ຂ່າວເດັ່ນ

ຜູ້ປົກຄອງຕັ້ງຊື່ຜູ້ບໍລິຫານ DHCS ຄົນໃໝ່ສຳລັບໂຄງການ (COOP)

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.

ການປັບປຸງການຕໍ່ອາຍຸ Medi-Cal

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. 

ແຜນ Medi-Medi ທີ່ມີຢູ່ໃນລະຫວ່າງການລົງທະບຽນເປີດ Medicare

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.

ແຜນ Medi-Medi ປະສານງານຜົນປະໂຫຍດ ແລະ ການບໍລິການທັງໝົດໃນທົ່ວທັງສອງໂຄງການ, ລວມທັງການບໍລິການທີ່ຄຸ້ມຄອງໂດຍ Medicare ທັງໝົດ, ການບໍລິການທີ່ຄຸ້ມຄອງໂດຍ Medi-Cal ທັງໝົດ, ຜົນປະໂຫຍດເພີ່ມເຕີມ, ຜົນປະໂຫຍດທີ່ແຍກອອກມາ (ເຊັ່ນ: ການບໍລິການສະໜັບສະໜູນໃນບ້ານ, ໂຄງການບໍລິການຜູ້ສູງອາຍຸຫຼາຍຈຸດປະສົງ, ການບໍລິການຜູ້ໃຫຍ່ໃນຊຸມຊົນ, ແລະ ການປິ່ນປົວແຂ້ວ), ທີມງານຄຸ້ມຄອງການດູແລໜຶ່ງຄົນເພື່ອປະສານງານການດູແລ, ແລະ ການສະໜັບສະໜູນຊຸມຊົນທີ່ສະເໜີໂດຍແຜນການດູແລທີ່ຄຸ້ມຄອງໂດຍ Medi-Cal.

ອັບເດດໂຄງການ

ການຄຸ້ມຄອງຢ່າງຕໍ່ເນື່ອງເພີ່ມເຕີມ unwinding Flexibilities

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.

ບົດບັນທຶກຄວາມເຂົ້າໃຈລະຫວ່າງແຜນການດູແລທີ່ຄຸ້ມຄອງ ແລະ ໜ່ວຍງານພາກສ່ວນທີສາມ

ໃນອາທິດນີ້ໄດ້ອອກຈົດໝາຍແຜນການທັງໝົດ (APL), ແຈ້ງການຂໍ້ມູນສຸຂະພາບທາງດ້ານພຶດຕິກຳສອງສະບັບ (BHIN), ແລະແມ່ແບບບົດບັນທຶກຄວາມເຂົ້າໃຈ (MOU) ທີ່ກ່ຽວຂ້ອງສຳລັບແຜນການດູແລທີ່ມີການຄຸ້ມຄອງຂອງ Medi-Cal (MCP) ທີ່ກຳນົດໄວ້ໃນສັນຍາ MCP ປີ 2024 ເພື່ອປະຕິບັດ MOU ກັບໜ່ວຍງານພາກສ່ວນທີສາມທີ່ແນ່ນອນເພື່ອຮັບປະກັນວ່າການດູແລສະມາຊິກໄດ້ຮັບການປະສານງານ ແລະສະມາຊິກສາມາດເຂົ້າເຖິງຊັບພະຍາກອນທີ່ອີງໃສ່ຊຸມຊົນເພື່ອສະໜັບສະໜູນການດູແລບຸກຄົນທັງໝົດ. ບົດບັນທຶກຄວາມເຂົ້າໃຈດັ່ງກ່າວມີຈຸດປະສົງເພື່ອເປັນພາຫະນະທີ່ມີປະສິດທິພາບໃນການຊີ້ແຈງບົດບາດ ແລະ ຄວາມຮັບຜິດຊອບລະຫວ່າງບັນດາຝ່າຍ ແລະ ສະໜັບສະໜູນການມີສ່ວນຮ່ວມໃນທ້ອງຖິ່ນ, ການປະສານງານດ້ານການດູແລ, ການແລກປ່ຽນຂໍ້ມູນ, ຄວາມຮັບຜິດຊອບຮ່ວມກັນ ແລະ ຄວາມໂປ່ງໃສ.

