2022年6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​​ 

Medi-Cal COVID-19公衆衛生上の緊急事態(PHE)運用巻き戻し計画​​ 

On May 17, DHCS released the Medi-Cal COVID-19 PHE Operational Unwinding Plan. The two primary purposes of the plan are to: 1) describe DHCS’ approach to unwinding or making permanent the temporary flexibilities implemented across the Medi-Cal program during the PHE; and 2) describe DHCS’ approach to resuming normal Medi-Cal eligibility operations following the end of the PHE. The PHE is currently set to expire on July 15, 2022, and the U.S. Department of Health and Human Services (HHS) has committed to providing at least a 60-day notice prior to the official PHE end date.​​ 

Since the initiation of the PHE, DHCS implemented more than 100 programmatic flexibilities to help minimize the strain to the Medi-Cal program, its beneficiaries, and California’s health care providers and systems. While many of these programmatic flexibilities will terminate on or around the end of the PHE, some will continue due to the positive impact they have made on the Medi-Cal program. Additionally, under the continuous coverage requirement in the Families First Coronavirus Response Act, states are required to maintain enrollment of nearly all Medicaid enrollees through the end of the month in which the PHE ends. When continuous coverage requirements expire, states must conduct a full redetermination for all beneficiaries who would otherwise have been subject to redetermination.​​ 

The Operational Unwinding Plan is intended to inform the public of DHCS’ approach to return Medi-Cal to a normal state of operations. The document also includes additional resources, including information about the DHCS Coverage Ambassadors campaign and links to the Centers for Medicare & Medicaid Services’ (CMS) guidance documents.​​ 

Governor’s May Revision​​ 

On May 13, Governor Newsom unveiled his $300 billion fiscal year (FY) 2022-23 May Revision budget proposal, which is an increase of approximately $14 billion compared to the budget released on January 10, 2022. The state now has a projected surplus in excess of $86 billion that is reflected in increased budgetary reserves as well as an increased use of discretionary surplus amounts to fund one-time projects. The Governor’s May Revision proposes a $141.8 billion total funds ($37 billion General Fund) budget for DHCS programs and services. The total amount is allocated between $1.6 billion in DHCS state operations and $140.2 billion that supports funding for program costs, partners, and administration.​​ 

COVID-19 PHEは、DHCSの予算に大きな影響を与え続けており、PHEに関連する総資金全体の純費用は115億ドルに上ります。 この影響には、2022年7月15日までのPHEの最近の延長が含まれます。COVID-19の予測される影響の主な更新には、PHEの巻き戻しに関連する費用(適格性の再決定を含む)が含まれます。ワクチン投与については、連邦認定保健センターによる継続的な個別請求。65歳以上、盲人または障害者の推定資格の継続。連邦医療支援率(FMAP)の増加に関連する収益の追加四半期。​​ 

The May Revision includes a significant additional investment in the Equity and Practice Transformation Payment program ($700 million total funds) to advance equity, address gaps in preventive, maternity, and behavioral health care measures, reduce disparities driven by COVID-19, and support practices to transition from fee-for-service reimbursement (where providers are paid for visits/volume and not quality/outcomes) to value-based payments/alternative payment models (e.g., capitated payments tied to quality outcomes)). This aligns with the goals of the Medi-Cal Comprehensive Quality and Equity Strategy and the Bold Goals of 50×2025 initiative. Preparing practices for value-based care also includes implementing practice infrastructure, such as electronic health records and improved data collection and exchange.​​ 

The May Revision also proposes $933 million for one-time retention payments to approximately 600,000 California hospital and nursing facility workers who have been at the frontlines delivering care to the most acute patients during the COVID-19 Pandemic. The ongoing response to COVID-19 has significantly impacted California’s workforce in hospitals and nursing facilities. Retaining essential workers in these settings is a priority of the Administration, and these payments are designed to help retain this critical workforce in an environment of high vacancies and turnover. The state will provide a baseline payment and will increase the payment up to $1,500 if employers commit to fully matching the additional amount, subject to available funding.​​ 

さらに、DHCSはカリフォルニア州保健福祉庁と提携し、子供、若者、親の健康を支援し、レジリエンスを構築するための助成金(8,500万ドルの一般基金)を提供しています。 これらのプログラムは、PHEによって引き起こされたトラウマ、ストレス、社会的孤立の影響を受けた若者を支援するもので、学校、市、郡、部族、およびコミュニティベースの組織(CBO)に追加の子供と若者の行動健康イニシアチブの助成金を提供します。​​ 

DHCSは、COVID-19 PHE関連の活動に重点を置いて、Health Enrollment Navigatorsがプロジェクト活動を継続するためにより多くの資金(合計6,000万ドル)を提供することを提案しています。特に、年次更新を支援し、更新された連絡先情報を報告し、到達が困難な対象集団へのアウトリーチに従事することにより、受益者がMedi-Calの補償範囲を維持できるように支援します。​​ 

