DHCS Stakeholder News – August 4, 2023
トップニュース
Medi-Cal更新データウェビナー
On August 7, from 3 to 4 p.m., DHCS will virtually host a webinar on the new DHCS continuous coverage unwinding data dashboard (advance registration required) to discuss data for June 2023 Medi-Cal renewals, the first month of California’s redeterminations since the end of the federal continuous coverage requirement on March 31. These data will include initial disenrollments from Medi-Cal eligibility renewals that occurred on July 1. Annual redeterminations will continue monthly, with the last eligibility renewal under the continuous coverage requirement occurring in May 2024, followed by a return to the normal annual renewal process.
BH-CONNECTとCalAIM移行型レントサービスの公聴会
On August 11, from 10 to 11:30 a.m., DHCS will host the first public hearing (advance registration required) to solicit stakeholder comments on the California Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) demonstration and proposed amendment to the California Advancing and Innovating Medi-Cal (CalAIM) Section 1115 demonstration related to transitional rent services. The public hearing will take place in person and have online video streaming and telephonic conference capabilities to ensure accessibility. Please view the “In Case You Missed It” section below for additional details on BH-CONNECT and CalAIM transitional rent services. Please email your questions to 1115Waiver@dhcs.ca.gov.
ECMとコミュニティサポートウェビナー
DHCS will host two virtual webinars (advance registration required) for all stakeholders to provide an overview of the progress of Enhanced Care Management (ECM) and Community Supports implementation and to discuss important policy refinements and areas of reinforcement. The webinars will cover a range of topics, including eligibility, referrals and authorizations, provider networks, payment, market awareness, and data exchange. Key insights from the ECM and Community Supports calendar year 2022 implementation report will also be unveiled:
- ECM 1年目以降：実施の進捗とポリシーの改良、8月14日午後2時から3時
- 1年目以降のコミュニティ支援：実施の進捗と政策の見直し、8月18日午前9時30分～10時30分
For more information, visit the ECM and Community Supports webpage. For questions, please email CalAIMECMILOS@dhcs.ca.gov.
デンタルマネージドケア(DMC)提案依頼書(RFP)
On August 3, DHCS released the Medi-Cal DMC RFP for Sacramento and Los Angeles counties, with responses due no later than 4 p.m. on October 6, 2023. This contract will provide positive changes to the Medi-Cal DMC program. Recognizing the historical shortcomings of DMC plan performance, DHCS worked diligently to ensure there is a revised and comprehensive reform of California’s DMC contracts. DHCS is committed to improving Medi-Cal members’ oral health care delivery and experience—ensuring members have access to person-centered, equity-focused, and data-driven dental care. As a result, Medi-Cal’s DMC contracts will include:
- The Quality Improvement and Oral Health Equity Transformation Program to assess and evaluate DMC plan performance and practices and develop recommendations and implement best practices under a continuous quality improvement methodology. There is engagement at multiple levels of the plan, including Medi-Cal members, plan governing board members, local oral health programs, and others. The program will also engage oral health community advisory committees to develop and implement best practices for the DMC plans’ activities.
- Accountability and commitment to compliance, including monitoring and overseeing delegated entities. The goal is to ensure that members receive high-quality care and have equitable access to services through robust compliance, monitoring, and oversight of all delegated entities. DMC plans will be held accountable for quality of care at all levels of delegation. This will include justifying the use of delegated entities and subcontractors to ensure that the member’s experience and outcomes are front and center.
- Increased focus on integrating medical and dental care. Providers are empowered to educate members about preventive services for oral health, using data-driven metrics to monitor the efficacy of the DMC plan’s and medical plan’s efforts. Members will benefit from medical-dental care coordination of focused member outreach from a plan to a member when the plan receives data that an emergency room visit related to oral health has occurred. Members will also receive more information to help them choose the best plan for their families and/or individual needs. Plans will be required to regularly report publicly on access, quality improvement, and oral health equity activities, including performance and consumer satisfaction.
