original Medicare beneficiaries in California as well as Medicare spending and co-occurring conditions for those with each condition. The data are available for each of California’s 19 geographic regions and include demographic information. The dataset includes both Medicare-only and dually eligible Medicare beneficiaries. The dataset excludes Medicare Advantage (MA) data. In December 2023, DHCS released a related summary chartbook, and held a webinar on the chartbook. The Open Data portal dataset, as well as the chartbook, were prepared by ATI Advisory for DHCS’ Office of Medicare Innovation and Integration, with funding from The SCAN Foundation.​​ 

Medicare thiab Medi-Cal Hearing Aid Benefits Fact Sheet​​ 

DHCS tau tshaj tawm ib daim ntawv qhia txog kev mloog lus thiab kev hnov lus tshiab hauv Medicare thiab Medi-Cal cov ntaub ntawv qhia tseeb rau cov kws kho mob. Daim ntawv qhia tseeb muab cov ntaub ntawv hais txog cov txiaj ntsig kev hnov lus uas Medicare thiab Medi-Cal muab, suav nrog cov txheej txheem uas cov kws kho mob tuaj yeem sau nqi rau cov kev pab cuam hnov lus uas tau muab rau cov tswv cuab. Medicare, tus thawj them nyiaj rau ob tus tswvcuab tsim nyog, tsis them rau feem ntau cov txiaj ntsig kev hnov lus, xws li cov khoom siv hnov lus lossis kev kuaj rau cov khoom siv hnov lus. Txawm li cas los xij, Medicare Advantage cov phiaj xwm feem ntau muab cov txiaj ntsig kev hnov lus rau lawv cov tswv cuab, suav nrog cov tswv cuab tsim nyog tau txais ob. Tsis tas li ntawd, Medicare Tshooj A (kev mus ntsib tsev kho mob) suav nrog qee cov kev pabcuam hnov lus uas tau muab rau hauv tsev kho mob, xws li cov txheej txheem xwm txheej ceev. Medi-Cal suav nrog ntau yam txiaj ntsig kev hnov lus uas tswj hwm los ntawm cov kws kho mob sau npe. Medi-Cal yog tus them nyiaj rau qhov chaw kawg, yog li qee qhov kev pabcuam rau qee tus tswvcuab yuav tsum tau them rau Medicare ua ntej.​​ 

Medicare Advantage (MA) Cov Nyiaj Pab Ntxiv thiab Medi-Cal Cov Ntaub Ntawv Pov Thawj​​ 

DHCS tau tshaj tawm ib daim ntawv qhia tseeb uas piav qhia txog cov txiaj ntsig ntxiv muaj nyob hauv MA cov phiaj xwm hauv California xyoo 2023 thiab cov txiaj ntsig zoo li cas piv nrog cov txiaj ntsig Medi-Cal. Txhua xyoo, MA cov phiaj xwm, suav nrog Dual Tsim Nyog Cov Kev Xav Tau Tshwj Xeeb (D-SNPs), muab cov txiaj ntsig ntxiv, uas yog cov khoom thiab cov kev pab cuam uas cov phiaj xwm tuaj yeem them tsis tau raws li Kev Cai Lij Choj. Qee qhov xwm txheej, Medi-Cal suav nrog cov txiaj ntsig zoo sib xws, tab sis Medi-Cal yeej ib txwm yog tus them nyiaj ntawm qhov chaw kawg. Yog xav paub ntxiv txog MA cov nyiaj pab ntxiv rau hauv California rau xyoo 2023, thov mus saib Phau Ntawv Qhia #4: Cov Nyiaj Pab Ntxiv hauv Medicare Advantage Plans in California, Daim Ntawv Cog Lus Xyoo 2023.​​  

