ກັບໄປທີ່ເດືອນມິຖຸນາ 2022 ການປັບປຸງການສື່ສານຂອງພາກສ່ວນກ່ຽວຂ້ອງ​​ 

Medi-Cal ແຜນປະຕິບັດງານສຸກເສີນດ້ານສາທາລະນະສຸກ COVID-19 (PHE).​​ 

On May 17, DHCS released the Medi-Cal COVID-19 PHE Operational Unwinding Plan. The two primary purposes of the plan are to: 1) describe DHCS’ approach to unwinding or making permanent the temporary flexibilities implemented across the Medi-Cal program during the PHE; and 2) describe DHCS’ approach to resuming normal Medi-Cal eligibility operations following the end of the PHE. The PHE is currently set to expire on July 15, 2022, and the U.S. Department of Health and Human Services (HHS) has committed to providing at least a 60-day notice prior to the official PHE end date.​​ 

Since the initiation of the PHE, DHCS implemented more than 100 programmatic flexibilities to help minimize the strain to the Medi-Cal program, its beneficiaries, and California’s health care providers and systems. While many of these programmatic flexibilities will terminate on or around the end of the PHE, some will continue due to the positive impact they have made on the Medi-Cal program. Additionally, under the continuous coverage requirement in the Families First Coronavirus Response Act, states are required to maintain enrollment of nearly all Medicaid enrollees through the end of the month in which the PHE ends. When continuous coverage requirements expire, states must conduct a full redetermination for all beneficiaries who would otherwise have been subject to redetermination.​​ 

The Operational Unwinding Plan is intended to inform the public of DHCS’ approach to return Medi-Cal to a normal state of operations. The document also includes additional resources, including information about the DHCS Coverage Ambassadors campaign and links to the Centers for Medicare & Medicaid Services’ (CMS) guidance documents.​​ 

Governor’s May Revision​​ 

On May 13, Governor Newsom unveiled his $300 billion fiscal year (FY) 2022-23 May Revision budget proposal, which is an increase of approximately $14 billion compared to the budget released on January 10, 2022. The state now has a projected surplus in excess of $86 billion that is reflected in increased budgetary reserves as well as an increased use of discretionary surplus amounts to fund one-time projects. The Governor’s May Revision proposes a $141.8 billion total funds ($37 billion General Fund) budget for DHCS programs and services. The total amount is allocated between $1.6 billion in DHCS state operations and $140.2 billion that supports funding for program costs, partners, and administration.​​ 

COVID-19 PHE ຍັງສືບຕໍ່ສົ່ງຜົນກະທົບຢ່າງຫຼວງຫຼາຍຕໍ່ງົບປະມານຂອງ DHCS, ເຊິ່ງສະທ້ອນເຖິງຄ່າໃຊ້ຈ່າຍສຸດທິລວມທີ່ກ່ຽວຂ້ອງກັບ PHE ຂອງກອງທຶນທັງໝົດ $11.5 ຕື້ໂດລາ. ຜົນກະທົບນີ້ລວມມີສ່ວນຂະຫຍາຍຫຼ້າສຸດຂອງ PHE ຈົນຮອດເດືອນກໍລະກົດ 15, 2022. ການປັບປຸງທີ່ສໍາຄັນຕໍ່ກັບຜົນກະທົບທີ່ຄາດໄວ້ຂອງ COVID-19 ລວມເຖິງຄ່າໃຊ້ຈ່າຍທີ່ກ່ຽວຂ້ອງກັບການຍົກເລີກ PHE (ລວມທັງການກໍານົດຄືນການມີສິດໄດ້ຮັບ); ສືບຕໍ່ການເກັບເງິນແຍກຕ່າງຫາກໂດຍສູນສຸຂະພາບທີ່ມີຄຸນວຸດທິຂອງລັດຖະບານກາງສໍາລັບການຄຸ້ມຄອງຢາວັກຊີນ; ສືບຕໍ່ການມີສິດໄດ້ຮັບສົມມຸດຕິຖານສໍາລັບບຸກຄົນ 65 ປີຂຶ້ນໄປ, ຕາບອດຫຼືພິການ; ແລະລາຍໄດ້ເພີ່ມເຕີມໃນໄຕມາດທີ່ກ່ຽວຂ້ອງກັບອັດຕາສ່ວນການຊ່ວຍເຫຼືອທາງການແພດຂອງລັດຖະບານກາງ (FMAP).​​ 