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.

ຜົນປະໂຫຍດດ້ານແຂ້ວຂອງ Medicare ແລະ Medi-Cal

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.

ຮອດວັນທີ 17 ຕຸລາ, ຜູ້ມີສ່ວນຮ່ວມທັງໝົດຂອງ Medi-Cal Rx ທີ່ DHCS ໄດ້ມີສ່ວນຮ່ວມຈະໄດ້ຮັບການນຳສະເໜີການສື່ສານ Advancing Medi-Cal Rx, ເຊິ່ງປະກາດການສິ້ນສຸດຄວາມພະຍາຍາມຟື້ນຟູສຳລັບຜູ້ໃຫຍ່ ແລະ ບໍ່ມີການປ່ຽນແປງສຳລັບປະຊາກອນເດັກຈົນກວ່າປີ 2024. ຜູ້ມີສ່ວນຮ່ວມລວມມີແຜນສຸຂະພາບທ້ອງຖິ່ນຂອງລັດຄາລິຟໍເນຍ, ສະມາຄົມແຜນສຸຂະພາບຂອງລັດຄາລິຟໍເນຍ, ສະມາຄົມສຸຂະພາບຂອງລັດຄາລິຟໍເນຍ, ຜູ້ອຳນວຍການຮ້ານຂາຍຢາແຜນການດູແລທີ່ຄຸ້ມຄອງໂດຍ Medi-Cal, ສະມາຄົມໂຮງໝໍເດັກຂອງລັດຄາລິຟໍເນຍ, ກຸ່ມຮ່ວມມືການດູແລພິເສດສຳລັບເດັກ, ລະບົບການບໍລິການປະສົມປະສານພາກພື້ນສຳລັບເດັກ, ສະມາຄົມແພດລັດຄາລິຟໍເນຍ, ສະມາຄົມຜູ້ຂາຍຍ່ອຍຂອງລັດຄາລິຟໍເນຍ, ສະມາຄົມຮ້ານຂາຍຢາລະບົບຕ່ອງໂສ້ແຫ່ງຊາດ, ສະມາຄົມຮ້ານຂາຍຢາລັດຄາລິຟໍເນຍ, ສະມາຄົມການດູແລຂັ້ນຕົ້ນຂອງລັດຄາລິຟໍເນຍ, ສະມາຄົມຄຳແນະນຳດ້ານສຸຂະພາບພຶດຕິກຳຂອງລັດຄາລິຟໍເນຍ, ສະມາຄົມຜູ້ສະໜອງຜະລິດຕະພັນທາງການແພດຂອງລັດຄາລິຟໍເນຍ, ແລະ ສະພາພະຍາດເລືອດອອກໃນເລືອດຂອງລັດຄາລິຟໍເນຍ.

ເຂົ້າຮ່ວມທີມງານຂອງພວກເຮົາ

DHCS ກໍາລັງຈ້າງສໍາລັບທີມງານງົບປະມານ, ຊັບພະຍາກອນມະນຸດ, ທາງດ້ານກົດຫມາຍ, ການກວດສອບ, ນະໂຍບາຍສຸຂະພາບ, ແລະທີມງານເຕັກໂນໂລຊີຂໍ້ມູນຂ່າວສານຂອງພວກເຮົາ. ສໍາລັບຂໍ້ມູນເພີ່ມເຕີມ, ກະລຸນາເຂົ້າໄປທີ່ ເວັບໄຊທ໌ CalCareers.

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.

