인기 뉴스

주지사, 새로운 DHCS 프로그램 최고 운영 책임자(COOP) 임명

On October 10, Governor Newsom announced the appointment of Chris Riesen as DHCS’ new COOP, effective October 16. As part of the Directorate, Chris will provide leadership of Enterprise Data and Information Management, Enterprise Technology Services, and Program Operations. The COOP position expands the Director’s Office to increase capacity to manage the growth and increased complexity of DHCS’ programs, as well as to better support work/life balance. This position will support Erika Sperbeck’s work as Chief Deputy Director for Policy and Program Support, leading Department operations and program integrity functions. Since July 2018, Chris has served as DHCS’ Deputy Director for Enterprise Technology Services and Chief Information Officer.

메디칼 갱신 업데이트

DHCS today published the August 2023 Medi-Cal continuous coverage unwinding eligibility measures data on the Medi-Cal Enrollment and Renewal Data webpage. The August dashboard includes data on Medi-Cal enrollment, applications in progress, redeterminations, and disenrollments. The data also include demographic details for all redetermination measures, along with the top reasons for disenrollments. 

메디케어 공개 등록 기간 동안 이용 가능한 메디 메디 플랜

During the upcoming Medicare open enrollment period (October 15 through December 7), Medicare-Medi-Cal Plans (Medi-Medi Plans) are available for enrollment in twelve counties (Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara currently, as well as five new counties – Fresno, Kings, Madera, Sacramento, and Tulare – beginning on January 1, 2024). Medi-Medi Plans combine Medicare and Medi-Cal benefits and Medicare prescription drug benefits into one plan.

Approximately 45 percent of dually eligible members are enrolled in some type of Medicare Advantage plan. Enrollment in Medi-Medi Plans as of July 2023 is approximately 241,105 members. The benefits of Medi-Medi Plans include integrated materials, such as a single health plan card and one phone number to call for both Medicare and Medi-Cal benefits, leading to improved care coordination and support for members.

메디-메디 플랜은 모든 메디케어 보장 서비스, 모든 메디칼 보장 서비스, 추가 보충 혜택, 분리된 혜택(예: 재택 지원 서비스, 다목적 노인 서비스 프로그램, 지역사회 기반 성인 서비스 및 치과), 진료를 조정하는 단일 진료 관리팀, 그리고 메디칼 관리형 진료 플랜에서 제공하는 지역사회 지원을 포함하여 두 프로그램의 모든 혜택과 서비스를 통합적으로 제공합니다.

프로그램 업데이트

추가 연속 커버리지 언와인딩 유연성 확보

On September 22, the federal Centers for Medicare & Medicaid Services approved DHCS’ request for two flexibilities that leverage existing regulations to help streamline the processing of annual Medi-Cal eligibility renewals and ease burdens on county program administrators and Medi-Cal members. The first flexibility waives the requirement for Medi-Cal members to sign and return a renewal packet that had already been submitted if counties receive verification of missing information after the packet was mailed. The second flexibility allows the use of the explanation submitted by the member within the renewal packet as sufficient verification for a successful redetermination, eliminating the need for additional supporting documentation. These flexibilities will streamline the renewal process for Medi-Cal members, especially individuals experiencing homelessness and elderly or disabled populations. Additionally, the flexibilities will ease burdens to provide additional paperwork or documentation and reduce procedural terminations during the continuous coverage unwinding period.

The flexibilities will continue throughout the unwinding period. DHCS issued Medi-Cal Eligibility Division Information Letter (MEDIL) I 23-49 to provide counties with immediate guidance on operationalizing these flexibilities.

매니지 케어 플랜과 제3자 기관 간의 양해각서

DHCS는 이번 주에 Medi-Cal 관리형 의료 플랜(MCP)을 위한 모든 플랜 서한(APL), 두 가지 행동 건강 정보 고지(BHIN) 및 관련 양해각서(MOU) 템플릿을 발표했습니다. 이는 2024년 MCP 계약에 따라 회원의 치료가 조정되고 회원이 전인적 치료를 지원하는 지역 사회 기반 자원에 접근할 수 있도록 특정 제3자 기관과 양해각서를 체결하도록 요구하는 것입니다. 양해각서는 당사자 간의 역할과 책임을 명확히 하고 지역 사회 참여, 의료 서비스 조정, 정보 교환, 상호 책임 및 투명성을 지원하는 효과적인 수단이 되도록 고안되었습니다.

The MOU templates include a base template, which contains general provisions required to be included in all MOUs, and a set of bespoke templates tailored for programs or services administered by third-party entities that contain the required general MOU provisions and program-specific provisions. The bespoke templates are for MCPs to enter into MOUs with third-party entities with whom MCPs must make a good faith effort to execute by January 1, 2024, and include: local governmental agencies, such as county behavioral health departments for specialty mental health care and substance use disorder services; other local programs and services, including social services; child welfare departments; Regional Centers; In-Home Supportive Services programs; and Women, Infants, and Children Supplemental Nutrition Programs. DHCS will release additional required MOU templates for use by MCPs and third-party entities as they are finalized, including those required to be executed on July 1, 2024, and January 1, 2025. Additional information and copies of the MOU templates are available on the DHCS MOU webpage.

