5월 27, 2025
인기 뉴스
수익 안정성 및 계획을 지원하는 새로운 행동 건강 서비스법(BHSA) 보고서
DHCS released the BHSA Revenue Stability Workgroup Report with recommendations to reduce the variance of county Behavioral Health Services Funds (BHSF). The recommendations are intended to help counties manage revenue more consistently, maintain services through economic ups and downs, and bring greater predictability and accountability to local behavioral health care funding.
The BHSA Revenue Stability Workgroup, comprising state leaders and counties, was required to develop and recommend solutions to reduce BHSA revenue volatility and propose appropriate prudent reserve levels to support the sustainability of county programs and services. It reviewed and analyzed current and historical revenues generated by the MHSA and the BHSA and prudent reserve levels to develop the recommendations.
The State Controller’s Office will continue to follow the current process to distribute BHSA local assistance funds to counties monthly. The goal is to balance local assistance revenue allocation and program stability, helping counties effectively plan and provide critical behavioral health services during revenue downturns. Highlights include:
- 연간 지출 한도는 인플레이션을 고려하여 조정된 3년 평균을 기준으로 합니다.
- 새로운 예비금 한도(카운티 규모에 따라 10~15%).
- 2026~2029년 사이에 한 번만 초과 적립금을 사용해야 합니다.
- 수익이 감소할 경우 예산을 유연하게 조정할 수 있습니다.
- 공개 보고 및 커뮤니티 의견 수렴을 의무화하여 투명성을 높입니다.
This approach supports California’s Mental Health for All vision by promoting stability, transparency, and community-centered behavioral health care. State legislation is required to enact recommendations from the BHSA Revenue Stability Workgroup Report.
메디칼 회원의 요구 사항을 충족하면서 조기 비용 효율성을 보여주는 커뮤니티 지원
DHCS recently submitted to the Centers for Medicare & Medicaid Services (CMS) its Community Supports, or In Lieu of Services (ILOS), Annual Report[TO1] , which reviews the progress and impact of Medi-Cal Community Supports in 2024. For the first time, the report also includes a cost-effectiveness analysis for 2023. The report highlights key achievements, such as reduced emergency room visits, hospitalizations, and long-term care use, pointing to early evidence of both improved health outcomes and reduced costs when compared to the services they are replacing, such as inpatient, emergency department, and long-term care services. Of the 12 Community Supports studied, nine are already proving cost-effective, and the remaining three are expected to prove to be cost-effective over time.
The report also outlines operational improvements made by DHCS and managed care plans (MCP) to expand services, grow provider networks, and support implementation. While progress has been significant, the report also identifies ongoing challenges and opportunities for further improvement, ensuring these services continue to evolve to meet the needs of Medi-Cal members.
프로그램 업데이트
Medi-Cal 상업용 MCP 조달 업데이트
DHCS will postpone the next commercial Medi-Cal MCP procurement by at least two years. The next competitive procurement for MCPs will begin no sooner than 2029, with contracts expected to take effect no sooner than 2031. DHCS previously indicated that the re-procurement for commercial MCPs would be conducted once every five years. Under this assumed timeline, DHCS would have had to release the Request for Proposal (RFP) in 2027 for a contract effective date of January 1, 2029.
The additional time will allow DHCS to focus on critical California Advancing and Innovating Medi-Cal (CalAIM) initiatives. It will also help maintain stability for members and support ongoing improvements to care quality and access, while also supporting the long-term success of the Medi-Cal managed care program.
In accordance with current policy, MCP contracts will be renewed annually following the contractual requirements identified in Exhibit E, 1.1.15 of the 2024 Managed Care Boilerplate Contract. Current MCP contracts will be extended from January 1, 2026, to December 31, 2026, by the established annual process. DHCS remains committed to fostering an inclusive, flexible, and responsive process that supports the Medi-Cal program and ensures continued equitable access to high-quality care for Californians. Please visit the Medi-Cal Managed Care webpage for more information.
