DHCS Stakeholder News – August 12, 2022
親愛なるステークホルダーの皆様へ
医療サービス省(DHCS)は、DHCSプログラムに関する重要な進展について、この最新情報を提供しています。
トップニュース
DHCSがサル痘ガイダンスを連邦パートナーに要請
On August 12, DHCS sent a letter to the Centers for Medicare & Medicaid Services (CMS) requesting immediate guidance for establishing a Medicare rate for the monkeypox vaccine administration.
In an effort to be responsive to our Medi-Cal beneficiaries and providers, California will submit a Disaster State Plan Amendment to seek federal approval to reimburse vaccine administration and applicable laboratory testing at 100 percent of the Medicare rate, once established. As part of this request, DHCS will seek federal approval to reimburse Federally Qualified Health Centers, and similarly situated clinics that are paid an all-inclusive rate, the vaccine administration fee for vaccine-only visits, consistent with how DHCS is reimbursing for COVID-19 vaccine-only visits. The requested federal approvals will also include reimbursement for vaccine administration performed by non-clinic providers.
Additionally, please see the Centers for Disease Control and Prevention’s Reducing Stigma in Monkeypox Communication and Community Engagement and the California Department of Public Health’s toolkit messaging for sharing broadly among your networks.
Medi-Calプレミアムの払い戻し
上院法案184号(Omnibus Health Bill 2022)は、DHCSがMedi-Calプログラムの保険料をゼロに引き下げることを承認しました。 2022年7月1日より、以下のプログラムにご入会のお客様は、参加資格の要件としてプレミアムを支払う必要がなくなりました。
- Optional Targeted Low Income Children’s Program
- Medi-Calアクセスプログラム
- Medi-Cal Access 幼児プログラム
- County Children’s Health Initiative Program
- 250パーセントワーキング障害者プログラム
DHCS released policy guidance via All County Welfare Directors Letter #22-14 and Medi-Cal Eligibility Division Information Letter #I 22-25, and is seeking federal authority to implement this policy through SPA 22-0042 and SPA 22-0034, which are pending CMS approval. Furthermore, DHCS has begun the process of issuing refunds to Medi-Cal and Children’s Health Insurance Program (CHIP) beneficiaries who overpaid their premiums as of July 1.
U.S. Surgeon General’s Comments on the Children and Youth Behavioral Health Initiative (CYBHI)
In a recent SAGE Journals article, U.S. Surgeon General Dr. Vivek H. Murthy highlighted the work that is underway through the CYBHI. The article serves as a call to action for the nation, with a stark reminder of what’s at stake in ensuring that children and youth receive the help they need when and where they need it, especially those in our most underserved communities.
The CYBHI, which includes multiple work streams that are led by five departments and offices within the California Health & Human Services Agency (CalHHS) – DHCS, Department of Health Care Access and Information, Department of Managed Health Care, California Department of Public Health, and the Office of the California Surgeon General – focuses on promoting mental, emotional, and behavioral well-being by preventing challenges and providing services, support, and routine screening for all children and youth for emerging and existing needs.
プログラムの最新情報
カリフォルニア州の高齢者のためのMedi-Calアウトリーチと登録支援
DHCSは、Medi-Cal健康保険の対象となる可能性のある28,000人の高齢者にアウトリーチと登録支援を提供しています。 DHCSは、カリフォルニア州郡協会とCalifornia Coverage & Health Initiatives(CCHI)に2,400万ドルを授与し、2024年6月30日まで登録支援の取り組みで提携しました。取り組みは、以下のことを目的としています。
- 二重の適格受益者または65歳以上の受益者で、Medi-Calの適格性再決定が保留されています。
- すでにMedi-Calに登録されており、メディケアの適格性を判断するための支援が必要な65歳以上の人々。
- Medi-Calの資格があるが、現在登録されていない65歳以上または障害のある個人(Medicare Savings Programsの資格がある人を含む)。
- 移民ステータスに関係なく、Medi-Calが50歳以上の成人に拡大されたため、新たにMedi-Calの資格を持つ個人。
- 65歳になるMedi-Calの受給者は、その郡の1つ以上のMedi-Calマネージドケアプラン(MCP)との契約を条件として、まだメディケアに登録していません。
CCHIは、Medi-Calの受益者へのアウトリーチと登録支援を長年行ってきた経験を持つコミュニティベースの組織によって支援され、Medi-Calの受給者の対象となる人々が医療サービスへのアクセスを増やして結果を改善し、健康格差を減らすことができるようにします。 詳細については、 Medi-Cal Outreach and Enrollment for Older CaliforniansのWebページをご覧ください。
CHIP登録および再決定ポリシーの更新
On August 3, CMS approved DHCS’ State Plan Amendment (SPA) CA-22-0035 submission, allowing DHCS to implement provisions for temporary adjustments to enrollment and redetermination policies. Effective July 1, 2022, DHCS is able to use a regulatory timeliness exception for the timely processing of CHIP applications and renewals for children in families living and/or working in state- or federally-declared disaster areas.