ກອງປະຊຸມຜູ້ມີສ່ວນກ່ຽວຂ້ອງ ແລະກອງປະຊຸມທາງເວັບທີ່ຈະມາເຖິງ

Webinar ການຂະຫຍາຍຕົວຂອງຜູ້ໃຫຍ່

ໃນວັນທີ 18 ຕຸລາ, DHCS ຈະຈັດກອງປະຊຸມທາງເວັບຄັ້ງທຳອິດໃນສອງຄັ້ງກ່ຽວກັບການຂະຫຍາຍ Medi-Cal ສຳລັບຜູ້ໃຫຍ່ (ອາຍຸ 26-49 ປີ) ສຳລັບຫ້ອງການຂອງເຂດປົກຄອງທ້ອງຖິ່ນ ແລະ ຜູ້ມີສ່ວນຮ່ວມອື່ນໆ. ການສຳມະນາທາງເວັບຄັ້ງທີສອງແມ່ນກຳນົດໄວ້ລ່ວງໜ້າໃນຕົ້ນເດືອນທັນວາ. ການສຳມະນາທາງເວັບຈະໃຫ້ຂໍ້ມູນພື້ນຖານກ່ຽວກັບການຂະຫຍາຍຕົວ, ການວາງແຜນການຈັດຕັ້ງປະຕິບັດ, ການແຈ້ງການ, ການເຜີຍແຜ່ຂໍ້ມູນ, ແລະອື່ນໆ. ຂໍ້ມູນການລົງທະບຽນຈະຖືກປະກາດຢູ່ໃນໜ້າເວັບການຂະຫຍາຍ Medi-Cal ຂະໜາດເຕັມສຳລັບຜູ້ໃຫຍ່ອາຍຸ 26 ຫາ 49 ປີ. ບຸກຄົນສາມາດລົງທະບຽນເຂົ້າຮ່ວມການສຳມະນາທາງເວັບໄດ້ໂດຍການສົ່ງອີເມວໄປທີ່ AdultExpansion@dhcs.ca.gov.

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.

ກອງ​ປະ​ຊຸມ​ຄະ​ນະ​ກໍາ​ມະ​ທີ່​ປຶກ​ສາ​ຜູ້​ມີ​ສ່ວນ​ຮ່ວມ (SAC) ແລະ​ສຸ​ຂະ​ພາບ​ພຶດ​ຕິ​ກໍາ-SAC (BH-SAC)

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.

ການສະຫນອງການເຂົ້າເຖິງແລະການຫັນປ່ຽນສຸຂະພາບ (PATH) ຊົ່ວໂມງຫ້ອງການທີ່ກ່ຽວຂ້ອງກັບຄວາມຍຸຕິທໍາ

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.

ການຍິນຍອມເຫັນດີເລັກນ້ອຍແລະຄວາມລັບສໍາລັບການບໍລິການສຸຂະພາບທາງເພດ Webinar

ໃນວັນທີ 25 ຕຸລາ, ຕັ້ງແຕ່ເວລາ 12 ໂມງ ຫາ 13:30 ໂມງ, DHCS ແລະສູນຝຶກອົບຮົມການປ້ອງກັນລັດ California ຈະເປັນເຈົ້າພາບຈັດກອງປະຊຸມ webinar ກ່ຽວກັບການຍິນຍອມຂອງຜູ້ນ້ອຍ ແລະ ການຮັກສາຄວາມລັບສຳລັບການບໍລິການສຸຂະພາບທາງເພດ (ຕ້ອງລົງທະບຽນລ່ວງໜ້າ). ການສຳມະນາທາງເວັບນີ້ຈະໃຫ້ພາບລວມກ່ຽວກັບກົດໝາຍຂອງລັດຄາລິຟໍເນຍທີ່ສົ່ງຜົນກະທົບຕໍ່ເດັກນ້ອຍ ແລະ ການເຂົ້າເຖິງການບໍລິການສຸຂະພາບທາງເພດ ແລະ ການວາງແຜນຄອບຄົວທີ່ເປັນຄວາມລັບ. ມັນຈະທົບທວນຂໍ້ຍົກເວັ້ນທີ່ສຳຄັນຕໍ່ການຮັກສາຄວາມລັບ, ລວມທັງການລາຍງານການລ່ວງລະເມີດເດັກທີ່ຖືກບັງຄັບ, ແລະ ແບ່ງປັນຕົວຢ່າງບາງຢ່າງຂອງການປະຕິບັດທີ່ດີທີ່ສຸດສຳລັບການຈັດຕັ້ງປະຕິບັດໃນສະຖານະການທີ່ຫຍຸ້ງຍາກ. ຜູ້ເຂົ້າຮ່ວມຈະໄດ້ຮຽນຮູ້ກ່ຽວກັບຊັບພະຍາກອນເພື່ອສະໜັບສະໜູນການຈັດຕັ້ງປະຕິບັດກົດໝາຍວ່າດ້ວຍການຍິນຍອມຂອງເດັກນ້ອຍ ແລະ ໄດ້ຮັບໂອກາດໃນການທົດສອບຄວາມຮູ້ຂອງຕົນເອງຜ່ານການສຶກສາກໍລະນີ.

