Nangungunang Balita

Pinangalanan ng Gobernador ang Bagong DHCS Chief Operating Officer for Programs (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.

Update sa Mga Pag-renew ng 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. 

Magagamit ang Mga Medi-Medi Plan sa Panahon ng Medicare Open Enrollment

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.

Pinag-uugnay ng mga Plano ng Medi-Medi ang lahat ng benepisyo at serbisyo sa parehong programa, kabilang ang lahat ng serbisyong sakop ng Medicare, lahat ng serbisyong sakop ng Medi-Cal, mga karagdagang karagdagang benepisyo, mga carved-out na benepisyo (ibig sabihin, Mga Serbisyong Suporta sa Bahay, Programa para sa Maraming Gamit na Serbisyo para sa mga Nakatatanda, Mga Serbisyo para sa Matanda na Nakabatay sa Komunidad, at mga serbisyong dental), isang pangkat ng tagapamahala ng pangangalaga upang mag-coordinate ng pangangalaga, at mga suporta sa komunidad na inaalok ng planong pinamamahalaang pangangalaga ng Medi-Cal.

Mga Update sa Programa

Karagdagang Tuloy-tuloy na Saklaw na Mga Kakayahang umakma

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.

Memorandum of Understandings sa pagitan ng Managed Care Plans at Third-Party Entity

Naglabas ang DHCS ngayong linggo ng isang All Plan Letter (APL), dalawang Behavioral Health Information Notices (BHIN), at mga kaugnay na template ng Memoranda of Understandings (MOU) para sa mga plano sa pangangalagang pinamamahalaang (MCP) ng Medi-Cal na kinakailangan ng kontrata ng MCP sa 2024 upang maisagawa ang mga MOU sa ilang partikular na entidad ng ikatlong partido upang matiyak na ang pangangalaga sa miyembro ay nakoordina at ang mga miyembro ay may access sa mga mapagkukunang nakabatay sa komunidad upang suportahan ang pangangalaga sa buong tao. Ang mga MOU ay nilayong maging mabisang paraan upang linawin ang mga tungkulin at responsibilidad sa pagitan ng mga partido at suportahan ang lokal na pakikipag-ugnayan, koordinasyon ng pangangalaga, pagpapalitan ng impormasyon, mutual na pananagutan, at transparency.

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.

Mga Benepisyo ng Medicare at Medi-Cal Dental

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.

Pagsapit ng Oktubre 17, lahat ng stakeholder ng Medi-Cal Rx na nakausap ng DHCS ay maipapakita na ang komunikasyon tungkol sa Advancing Medi-Cal Rx, na nagpapahayag ng pagtatapos ng pagsisikap na maibalik ang serbisyo sa mga nasa hustong gulang at walang pagbabago para sa populasyon ng mga bata hanggang 2024. Kabilang sa mga stakeholder ang Local Health Plans of California, California Association of Health Plans, California Health Association, mga direktor ng parmasya ng Medi-Cal managed care plan, California Children's Hospital Association, Children's Specialty Care Coalition, Children's Regional Integrated Service System, California Medical Association, California Retailers Association, National Association of Chain Drug Stores, California Pharmacists Association, California Primary Care Association, California Behavioral Health Directions Association, California Association of Medical Product Suppliers, at Hemophilia Council of California.

Sumali sa Aming Koponan

Ang DHCS ay kumukuha para sa aming mga pangkat ng piskal, human resources, legal, pag-audit, patakaran sa kalusugan, at teknolohiya ng impormasyon. Para sa karagdagang impormasyon, mangyaring bisitahin ang website ng 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.

Mga Paparating na Mga Pagpupulong ng Stakeholder at Webinar

Webinar ng Pagpapalawak ng Pang-adulto

Sa Oktubre 18, magsasagawa ang DHCS ng una sa dalawang webinar tungkol sa pagpapalawak ng Medi-Cal adult (edad 26-49) para sa mga lokal na tanggapan ng county at iba pang mga stakeholder. Ang pangalawang webinar ay pansamantalang nakatakda sa unang bahagi ng Disyembre. Ang webinar ay magbibigay ng impormasyon tungkol sa pagpapalawak, pagpaplano ng implementasyon, pag-abiso, pakikipag-ugnayan, at marami pang iba. Ang impormasyon sa pagpaparehistro ay ipo-post sa webpage ng Adult Full Scope Medi-Cal Expansion para sa mga edad 26 hanggang 49. Maaaring magparehistro ang mga indibidwal para sa webinar sa pamamagitan ng pag-email sa 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.

Stakeholder Advisory Committee (SAC) at Behavioral Health- SAC (BH-SAC) Meeting

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.

Pagbibigay ng Access and Transforming Health (PATH) Mga Oras ng Opisina ng Programang Kasangkot sa Katarungan

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.

Minor na Pahintulot at Pagiging Kumpidensyal para sa Webinar ng Mga Serbisyong Pangkalusugan sa Sekswal

Sa Oktubre 25, mula 12 hanggang 1:30 ng hapon, ang DHCS at ang California Prevention Training Center ay magho-host ng isang webinar tungkol sa Minor Consent and Confidentiality for Sexual Health Services (kinakailangan ang paunang pagpaparehistro). Ang webinar na ito ay magbibigay ng pangkalahatang-ideya ng mga batas ng California na nakakaapekto sa mga menor de edad at ang kanilang pag-access sa mga kumpidensyal na serbisyo sa kalusugang sekswal at pagpaplano ng pamilya. Susuriin nito ang mahahalagang eksepsiyon sa kumpidensyalidad, kabilang ang ipinag-uutos na pag-uulat ng pang-aabuso sa bata, at magbabahagi ng ilang halimbawa ng mga pinakamahusay na kasanayan para sa pagpapatupad sa mga mahihirap na sitwasyon. Matututunan ng mga kalahok ang tungkol sa mga mapagkukunan upang suportahan ang pagpapatupad ng mga batas sa pahintulot ng menor de edad at bibigyan ng pagkakataong subukan ang kanilang sariling kaalaman sa pamamagitan ng mga case study.

Para sa mga hindi makakadalo sa live webinar, ang transcript at recording ng webinar, kasama ang mga karagdagang resources, ay ibibigay sa website ng Family PACT.

PATH Collaborative Planning and Implementation (CPI) Best Practices Webinar

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.

Kung sakaling Nalampasan Mo Ito

Ang California ay nagbibigay ng Milyun-milyon sa Mga Tagabigay ng Kalusugan ng Pag-uugali upang Labanan ang 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.

Dental Managed Care Plan Parity

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. 

Simula Nobyembre 2023, magpapadala ang DHCS ng mga abiso sa humigit-kumulang 614,000 miyembro na kasalukuyang naka-enroll sa mga plano ng DMC sa Sacramento County upang ipaalam sa kanila ang kanilang opsyon na manatili sa kanilang kasalukuyang plano o mag-disenroll at sumali sa FFS, epektibo sa Disyembre 1, 2023. Ang abiso ay magbibigay lamang ng impormasyon kung paano makakakuha ng mga serbisyong dental ang mga miyembro kung pipiliin nila ang FFS o ang kanilang opsyon na pumili ng alternatibong plano ng DMC kung ang miyembro ay makapagtatag lamang ng isyu sa access to care sa FFS. Bukod pa rito, epektibo sa Disyembre 1, ang mga bagong kwalipikadong miyembro ng Medi-Cal ay awtomatikong ie-enroll sa dental FFS. Para masuri ang mga ulat ng pagganap ng dental FFS at DMC, bisitahin ang webpage na Dental Data Reports.