PATH Collaborative Planning and Implementation (CPI) Initiative Fact Sheet​​ 

DHCS tau tshaj tawm PATH CPI cov ntaub ntawv tseeb los pab cov kws kho mob ntawm txhua theem ntawm Kev Tswj Xyuas Kev Kho Mob Zoo (ECM) thiab Kev Txhawb Zej Zog rau kev siv uas xav paub ntxiv txog kev koom tes hauv kev pib. Daim ntawv qhia tseeb muab cov ntsiab lus dav dav ntawm cov neeg koom nrog kev tsim nyog, piv txwv ntawm kev ua tiav hauv zos, thiab qhov tseem ceeb ntawm qhov tsis sib xws thiab cov teeb meem. Xav paub ntau ntxiv muaj nyob rau ntawm PATH CPI lub vev xaib.​​  

PATH Technical Assistance (TA) Marketplace Resource​​ 

DHCS tau tshaj tawm PATH TA Marketplace cov ntaub ntawv qhov tseeb los pab cov koom haum tsim nyog kawm seb cov kev pabcuam TA dawb tuaj yeem tsim kom muaj peev xwm ua haujlwm los siv ECM thiab Kev Txhawb Zej Zog. Daim ntawv qhia tseeb muab cov ntsiab lus dav dav ntawm TA tus neeg tau txais kev pab tsim nyog, muab kev pabcuam piv txwv, thiab txoj hauv kev rau npe kom tau txais TA dawb. Nkag mus rau cov peev txheej los ntawm kev mus saib PATH TA Marketplace lub vev xaib.​​ 

Koom nrog peb pab neeg​​ 

DHCS tab tom ntiav:​​ 

• Tus Thawj Coj ntawm Pawg Neeg Tsim Kho Tus Nqi Capitated hauv Kev Pab Nyiaj Txiag Kev Kho Mob ua haujlwm ua tus tsim cai tseem ceeb rau txhua yam kev ua ub no teem tus nqi kom ntseeg tau tias kev kho mob zoo thiab siv nyiaj tau zoo los ntawm DHCS cov Medi-Cal MCPs uas tau cog lus. (Hnub kawg xa daim ntawv thov txuas ntxiv mus txog rau lub Ib Hlis 30)​​ 

DHCS is also hiring for our communications, human resources, auditing, health policy, information technology, and other teams. For more information, please visit the CalCareers website.​​ 

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

Long-Term Services and Support (LTSS) Data Dashboard​​ 

Thaum Lub Ib Hlis 18, txij 10 txog 11 teev sawv ntxov, DHCS yuav tuav lub vev xaib (yuav tsum tau sau npe ua ntej) los muab cov ntsiab lus thiab ua qauv qhia txog kev txhim kho tshiab rau LTSS Data Dashboard. Thaum Lub Kaum Ob Hlis 15, 2023, DHCS tau tshaj tawm qhov hloov tshiab, sib tham sib LTSS cov ntaub ntawv dashboard los qhia txog kev siv thiab cov ntaub ntawv pej xeem los ntawm cov nroog thiab Medi-Cal MCPs thiab tso cai rau cov neeg siv tshawb nrhiav cov kev hloov pauv thoob plaws cov kev pabcuam thiab cov neeg nyob thoob plaws hauv California.​​  

Lub dashboard cov ntaub ntawv LTSS muaj cov ntaub ntawv txij xyoo 2017 txog 2022 thiab muaj 16 qhov kev ntsuas siv ntxiv rau cov kev pabcuam kev noj qab haus huv hauv tsev, qhov project California Community Transitions, thiab cov kev pabcuam uas cov neeg California uas muaj teeb meem kev loj hlob siv. Lub dashboard yuav raug hloov kho tshiab txhua ob xyoos ib zaug. Cov kev hloov pauv yav tom ntej yuav suav nrog cov kev ntsuas tus nqi thiab qhov zoo ntxiv, thiab cov ntaub ntawv yuav qhia txog kev nce qib mus rau "kev rov ua kom sib npaug" LTSS ntawm kev saib xyuas hauv tsev mus rau kev pabcuam hauv tsev thiab hauv zej zog.​​ 

Population Health Management Updated Transitional Care Services (TCS) Policy Webinar​​ 