The May Revision includes a significant additional investment in the Equity and Practice Transformation Payment program ($700 million total funds) to advance equity, address gaps in preventive, maternity, and behavioral health care measures, reduce disparities driven by COVID-19, and support practices to transition from fee-for-service reimbursement (where providers are paid for visits/volume and not quality/outcomes) to value-based payments/alternative payment models (e.g., capitated payments tied to quality outcomes)). This aligns with the goals of the Medi-Cal Comprehensive Quality and Equity Strategy and the Bold Goals of 50×2025 initiative. Preparing practices for value-based care also includes implementing practice infrastructure, such as electronic health records and improved data collection and exchange.​​ 

The May Revision also proposes $933 million for one-time retention payments to approximately 600,000 California hospital and nursing facility workers who have been at the frontlines delivering care to the most acute patients during the COVID-19 Pandemic. The ongoing response to COVID-19 has significantly impacted California’s workforce in hospitals and nursing facilities. Retaining essential workers in these settings is a priority of the Administration, and these payments are designed to help retain this critical workforce in an environment of high vacancies and turnover. The state will provide a baseline payment and will increase the payment up to $1,500 if employers commit to fully matching the additional amount, subject to available funding.​​ 

ນອກຈາກນັ້ນ, DHCS ກໍາລັງຮ່ວມມືກັບອົງການບໍລິການສຸຂະພາບ ແລະມະນຸດຂອງຄາລິຟໍເນຍ ເພື່ອສະຫນອງການຊ່ວຍເຫຼືອລ້າ (ກອງທຶນທົ່ວໄປ 85 ລ້ານໂດລາ) ເພື່ອສະໜັບສະໜູນສຸຂະພາບ ແລະສ້າງຄວາມຢືດຢຸ່ນຂອງເດັກນ້ອຍ, ໄວໜຸ່ມ ແລະ ພໍ່ແມ່.  ໂຄງການເຫຼົ່ານີ້, ເຊິ່ງຈະຊ່ວຍໃຫ້ໄວຫນຸ່ມທີ່ໄດ້ຮັບຜົນກະທົບຈາກການບາດເຈັບ, ຄວາມກົດດັນ, ແລະການໂດດດ່ຽວທາງສັງຄົມທີ່ເກີດຈາກ PHE, ຈະສະຫນອງການຊ່ວຍເຫຼືອດ້ານສຸຂະພາບພຶດຕິກໍາເດັກແລະໄວຫນຸ່ມເພີ່ມເຕີມໃຫ້ແກ່ໂຮງຮຽນ, ເມືອງ, ເຂດປົກຄອງ, ຊົນເຜົ່າ, ແລະອົງການຈັດຕັ້ງຊຸມຊົນ (CBOs).​​ 

DHCS ສະເໜີໃຫ້ສະໜອງທຶນເພີ່ມເຕີມ (ເງິນທັງໝົດ 60 ລ້ານໂດລາສະຫະລັດ) ໃຫ້ແກ່ຜູ້ແນະນຳການລົງທະບຽນສຸຂະພາບເພື່ອສືບຕໍ່ກິດຈະກຳຂອງໂຄງການ, ໂດຍເນັ້ນໃສ່ກິດຈະກຳທີ່ກ່ຽວຂ້ອງກັບ COVID-19 PHE, ໂດຍສະເພາະການຊ່ວຍໃຫ້ຜູ້ໄດ້ຮັບຜົນປະໂຫຍດສາມາດຮັກສາການຄຸ້ມຄອງຂອງ Medi-Cal ໂດຍການຊ່ວຍເຫຼືອຕໍ່ອາຍຸປະຈຳປີ, ການລາຍງານຂໍ້ມູນການຕິດຕໍ່ທີ່ອັບເດດໃໝ່, ແລະ ມີສ່ວນຮ່ວມໃນການເຂົ້າເຖິງປະຊາກອນທີ່ຫຍຸ້ງຍາກ.​​ 

ສະບັບປັບປຸງໃນເດືອນພຶດສະພາປະກອບມີການຮ້ອງຂໍເງິນ 10 ລ້ານໂດລາໃນກອງທຶນການຊໍາລະ Opioid ຄັ້ງດຽວເພື່ອຂະຫຍາຍການສະເຫນີໂຄງການການຂະຫຍາຍການປິ່ນປົວຂອງຢາເດືອນມັງກອນໂດຍການເພີ່ມການແຈກຢາຍ naloxone ໃຫ້ກັບຜູ້ໃຫ້ບໍລິການທີ່ບໍ່ມີທີ່ຢູ່ອາໄສ. ນອກຈາກນັ້ນ, DHCS ກໍາລັງສະເຫນີໃຫ້ເພີ່ມການສະເຫນີເດືອນມັງກອນທີ່ກ່ຽວຂ້ອງກັບການຝຶກອົບຮົມແຮງງານຂອງຜູ້ໃຫ້ບໍລິການດ້ານການນໍາໃຊ້ສານເສບຕິດໂດຍ $ 29.1 ລ້ານ.​​ 

