2021年12月に戻る ステークホルダーコミュニケーションの最新情報​​ 

Adverse Childhood Experiences(ACE)対応​​ 

Less than two years after launching, ACEs Aware has reached two key milestones by training more than 20,500 California clinicians to screen for ACEs, thereby facilitating the ACEs screening of more than 500,000 children and adults across the state. Since December 2019, DHCS and the Office of the California Surgeon General (CA-OSG) have co-led the ACEs Aware initiative to train clinical teams to screen children and adults for ACEs in primary care settings; become eligible for directed payments through Medi-Cal; and treat the impacts of toxic stress with trauma-informed care and evidence-based interventions.​​ 

Building upon these successes, two of the University of California’s nationally ranked medical centers – University of California, Los Angeles (UCLA) and University of California, San Francisco (UCSF) – have partnered with DHCS and CA-OSG to establish the UCLA/UCSF ACEs Aware Family Resilience Network (UCAAN). Led and administered through the Department of Pediatrics at the David Geffen School of Medicine at UCLA and the UCSF Center to Advance Trauma-Informed Health Care (CTHC), UCAAN leverages the rich and diverse expertise and resources of both UC campuses across disciplines to develop, promote, and sustain evidence-based methods to screen, treat, and heal from the impacts of childhood adversity.​​ 

ネットワーク認定の年次更新​​ 

DHCS submitted network adequacy certification documentation, including the assurance of compliance for Medi-Cal MCPs and Dental Managed Care plans to CMS on November 1. Five MCPs were placed under corrective action plans (CAP) for not fully meeting network adequacy standards. DHCS is working with the MCPs on their CAP efforts and is analyzing the most recent network adequacy data to determine MCP compliance. The MCPs will have six months to address and rectify the CAP findings. The network adequacy assurance and certification letters to CMS are available on the DHCS website.​​ 

DHCS submitted network adequacy documentation, including assurance of compliance for Mental Health Plans (MHPs) and Drug Medi-Cal Organized Delivery System (DMC-ODS) plans, to CMS on December 1. A total of 39 MHPs and 31 DMC-ODS were placed on CAPs for not fully meeting network adequacy standards. DHCS is working with the MHPs and DMC-ODS on their CAP resolution efforts and will meet with counties on a monthly basis to provide technical assistance. The MHPs and DMC-ODS will have five months to address and rectify the CAP findings, with all CAP resolution documentation and data due March 2022. The network adequacy assurance and certification letters to CMS will be posted to the DHCS website within the month of December 2022.​​ 

資産制限 – 非修正調整総利益 (MAGI) Medi-Cal​​ 

Assembly Bill (AB) 133 (Chapter 143, Statutes of 2021) added Welfare and Institutions Code (WIC) section 14005.62, which authorizes a two-phased approach to eliminating the asset test for all non-MAGI Medi-Cal programs, including long-term care and the Medicare Savings Programs. Phase I will be implemented on July 1, 2022, and will increase asset limits to $130,000 per person and $65,000 per additional person being evaluated. Phase II will be implemented on January 1, 2024, and will eliminate the asset test. In November, DHCS issued policy guidance to the counties regarding the Phase I implementation in an All County Welfare Directors Letter (ACWDL 21-31).​​ 

Behavioral Health Continuum Infrastructure Program(BHCIP)アップデート​​ 

On November 1, DHCS released the Request for Application (RFA) for the BHCIP Round Two County and Tribal Planning Grant. Eligible applicants are county agencies and Tribal entities. These grant funds will allow county and Tribal partners to plan how best to address local behavioral health facility needs, along with developing strategies and action steps to meet these needs. Grant amounts will be up to $150,000. The BHCIP’s goal is to expand behavioral health infrastructure capacity statewide, and this grant is the second in a series of six rounds of available funding. The RFA is available at https://www.infrastructure.buildingcalhhs.com/. For more information, please email BHCIP@dhcs.ca.gov, visit the DHCS website, or go to the BHCIP project website.​​ 

行動健康連邦助成金の更新​​ 

10月25日、DHCSは、リカバリー・サービス・プロジェクト(RSP)を実施するために、Sierra Health Foundation: Center for Health Program Managementに約7,730万ドルを授与しました。 センターは、深刻な精神疾患(SMI)、深刻な感情障害(SED)、および物質使用障害(SUD)を持つ個人のための州全体の回復サービスを支援するために、RFAを通じて7,350万ドル以上を利用できるようにします。 DHCSとセンターは、多様なステークホルダーと広範なコミュニティエンゲージメントを行い、復旧サービスプログラムを定義し、地域社会のユニークな復興サービスのニーズをよりよく理解します。 その後、DHCSとセンターは、コミュニティのフィードバックをRFAプロセスに統合し、これらのコミュニティのニーズを反映した助成金の最適な使用方法を決定します。 コミュニティエンゲージメントプロセスの調査結果に応じて、被付与者は次のことができます。​​ 