Thaum Lub Ib Hlis Ntuj hnub tim 22, txij thaum 11 teev sawv ntxov txog 12 teev tav su, DHCS yuav tuav lub rooj sib tham hauv online los muab kev piav qhia txog cov kev hloov tshiab tshiab rau txoj cai TCS (yuav tsum tau sau npe ua ntej), raws li tau teev tseg hauv Phau Ntawv Qhia Txoj Cai Tswj Xyuas Kev Noj Qab Haus Huv ntawm Cov Neeg. Txoj cai kho dua tshiab no piav qhia meej txog cov kev cai rau cov tswv cuab uas muaj kev pheej hmoo siab los ntawm kev hloov kho cov lus txhais ntawm "cov pab pawg uas muaj kev pheej hmoo siab", rov lees paub dua DHCS qhov kev tsom mus rau kev saib xyuas cev xeeb tub thiab cov pej xeem uas muaj kev xav tau kev noj qab haus huv, hais txog MCP kev saib xyuas ntawm cov txheej txheem npaj tso tawm hauv chaw kho mob, thiab hais txog qhov tseem ceeb ntawm kev koom tes ntawm cov tswv cuab.​​ 

TCS txoj cai rau cov tswvcuab uas pheej hmoo qis dua kuj tau hloov kho rau xyoo 2024 thiab 2025 los muab kev pabcuam rau cov tswvcuab kev hloov pauv hloov pauv nrog kev sib zog-kov dua li tus qauv rau cov tswvcuab uas muaj kev pheej hmoo siab. Thaum qhov kev hloov kho qis dua tus qauv tshem tawm ib qho kev xav tau ntawm kev sib cuag, nws ua kom pom tseeb tab sis tsawg dua cov neeg ua haujlwm-hnyav rau pawg MCP xov tooj kom muaj rau txhua tus tswvcuab hloov pauv thiab yuav tsum tau rov qab nrog thawj tus kws kho mob lossis chaw kho mob hauv 30 hnub tom qab tso tawm. Nws kuj tseem hais txog cov cai uas twb muaj lawm hauv tsev kho mob hais txog cov txheej txheem tawm. Lub webinar yuav muab sijhawm rau cov neeg koom nrog txaus siab kawm ntxiv thiab nug cov lus nug txog cov kev hloov tshiab tsis ntev los no.​​ 

Statewide Home and Community-Based Services (HCBS) Gap Analysis and Multi-Year Roadmap Stakeholder Meeting​​ 

Thaum Lub Ib Hlis 24, thaum 1 teev tsaus ntuj txog 2:30 teev tsaus ntuj, DHCS thiab California Lub Tsev Haujlwm Saib Xyuas Kev Laus (CDA) yuav tuav lub rooj sib tham nrog cov neeg koom nrog (yuav tsum tau sau npe ua ntej) rau kev soj ntsuam HCBS Gap Analysis thiab Multi-Year Roadmap. Cov neeg hais lus yuav muab cov ntaub ntawv hloov tshiab thiab kev nce qib ntawm txoj hauv kev rau kev tsom xam qhov tsis sib xws nrog rau cov ntsiab lus hais txog kev koom tes nrog cov neeg koom tes thiab cov neeg siv khoom mloog cov kev sib tham ua ib feem ntawm txoj haujlwm no.​​ 

Yog xav paub ntxiv txog cov haujlwm thiab cov ntaub ntawv sib tham yav dhau los, thov mus saib ntawm DHCS lub vev xaib thiab CDA lub vev xaib. Yog tias koj muaj lus nug, thov xa email rau HCBSGapAnalysis@dhcs.ca.gov.​​ 

Launching ECM for Birth Equity Populations: Webinar​​ 

Thaum Lub Ob Hlis 2, thaum 1:30 txog 3 teev tsaus ntuj, DHCS yuav tuav lub vev xaib ntawm Kev Tshaj Tawm ECM rau Cov Neeg Yug Me Nyuam (yuav tsum tau sau npe ua ntej) los tshuaj xyuas lub zeem muag ntawm ECM rau cov neeg yug me nyuam ntawm kev tsom xam (POF) thiab cov hnub pib ntawm kev siv. DHCS, koom tes nrog Medi-Cal MCPs thiab cov chaw muab kev pabcuam thoob plaws lub xeev, tau pib ECM rau kev sib npaug POF thaum Lub Ib Hlis 1.​​ 