このSPAを通じて、カリフォルニア州は、SPA CA-17-0043を通じて承認された災害救援規定を、2022年3月にリリースされた更新された災害救援SPAテンプレートに合わせるための技術的な変更を加えています。 これらのSPA規定は、災害の影響を受けた規定と地域の発効日をCMSに通知することにより、将来の州または連邦が宣言した災害時に実施できます。
Mobile Crisis Services Request for Information(RFI)がリリースされました
On August 8, DHCS released a RFI for the mobile crisis services benefit. The RFI invites vendors to provide DHCS with information to support training for and implementation of mobile crisis services. DHCS intends to submit a SPA to add qualifying community-based mobile crisis intervention services as a new Medi-Cal benefit, effective no sooner than January 2023. Implementing mobile crisis services is an integral part of California’s broader efforts to strengthen the continuum of community-based care for Medi-Cal beneficiaries who are experiencing a mental health or substance use disorder crisis.
DHCSは、トレーニング、準備レビュー、および技術支援に関連する資料とガイダンスを含む Medi-Calモバイル危機サービス給付を開発しています。
病院および熟練した看護施設のCOVID-19労働者維持支払いプログラム
DHCSは、このプログラムの基準日と最終提出日に関する最新のガイダンスを提供しています。
- 記録日については、対象となる従業員は、2022年11月28日までに対象事業体または対象サービス雇用主に雇用され、留保金の対象となる必要があります。
- 提出の最終日については、対象事業体および対象サービスの雇用主は、2022年12月30日午後5時までに、適格な従業員のリストを含む申請書を提出する必要があります。
今後数週間のうちに、DHCSは、毎週のステークホルダー発表を通じて、提出プロセスと一般的な更新に関する追加のガイダンスを提供し、 病院および熟練看護施設のCOVID-19労働者維持支払いのウェブページで提供します。
子供向け補聴器補償プログラム(HACCP)の更新
DHCSは、援助コードA1の対象給付を拡大し、骨伝導補聴器(BCHD)に関連する新しいHACCP給付を含め、2021年7月1日以降のサービス日に遡って有効になりました。
For more information about HACCP coverage of BCHDs, please see the Medi-Cal Provider Newsflash. For information about the program more broadly, please see DHCS’ HACCP webpage, which was recently expanded to include additional resources for families and providers, including a secure chat option for communicating with the HACCP Call Center or uploading additional materials for an application that has already been submitted. Additionally, families seeking to apply for HACCP coverage may now submit their application electronically through the HACCP Online Application Portal.