• 地域復興コミュニティ支援機関の発展を支援する。​​ 
• 地域レベルでの回復関連のスティグマと差別を減らすための戦略と教育キャンペーン、トレーニング、およびイベントを開発します。​​ 
• SMI、SED、SUDのエビデンスに基づく回復モデルの使用を拡大します。​​ 
• SMI、SED、および SUD のリカバリ リソースを提供し、システム ナビゲーションをサポートします。​​ 
• 多様な集団に対するピアリカバリー支援サービスのアクセシビリティを向上させます。​​ 
• 地元の民間および非営利の臨床医療提供者、宗教コミュニティ、市、郡、州、および連邦の公衆衛生機関、および回復サービスを拡大するための刑事司法対応の取り組みと協力および調整します。​​ 

RSPの詳細については、BHRRP@dhcs.ca.gov に電子メールを送信するか、DHCSのWebサイトにアクセスしてください。​​ 

CalHOPE​​ 

The CalHOPE Crisis Counseling Assistance and Training Program (CCP) received federal approval to extend services, allowing the program to continue through February 9, 2022, providing emotional support for all Californians. CalHOPE Connect provides CCP services through the chat feature. CalHOPE also continues to partner with Together for Wellness and Juntos por Nuestro Bienestar, which feature evidence-based community resources to help manage stress and anxiety; the CalHOPE Warm Line, (800) 317-HOPE (4673), which connects callers to other people who have persevered through struggles with stress, anxiety, and depression; CalHOPE Redline connecting urban Native American Indian and Alaskan Natives to resources and providing outreach through phone, chat, and in-person services; and CalHOPE Student Support, which develops courses to train teachers and school staff to identify students suffering from mental distress, provide brief interventions, and refer children and their families to mental health providers.​​ 

The IndieFlix Foundation, in partnership with CalHOPE, Blue Shield of California, and the California Department of Education, developed ANGST: Building Resilience, a film based on a mental health support program, endorsed by educators, psychiatrists, and mental health advocates. The film includes Olympic swimmer Michael Phelps, who spoke of his own challenges with anxiety. The kick-off event was held on October 19, and the film aired on Sacramento PBS affiliate KVIE on October 20. The program will be provided to all California public middle and high schools during the 2021-2022 academic year.​​ 

コンプライアンスの証明 – 異動、退院、および再任の拒否 ヒアリングの決定​​ 

In December, DHCS will post a certification of compliance to its website. Pursuant to AB 133 (Chapter 143, Statutes of 2021), section 14126.029 was added to the WIC, requiring long-term care facilities to timely comply with a hearing decision of DHCS’ Office of Administrative Hearing and Appeals finding that a long-term health care facility improperly transferred, discharged, or refused to readmit a resident. Once posted, long-term care facilities will be required to submit the certification pursuant to the instructions provided. The certification form will be included with each decision.​​ 

コンプライアンスを実証するために、長期医療施設は、ヒアリング決定が送達された日から3暦日以内にDHCSへのコンプライアンス証明書を提出する必要があります。 施設が適時に認証を提出しなかった場合、または聴聞会の決定を適時に遵守しなかった場合、DHCSは、施設が遵守しなかった日ごとに1日あたり750ドルの罰金を課すことができ、合計で75,000ドルを上限とします。​​ 

連続血糖値モニター​​ 

DHCS will add Therapeutic Continuous Glucose Monitoring Systems as a pharmacy-billed medical supply benefit through Medi-Cal Rx, effective January 1, 2022. The coverage criteria and provider bulletins will be available on the Medi-Cal Rx website the first week of December 2021.​​ 

Dental Integration – Health Plan of San Mateo (HPSM)​​ 

Senate Bill (SB) 849 (Chapter 47, Statutes of 2018) authorized DHCS to establish a dental integration program in San Mateo County to include Medi-Cal dental services as a covered benefit under HPSM. The purpose of this effort is to test the impact on oral care access, quality, utilization, and medical costs by delivering covered dental services under the Medi-Cal managed care delivery system. The integration of the dental benefit into HPSM will take effect on January 1, 2022, and will be authorized for no more than six years, ending on December 31, 2027. All Medi-Cal members enrolled in HPSM will receive their dental care through HPSM in addition to their medical services. HPSM members were mailed notices in October, November, and December to inform them of this benefit change. Provider bulletins are also posted on the Medi-Cal Dental website.​​ 

