DHCS Stakeholder News – January 6, 2023
Nangungunang Balita
Limang Plano na Maglingkod sa Mga Miyembro ng Pinamamahalaang Pangangalaga ng Medi-Cal sa ilalim ng Kasunduan
On December 30, DHCS and five commercial health plans – Blue Cross of California Partnership Plan (“Anthem”), Blue Shield of California Promise Health Plan, CHG Foundation d.b.a. Community Health Group Partnership Plan, Health Net Community Solutions, Inc. and Molina Healthcare of California – announced an agreement to deliver Medi-Cal services to Medi-Cal managed care members in 21 counties across the state starting in January 2024. RFP #20-10029 for the Medi-Cal MCPs was cancelled.
The state’s top priority is to ensure that Medi-Cal members have access to managed care plans that provide high-quality and timely care and are focused on delivering on the State’s transformations that are designed to move the health system to become person-centered, equity-focused, and data-driven. To bring certainty for members, providers and plans, the state used its authority to work directly with the plans to re-chart our partnership and move with confidence and speed toward the implementation of the changes we want to see. As part of this agreement, Medi-Cal managed care plans will be held to new standards of care and greater accountability, helping ensure Medi-Cal members have the care and support they need to live healthier, more fulfilling lives.
Ang Mga Aplikasyon ng Doula Provider ay Tinanggap Ngayon
Effective January 1, 2023, DHCS added doula services throughout pregnancy, childbirth, and postpartum period as a Medi-Cal benefit. Updates to the Provider Application and Validation for Enrollment (PAVE) portal have been completed, and doulas may now access PAVE and submit their Medi-Cal enrollment application.
DHCS has created a self-paced video demonstration, Introduction to PAVE for Doula Providers, specifically for doula providers who are accessing PAVE for the first time. On January 10 at 10 a.m., DHCS will also host a virtual live session (advance registration required) to demonstrate how to use the PAVE portal. In addition, DHCS created a webpage, Medi-Cal: Doulas – Training as Medi-Cal Providers, that hosts different trainings for doulas regarding Medi-Cal. Additional trainings will be added as they become available.
Mga Bagong Programa at Inisyatiba na Ilulunsad sa 2023
Ang mga hakbangin sa ibaba ng Medi-Cal na inilunsad noong Enero 1, 2023, na higit na isinusulong ang programang Medi-Cal upang maging mas komprehensibo, magkakaugnay, at nakasentro sa tao—at sa huli ay humahantong sa pinabuting mga resulta sa kalusugan para sa mga miyembro ng Medi-Cal.
- CalAIM Population Health Management (PHM) Program: Medi-Cal managed care plans (MCPs) began implementing the PHM Program, a cornerstone of CalAIM. The PHM Program establishes a cohesive, statewide approach that ensures all Medi-Cal members have access to a comprehensive program that leads to longer and healthier lives, improved health outcomes, and health equity. The updated PHM Policy Guide and new Frequently Asked Questions (FAQs) are available on the DHCS CalAIM PHM webpage.
- Enhanced Care Management (ECM) Expanded to Long-Term Care Populations of Focus: MCPs launched the next phase of the ECM implementation, specifically for the long-term care population: adults living in the community and at risk for LTC institutionalization and adult nursing facility residents transitioning to the community. ECM is a Medi-Cal benefit that addresses the clinical and non-clinical needs of high-need, high-cost individuals through the coordination of services and comprehensive care management. ECM is part of the broader PHM Program through which MCPs will offer care management interventions at different levels of intensity based on member need, with ECM as the highest intensity level. For more information, please visit the ECM and Community Supports webpage. The updated ECM Policy Guide, ECM Implementation Timeline & Updated Populations of Focus, and ECM Model of Care Template Addendum II are now available on the DHCS CalAIM ECM and Community Supports webpage.
- Cal MediConnect (CMC) transition to Medicare Medi-Cal (Medi-Medi) Plans: Medi-Medi plans were launched in seven counties, and CMC members were automatically transitioned to Medi-Medi Plans in those counties. Medi-Medi Plans provide comprehensive care to individuals dually eligible for Medicare and Medi-Cal. DHCS also transitioned the Medi-Cal pharmacy benefit for these members to Medi-Cal Rx. Medi-Medi Plans will coordinate benefits and services across both Medicare and Medi-Cal including Part D drug coverage. Medi-Cal Rx will resume the role as the Medi-Cal pharmacy benefits administrator for non-Medicare prescription drug coverage. Post-implementation review monitoring will continue for several weeks.