DHCSは現在、ロサンゼルス郡のプリペイドヘルスプラン(PHP)プログラムとサクラメント郡のジオグラフィックマネージドケア(GMC)プログラムの3つのDMCプランと契約しています。 このRFPは、DMCがサクラメント郡でGMCを、ロサンゼルス郡でPHPを引き続き運営する計画を対象としています。 RFPの契約締結予定日は2024年1月で、その後すぐに契約準備期間が開始されます。 DHCSは、2024年8月1日に開始すると予想される54か月の契約運用期間のキャピテーションレートを設定します。
プログラムの最新情報
子供と若者の行動健康イニシアチブ(CYBHI)助成金が利用可能
On August 7, DHCS will release a Request for Application (RFA) seeking proposals from various individuals, organizations, and agencies for the third round of grant funding, totaling $60 million, to scale evidence-based practices and community-defined evidence practices (EBP/CDEP) for early childhood wraparound services. The application deadline is October 6 at 5 p.m. Details are posted on the DHCS EBP/CDEP website.
Also, on July 31, the Mental Health Services Oversight and Accountability Commission (MHSOAC), in partnership with DHCS, released a separate RFA seeking proposals for the fourth round of grant funding, totaling $50 million, to scale youth-driven EBPs and CDEPs. MHSOAC will host a Bidders Conference webinar on August 9, from 11 a.m. to 12:30 p.m. to walk through the RFA and provide applicants the opportunity to ask questions about the procurement process and to obtain clarification on any component of the RFA. For this RFA, applications must be submitted electronically to the MHSOAC via e-mail to procurements@mhsoac.ca.gov by September 15 at 3 p.m. Please email any questions to procurements@mhsoac.ca.gov.
For all other questions about CYBHI EBP/CDEP grants, please contact DHCS at CYBHI@dhcs.ca.gov. For additional information, please see DHCS’ CYBHI webpage, which includes the CYBHI EBP/CDEP Grant Strategy that highlights DHCS’ overall strategy to scale EBPs/CDEPs across multiple funding rounds.
薬物による中絶に関する公衆衛生上の緊急事態(PHE)後の政策の明確化
On August 1, DHCS updated its policies on medication abortions. Under this new policy, providers may be reimbursed for medication abortions through 77 gestational days for services provided on or after July 1. In addition, DHCS made permanent COVID-19 flexibilities, including those that allowed the use of telehealth modalities for services without payment reduction when providing medication abortions. For more information about Medi-Cal’s abortion policies, please see the Medi-Cal Provider Manual for Abortion and the Post-PHE Policy Clarification for Medication Abortion news article.
ポピュレーションヘルスマネジメントイニシアチブ:Building the Foundation実装ガイドシリーズが利用可能になりました
DHCS is pleased to share progress updates on the Population Health Management Initiative (PHMI), a California partnership between DHCS, Kaiser Permanente, and community health centers. The goal is that each participating community health center will focus on a common set of priority measures and specific populations, including children, pregnant people, people with behavioral health conditions, and adults living with chronic conditions and preventive care needs. The common set of priority measures directly align with the Federally Qualified Health Center (FQHC) Alternative Payment Methodology, which is a new payment system that seeks to transform the care provided through community health centers.
As of July 31, PHMI has launched the executive summaries of the Building the Foundation Implementation Guide series, which previews four implementation guides for primary care practices in California. These guides serve as an organized quality improvement strategy, with the goal of supporting substantive cultural, technological, and process changes that improve population-based care. The first version of these guides will be made available this fall.
For more information about PHMI, visit www.phminitiative.com. To receive quarterly newsletter updates about PHMI, sign up here.
Medi-Cal Rxの
On August 4, the next wave of reinstatement will occur. Phase IV, Lift 1 will be the first lift impacting claims utilization management for members 22 years of age and older. The claim edits will be reinstated for Product/Service Not Covered for Patient Age, Product/Service Not Covered for Patient Gender, and Brand Drug/Specific Labeler Code Required. Pharmacy providers will also receive supplemental messaging with the reject codes.
私たちのチームに参加しませんか
DHCS is hiring for 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.
今後のステークホルダーミーティングとウェビナー
Health Enrollment Navigators Project ステークホルダーミーティング
On August 7, from 1 to 2:30 pm, the DHCS Medi-Cal Health Enrollment Navigators Project will host their next quarterly stakeholder meeting. The Navigators Project team will provide updates on project activities. For more information, visit the Navigators Project website.
CYBHIウェビナー
On August 7, from 2 to 3:30 p.m., DHCS will virtually host a CYBHI webinar (advance registration required) to keep stakeholders apprised of DHCS’ progress in implementing various CYBHI work streams and to share CYBHI updates, including a walkthrough of the EBP/CDEP Round 3 RFA. Key attendees include youth, parents, family members, behavioral health providers, Medi-Cal managed care plans, county behavioral health departments, commercial health plans, education, and other cross-sector partners.