デンタル・トランスフォーメーション・イニシアチブ(DTI)​​ 

As of October 31, 2021, the total amount of Domain 2 payments issued is approximately $210 million, and 3,461 providers have opted in to participate. The goal of Domain 2 is to diagnose early childhood caries by using caries risk assessments to treat it as a chronic disease and to introduce a model that prevents and mitigates oral disease. For more information, please visit the DHCS website. In accordance with the Medi-Cal 2020 waiver extension, DTI will end on December 31, and payments will continue for dates of service through December 31, 2021.​​ 

医薬品Medi-Cal組織化デリバリーシステム(DMC-ODS)​​ 

The DMC-ODS 1115 demonstration waiver is active in 37 counties, covering 96 percent of California’s population. DHCS is in negotiations with CMS for approval of the DMC-ODS program in the new waiver period, from 2022-2026; DHCS developed the policies included in the new waiver through multiple stakeholder engagement meetings and stakeholder comments on a draft information notice posted in November. The final information notice outlining updated DMC-ODS policy will be released in December.​​ 

Also, DHCS implemented SB 823 (Chapter 781, Statutes of 2018) through Behavioral Health Notice No.: 21-001, which requires DHCS’ licensed alcohol and other drug (AOD) recovery treatment facilities to obtain at least one DHCS Level of Care (LOC) Designation and/or at least one residential ASAM LOC Certification consistent with all of its program services. As of October 2021, DHCS has processed 1,527 total designations for AOD providers in California. Of those designations, 1,227 are active for 437 providers. More information about the DMC-ODS is available on the DHCS website.​​ 

Additionally, DHCS contracts with an External Quality Review Organization (EQRO) to review DMC-ODS counties annually regarding access, timely access, and quality of care. The information from these reviews is summarized in annual county reports, which are posted on the EQRO website. Through a contract with UCLA Integrated Substance Abuse Programs, DHCS is conducts annual DMC‑ODS waiver evaluation activities to measure and monitor program outcomes; DMC‑ODS waiver evaluation reports are posted on the UCLA ISAP website.​​ 

ホームおよびコミュニティベースの代替案(HCBA)免除修正​​ 

DHCS will be submitting a technical amendment to CMS to increase the daily reimbursement rates to providers for HCBA Waiver Intermediate Care Facilities for the Developmentally Disabled – Continuous Nursing Care (ICF/DD-CNC), pursuant to AB 133 (Chapter 143, Statutes of 2021). The rate increases will go into effect upon authorization by CMS, which can be up to 90 days after submission.​​ 

HCBAの免除は、Medi-Calの受益者が選択したコミュニティ環境で、長期的なコミュニティベースのサービスとサポートを提供します。 これらのサービスには、施設ではなくコミュニティ環境で看護レベルのケアを必要とする個人の健康と安全を維持するために必要な私的看護、ケース管理、およびパーソナルケアサービスが含まれます。​​ 

MCP Procurement – Model Changes Update​​ 

DHCS completed its review of the approved county ordinances that were required to be submitted to DHCS by October 10. A final list of counties approved to move forward with a Plan Model change was posted on the DHCS website.​​ 

Additionally, by December 3, MCPs were each required to submit for DHCS review a network contracting strategy; those strategies are being reviewed. Final approval to implement on January 1, 2024, will be based upon MCP operational readiness and CMS approval. Additional information is available on the DHCS website.​​ 

Medi-Cal Health Enrollment Navigators プロジェクト​​ 

DHCS is expanding and extending efforts to enroll hard-to-reach Medi-Cal populations. Effective July 1, 2019, AB 74 (Chapter 23, Statutes of 2019) appropriated $59.7 million for DHCS to partner with counties and community-based organizations (CBOs) to conduct Medi-Cal outreach, enrollment, retention, and navigation services for hard-to-reach Medi-Cal and potentially eligible Medi-Cal populations. Due to the community health impacts of COVID-19, navigator services are now more critical than ever. Project partners have implemented innovative and creative approaches to contact and enroll eligible populations in their local communities, provided vaccine information and outreach at the local level, and engaged college students at all levels. The current phase of the project allows CBOs and counties to incorporate new or expand existing activities for all participants, and continue adjusting their outreach and enrollment approaches to overcome challenges presented by COVID-19. As of November 2021, all remaining funding was allocated to project partners, enabling them to extend their project performance period to June 30, 2022. Information and updates related to the project are available on the DHCS website.​​ 

Medi-Cal Rx実装アップデート​​ 

Medi-Cal Rx is scheduled to launch on January 1, 2022. Outreach and education activities are ongoing and will run through December. DHCS sent a 60-day notice to all Medi-Cal beneficiaries, and will send a 30-day notice to all FFS beneficiaries. MCPs will also send a 30-day notice to their members as part of a broader outreach campaign. Additionally, DHCS continues to host Medi-Cal Rx stakeholder engagements and meetings. Upcoming public forum webinars will be posted on the DHCS website. For questions or comments related to Medi-Cal Rx, please email RxCarveOut@dhcs.ca.gov.​​ 