치과 매니지드 케어 전환
During the week of May 26, DHCS will mail a 30-day notice to about 350,000 Medi-Cal members in Sacramento and Los Angeles counties to notify them of upcoming changes to their dental service delivery, effective July 1, 2025. The member notice explains what is changing, if the member needs to make a plan choice, the member’s continuity of care protections, and other important information, and will include a Medi-Cal managed care enrollment packet.
Members in Sacramento County who are currently enrolled in Access Dental Plan or dental fee-for-service (FFS) must select a new Dental Managed Care plan, while members in Los Angeles County who do not choose a Dental Managed Care plan will remain in FFS. Members currently enrolled with Health Net or Liberty will not be affected by these changes. Additionally, changing Dental Managed Care plans will not affect Medi-Cal coverage or benefits.
Medi-Cal Health Care Options is conducting an outbound call campaign to members who receive a managed care enrollment packet. During these calls, HCO representatives will review available Dental Managed Care plan choices, answer questions, and facilitate enrollment in the member’s chosen plan over the phone. DHCS developed the Dental Transition Member Notices webpage for members to view notices and other information about the Dental Managed Care transition.
약국 제공자를 위한 Medi-Cal 등록 요건 및 절차
Effective August 1, 2025, pharmacy providers that hold a valid Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver and current Certificate of California Clinical Laboratory Registration may bill for CLIA-waived tests provided within the pharmacist’s scope of practice as defined by the California State Board of Pharmacy and authorized in Business and Professions Code Section 4052.4. Pharmacy providers must apply to enroll in the Medi-Cal program by submitting a Medi-Cal provider enrollment online application, along with all supporting documentation.
On June 10, from 10 to 11 a.m. PDT, DHCS will hold a public stakeholder hearing via webinar (advance registration required) to discuss the draft regulatory provider bulletin entitled, “Medi-Cal Enrollment Requirements and Procedures for Pharmacy Providers that Hold a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver.”
Written comments, questions, or suggestions may be submitted during the hearing in the webinar chat. For those unable to attend, written comments must be submitted by 5 p.m. PDT on June 10 to be considered for publication. When submitting written comments, please ensure that the commenter and organization/association being represented are both identified in the comments. Please submit written comments to DHCSPEDStakeholder@dhcs.ca.gov. Based on the public comments received, DHCS will publish the final bulletin on the Medi-Cal providers and DHCS Provider Enrollment Division websites.
팀에 합류하세요
DHCS는 재능 있고 의욕적인 인재를 찾고 있습니다:
- 캡티브 요금 개발 부서 책임자. 최고 책임자는 Medi-Cal 매니지 케어 플랜 및 노인 종합 케어 프로그램의 요금 책정 활동을 주도합니다. 활동에는 보험요율 설정을 위한 보험수리적 방법을 구현하고 환급을 위한 정책 및 프로토콜의 개발과 시행을 감독하는 것이 포함됩니다. 또한 최고 책임자는 재무 방법론이 양질의 의료 서비스를 효율적으로 제공하고 주 및 연방 법률, 규정 및 규칙을 준수하는 데 부합하는지 확인합니다. 신청서는 5월 30일까지 제출해야 합니다.
- Assistant Deputy Director (ADD), Enterprise Technology Services (ETS). This new ADD role will build collaborative working relationships with DHCS Executive Staff, program partners, and external stakeholders, and assist with leading DHCS’ IT programs and services. Additionally, the ADD will play a vital role in leading the development and implementation of IT policies, system architecture, security, improvements, and solutions for DHCS programs, including Medi-Cal and behavioral health. Applications must be submitted by June 2.
DHCS is hiring for its Medi-Cal managed care, data analytics, Medi-Cal eligibility, and other teams. For more information, please visit the CalCareers website.
예정된 이해관계자 회의 및 웨비나
DHCS posts upcoming public meetings on the Calendar of Events. DHCS provides free assistive services, including language interpretation, real-time captioning, and alternate formatting of meeting materials. To request services, please email DHCS at the appropriate contact email address at least ten working days before the meeting.
