DHCS Stakeholder Updates – July 1, 2022
Dear Stakeholders,
The Department of Health Care Services (DHCS) is providing this update of significant developments regarding DHCS programs.
Paggawad ng Dental Contract
On July 1, 2022, DHCS issued a Notice of Intent to Award for the Fiscal Intermediary-Dental Business Operations (FI-DBO) contract, which will provide services to support California’s Medi-Cal fee-for-service dental benefit. Following a competitive procurement process, the successful bidder is Gainwell Technologies LLC.
Over the next year, the incumbent vendor, Delta Dental of California, will transition operations to the new vendor, Gainwell. The anticipated date for Gainwell to assume responsibility for dental business operations is October 1, 2023. DHCS’ goal is for this transition to be seamless for Medi-Cal members and providers, with no reduction in or delay of services.
Proposition 56 Loan Repayment Program – CalHealthCares
DHCS announced its commitment to pay $64.9 million toward student loans for 222 physicians and 35 dentists under CalHealthCares to expand access to care for Medi-Cal patients under a fourth cohort of awardees. Of the 257 awardees, 62 percent are persons of color, and 79 percent speak a language other than English. The physicians represent 67 specialties and serve 33 counties. The dentists represent four specialties and serve 19 counties. The awardees have agreed to maintain a caseload of at least 30 percent Medi-Cal patients, with more than 57 percent of awardees committing to maintaining a caseload of 65 percent or higher. A fifth cohort is scheduled for 2023. For more information, visit the CalHealthCares website.
Update sa Benepisyo ng Enhanced Care Management (ECM) at Community Supports Benefit
Simula sa Hulyo 1, ang benepisyo ng ECM ay makukuha sa lahat ng mga county ng California sa mga karapat-dapat na miyembro ng Medi-Cal managed care plan (MCP) para sa mga sumusunod na populasyong pinagtutuunan ng pansin: mga indibidwal at pamilyang nakararanas ng kawalan ng tirahan, mataas na gumagamit, at mga nasa hustong gulang na may malubhang sakit sa isip (SMI) / substance use disorders (SUD). Ang mga county na bagong nagpapatupad ng ECM simula noong Hulyo 1 ay kinabibilangan ng Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, El Dorado, Fresno, Glenn, Humboldt, Inyo, Lake, Lassen, Madera, Mariposa, Merced, Modoc, Mono, Nevada, Plumas, San Benito, San Luis Obispo, Santayo Barbarau, Sierrama Trinity, Tuolumne, Yolo, at Yuba.
Gayundin, simula noong Hulyo 1, ang mga MCP ay nagpapatupad ng karagdagang 266 na Suporta sa Komunidad, na nagpapalawak ng pagkakaroon ng serbisyo para sa mga natatanging handog na ito sa lahat ng 58 na county ng California. Kabilang sa mga makabuluhang pagpapalawak ng serbisyo ang mga serbisyong Suporta ng Komunidad na nauugnay sa pabahay, kung saan ang mga MCP ay nagpapakilala ng 35 bagong mga serbisyo sa pag-navigate sa paglipat ng pabahay, 44 na bagong deposito sa pabahay, at 36 na bagong pangungupahan at mga serbisyo sa pagpapanatili ng pabahay, pati na rin ang mga serbisyo ng pahinga (34 na bagong alok) at mga serbisyo sa personal na pangangalaga at homemaker (31 mga bagong alok). Sa 518 na Mga Suporta sa Komunidad na magagamit na mula noong unang pagpapatupad ng programa noong Enero 1, mayroon na ngayong 784 na natatanging mga handog na Mga Suporta sa Komunidad na magagamit sa lahat ng 58 na mga county sa California. Gumawa ang DHCS ng pampublikong magagamit na mapa ng Mga Suporta sa Komunidad na nagpapakita ng bilang ng 14 na paunang naaprubahang Mga Suporta sa Komunidad na magiging live sa 2022 ayon sa county at petsa ng pagpapatupad. Available din ang Tsart ng Halalan na Sumusuporta sa Komunidad , na nagdedetalye kung alin ang available sa ilalim ng bawat MCP sa bawat county at nagtataya ng mga inaasahang alok na serbisyo sa hinaharap.
Benepisyo ng community health worker (CHW).
On July 1, the CHW benefit went live in both the Medi-Cal fee-for-service (FFS) and managed care delivery systems. The State Plan Amendment (SPA) for CHWs was submitted to the Centers for Medicare & Medicaid Services (CMS) on April 29, 2022, and is pending approval. DHCS published the final CHW policy on June 29 to assist providers with rolling out this new benefit. DHCS shared a draft of the Provider Manual pages for CHW services, as well as a new Provider Manual section for asthma preventive services, with stakeholders prior to finalizing them for publication. The Provider Manual pages are scheduled to be published on July 15. In addition, DHCS shared a draft All Plan Letter (APL) for CHW services with its managed care health plan partners on June 28 for comments prior to issuing the APL. Comments on the APL are due by July 12. More information about the Department’s development of the CHW benefit, including the pending SPA that was submitted to CMS, is available on CHW webpage.