Вернуться к обновлению информации для заинтересованных сторон за октябрь​​ 

Переход руководства​​ 

10 сентября 2021 губернатор Гэвин Ньюсом назначил Мишель Баас директором DHCS, вступление в должность вступило в силу 15 сентября. С 2017 года Баас занимал должность заместителя министра и заместителя секретаря Управления по программам и финансовым вопросам Калифорнийского агентства здравоохранения и социальных служб (CHHSA). До прихода в CHHSA Баас в течение 13 лет проработал в Законодательном собрании на различных должностях. Она рассматривает свою новую роль как возможность решить проблему равенства и неравенства в сфере здравоохранения, чтобы у всех жителей Калифорнии были возможности для достижения здоровых результатов. Баас сменит Уилла Лайтборна, который вышел на пенсию в 2020 году, чтобы занять пост директора DHCS во время всемирной пандемии.​​ 

Калифорния, развивающая и инновационная программа Medi-Cal (CalAIM)​​ 

On October 1, Medi-Cal managed care plans (MCP) submitted their Model of Care (MOC) for Enhanced Care Management (ECM) and Community Supports (formerly called “In Lieu of Services”). These submissions include initial ECM and Community Supports provider capacity and other critical information, including organizational descriptions, key policies and procedures, and provider contract boilerplates related to the transition of the Health Homes and Whole Person Care pilot programs to the ECM and Community Supports benefits. ECM and Community Supports are scheduled to go live on January 1, 2022.​​ 

ECM and Community Supports are foundational components of CalAIM. ECM will be a whole-person, interdisciplinary approach to comprehensive care management that addresses the clinical and non-clinical needs of high-cost, high-need managed care members through systematic coordination of services that is community-based, interdisciplinary, high-touch, and person-centered. Community Supports are medically appropriate and cost-effective alternatives to services covered under the State Plan. Community Supports are optional services for MCPs to provide and optional for managed care members to access. For more information about ECM and Community Supports, please visit the DHCS website.​​ 

Обновление графика закупок MCP и изменений модели​​ 

DHCS is adjusting the release date of the Medi-Cal MCP Request for Proposal (RFP) to February 2, 2022. Though the RFP was scheduled to be released at the end of 2021, this change will not affect the implementation date of January 1, 2024. Additional time is needed to address stakeholder comments received during the comment period for the draft RFP. DHCS is also timing the release of the final RFP so that it does not coincide with the winter holiday period. County Managed Care Transition to Local Plan: Letter of Intent Instructions, and notified them of their conditional approval to advance to the next stage of the assessment process. DHCS has authority to determine which, and how many, MCPs the state contracts with for Medi-Cal services in all counties. DHCS’ evaluation includes assessment of historical quality of care performance and the financial health and viability of the plan.​​ 

The conditionally approved counties must now submit an approved county ordinance to DHCS by October 10. By December 3, MCPs are required to submit to DHCS a network contracting strategy for review. A final list of counties approved to move forward with a Plan Model change, will be posted at Plan Model County Changes in early November. Final approval to implement on January 1, 2024, will be based upon MCP operational readiness and Centers for Medicare & Medicaid Services (CMS) approval.​​ 

DHCS’ determination will be guided by the best interests of Medi-Cal beneficiaries and DHCS’ goals for the Medi-Cal managed care delivery system under CalAIM: drive quality of care improvements, streamline and reduce complexity, and build upon whole-person care approaches. Additional information is available on the DHCS website.​​ 

Программа стимулирования вакцинации от COVID-19 Medi-Cal​​ 

DHCS is allocating 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 MCPs are eligible to earn incentive payments for activities that are designed to close vaccination gaps with their enrolled members, and to address vaccine uptake disparities for specific age and race/ethnicity groups. MCPs collectively may earn up to $50 million for achieving specified process measures and $200 million for outcome measures, with $100 million available for all MCPs to use for direct member incentives. DHCS will issue payment allocations upon approval of the MCP’s Vaccination Response Plan, and will assess program achievements in October 2021, January 2022, and March 2022. All 25 full-service MCPs, one population-specific health plan, and one Cal MediConnect plan submitted a Vaccination Response Plan and were approved for participation in the program. For more information, please visit the DHCS website.​​