医療提供者および聴覚専門家向けの子供向け補聴器カバレッジプログラム(HACCP)ウェビナー
On September 14, from 12 to 1 p.m., DHCS will host a HACCP webinar (advance registration required) to share information with providers to help pediatric patients and their families maximize HACCP benefits. The training session will address program requirements for families to apply for coverage and the claims submission process for audiologists, otolaryngologists, physicians, and their office staff.
見逃した場合に備えて
BH-CONNECTおよびCalAIM移行レンタルサービス
2023年8月1日、DHCSは、BH-CONNECTデモンストレーションと題された新しいセクション1115デモンストレーションリクエストに対するフィードバックを求めるために、30日間のパブリックコメント期間を開始しました。DHCSはまた、移行期の賃貸サービスに関連するCalAIMセクション1115のデモンストレーションの修正案に対するフィードバックを求めるために、30日間のパブリックコメント期間を開始しました。 両方のパブリックコメント期間は、2023年8月31日までです。
BH-CONNECTの背景
The BH-CONNECT demonstration builds upon unprecedented investments and policy transformations currently underway in California that are designed to expand access to community-based behavioral health care and improve outcomes for Medi-Cal members living with the most significant mental health and substance use needs. California has invested more than $10 billion and is implementing landmark policy reforms to strengthen the behavioral health care continuum. California’s proposed goal for the BH-CONNECT demonstration is to complement and amplify these major behavioral health initiatives to establish a robust continuum of community-based behavioral health care services and improve access, equity, and quality for Medi-Cal members living with SMI and SED, particularly populations experiencing disparities in behavioral health care and outcomes. The BH-CONNECT demonstration aims to expand Medi-Cal service coverage, drive performance improvement, and support fidelity implementation for key interventions proven to improve outcomes for Medi-Cal members experiencing the greatest inequities, including children and youth involved in child welfare, individuals with lived experience with the criminal justice system, and individuals at risk of or experiencing homelessness.
CALAIM移行家賃改定の背景
重要な移行期または高リスクの基準を満たすMedi-Calメンバーの幸福と健康状態を改善するために、DHCSは、ホームレスまたはホームレスのリスクがあり、施設レベルのケアから移行する適格な個人に最大6か月の移行レンタルサービスを提供するために、CalAIMセクション1115デモンストレーションの修正を求めています。 住宅環境、矯正施設、児童福祉制度、療養施設、入院後の短期住宅、移行住宅、ホームレスシェルター、または暫定住宅、および保護されていないホームレスまたはフルサービスパートナーシップ(FSP)プログラムの基準を満たす人々。 移行期の賃貸サービスは、6か月以内の期間利用できます。費用対効果が高いものでなければなりません。また、臨床的およびその他の健康関連の社会的ニーズ基準を使用して医学的に適切であると判断された場合にのみ提供されます。 移行期の賃貸サービスは、Medi-Calのマネージドケアプランが提供する、およびMedi-Calメンバーが使用する場合は任意です。
Please visit the DHCS BH-CONNECT webpage and DHCS CalAIM 1115 Demonstration & 1915(b) Waiver webpage for background information, links to public comment materials, and information about how to provide feedback during the public comment period.
カリフォルニア州スマイルMedi-Cal Dental Servicesのキャンペーン
On July 25, DHCS issued a news release in English and Spanish to promote the Sealants for a Healthy Smile (SHS) statewide push to encourage parents and guardians to protect their children’s dental health by utilizing their Medi-Cal Dental benefits and scheduling dental checkups for sealant applications. Subsequent stops of the mobile van tour will continue on August 11 in Trinity County, August 17-18 in Mono County, and August 29 in Colusa County. To reach and inform parents in the Central Valley, Smile, California partnered with Radio Bilingüe, a leading Latino public radio network, to run promotional programming through September.
To disseminate resources and information (fact sheet, infographic, and coloring sheet) to Medi-Cal members statewide, Smile, California outreach representatives are identifying and participating in in-person opportunities within their assigned regions during the promotion period. Representatives will assist with provider referrals, distribute relevant Smile, California resources, and promote Medi-Cal Dental covered services at community events, such as health fairs, parent nights, and back-to-school/open house events.