Medi-Cal Rx実装アップデート
DHCSとマゼラン(MMA)は、クレーム編集の段階的な復活と事前承認(PA)要件のための集中的な計画プロセスに取り組みました。
- フェーズ 1 のウェーブ 1 は、2022年 7 月 22日に実施され、National Council for Prescription Drug Programs (NCPDP) Reject Code 88 – Drug Utilization Review (DUR) Reject Error for DUR alerts (薬物間相互作用、高用量、早期補充など) の請求編集を復活させました。復職のアプローチは段階的かつ反復的であり、ステークホルダーの準備とパフォーマンスの監視に重点を置いています。 これは、データ分析、運用経験、および利害関係者のフィードバックに基づいて、時間の経過とともに必要に応じて改善されます。
- フェーズ1、ウェーブ2は、現在実施されており、CoverMyMeds(CMM)の使用の促進に焦点を当てています。
- Phase one, wave three is slated to begin on September 16 with the reinstatement of PA requirements for 11 drug classes for new start prescriptions for beneficiaries 22 years of age and older. Stakeholders are encouraged to continue submitting comments and feedback on the reinstatement approach via Reinstatement@dhcs.ca.gov.
コミュニティヘルスワーカー(CHW)SPA承認
On July 26, DHCS received CMS approval for SPA 22-0001, which adds CHW as a preventive service. Developed in consultation with stakeholders, this SPA created CHW services as a Medi-Cal benefit, effective July 1, 2022, for both fee-for-service and managed care delivery systems. For more information about CHW services, including a link to the provider manual, please see the CHW webpage.
公開されたCOVID-19情報
今後のステークホルダーミーティングとウェビナー
California Advancing and Innovating Medi-Cal(CalAIM)免除更新ウェビナー
On August 22 at 10 a.m., DHCS will virtually host a public hearing to receive stakeholder feedback on the proposed amendments to the CalAIM Section 1115 demonstration and Section 1915(b) waiver. Please register for this webinar in advance.
DHCS launched 30-day public comment and Tribal public comment periods on August 12. DHCS is seeking the CalAIM Section 1115 and 1915(b) amendment approvals from CMS to implement county-based model changes in the Medi-Cal Managed Care (MCMC) program. Through the Section 1915(b) waiver amendment, DHCS also plans to add or update language on policies or programs in the approved CalAIM 1915(b) waiver, including to reflect the MCMC model changes in select counties and direct contracts with the Kaiser Foundation Health Plan available for enrollment of certain Medi-Cal beneficiary populations in select counties. Additional information about the CalAIM Section 1115 demonstration application and Section 1915(b) overview are available on the CalAIM 1115 Demonstration & 1915(b) Waiver webpage. The 30-day public comment and Tribal public comment periods end on September 12.
HPV予防接種について家族PACTのクライアントと話す
On August 17, DHCS and the California Prevention Training Center will hold a webinar to provide information about the effectiveness and safety of the human papillomavirus (HPV) vaccine, review current Centers for Disease Control and Prevention recommendations for the use of the HPV vaccine, and provide advice on how to have effective shared decision-making conversations with clients about being immunized. Advance registration for PACT webinar is required. Effective July 1, 2022, the Family PACT program added HPV vaccination as a clinic benefit for individuals ages 19 through 45. For those unable to attend the live webinar, a transcript and recording of the webinar, along with additional resources, will be available on the Family PACT website.
Medi-Cal Dental Statewideステークホルダーミーティング
8月18日午前10時、DHCSは仮想のMedi-Cal Dental Statewide Stakeholder会議を開催します。 この会議の目的は、州全体の歯科関係者に、Medi-Cal Dentalプログラムに関するフィードバックを共有するためのフォーラムを提供し、DHCSが新規および/または今後の作業努力に関する重要な最新情報と情報を共有することです。 追加情報は、 Medi-Cal Dental Statewide Stakeholder meetingのWebページで入手できます。
DHCS CalAIM MLTSSおよびDuals統合ワークグループ会議
On August 18 at 10 a.m., DHCS will virtually host the CalAIM Managed Long-Term Services and Supports (MLTSS) and Duals Integration Workgroup meeting. Please register for the meeting, which is open to the public.
The meeting will serve as a stakeholder collaboration hub for CalAIM MLTSS and integrated care for dual eligible beneficiaries. It will also give stakeholders an opportunity to provide feedback and share information about policy, operations, and strategy for upcoming changes to Medicare and Medi-Cal. Agenda items include a summary of January 2023 enrollment changes; a presentation on the January 2023 transitions impacting dual eligible beneficiaries, including noticing, monitoring, and timelines; and an update on the Dementia Care Aware initiative.