커버리지 앰배서더 웨비나 시리즈: 출산 관리 경로
On May 29, from 11 a.m. to 12 p.m. PDT, DHCS will hold a Coverage Ambassador webinar that will focus on DHCS’ Birthing Care Pathway initiative (advance registration required). The webinar will provide information about maternity services for pregnant and postpartum Medi-Cal members from conception through 12 months postpartum and review highlights from the Birthing Care Pathway Report released on February 4. This initiative helps to ensure Medi-Cal members have access to high-quality, equitable care to improve maternal health outcomes and reduce disparities. Coverage Ambassadors will also learn about DHCS’ social media platforms, which offer up-to-date information on relevant topics that can benefit both Coverage Ambassadors and Medi-Cal members. Simultaneous interpretation in Spanish will be offered during the webinar.
놓친 경우를 대비하여
신청 요청(RFA): 유연한 주택 보조금 풀
On May 7, DHCS announced the Flexible Housing Subsidy Pools (“Flex Pools”) RFA. DHCS will select up to 10 local teams to participate in the Flex Pools TA Academy and receive Flex Pools planning grants of approximately $150,000. The launch of Medi-Cal Transitional Rent and Behavioral Health Services Act (BHSA) Housing Interventions creates an unprecedented opportunity to help people achieve better health outcomes through housing stability.
Flex Pools are intended to help counties and Tribal entities improve housing stability for individuals experiencing or at risk of homelessness. They are a locally designed model to coordinate rental assistance and make the best use of available housing supports, aligning the work of managed care plans, county behavioral health agencies, and other key partners in the homeless services and rehousing systems. Applications are due to DHCS by 5 p.m. PDT on June 13, 2025. Organizations selected will be notified in July 2025. To learn more and apply, please visit the DHCS Housing for Health website.
HCBA 면제 수정 신청 - 30일간의 공개 의견 수렴 기간
On May 12, DHCS posted a draft of the 2025 Home and Community-Based Alternatives (HCBA) waiver amendment for a 30-day public comment period, prior to submitting the final version to CMS for reauthorization. The HCBA waiver allows eligible enrollees to receive approved services via the telehealth delivery system. Proposed changes in the waiver amendment include:
- 원격 의료 서비스에 대한 지침과 기대치를 명확히 합니다.
- 발달장애인을 위한 중간 요양 시설-지속 간호(ICF/DD-CN)의 비환기 및 환기 의존적 혜택 및 환경이 메디케이드 주 플랜에서 장기 요양 혜택으로 전환됨에 따라 삭제됩니다.
This transition advances California’s efforts to comply with the federal Medicaid Home and Community-Based Settings (HCBS) Final Rule by reinforcing the delivery of services in integrated, community-based settings that support individual choice and autonomy.
DHCS invites all interested parties to review the amendments and comment instructions on the DHCS HCBA Waiver webpage under the HCBA Waiver Amendment Application – 30-Day Public Comment from May 12, 2025 – June 12, 2025 heading. All comments must be received by June 12, 2025. If you have any questions, please email hcbspolicy@dhcs.ca.gov.
메디케이드 주 계획 수정안(SPA) - 30일간의 공개 의견 수렴 기간
On May 12, DHCS posted the ICF/DD-CN: Transition of Benefit/Setting SPA (SPA #25-0026) for a 30-day public comment period, prior to submitting the final version to CMS for approval. ICF/DD-CNs provide 24-hour personal care, developmental services, and nursing supervision for individuals with developmental disabilities who have continuous needs for skilled nursing care and have been certified by a physician and surgeon as warranting continuous skilled nursing care. This service is currently provided through the HCBA waiver. This SPA will transition the ICF/DD-CN benefit/setting from the HCBA waiver to the Medicaid State Plan as a long-term care setting. This transition advances California’s efforts to comply with the federal HCBS Final Rule by reinforcing the delivery of services in integrated, community-based settings that support individual choice and autonomy. All comments must be received by June 12, 2025. If you have any questions, please email PublicInput@dhcs.ca.gov.