메디케어 및 메디칼 치과 혜택

On October 11, DHCS released a new fact sheet for dental providers regarding dental benefits for dual eligible (Medicare and Medi-Cal) members. The fact sheet provides information about dental benefits that both Medicare and Medi-Cal offer and how providers can bill for dental services provided to members. Medicare, the primary payer for dual eligible patients, does not cover most dental care. Medi-Cal covers a variety of dental benefits administered by Medi-Cal dental providers. A dual eligible patient may also receive dental benefits through their Medicare Advantage plan. For dental services covered by Original Medicare or a Medicare Advantage plan, the services must be billed to Original Medicare or the Medicare Advantage plan first.

Medi-Cal Rx

On October 13, reinstatement Phase 3/Lift 3 will reinstate Quantity Restriction Edits for members 22 years of age and older. Quantity Limit restrictions will be applied to all (new and continuing) pharmacy claims. Some commonly prescribed Code I medications on the Medi-Cal Rx Contract Drugs List (CDL) have quantity limits based on the U.S. Food and Drug Administration-approved or clinically sound dosing guidelines. Claims may reject if billed incorrectly.

Also, a 30-day countdown alert was released on October 10 for the final reinstatement action. On November 10, implementation of Phase 4/Lift 4 of reinstatement will retire the transition policy for all pharmacy benefits for members 22 years of age and older; reinstate prior authorization (PA) requirements for all therapies for standard therapeutic classes 68, 86, and 87, which includes enteral nutrition products; reinstate utilization management claim edits for Reject Code 80 – Diagnosis Code Submitted Does Not Meet Drug Coverage Criteria; and reinstate Brand Medically Necessary PA requirements for all claims.

10월 17일까지 DHCS가 접촉해 온 모든 Medi-Cal Rx 이해관계자에게 성인 대상 재활성화 노력 종료와 소아 대상자에 대한 2024년까지 변경 사항이 없음을 알리는 "Medi-Cal Rx 발전" 안내문이 전달될 예정입니다. 이해관계자에는 캘리포니아 지역 건강 보험 협회, 캘리포니아 건강 보험 협회, 메디칼 관리형 의료 플랜 약국 책임자, 캘리포니아 어린이 병원 협회, 어린이 전문 진료 연합, 어린이 지역 통합 서비스 시스템, 캘리포니아 의사 협회, 캘리포니아 소매업 협회, 전국 체인 약국 협회, 캘리포니아 약사 협회, 캘리포니아 1차 진료 협회, 캘리포니아 정신 건강 관리 협회, 캘리포니아 의료 제품 공급업체 협회 및 캘리포니아 혈우병 협의회가 포함됩니다.

팀에 합류하세요

DHCS는 재정, 인사, 법무, 감사, 건강 정책, 정보 기술 팀에서 채용을 진행 중입니다. 자세한 내용은 CalCareers 웹사이트를 참조하세요.

DHCS’ purpose is to provide equitable access to quality health care leading to a healthy California for all. DHCS’ goals and objectives reflect DHCS’ tremendous work to transform the state’s health care system and strengthen organizational excellence.

예정된 이해관계자 회의 및 웨비나

성인용 확장 웨비나

10월 18일, DHCS는 지역 카운티 사무소 및 기타 이해 관계자를 대상으로 메디칼 성인(26~49세) 확대에 관한 두 차례의 웹 세미나 중 첫 번째 세미나를 개최할 예정입니다. 두 번째 웹 세미나는 12월 초로 잠정적으로 예정되어 있습니다. 이번 웨비나에서는 확장 계획, 실행 계획, 공지, 홍보 활동 등에 대한 배경 정보를 제공할 예정입니다. 등록 정보는 26세~49세 성인 대상 메디칼 확대 프로그램 웹페이지에 게시될 예정입니다. 웨비나 참가를 원하시는 분은 AdultExpansion@dhcs.ca.gov로 이메일을 보내 등록해 주시기 바랍니다.

DHCS will implement this expansion pursuant to Senate Bill 184 (Chapter 47, Statutes of 2022) on January 1, 2024. When implemented, the expansion will provide individuals 26-49 years of age with full scope Medi-Cal benefits, regardless of citizenship or immigration status, if they meet all other Medi-Cal eligibility criteria.