薬物療法管理(MTM)​​ 

On September 15, DHCS received CMS approval of SPA 21-0028, which adds MTM as a payable FFS pharmacy service provided in conjunction with certain complex chronic medical conditions. DHCS is finalizing provider contracts and expects to initiate the program in December. To participate in the program, Medi-Cal-enrolled pharmacies will be required to enter into a contract with DHCS. The contract will outline the requirements and guidelines necessary to receive reimbursement under this methodology.​​ 

多目的シニアサービスプログラム(MSSP)免除の修正​​ 

11月19日、DHCSはCMSに修正案を提出し、Coordinated Care Initiative(CCI)として知られる1115 Bridge to Reform Demonstrationの免除からMSSPプログラムを切り出し、1915(c)の免除を修正しました。 10月1日、DHCSはカリフォルニア州老化局と協力して、30日間のパブリックコメント期間の免除を掲載しました。 1915(c)免除の更新により、すべてのCCI郡(サンマテオ郡を除く)がFFS配信システムに戻ります。 免除のその他の変更には、すでにサービスを提供している郡の地理的サービスエリアの更新、予想される電子訪問検証(EVV)の実装、および2021年予算法に関連する参加者スロットの追加が含まれます。​​ 

MSSPの免除は、介護施設への配置の資格があるが、コミュニティに留まりたいと考えている虚弱な高齢のクライアントに対して、社会的および健康管理を提供します。 MSSPの目的は、高齢者施設への早期の収容を回避し、コミュニティでの自立した生活を促進することです。​​ 

高齢者向け拡張パック​​ 

AB 133 (Chapter 143, Statutes of 2021) expanded eligibility for full-scope Medi-Cal to individuals who are 50 years of age or older, and who do not have satisfactory immigration status or are unable to establish satisfactory immigration status, if otherwise eligible. DHCS is targeting system readiness and the implementation of the older adult expansion on May 1, 2022. DHCS has provided policy guidance to counties in ACWDL 21-13. DHCS will hold monthly advocate and county workgroup meetings through the implementation of this expansion. DHCS will post additional program details on its website in the coming months.​​ 

産後ケアの補償範囲​​ 

Under the provisions of the American Rescue Plan Act of 2021 (ARPA), DHCS is broadening the scope of Medi-Cal coverage for eligible and newly eligible pregnant individuals. Medi-Cal will cover the full breadth of medically necessary services, during both the pregnancy and postpartum periods, by adding ten months of coverage following the current 60-day postpartum period, for a total of 12 months. In the interest of aligning the Medi-Cal Access Program (MCAP) with the Medi-Cal postpartum care extension policies described above, DHCS submitted a Children’s Health Insurance Program (CHIP) SPA, CA-21-0032, proposing to create a Health Services Initiative (HSI) to extend the provisions allowed in ARPA to MCAP. On September 14, DHCS received federal approval for the HSI, allowing a retroactive effective date of July 1, 2020. Under the provisions of ARPA and the HSI, individuals will maintain coverage through their pregnancy and 12-month extended postpartum coverage period regardless of income changes, citizenship, or immigration status. This ARPA policy for Medi-Cal is targeted for implementation on April 1, 2022.​​ 

Quality Improvement Awards – 2021​​ 

DHCS annually recognizes Medi-Cal MCPs that have excelled in improving the quality of health care they provide to the nearly 12 million members receiving Medi-Cal benefits and services through the managed care delivery system. DHCS congratulates all of the winners, thanks them for their efforts, and encourages them to share promising practices with other health plans serving Medi-Cal members. To view the award recipients, as well as awards details, please visit the DHCS website.​​ 

スマイル、Medi-Cal歯科サービスのカリフォルニア州キャンペーン​​ 

Five “Behind the Smiles” Medi-Cal Dental provider testimonial videos were published to the Smile, California website and posted to Smile, California’s Instagram and Facebook accounts, highlighting why dentists enjoy participating in the Medi-Cal Dental program. Smile, California also developed a new educational brochure that highlights important information on aging and oral health. The new “A Healthy Smile Never Gets Old!” brochure explains common dental problems and symptoms associated with older adults, information on how to access and pay for dental care, tips for good oral health, and details on non-medical transportation services.​​ 

Additionally, Smile, California partnered with nine foodbanks in hard-to-reach communities, which serve a majority of the Medi-Cal member population, to distribute the “Healthy Smiles Start with Healthy Foods” insert and Smile, California-branded floss cards during their planned holiday food distribution drives.​​