2022년 2월 이해관계자 커뮤니케이션 업데이트로 돌아가기​​ 

매니지드 케어 플랜 제안 요청(RFP) 업데이트​​ 

On February 9, DHCS released a RFP for its commercial Medi-Cal managed care plan (MCP) contractors that will redefine how care is delivered to more than 12 million Californians. The RFP raises the state’s expectations of MCPs in the Medi-Cal program through a new and strengthened contract that will apply to all plans. This unprecedented Medi-Cal plan procurement, when implemented, will transform health care delivery for Californians enrolled in Medi-Cal managed care.​​ 

DHCS는 형평성, 품질, 접근성, 책임성 및 투명성을 향상하여 건강 격차를 줄이고 Medi-Cal 가입자의 의료 서비스 결과를 개선하기 위해 최선을 다하는 MCP 파트너를 찾고 있습니다. 선정된 MCP는 인구 건강 및 건강 형평성 개선에 중요한 사회 서비스 지원 및 케어 관리 서비스를 포함하여 회원들이 필요할 때 적절한 의료 서비스를 이용할 수 있도록 새롭고 향상된 요건을 충족하기 위해 노력할 것입니다. DHCS는 RFP 프로세스를 통해 플랜 파트너와 그 하청업체에 대한 감독을 개선하여 투명성과 책임성을 높이고 있습니다.​​ 

The RFP procurement is part of a larger set of state investments in the health and well-being of all Californians that includes CalAIM. Proposals from MCPs are due on April 11, 2022. DHCS will award contracts by fall 2022, and new contracts are scheduled to begin on January 1, 2024.​​ 

On February 15, DHCS hosted an all-comers webinar for members, advocates, providers, health plans, and other stakeholders to share how DHCS will leverage the MCP RFP and managed care contracts to further DHCS’ goals to enhance how care is delivered to Medi-Cal members.​​ 

On February 24, DHCS will host a voluntary pre-proposal web conference from 1 – 2:30 p.m. specifically for the MCP procurement and the RFP released on February 9; Register for the RFP web conference​​ 

자세한 내용은 MCP 조달 웹페이지를 참조하세요.​​  Visit the RFP webpage to view the RFP.​​ 

Medi-Cal Rx 구현 업데이트​​ 

On January 1, DHCS transitioned the Medi-Cal pharmacy benefit of more than 14 million Medi-Cal members to a single delivery system, a change that will benefit members and result in substantial savings. As is the case with any large project, some implementation issues were to be expected, and DHCS’ vendor, Magellan, is addressing those as quickly as possible. 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. Our actions are designed to ensure that Medi-Cal members 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.​​   

캘리포니아 발전 및 혁신 메디캘(CalAIM) 업데이트​​ 

On December 29, 2021, DHCS received approval of the CalAIM Section 1115 Demonstration, CalAIM Section 1915(b) waiver, and Medi-Cal State Plan Amendments from the federal Centers for Medicare & Medicaid Services (CMS). These approvals provide the authority to launch CalAIM, a long-term commitment to transform and strengthen Medi-Cal – the cornerstone of California’s health care system.​​ 

CalAIM shifts Medi-Cal to a population health approach, prioritizing prevention, addressing social drivers of health, and transforming services for communities who historically have been under-resourced and faced structural racism in the health care system. CalAIM is a bold transformation, putting people’s needs at the center of care and setting the pace for transformation of the entire health care sector.​​ 

On January 14, DHCS hosted a webinar to provide an overview of the recently approved CalAIM Section 1115 Demonstration and 1915(b) waiver. View the January 14 CalAIM Section 1115 demonstration 1915(b) waiver presentation.​​ 

Medi-Cal COVID-19 백신 접종 인센티브 프로그램​​ 

DHCS는 1, 2021년 9월부터 28, 2022년 2월까지 Medi-Cal 관리 의료 제공 시스템에서 COVID-19 백신 접종 노력을 장려하기 위해 최대 3억 5천만 달러를 할당하고 있습니다. Medi-Cal MCP는 등록 회원과의 백신 접종 격차를 줄이고 특정 연령 및 인종/민족 그룹의 백신 접종 격차를 해소하기 위한 활동에 대해 인센티브를 받을 수 있는 자격이 있습니다. MCP는 지정된 프로세스 측정값을 달성하면 최대 5천만 달러, 결과 측정값을 달성하면 최대 2억 달러를 받을 수 있으며, 이 중 1억 달러는 회원 인센티브에 직접 사용할 수 있습니다.​​ 

Effective September 1, 2021, all 25 full-service MCPs and one population-specific health plan were approved for participation in the program. The first outcome ascertainment period ended on October 31. Between September 1 and October 31, all plans reported improvement in all three intermediate outcome measures and all seven vaccine uptake outcome measures. Statewide, the target for Measure 3 was exceeded, improving the percentage of primary care providers in MCP networks providing COVID-19 vaccine in their office from 49.3 percent to 56.8 percent. In addition, almost one-third of the gap in COVID-19 vaccination rates between the Medi-Cal and overall California populations ages 12-25 was closed, and almost one-third of the gap in COVID-19 vaccination rates between the overall Medi-Cal population and both the Black/African American and American Indian/Alaska Native Medi-Cal populations was closed. Vaccination rates continued to improve through the second outcome ascertainment date of January 2, 2022, but statewide did not meet DHCS’ goal of closing two-thirds of the gap for any of the seven vaccine update outcome measures. January 2 data for the three intermediate outcome measures are being compiled.​​