- Long-Term Care Carve-in to Medi-Cal Managed Care: Under CalAIM, Medi-Cal MCPs will cover and coordinate institutional Long-Term Care in all counties in 2023 in a phased approach by facility type. This will provide a LTC resident with access to coordinated and integrated care within Medi-Cal managed care and make coverage consistent across California. All MCPs are now responsible for the full LTC benefit at skilled nursing facilities, including both freestanding and hospital-based SNFs. The January 2023 transition does not apply to Intermediate Care Facilities for Developmentally Disabled or Subacute Facilities.
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Justice-Involved Pre-Release Medi-Cal Application Process: All counties are now required to implement a Pre-Release Medi-Cal Application Process as codified in Assembly Bill 133 (Chapter 143, Statutes of 2021) to ensure all eligible inmates and youth who are released from county correctional facilities (county jails) and county youth correctional facilities have Medi-Cal coverage upon release. Additional information can be found in All County Welfare Directors Letter (ACWDL) 22-27.
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Pagpapatala ng Pangangalaga sa Pamamahala ng Medi-Cal sa Buong Estado para sa Mga Dalawahang Kwalipikado at Iba Pang Populasyon: Karamihan sa mga miyembrong dalawahang karapat-dapat na hindi pa nakatala sa pinamamahalaang pangangalaga ng Medi-Cal ay ipapatala na ngayon sa mga plano ng Medi-Cal. Ang mga plano ng Medi-Cal ay nagbibigay ng mga serbisyo sa wraparound at koordinasyon para sa dalawahang kwalipikadong miyembro. Ang mga tagapagbigay ng Medicare na naglilingkod sa dalawahang pasyente ay HINDI kailangang magpatala sa isang planong Medi-Cal upang magpatuloy sa pagtanggap ng reimbursement gaya ng dati. Bago ang Enero 2023, mahigit 70 porsyento ng dalawahang kwalipikadong miyembro ang naka-enroll na sa Medi-Cal MCPs.
- CalAIM Incentive Payment Program (IPP): The IPP Program Year 2 began on January 1. From January 2022 to December 2024, the IPP provides incentive payments, totaling $1 billion, to MCPs in order to complement and expand CalAIM. The goal of IPP is to drive change at the MCP and provider level by building appropriate and sustainable capacity; investing in necessary delivery system infrastructure; bridging current silos across physical and behavioral health care service delivery; reducing health disparities and promoting health equity; achieving improvements in quality performance; and incentivizing MCP take-up of Community Supports. For more information, please visit the ECM and Community Supports webpage.
- CalAIM Providing Access and Transforming Health (PATH): Sa Enero, iaanunsyo ng DHCS ang mga organisasyong nabigyan ng pagpopondo sa pamamagitan ng paunang round (Round 1) ng CalAIM PATH: CITED initiative. Ang inisyatiba ng PATH CITED ay nagbibigay ng pondo upang paganahin ang paglipat, pagpapalawak, at pagpapaunlad ng kapasidad at imprastraktura ng ECM at Community Supports. Ang mga organisasyong nakabatay sa komunidad, pampublikong ospital, ahensya ng county, Tribes, at iba pang provider ng komunidad ay karapat-dapat na mag-aplay sa panahon ng CITED grants Round 2 application window sa Pebrero. Sa Enero, ilulunsad din ng DHCS ang Technical Assistance (TA) Marketplace para sa mga aplikante na mag-aalok sa mga entidad na kalahok sa CalAIM ng kakayahang tumanggap ng suporta at tulong. Para sa karagdagang impormasyon sa TA Marketplace, pakibisita ang PATH website.