View the DHCS May Revision budget highlights and the Medi-Cal and Family Health Local Assistance Estimates.​​ 

ການປັບປຸງການຈັດຕັ້ງປະຕິບັດ Medi-Cal Rx​​ 

ນັບຕັ້ງແຕ່ເດືອນກຸມພາ 2022, Medi-Cal Rx ໄດ້ຮັກສາສະຖຽນລະພາບຂອງສູນການໂທຫາ ແລະການປະຕິບັດການອະນຸມັດກ່ອນ (PA). ນັບຕັ້ງແຕ່ນັ້ນມາ, DHCS ແລະ Magellan (MMA) ໄດ້ມີສ່ວນຮ່ວມໃນຂະບວນການວາງແຜນທີ່ເຂັ້ມງວດສໍາລັບການດໍາເນີນການຄືນໃຫມ່ຂອງການແກ້ໄຂການຮຽກຮ້ອງ ແລະຄວາມຕ້ອງການ PA. ວິທີການສາມຂັ້ນຕອນ, ແຈ້ງໃຫ້ຊາບໂດຍ ຄໍາຕິຊົມຂອງພາກສ່ວນກ່ຽວຂ້ອງ, ເລີ່ມຕົ້ນດ້ວຍການກັບຄືນຂອງກຸ່ມຂະຫນາດນ້ອຍແລະຄັດເລືອກຂອງການແກ້ໄຂການຮຽກຮ້ອງແລະ PAs ໂດຍປະເພດຢາເສບຕິດ; ກ້າວ​ໄປ​ເຖິງ​ການ​ຟື້ນ​ຟູ​ປ່າ​ໄມ້​ທັງ​ໝົດ​ທີ່​ໄດ້​ຮັບ​ການ​ແກ້​ໄຂ​ໃນ​ຕົ້ນ​ເດືອນ​ກຸມ​ພາ 2022; ແລະ​ໃນ​ໄລ​ຍະ​ສຸດ​ທ້າຍ​, ກິນ​ບໍາ​ນານ​ນະ​ໂຍ​ບາຍ​ການ​ຫັນ​ປ່ຽນ​. ວິທີການຟື້ນຟູແມ່ນເທື່ອລະກ້າວແລະຊ້ໍາຊ້ອນໂດຍສຸມໃສ່ການກຽມພ້ອມຂອງພາກສ່ວນກ່ຽວຂ້ອງແລະການຕິດຕາມການປະຕິບັດ. ມັນຈະຖືກປັບປຸງຕາມຄວາມຈໍາເປັນໃນໄລຍະເວລາໂດຍອີງໃສ່ການວິເຄາະຂໍ້ມູນ, ປະສົບການການດໍາເນີນງານ, ແລະຄໍາຄຶດຄໍາເຫັນຂອງຜູ້ມີສ່ວນຮ່ວມ. ພາກສ່ວນກ່ຽວຂ້ອງໄດ້ຮັບການຊຸກຍູ້ໃຫ້ສະແດງຄວາມຄິດເຫັນ ແລະໃຫ້ຄໍາຄິດເຫັນກ່ຽວກັບວິທີນີ້ຜ່ານທາງອີເມລ໌ທີ່ອຸທິດຕົນ, Reinstatement@dhcs.ca.gov.​​  

ທີມງານປະສານງານຄລີນິກປະຊາກອນພິເສດ​​ 
Using feedback from various stakeholders, Medi-Cal Rx has created a Special Populations Clinical Liaison Team within the Customer Service Center that is trained to serve the specific needs of populations enrolled in California Children’s Services, the Genetically Handicapped Persons Program, and those who have specialty behavioral health conditions. This team is comprised of pharmacy technicians and pharmacists.​​ 