ສຳລັບຜູ້ທີ່ບໍ່ສາມາດເຂົ້າຮ່ວມການສຳມະນາທາງເວັບສົດໄດ້, ບົດບັນທຶກ ແລະ ການບັນທຶກການສຳມະນາທາງເວັບ, ພ້ອມກັບຊັບພະຍາກອນເພີ່ມເຕີມ, ຈະມີໃຫ້ຢູ່ໃນ ເວັບໄຊທ໌ Family PACT.

PATH ການວາງແຜນການຮ່ວມມືແລະການຈັດຕັ້ງປະຕິບັດ (CPI) Webinar ການປະຕິບັດທີ່ດີທີ່ສຸດ

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.

ໃນກໍລະນີທີ່ທ່ານພາດມັນ

ລັດຄາລິຟໍເນຍມອບລາງວັນຫຼາຍລ້ານໃຫ້ຜູ້ໃຫ້ບໍລິການດ້ານສຸຂະພາບພຶດຕິກຳເພື່ອຕ້ານ COVID-19

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.

Parity ແຜນການດູແລຄຸ້ມຄອງແຂ້ວ

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. 

ເລີ່ມຕົ້ນໃນເດືອນພະຈິກ 2023, DHCS ຈະສົ່ງແຈ້ງການໄປຫາສະມາຊິກປະມານ 614,000 ຄົນທີ່ລົງທະບຽນໃນແຜນ DMC ໃນເຂດ Sacramento County ເພື່ອແຈ້ງໃຫ້ພວກເຂົາຮູ້ທາງເລືອກທີ່ຈະຢູ່ກັບແຜນປະຈຸບັນຂອງເຂົາເຈົ້າ ຫຼື ຖອນການລົງທະບຽນ ແລະ ເຂົ້າຮ່ວມ FFS, ມີຜົນບັງຄັບໃຊ້ໃນເດືອນທັນວາ 1, 2023. ແຈ້ງການດັ່ງກ່າວຈະໃຫ້ຂໍ້ມູນກ່ຽວກັບວິທີທີ່ສະມາຊິກສາມາດເຂົ້າເຖິງການບໍລິການດ້ານທັນຕະກຳໄດ້ ຖ້າພວກເຂົາເລືອກ FFS ຫຼື ທາງເລືອກຂອງພວກເຂົາທີ່ຈະເລືອກແຜນ DMC ທາງເລືອກອື່ນ ສະເພາະຖ້າສະມາຊິກສາມາດຢືນຢັນບັນຫາການເຂົ້າເຖິງການດູແລໃນ FFS ໄດ້. ນອກຈາກນັ້ນ, ມີຜົນບັງຄັບໃຊ້ໃນວັນທີ 1 ທັນວາ, ສະມາຊິກ Medi-Cal ທີ່ມີສິດໄດ້ຮັບໃໝ່ຈະຖືກລົງທະບຽນເຂົ້າໃນ FFS ດ້ານທັນຕະກຳໂດຍຄ່າເລີ່ມຕົ້ນ. ເພື່ອທົບທວນບົດລາຍງານປະສິດທິພາບຂອງ FFS ແລະ DMC ດ້ານທັນຕະກຳ, ເຂົ້າເບິ່ງ ໜ້າເວັບລາຍງານຂໍ້ມູນດ້ານທັນຕະກຳ.