Ilang iba pang pangunahing inisyatiba ng programa na darating online Enero 1, 2023, ay kinabibilangan ng:
- Doula Services as a Medi-Cal Benefit: After working with stakeholders for more than a year to develop the benefit, DHCS will begin covering doula services in both the fee-for-service and managed care delivery systems. Doula services are aimed at preventing perinatal complications and improving health outcomes for birthing parents and infants. Services include personal support to women and families throughout a woman’s pregnancy, childbirth, and postpartum experience. This includes emotional and physical support provided during pregnancy, labor, birth, and the postpartum period. Doulas will now be able to submit their Medi-Cal enrollment application through the PAVE portal, a portal designed to simplify and accelerate the Medi-Cal enrollment process. DHCS submitted State Plan Amendment 22-0002 to the Centers for Medicare & Medicaid Services (CMS) on November 7, 2022, to add doula services as a covered Medi-Cal benefit.
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Dyadic Services as a Medi-Cal Benefit: Dyadic services – such as Behavioral Health Well-Child Visits, specific assessment, screening, counseling, and brief intervention services – are a set of services provided specifically to a “dyad”: a child along with their parent or caregiver. Services provided to the parent or caregiver include depression screening, behavioral health assessment and interventions, screening for social drivers of health, and alcohol and drug screening, assessment, brief interventions and referral to treatment, among other services.
- Medi-Cal Mental Health Services Screening and Transition Tools: After working with stakeholders for more than a year, DHCS finalized the standardized, statewide Adult and Youth Screening and Transition of Care Tools for Medi-Cal Mental Health Services. Under CalAIM, DHCS streamlined the mental health screening process and improving patient care by creating standardized, statewide tools to guide referrals of adult and youth members to the appropriate Medi-Cal mental health delivery system and ensure that members requiring transition between delivery systems receive timely and coordinated care. The tools are available on DHCS’ Screening and Transition of Care Tools for Medi-Cal Mental Health Services webpage.
Kasama sa iba pang mga kilalang release at paparating na pagbabago ang:
- Updated Telehealth Policy: DHCS is making permanent many telehealth flexibilities from the COVID-19 public health emergency (PHE), including payment parity and broad coverage for clinically appropriate telehealth services. The updated policy will be published on January 16 in the Medi-Cal Provider Manual for telehealth, which will contain guidance on consent, establishing new patients via telehealth, billing guidance for services provided via audio-only, and brief virtual communications and check-ins.
Ang lahat ng kasalukuyang mga flexibilidad na inisyu sa panahon ng PHE ay mananatili hangga't ang PHE ay may bisa, at ang karamihan sa mga flexibilidad sa lugar sa panahon ng PHE ay magpapatuloy pagkatapos ng pag-expire ng PHE. Sa panahon ng PHE, ang mga provider ay dapat kumunsulta sa Medi-Cal Telehealth Provider Manual at anumang karagdagang patnubay sa PHE upang gabayan ang kanilang paghahatid ng mga serbisyo. Matapos ang PHE, ang mga provider ay dapat kumunsulta lamang sa Medi-Cal Telehealth Provider Manual.
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Hearing Aid Coverage for Children Program (HACCP) Eligibility Expansion: Beginning January 1, DHCS welcomes newly eligible young adults ages 18 to 20 who meet other program criteria and need coverage for their hearing aid(s) and related services to apply for HACCP enrollment. Also, effective January 1, applicants under age 21 who meet program eligibility requirements may apply to enroll in HACCP even if they have partial other health coverage for hearing aids subject to a coverage limit of $1,500 or less per year. Additional program information is available on the HACCP webpage. Families can apply to enroll for coverage through HACCP’s Online Application Portal.
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Community Assistance, Recovery, and Empowerment (CARE) Act Update: Nakikipagtulungan ang DHCS sa California Health & Human Services Agency at sa Judicial Council of California upang magkaloob ng pare-parehong komunikasyon at bumuo ng mga pagsasanay para sa mga stakeholder ng CARE Act . Ang CARE Act ay lumilikha ng isang bagong landas upang maghatid ng mga serbisyo sa kalusugan ng isip at karamdaman sa paggamit ng sangkap sa mga California na may pinakamalubhang kapansanan na madalas na nagdurusa sa kawalan ng tirahan o pagkakulong nang walang paggamot. Ang DHCS ay maglulunsad ng paunang pagsasanay at teknikal na tulong sa mga ahensya ng kalusugan ng pag-uugali ng county upang suportahan ang pagpapatupad ng CARE Act sa tagsibol ng 2023. Pitong county ang magpapatupad ng programa simula Oktubre 1, 2023, at ang natitirang mga county nang hindi lalampas sa Disyembre 1, 2024.