ເລີ່ມແຕ່ວັນທີ 9 ພຶດສະພາເປັນຕົ້ນໄປ, ທີມງານປະສານງານທາງດ້ານຄລີນິກປະຊາກອນພິເສດແມ່ນເປີດໃຫ້ບໍລິການວັນຈັນເຖິງວັນສຸກ, 8 ໂມງເຊົ້າຫາ 8 ໂມງແລງ, ບໍ່ລວມວັນພັກ, ແລະໃຫ້ບໍລິການຜູ້ໄດ້ຮັບຜົນປະໂຫຍດ, ຜູ້ໃຫ້ບໍລິການ, ແລະຜູ້ໃຊ້ເຂດປົກຄອງທີ່ສາມາດກວດສອບຄວາມຖືກຕ້ອງແລະປຶກສາຫາລືກ່ຽວກັບຂໍ້ມູນສຸຂະພາບທີ່ໄດ້ຮັບການປົກປ້ອງສໍາລັບຜູ້ໄດ້ຮັບຜົນປະໂຫຍດ. Medi-Cal Rx ມຸ່ງໝັ້ນທີ່ຈະສະໜອງການບໍລິການຮ້ານຂາຍຢາໃຫ້ທັນເວລາ ແລະປອດໄພໃຫ້ແກ່ຜູ້ໄດ້ຮັບຜົນປະໂຫຍດ ແລະຜູ້ໃຫ້ບໍລິການ Medi-Cal ທົ່ວລັດຄາລິຟໍເນຍ.​​ 

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. These actions are designed to ensure that Medi-Cal beneficiaries 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.​​   

Cuffs ຄວາມດັນເລືອດແລະຕິດຕາມກວດກາ​​ 
ນັບແຕ່ວັນທີ 1 ມິຖຸນາເປັນຕົ້ນໄປ, ເຄື່ອງກວດຄວາມດັນເລືອດທີ່ໃຊ້ສ່ວນຕົວ ແລະເຄື່ອງກວດຄວາມດັນເລືອດໄດ້ຖືກເພີ່ມເຂົ້າເປັນຜົນປະໂຫຍດທາງຮ້ານຂາຍຢາບາງສ່ວນຂອງ Medi-Cal Rx. ລາຍການເຫຼົ່ານີ້ຖືກຈໍາກັດຢູ່ໃນບັນຊີລາຍຊື່ອຸປະກອນແລະ cuffs ທີ່ສະເຫນີ, ແລະໄດ້ຖືກຄັດເລືອກຫຼັງຈາກການທົບທວນຄືນຢ່າງລະອຽດແລະຜູ້ມີສ່ວນຮ່ວມແລະຜູ້ໃຫ້ບໍລິການປ້ອນຂໍ້ມູນ. ການເພີ່ມລາຍການເຫຼົ່ານີ້ເປັນຜົນປະໂຫຍດທີ່ຈ່າຍຄືນຈາກຮ້ານຂາຍຢາຈະຊ່ວຍປັບປຸງການເຂົ້າເຖິງການດູແລ, ແລະຜົນປະໂຫຍດເຫຼົ່ານີ້ຈະສືບຕໍ່ມີຢູ່ໃນຖານະອຸປະກອນການແພດທີ່ທົນທານທີ່ຮຽກເກັບຄ່າປິ່ນປົວ. ລາຍຊື່ Medi-Cal Rx ຂອງລາຍລະອຽດຜະລິດຕະພັນການສະໜອງການແພດທີ່ຄຸ້ມຄອງ ແລະຂໍ້ມູນການຮຽກເກັບເງິນ ແລະຄູ່ມືຜູ້ໃຫ້ບໍລິການ Medi-Cal Rx ຈະຖືກປັບປຸງເພື່ອສະທ້ອນເຖິງການເພີ່ມເຕີມເຫຼົ່ານີ້. ສໍາ​ລັບ​ຄໍາ​ຖາມ​ຫຼື​ຄໍາ​ຄິດ​ເຫັນ​, ກະ​ລຸ​ນາ​ອີ​ເມລ​໌ medicalsupplies@dhcs.ca.gov.​​ 

ໂຄງການແຮງຈູງໃຈໃນການສັກວັກຊີນ Medi-Cal COVID-19​​ 

DHCS allocated up to $350 million to incentivize COVID-19 vaccination efforts in the Medi-Cal managed care delivery system from September 1, 2021, through February 28, 2022. Medi-Cal managed care plans (MCPs) were eligible to earn incentive payments for activities designed to close vaccination gaps with their enrolled members, and to address vaccine uptake disparities for specific age and race/ethnicity groups. The third outcome ascertainment period for the program ended on March 6. Between January 3 and March 6, the total vaccination rates showed improvement in all reported measures. On March 6, target goals for all vaccine outcome measures increased to closing 100 percent of the gap between Medi-Cal and county rates, which was a challenge for plans to meet. Three beneficiary sub-groups (ages 12-25 years, African Americans, and American Indian/Alaska Natives) were within 5 percent of closing two-thirds of the gap. For the high performance pool measures, preliminary data demonstrate that eight MCPs achieved targets of at least one dose for members age 5-11 years, and two MCPs achieved targets for fully vaccinated and boosted members age 12 years and older. For more information, please refer to All Plan Letter (APL) 21-010, Attachment A.​​