Март 24, 2025
Главные новости
Калифорния подала заявку на расширение лечения серповидноклеточной анемии
On March 11, DHCS applied to CMS to participate in the groundbreaking Cell and Gene Therapy (CGT) Access Model. If accepted, DHCS will implement this multi-year initiative to expand Medi-Cal members’ access to innovative and potentially life-changing therapies for sickle cell disease (SCD), a severe genetic blood disorder that disproportionately impacts people of African descent. Gene therapy represents a groundbreaking approach to SCD. However, these therapies come with extraordinary costs, making access difficult for patients and Medicaid programs, including Medi-Cal. The CGT Access Model addresses this challenge by using a negotiated rebate system that ties payments for these treatments to patient outcomes. If the therapy does not meet expected health improvements, drug manufacturers will provide rebates to Medicaid programs, helping ensure financial sustainability while expanding access to care. If California is approved, eligible Medi-Cal members would gain access to gene therapy treatment, fertility preservation services, case management, travel assistance, and behavioral health support. CMS anticipates testing the model over an 11-year performance period. If approved, California will begin participating in this model on July 1, 2025.
Традиционные практики здравоохранения приносят пользу
On March 21, DHCS published Behavioral Health Information Notice (BHIN) 25-007 – Traditional Health Care Practices Benefit Implementation. This policy, the result of years of dedicated effort and advocacy from California Tribal leaders and partners, provides guidance on the implementation of the traditional health care practices benefit in the Drug Med-Cal Organized Delivery System (DMC-ODS). The federal Centers for Medicare & Medicaid Services (CMS) approved DHCS to cover traditional health care practices provided by Indian Health Care Providers (IHCP) for Medi-Cal members in DMC-ODS counties through December 31, 2026, unless extended or amended. Traditional health care practices encompass two new service types: Traditional Healer and Natural Helper services. DMC-ODS counties will cover Traditional Healer and Natural Helper services provided by IHCPs to Medi-Cal members who meet DMC-ODS access criteria. For questions about traditional health care practices or this BHIN, please email traditionalhealing@dhcs.ca.gov.
Additionally, on April 22, DHCS will present an overview of BHIN 25-007 at the Tribes and Indian Health Program Representatives meeting (advance registration required). The presentation is open to the public and will review policy guidance to support IHCPs and DMC-ODS counties in implementing this new benefit. Attendees are encouraged to submit questions in advance to traditionalhealing@dhcs.ca.gov with the subject line “Traditional Health Care Practices Implementation.”
Обновления программы
Теперь доступно: материалы вебинара по руководству по внедрению замкнутого цикла рефералов
Effective July 1, 2025, Medi-Cal managed care plans will be required to implement Closed-Loop Referral (CLR) requirements for Enhanced Care Management (ECM) and Community Supports. CLR requirements aim to increase the number of Medi-Cal members successfully connected to these benefits and services. By improving information collection processes, managed care plans will be able to better support individual referrals and address system-level gaps in referral practices and service availability that impact members. DHCS released materials from the February 13 webinar (posted under Informational Webinars) to share more details about these requirements. In the webinar, DHCS provided:
- The Department’s goal and motivation for releasing new CLR requirements.
- Как требования CLR улучшат процесс направления участников за счет оптимизации отслеживания, поддержки и мониторинга направлений.
- Пример сценария использования того, как требования CLR помогут участнику получить поддержку сообщества в рамках программы медицинского питания.
Если у вас есть вопросы или комментарии относительно инициатив California Advancing and Innovating Medi-Cal (CalAIM) по управлению здоровьем населения, свяжитесь с DHCS по адресу PHMSection@dhcs.ca.gov.
Присоединяйтесь к нашей команде
DHCS нанимает сотрудников для своих финансовых, человеческих, фармацевтических, поведенческих и других команд. Для получения дополнительной информации, пожалуйста, посетите сайт CalCareers.
Предстоящие встречи заинтересованных сторон и вебинары
DHCS публикует предстоящие публичные встречи в Календаре мероприятий.
Вебинар посла освещения
25 марта с 11:00 до 12:00 по тихоокеанскому времени DHCS проведет вебинар для послов по страхованию (требуется предварительная регистрация), чтобы предоставить информацию о вариантах медицинского обслуживания и обновлениях для Medi-Cal. Послы страхового покрытия помогают распространять информацию о льготах Medi-Cal, информацию о регистрации и новых проектах, направленных на создание здоровой Калифорнии для всех. Пожалуйста, посетите веб-сайт Cover Ambassador для получения дополнительной информации или подпишитесь, чтобы стать Cover Ambassador и получать регулярные обновления.
Заседание рабочей группы по управлению долгосрочными услугами и поддержкой (MLTSS) и интеграции Duals
On March 27, from 10 a.m. to 12 p.m. PDT, DHCS will host the CalAIM MLTSS and Duals Integration Workgroup meeting (advance registration required). The workgroup is a stakeholder collaboration hub for CalAIM MLTSS and integrated care for dual eligible members. It allows stakeholders to provide feedback and share information about policy, operations, and strategy for upcoming changes to Medi-Cal and Medicare. The meeting agenda includes updates on Medicare enrollment data for dual eligible members, the Dual Eligible Special Needs Plan (D-SNP) Dashboard, D-SNP initiatives, and the D-SNP State Medicaid Agency Contract and Policy Guide. It also includes data updates on Enhanced Care Management and Community Supports for dual eligibles and a Community Supports service spotlight presentation on select service definition updates.
More information, background materials, transcripts, and video recordings of previous workgroup meetings are posted on the CalAIM MLTSS and Duals Integration Workgroup webpage. For questions or comments, please email DHCS at info@calduals.org.
Вебинар по программе обеспечения детей слуховыми аппаратами (HACCP) для медицинских работников и специалистов по слуху
On March 27, from 12 to 1 p.m. PDT, DHCS will host the quarterly HACCP webinar for medical providers and hearing professionals. For more information and to register, please visit DHCS’ HACCP webpage. Registration information will be posted as the webinar date approaches.
На случай, если вы это пропустили
Открыто: Предоставление доступа и трансформация здравоохранения (PATH) Переход, расширение и развитие инфраструктуры (CITED) Раунд 4 Заявка
On January 6, DHCS opened the PATH CITED Round 4 application window, which includes funding opportunities to support the implementation of the new transitional rent Community Support. The PATH CITED initiative provides funding to build the capacity and infrastructure of on-the-ground partners, including community-based organizations, hospitals, county agencies, Tribes, and others, to successfully participate in Medi-Cal. All organizations providing the transitional rent Community Support must do so in partnership with their county behavioral health department. To demonstrate this partnership, all CITED applicants planning to request funding to support the transitional rent Community Support must also submit a Letter of Support in collaboration with the county behavioral health department.
Крайний срок подачи заявок на финансирование PATH CITED Round 4 — 23:59 по тихоокеанскому времени 2 мая, 2025. Руководящий документ и заявка доступны на веб-странице PATH CITED. Пожалуйста, отправляйте любые вопросы по адресу cited@ca-path.com.