이해관계자 자문 위원회(SAC) 및 행동 건강 자문 위원회(BH-SAC) 회의

On October 19, from 9:30 a.m. to 3:30 p.m., DHCS will host the next SAC and BH-SAC hybrid meeting (advance registration required). It will open as a joint meeting, with topics shared by SAC and BH-SAC. A BH-SAC-only meeting will be held after the joint meeting; there is no SAC-only meeting. Participants may attend in person at The California Endowment, located at 1414 K Street in downtown Sacramento, or virtually. For more information, please visit the SAC and BH-SAC webpages.

접근성 제공 및 건강 변화(PATH) 법무부 관련 프로그램 업무 시간

On October 23, DHCS will host the next PATH Justice-Involved Program virtual office hours session for Round 3 awardees (advance registration required). Office hours will be held every other Monday at 11:30 a.m. through December 18 to assist Round 3 agencies, including supporting implementation plan submission. For more information, visit the Justice-Involved Program website.

성 건강 서비스 웨비나를 위한 미성년자 동의 및 기밀 유지

10월 25일 정오부터 오후 1시 30분까지, DHCS와 캘리포니아 예방 교육 센터는 성 건강 서비스 관련 미성년자 동의 및 비밀 유지에 관한 웹 세미나를 개최합니다(사전 등록 필수). 본 웨비나에서는 미성년자의 성 건강 및 가족 계획 서비스 이용에 영향을 미치는 캘리포니아 법률에 대한 개요를 제공합니다. 아동 학대 신고 의무를 포함한 중요한 비밀 유지 예외 사항을 검토하고, 어려운 상황에서 효과적으로 적용할 수 있는 모범 사례를 공유합니다. 참가자들은 미성년자 동의 관련 법률 시행을 지원하는 자료들을 살펴보고, 사례 연구를 통해 자신의 지식을 점검할 기회를 갖게 됩니다.

실시간 웹 세미나에 참석하지 못하시는 분들을 위해 웹 세미나 녹취록과 녹화본, 그리고 추가 자료가 Family PACT 웹사이트 에 게시될 예정입니다.

PATH 협업 계획 및 구현(CPI) 모범 사례 웨비나

On October 27, from 10 to 11 a.m., DHCS will host a statewide webinar, entitled Enhanced Care Management (ECM) and Community Supports Provider Peer Support and Contracting Self-Assessment (advance registration required). This virtual session is the first in a series of biannual best practices webinars designed to highlight best practices for implementing ECM and Community Supports, increase providers’ successful participation in California Advancing and Innovating Medi-Cal (CalAIM), and improve collaboration with MCPs, state and local government agencies, and others to build and deliver quality support services to Medi-Cal members. For more information and to register, please visit the PATH CPI webpage.

놓친 경우를 대비하여

캘리포니아, COVID-19 대응을 위해 행동 건강 서비스 제공자에게 수백만 달러 지원

DHCS awarded nearly $5.2 million to 36 mental health and/or substance use disorder providers through the COVID-19 Substance Use and Mental Health Disorder Mitigation Project to support community mitigation measures that prevent the spread of COVID-19 and protect those who are at increased risk for severe illness. From September 15, 2023, through March 31, 2025, providers will receive up to $500,000 to expand services to provide education about COVID-19 testing, implement onsite COVID-19 testing, collaborate with community partners to prevent infectious disease transmission, and expand COVID-19 response services to individuals connected to the behavioral health system.

치과 매니지 케어 플랜 패리티

As part of the CalAIM 1915(b) waiver Special Terms and Conditions, DHCS conducted a parity evaluation to assess the performance (utilization) of Sacramento County dental managed care (DMC) plans compared to the statewide dental fee-for-service (FFS) delivery system. The evaluation was based on utilization measures for calendar year 2022 in the following categories: annual dental visits, preventive dental services, and use of sealants for children and adults. Based on the evaluations, DHCS determined that none of the three DMC plans operating in Sacramento County – Access Dental Plan, Health Net Dental, and Liberty Dental Plan – met parity with statewide FFS utilization averages in all required measures. As a result, members currently enrolled in DMC plans will have the option to enroll in FFS. 

2023년 11월부터 DHCS는 현재 새크라멘토 카운티의 DMC 플랜에 등록된 약 614,000명의 회원에게 현재 플랜을 유지하거나 탈퇴하고 12월 1, 2023 부터 FFS에 가입할 수 있는 옵션에 대해 알리는 통지를 보낼 예정입니다. 해당 공지에는 회원이 진료비 지불 방식(FFS)을 선택했을 경우 치과 서비스를 이용하는 방법 또는 FFS에서 진료 접근성 문제를 입증할 수 있는 경우에만 다른 DMC 플랜을 선택할 수 있는 옵션에 대한 정보가 제공됩니다. 또한, 12월 1일부터 새로 메디칼(Medi-Cal) 자격을 얻는 회원은 자동으로 치과 진료비 지불 방식(FFS)에 등록됩니다. 치과 FFS 및 DMC 실적 보고서를 검토하려면 치과 데이터 보고서 웹페이지를 방문하십시오.