Background materials, transcripts, and video recordings of the previous workgroup meetings, along with additional information about the workgroup, are posted on the CalAIM MLTSS and Duals Integration Workgroup webpage.
カリフォルニア州スマイル Medi-Cal Dental Servicesのキャンペーン
Smile, California is hosting Facebook Live presentations for Medi-Cal members in Spanish and English. The Spanish presentation will be held on August 24 at 1 p.m.; RSVP on Facebook. The English presentation will be held on August 26 at 1 p.m.; RSVP on Facebook. A Smile, California member outreach representative will deliver the Smile, your Medi-Cal benefits include dental! presentation, and a provider relations trainer will assist with answering audience questions.
歯科医療従事者のためのPAVEポータルトレーニング
On August 24 at 11 a.m., DHCS will host a webinar introduction to PAVE for dental providers. Beginning on October 31, DHCS will implement the PAVE portal for dental providers, offering a new mode for submitting dental provider enrollment applications and required documentation to DHCS. This allows applicants to use the Medi-Cal Provider e-Form Application, as DHCS will no longer accept paper applications once PAVE is implemented. For more information about the webinar, including the registration link for the August 24 training, please view this Medi-Cal Dental Provider Bulletin. The PAVE demonstrations will be recorded and posted on the DHCS PAVE webpage.
DHCS家族計画事務所ステークホルダー会議
On August 24, DHCS will host a virtual family planning stakeholder meeting. The link to the meeting will be available on the Office of Family Planning webpage prior to the meeting.
ドゥーラベネフィットステークホルダーミーティング
On August 24, DHCS will host a virtual stakeholder workgroup meeting about adding doula services as a covered Medi-Cal benefit. The meeting is open to the public. DHCS will engage with workgroup members on policy development details that will be reflected in the Medi-Cal provider manual and other policy guidance documents. All interested stakeholders may listen to the workgroup discussion regarding stakeholder feedback and provide input via email. DHCS will also share an update on the status of formal submission of the SPA to CMS. The link for the stakeholder meeting will be available on the doula webpage prior to the meeting.
CalAIMウェビナー:強化されたケア管理(ECM)とコミュニティサポートメンバーエンゲージメント
On August 25 at 1:30 p.m., DHCS will host an all-comers webinar on CalAIM ECM and Community Supports member engagement. Topics for this session will include provider and member communications, referrals, outreach, and enrollment. This event is part of a series of technical assistance and informational sessions focused on supporting implementation of ECM and Community Supports. Throughout the series, DHCS leaders will be joined by presenters from MCPs, providers, and CBOs implementing CalAIM.
Advance registration for CalAIM webinar is required. Participants are invited to submit questions by August 22 to CalAIMECMILOS@dhcs.ca.gov. Attendees will also have the opportunity to ask questions during the webinar. An additional “Office Hours” event will be held on September 1 at 2 p.m. (see below) for attendees to ask any other questions not covered during the webinar.
CYBHIマンスリーウェビナー
On August 29 at 3 p.m., DHCS will virtually host a webinar to keep stakeholders apprised of DHCS’ progress in implementing various work streams of the CYBHI. Key attendees include, but are not limited to, youth, parents, family members, behavioral health providers, Medi-Cal MCPs, county behavioral health departments, and commercial health plans, as well as education and other cross-sector partners. CYBHI Monthly Webinar advance registration is required.
CalAIMオフィスアワー:ECMとコミュニティがメンバーのエンゲージメントをサポート
On September 1 at 2 p.m., DHCS will virtually host an “Office Hours” discussion on CalAIM ECM and Community Supports member engagement. As a follow-up to the August 25 webinar on this topic, this question and answer session will cover provider and member communications, referrals, outreach, and enrollment. This event is part of a series of “Office Hours” events focused on answering implementation questions from the field.
Advance registration is required. Participants are invited to submit questions by August 29 to CalAIMECMILOS@dhcs.ca.gov. Attendees will also have an opportunity to ask questions during the session.