5月の改訂には、ホームレスのサービスプロバイダーへのナロキソンの配布を増やすことにより、1月の薬物支援治療拡大プロジェクトの提案を補強するための1回限りのオピオイド和解基金の1,000万ドルの要求が含まれています。 さらに、DHCSは、物質使用障害プロバイダーの労働力トレーニングに関連する1月の提案を2,910万ドル増やすことを提案しています。​​ 

View the DHCS May Revision budget highlights and the Medi-Cal and Family Health Local Assistance Estimates.​​ 

Medi-Cal Rx実装アップデート​​ 

2022年2月以降、Medi-Cal Rxはコールセンターと事前認証(PA)業務を安定させています。 それ以来、DHCSとマゼラン(MMA)は、クレーム編集とPA要件の段階的な復活のための集中的な計画プロセスに取り組んできました。 ステークホルダーからのフィードバックに基づく3段階のアプローチは、薬剤クラスごとに請求編集とPAの小規模で選ばれたグループの復活から始まります。2022年2月上旬に講じられた緩和措置の対象となったすべてのPAを復活させることに進みます。そして最終段階では、移行ポリシーを廃止します。復職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。 利害関係者は、専用の電子メール受信トレイ Reinstatement@dhcs.ca.gov を通じて、このアプローチに関するコメントやフィードバックを提供することをお勧めします。​​  

特別人口臨床医連絡チーム​​ 
Using feedback from various stakeholders, Medi-Cal Rx has created a Special Populations Clinical Liaison Team within the Customer Service Center that is trained to serve the specific needs of populations enrolled in California Children’s Services, the Genetically Handicapped Persons Program, and those who have specialty behavioral health conditions. This team is comprised of pharmacy technicians and pharmacists.​​ 

5月9日から、Special Populations Clinical Liaison Teamは、祝日を除く月曜日から金曜日の午前8時から午後8時まで利用可能で、特定の受益者の保護された健康情報を認証し、話し合うことができる受益者、プロバイダー、および郡のユーザーにサービスを提供します。 Medi-Cal Rxは、カリフォルニア州全域のMedi-Calの受益者とプロバイダーにタイムリーで安全な薬局サービスを提供することをお約束します。​​ 

DHCS is also ensuring that providers are kept updated and that relevant information is communicated to them via e-mail blasts, provider newsflashes, information on the DHCS and Medi-Cal Rx websites, and direct provider outreach. These actions are designed to ensure that Medi-Cal beneficiaries can get the prescription drugs they need when they need them. For questions or comments related to Medi-Cal Rx, please email RxCarveOut@dhcs.ca.gov.​​   

血圧計カフとモニター​​ 
6月1日より、個人用血圧モニターと血圧カフがMedi-Cal Rxの部分的なカーブアウト薬局の給付金として追加されました。 これらのアイテムは、提案されたデバイスとカフのリストに限定されており、慎重なレビューと利害関係者とプロバイダーの意見を取り入れた後に選択されました。 これらのアイテムを薬局払いの給付金として追加すると、治療へのアクセスが改善され、これらの給付金は、医療請求に基づいて請求される耐久性のある医療機器として引き続き利用できます。 対象となる医療用品、製品の説明、請求情報のMedi-Cal Rxリスト、およびMedi-Cal Rxプロバイダーマニュアルは、これらの追加を反映するように更新されます。 ご質問やご意見は、 medicalsupplies@dhcs.ca.gov までメールでお問い合わせください。​​ 

Medi-Cal COVID-19ワクチン接種インセンティブプログラム​​ 

DHCS allocated up to $350 million to incentivize COVID-19 vaccination efforts in the Medi-Cal managed care delivery system from September 1, 2021, through February 28, 2022. Medi-Cal managed care plans (MCPs) were eligible to earn incentive payments for activities designed to close vaccination gaps with their enrolled members, and to address vaccine uptake disparities for specific age and race/ethnicity groups. The third outcome ascertainment period for the program ended on March 6. Between January 3 and March 6, the total vaccination rates showed improvement in all reported measures. On March 6, target goals for all vaccine outcome measures increased to closing 100 percent of the gap between Medi-Cal and county rates, which was a challenge for plans to meet. Three beneficiary sub-groups (ages 12-25 years, African Americans, and American Indian/Alaska Natives) were within 5 percent of closing two-thirds of the gap. For the high performance pool measures, preliminary data demonstrate that eight MCPs achieved targets of at least one dose for members age 5-11 years, and two MCPs achieved targets for fully vaccinated and boosted members age 12 years and older. For more information, please refer to All Plan Letter (APL) 21-010, Attachment A.​​