- Mobile Crisis Services Benefit: On December 19, DHCS released BHIN 22-064 providing guidance for implementation of the Mobile Crisis Services Benefit on January 1. Mobile crisis services are a community-based intervention designed to provide de-escalation and relief to individuals experiencing a behavioral health crisis wherever they are, reducing unnecessary law enforcement involvement and emergency department utilization. Mobile crisis services are provided year-round by a multidisciplinary team of trained behavioral health professionals in the least restrictive setting. Mobile crisis services include screening, assessment, stabilization, de-escalation, follow-up, and coordination with health care services and other supports.
- Recovery Incentives Program – California’s Contingency Management (CM) Benefit: In the first quarter of 2023, DHCS will pilot Medi-Cal coverage of CM in select Drug Medi-Cal Organized Delivery System (DMC-ODS) counties through the Recovery Incentives Program. As part of CalAIM, California became the first state in the nation to receive federal approval to cover CM services for substance use disorders (SUD). CM is an evidence-based, cost-effective treatment for SUD. DHCS intends to use the pilot as a basis for informing the design and implementation of a statewide CM benefit through the DMC-ODS program, pending budgetary and statutory authority.
Mga Update sa Programa
Pangwakas na Ulat sa Pagsusuri ng Whole Person Care (WPC) Pilot Program
On December 23, DHCS submitted the WPC pilot program final evaluation report to CMS. The WPC pilot program was a demonstration program under California’s Medi-Cal 2020 waiver that concluded on December 31, 2021. The program aimed to achieve better care, better health, and lower costs for Medi-Cal members in California while promoting the coordination of health, behavioral health, and social services in a patient-centered manner.
The final evaluation report, developed by the UCLA Center for Health Policy Research, found that the pilot programs were successful in developing diverse and appropriate infrastructure, sharing data across sectors, and implementing new data systems. Further, the pilots were successful in delivering care coordination services, resulting in improved overall member health, reduced emergency department visits, and lowered inpatient utilization. The interventions achieved through the program lowered member costs by $99 per enrollee per year. The delivery infrastructure and partnerships developed during WPC enabled the successful transition to CalAIM’s ECM and Community Supports. The final evaluation report will be posted on the Medi-Cal 2020 Evaluations webpage later in January.
Aplikasyon ng Youth Opioid Response California 3 (YOR 3).
DHCS released a RFA to strengthen capacity and access to prevention, treatment, and recovery services, as well as access points to Medication-Assisted Treatment (MAT), for youth (ages 12-24) and their families. This opportunity is designed to foster the coordination and strengthening of existing multi-system networks and encourage the development of new partnerships between agencies reaching youth. Implementation grantees may receive up to $750,000 and capacity building grantees may receive up to $50,000. For more information and to apply by the January 19 deadline, please visit the YOR CA website or email YORCalifornia@ahpnet.com.
MAT at California Hub and Spoke (CA H&SS) Awards
On January 9, DHCS will award $52 million to 105 entities providing MAT services to implement the CA H&SS from January 1, 2023, to June 30, 2024. Each entity will receive between $100,000 – $1,848,000 annually to fund prevention, assessment, diagnosis, treatment, and recovery from opioid and substance use disorders. This funding opportunity will be used to further the development and implementation of regional “Hubs” (Regional Centers of Excellence in MAT) and “Spokes” (any federally approved DATA-2000 waivered prescribers who prescribe or dispense buprenorphine) to collectively enhance the opioid and substance use continuum of care. The project is funded by the State Opioid Response (SOR) III grant, awarded by the Substance Abuse and Mental Health Services Administration (SAMHSA), and is administered by Advocates for Human Potential, Inc. (AHP). For more information, please visit the MAT website.