Qhov webinar no yuav muab cov ntsiab lus ntawm kev tsim thiab kev taw qhia kev ua haujlwm rau kev yug me nyuam POF; muab kev pom zoo rau tus kws kho mob txog seb lawv tau npaj li cas rau kev tshaj tawm ECM rau kev yug me nyuam POF thiab cov txheej txheem tsim los muab ECM; thiab muab kev taw qhia rau MCPs, cov nroog, thiab cov chaw muab kev cog lus thiab npaj kom xa cov txiaj ntsig ECM los daws qhov tsis sib xws hauv kev noj qab haus huv thiab kev yug me nyuam hauv cov haiv neeg thiab haiv neeg uas muaj leej niam leej txiv thiab cov neeg tuag coob.   ​​   

Lub webinar yog qhib rau txhua tus, tab sis yuav muaj kev txaus siab tshwj xeeb rau MCPs thiab cov chaw zov me nyuam ua haujlwm nrog cov neeg yug me nyuam, suav nrog cov nroog thiab cov koom haum hauv zej zog. Cov kws kho mob xav paub ntau ntxiv txog ECM rau kev sib npaug ntawm kev yug me nyuam POF lossis hais txog cov tswv cuab tuaj yeem tuaj koom. Cov neeg koom nrog raug caw kom xa cov lus nug ua ntej Lub Ib Hlis 29 mus rau CalAIMECMILOS@dhcs.ca.gov. Cov neeg tuaj koom yuav tuaj yeem nug cov lus nug thaum lub webinar.​​  

Hauv Case Koj Tsis Tau Nws​​ 

Children and Youth Behavioral Health Initiative (CYBHI) Daim Ntawv Qhia Txhua Xyoo​​ 

The California Health & Human Services Agency (CalHHS) today released the CYBHI Annual Report, “Implementing the Vision,” which showcases how the historic initiative is making progress in key areas, from launching trauma-informed training for educators to rolling out new digital behavioral health platforms for youth and families. In 2023, CalHHS departments, grantees, and key partners made incredible strides toward achieving the five-year initiative’s goals to transform how California supports the behavioral health of children, youth, and families. Read about substantial investments to build and strengthen the behavioral health workforce, and learn about the impact of $180.5 million in grants for innovative evidence-based and community-defined practices. The CYBHI is shaping a brighter, healthier future for our children, youth, and families. Learn more by diving into the report for an in-depth look at its journey and progress.​​ 

Lub Ib Hlis 2024 Medi-Cal MCP Kev Hloov Pauv​​ 

On January 1, DHCS achieved a significant milestone in its transformation of Medi-Cal with the launch of the new managed care contract and the MCP transition, under which approximately 1.2 million members gained new health plan options and/or transitioned to new MCPs (note: changing MCPs does not affect Medi-Cal member coverage or benefits). To facilitate a smooth transition between MCPs for members, DHCS created Continuity of Care protections to minimize disruptions to members’ care.​​ 

DHCS developed several resources to support members, providers, and other stakeholders with the transition, including the MCP Transition Member webpage with a county “lookup” tool, links to the member notices sent by Medi-Cal about MCP changes, member frequently asked questions in all threshold languages, and a Contact Us page for members to learn more about health plan changes. There are also transition resources for providers, MCPs, and stakeholders. More information about the transition is available in the 2024 MCP Transition Policy Guide and Medi-Cal Eligibility Division Information Letter Number I 23-54.​​ 

The MCP Transition Member webpage includes resources and information to support members’ transition. Members unable to resolve issues or questions after working with their MCP may contact DHCS’ Office of the Ombudsman at toll-free (888) 452-8609 or by emailing MMCDOmbudsmanOffice@dhcs.ca.gov.​​