2021년 12월 이해관계자 커뮤니케이션 업데이트로 돌아가기​​ 

아동기 이상 경험(ACE) 인식​​ 

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.​​ 

연간 네트워크 인증 업데이트​​ 

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.​​ 

자산 한도 - 수정되지 않은 조정 총소득(MAGI) Medi-Cal 메디칼​​ 

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).​​ 

행동 건강 연속성 인프라 프로그램(BHCIP) 업데이트​​ 

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.​​ 

행동 건강 연방 보조금 업데이트​​ 

10월 25일, DHCS는 시에라 보건 재단에 약 7,730만 달러의 기부금을 전달했습니다: 건강 프로그램 관리 센터에 복구 서비스 프로젝트(RSP)를 시행하기 위해 약 330만 달러를 지원했습니다. 이 센터는 심각한 정신 질환(SMI), 심각한 정서 장애(SED), 약물 사용 장애(SUD)를 가진 개인을 위한 주 전역의 회복 서비스를 지원하기 위해 7,350만 달러 이상을 RFA를 통해 사용할 수 있습니다. DHCS와 센터는 복구 서비스 프로그램을 정의하고 지역사회의 고유한 복구 서비스 요구를 더 잘 이해하기 위해 다양한 이해관계자와 함께 광범위한 커뮤니티 참여를 실시할 것입니다. 이후 DHCS와 센터는 커뮤니티 피드백을 RFA 프로세스에 통합하여 이러한 커뮤니티의 요구를 반영한 최적의 보조금 사용을 결정할 것입니다. 커뮤니티 참여 프로세스의 결과에 따라 수혜자는 다음과 같은 조치를 취할 수 있습니다:​​ 

• 지역 복구 커뮤니티 지원 기관의 개발을 지원합니다.​​ 
• 지역 차원에서 회복 관련 낙인과 차별을 줄이기 위한 전략과 교육 캠페인, 훈련 및 이벤트를 개발합니다.​​ 
• SMI, SED 및 SUD에 대한 증거 기반 복구 모델 사용을 확대합니다.​​ 
• SMI, SED 및 SUD 복구 리소스를 제공하고 시스템 탐색을 지원합니다.​​ 
• 다양한 인구 집단에 대한 동료 회복 지원 서비스의 접근성을 개선합니다.​​ 
• 지역 민간 및 비영리 임상 의료 서비스 제공자, 종교계, 시, 카운티, 주, 연방 공중 보건 기관, 형사 사법 대응 노력과 협력하고 조율하여 회복 서비스를 확대합니다.​​ 

RSP에 대한 자세한 내용은 이메일(BHRRP@dhcs.ca.gov)로 문의하거나 DHCS 웹사이트를 방문하세요.​​ 

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.​​ 

규정 준수 인증 - 전학, 퇴원 및 청문회 결정 재입원 거부​​ 

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.​​ 

규정 준수를 입증하기 위해 장기 요양 시설은 심리 결정이 송달된 날로부터 역일 기준 3일 이내에 DHCS에 규정 준수 증명서를 제출해야 합니다. 시설이 적시에 인증서를 제출하지 않거나 청문회 결정을 적시에 준수하지 않을 경우, DHCS는 시설의 미준수 일수당 하루당 750달러, 최대 총 75,000달러의 벌금을 부과할 수 있습니다.​​ 

연속 혈당 측정기​​ 

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.​​ 

치과 혁신 이니셔티브(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.​​ 

약물 Medi-Cal 조직화된 전달 시스템(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.​​ 

가정 및 지역사회 기반 대안(HCBA) 면제 수정안​​ 

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 면제는 Medi-Cal 자격을 갖춘 수혜자가 선택한 지역사회 환경에서 장기적인 지역사회 기반 서비스 및 지원을 제공합니다. 이러한 서비스에는 기관이 아닌 지역사회 환경에서 간호 수준의 케어가 필요한 개인의 건강과 안전을 유지하는 데 필요한 개인 간호, 사례 관리 및 개인 케어 서비스가 포함됩니다.​​ 

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.​​ 

메디칼 건강 등록 네비게이터 프로젝트​​ 

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 구현 업데이트​​ 

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.​​ 

약물 치료 관리(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.​​ 

다목적 노인 서비스 프로그램(MSSP) 면제 수정안​​ 

11월 19일, DHCS는 1115 브릿지 투 리폼 데모 면제에서 조정 치료 이니셔티브(CCI)로 알려진 MSSP 프로그램을 분리하고 1915(c) 면제를 개정하는 수정안을 CMS에 제출했습니다. 10월 1일, DHCS는 캘리포니아 노인복지부와 협력하여 30일간의 공개 의견 수렴 기간 동안 면제를 게시했습니다. 1915(c) 면제에 대한 업데이트는 모든 CCI 카운티(샌마테오 카운티 제외)를 FFS 배송 시스템으로 되돌릴 것입니다. 면제에 대한 추가 변경 사항에는 이미 서비스를 제공 중인 카운티의 지리적 서비스 지역 업데이트, 예상되는 전자 방문 확인(EVV) 구현, 2021년 예산법과 관련된 참여자 슬롯 추가 등이 있습니다.​​ 

MSSP 면제는 요양 시설에 입소할 자격이 있지만 지역사회에 남아 있기를 원하는 허약 노인 고객을 위한 사회 및 건강 관리 서비스를 제공합니다. MSSP의 목적은 요양 시설에 조기 입소하는 것을 방지하고 지역사회에서 자립 생활을 촉진하는 것입니다.​​ 

고령자 확장​​ 

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.​​ 

산후조리 보험 적용​​ 

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.​​ 

메디칼 치과 서비스를 위한 캘리포니아 스마일 캠페인​​ 

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.​​