Home and Community-Based Alternatives (HCBA) at Medi-Cal Waiver Program (MCWP) Renewals
On December 20, DHCS submitted formal responses to the CMS Request for Additional Information to reauthorize the HCBA and MCWP waivers. The current HCBA and MCWP waiver terms were set to end on December 31, 2021. On December 13, CMS approved a fifth temporary extension to allow the HCBA and MCWP waivers to continue to operate until March 26, 2023. CMS is expected to approve the HCBA and MCWP renewals in January 2023. Due to the delay in the review and approval process, CMS and the state agreed to delay the implementation date of the new HCBA and MCWP waivers to January 1, 2023, which extends the new waiver terms to the end of 2027.
The HCBA renewal includes several significant updates, including, but not limited to:
- Tumaas ang kabuuang kapasidad ng waiver
- Binagong mga minimum na kinakailangan para sa mga kwalipikasyon ng social worker case manager
- Tinukoy ang tungkulin ng Circle of Support sa loob ng waiver
- Added Assistive Technology as a waiver service, to maintain the participant’s health and safety
- Inalis ang paghihigpit sa edad para sa Mga Serbisyo sa Pagpapahinga at Habilitation
- Kasama ang Pediatric Day Health Care bilang isang uri ng provider para sa Mga Serbisyong Pahinga na nakabatay sa pasilidad
- Nagdagdag ng mga serbisyong paramedikal bilang pinalawig na serbisyo ng plano ng estado
The MCWP renewal includes a limited number of significant updates, including:
- Binago ang pangalan ng waiver
- Binagong mga minimum na kinakailangan para sa Social Worker Case Manager Qualifications
- Binagong timeline para sa mga muling pagtatasa
- Tumaas na mga limitasyon sa gastos
- Na-update na mga ratio ng staff-to-client
Intimate Partner Violence (IPV) Screening at Referrals Survey para sa Medicaid Primary Care Clinician
There is an upcoming invitation-only survey for Medicaid primary care clinicians who treated adult (18 years of age or older) Medicaid members in 2021. The Office of Evaluation and Inspections, a component of the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS), is conducting a study on challenges faced by primary care clinicians related to intimate IPV screening and referrals beginning January 9 on a rolling basis. The survey will focus on clinicians’ IPV screening (which is a recommended screening by the U.S. Preventive Services Task Force, referral practices, the challenges they encounter related to these services, and potential measures that might improve the screening for IPV. The survey is voluntary, and clinicians’ responses will be anonymous. Responses will be aggregated and will be used to help make recommendations to address the screening of patients experiencing IPV.
Ang mga klinika ay makakahanap ng higit pang impormasyon tungkol sa pederal na pag-aaral na ito at mga FAQ sa website ng HHS-OIG. Para sa mga tanong, mag-email sa IPVsurvey@oig.hhs.gov.
Sumali sa Aming Koponan
DHCS is hiring Californians to join our fiscal, human resources, legal, auditing, health policy, and information technology teams. For more information, please visit the CalCareers website.
DHCS is dedicated to preserving and improving the overall health and well-being of all Californians. DHCS’ mission is to provide the most vulnerable residents with equitable access to affordable, integrated, high-quality health care, and the Department is currently transforming the Medi-Cal program to make sure it provides the quality-focused and person-centered care Californians need to live healthier, happier lives.
Mga Paparating na Mga Pagpupulong ng Stakeholder at Webinar
Mga Webinar ng Children and Youth Behavioral Health Initiative (CYBHI).
On January 13 and 20, from 2 to 3 p.m., DHCS will virtually host webinars (advance registration required) on behalf of the CYBHI Evidence-Based and Community-Defined Evidence Practices grants program. These webinars will focus on the Round One: Parent and Caregiver Programs and Practices RFA. DHCS’ intent is to provide technical assistance by sharing responses to frequently asked questions received based on themes. During the webinars, DHCS will not address any live questions. Please email questions related to the round one to CYBHI@dhcs.ca.gov. DHCS will post the FAQs to the CYBHI webpage by January 9.
CalAIM Screening at Transition of Care Tools
Sa Enero 19, mula 3 hanggang 4 ng hapon, ang DHCS ay magdaraos ng webinar tungkol sa Adult and Youth Screening and Transition of Care Tools (kinakailangan ang maagang pagpaparehistro) para sa inisyatiba ng Medi-Cal Mental Health Services. Ang inisyatiba na ito ay nakatutok sa pagpapatupad ng statewide Screening at Transition of Care Tools para sa parehong mga nasa hustong gulang at indibidwal na wala pang edad 21 para sa paggamit ng Medi-Cal MCPs at County Mental Health Plans (MHPs). Ang webinar ay magsasama ng isang pangkalahatang-ideya ng layunin ng inisyatiba, isang pagsusuri ng panghuling gabay at mga tool, at mga tugon sa mga madalas itanong. Ang oras ay nakalaan sa pagtatapos ng webinar para sa isang sesyon ng mga tanong at sagot. Para sa higit pang impormasyon, pakibisita ang screening at Transition of Care Tools webpage.
Webinar ng Tagapagbigay ng HACCP
On January 24, from 12 to 12:50 p.m., DHCS will host a webinar session (advance registration required) to assist providers with information to help pediatric patients and their families to maximize the HACCP benefits. The training session will address the program requirements for families to apply for coverage and the claims submission process for audiologists, otolaryngologists, other physicians, and their office staff.
Kung sakaling Nalampasan Mo Ito
Consolidated Appropriations Act of 2023 at Medi-Cal Redeterminations
On December 29, President Biden signed into law the Consolidated Appropriations Act of 2023 (the omnibus spending bill), which has broad implications for the Medi-Cal program and in particular the resumption of Medi-Cal redeterminations. Previously, the resumption of Medi-Cal redeterminations was tied to the termination of the COVID-19 public health emergency (PHE). With the passage of this bill, the continuous coverage requirements that paused all Medi-Cal redeterminations since March 2020 would be decoupled from the PHE termination date as of April 1, 2023, setting the stage for the resumption of Medi-Cal redeterminations.
CMS will provide updated guidance to states this month on the Medicaid program. DHCS will update the Medi-Cal COVID-19 PHE Operational Unwinding Plan and additional plan, county and provider guidance once CMS releases updated guidance.
DHCS will work closely with all Coverage Ambassadors to share newly developed outreach materials to Medi-Cal members across California. Individuals can join the DHCS Coverage Ambassador mailing list to receive the latest information and updated toolkits as they become available. For questions, please email Ambassadors@dhcs.ca.gov.
Sinusuportahan ng ECM at Komunidad ang Data ng Maagang Pagpapatupad
Noong Disyembre 22, naglabas ang DHCS ng data ng maagang pagpapatupad para sa ECM at Community Supports, dalawang pangunahing programa ng CalAIM na inilunsad noong 2022. Ang ECM at Mga Suporta sa Komunidad ay idinisenyo upang suportahan ang mga miyembro ng Medi-Cal na nangangailangan at tugunan ang mga panlipunang salik na nakakaapekto sa kanilang kalusugan, tulad ng pabahay at nutrisyon. Ipinapakita ng data ang maagang pag-abot ng ECM at Mga Suporta sa Komunidad noong Enero hanggang Hunyo, at binibigyang-diin ang lumalaking enrollment ng miyembro sa parehong mga programa, lalo na sa mga populasyong hindi gaanong naseserbisyuhan sa kasaysayan.
Impormasyon sa Pagsingil ng Provider ng Medicare para sa Dalawahang Kwalipikadong Pasyente
DHCS published an updated fact sheet for Medicare providers to explain the provider billing process for dual eligible members enrolled in Medi-Cal managed care. This fact sheet describes the existing crossover billing process, which does not change under CalAIM. Medicare providers serving dual eligible patients do not need to enroll in a Medi-Cal managed care plan (MCP) to continue receiving reimbursement. More than 70 percent of dual eligible members statewide are already enrolled in Medi-Cal MCPs. Medicare benefits and providers do not change upon enrollment in a Medi-Cal MCP.
For patients in Original (FFS) Medicare, the Medicare Administrative Contractor processes the primary claim for Medicare payment, and then forwards the claim to the Medi-Cal MCP (or DHCS) for secondary Medi-Cal payment. For patients in Medicare Advantage (MA), the Medicare provider bills the MA plan for primary payment. The secondary payment process may depend upon whether the patient’s Medi-Cal MCP is the same or different than the MA plan. For more information, please visit the Statewide Medi-Cal Managed Care Enrollment for Dual Eligible Members webpage.