DHCS Stakeholder News – August 12, 2022
尊敬的各位利益相关方：
卫生保健服务部 (DHCS) 正在提供有关 DHCS 计划重大进展的最新消息。
热门新闻
DHCS 向联邦合作伙伴发出猴痘指导请求
On August 12, DHCS sent a letter to the Centers for Medicare & Medicaid Services (CMS) requesting immediate guidance for establishing a Medicare rate for the monkeypox vaccine administration.
In an effort to be responsive to our Medi-Cal beneficiaries and providers, California will submit a Disaster State Plan Amendment to seek federal approval to reimburse vaccine administration and applicable laboratory testing at 100 percent of the Medicare rate, once established. As part of this request, DHCS will seek federal approval to reimburse Federally Qualified Health Centers, and similarly situated clinics that are paid an all-inclusive rate, the vaccine administration fee for vaccine-only visits, consistent with how DHCS is reimbursing for COVID-19 vaccine-only visits. The requested federal approvals will also include reimbursement for vaccine administration performed by non-clinic providers.
Additionally, please see the Centers for Disease Control and Prevention’s Reducing Stigma in Monkeypox Communication and Community Engagement and the California Department of Public Health’s toolkit messaging for sharing broadly among your networks.
Medi-Cal 保费退款
参议院第 184 号法案（2022 年综合健康法案）授权 DHCS 将 Medi-Cal 计划的保费降至零。 自1年2022月起，参加以下计划的会员不再需要支付保费作为资格要求：
- Optional Targeted Low Income Children’s Program
- 加州医疗补助计划
- Medi-Cal Access 婴儿计划
- County Children’s Health Initiative Program
- 250% 残疾人工作计划
DHCS released policy guidance via All County Welfare Directors Letter #22-14 and Medi-Cal Eligibility Division Information Letter #I 22-25, and is seeking federal authority to implement this policy through SPA 22-0042 and SPA 22-0034, which are pending CMS approval. Furthermore, DHCS has begun the process of issuing refunds to Medi-Cal and Children’s Health Insurance Program (CHIP) beneficiaries who overpaid their premiums as of July 1.
U.S. Surgeon General’s Comments on the Children and Youth Behavioral Health Initiative (CYBHI)
In a recent SAGE Journals article, U.S. Surgeon General Dr. Vivek H. Murthy highlighted the work that is underway through the CYBHI. The article serves as a call to action for the nation, with a stark reminder of what’s at stake in ensuring that children and youth receive the help they need when and where they need it, especially those in our most underserved communities.
The CYBHI, which includes multiple work streams that are led by five departments and offices within the California Health & Human Services Agency (CalHHS) – DHCS, Department of Health Care Access and Information, Department of Managed Health Care, California Department of Public Health, and the Office of the California Surgeon General – focuses on promoting mental, emotional, and behavioral well-being by preventing challenges and providing services, support, and routine screening for all children and youth for emerging and existing needs.
项目更新
为加州老年人提供 Medi-Cal 外展和登记援助
DHCS 正在向 28,000 名可能有资格享受 Medi-Cal 医疗保险的老年人提供外展和入学援助。 DHCS 向加利福尼亚州县协会和加利福尼亚州保险与健康计划 (CCHI) 拨款 2400 万美元，以合作开展入学援助工作，截止日期为30年 6 月、 2024年。 努力的目标是：
- 双重合格受益人或 65 岁及以上的受益人，且正在等待 Medi-Cal 资格重新确定。
- 65 岁及以上且已加入 Medi-Cal 且需要帮助确定 Medicare 资格的人。
- 符合 Medi-Cal 资格但目前尚未登记的 65 岁及以上或残疾个人，包括符合 Medicare 储蓄计划资格的个人。
- 由于 Medi-Cal 扩展至 50 岁及以上的成年人，新个人有资格享受 Medi-Cal，无论其移民身份如何。
- 年满 65 岁且尚未加入 Medicare 的 Medi-Cal 受益人，须与该县的一个或多个 Medi-Cal 管理式医疗计划 (MCP) 达成协议。
CCHI 将得到社区组织的协助，这些组织在为 Medi-Cal 受益人提供外展和登记援助方面拥有多年的经验，以确保符合 Medi-Cal 资格的人能够更多地获得医疗服务，从而改善治疗结果并减少健康差距。 欲了解更多信息，请访问加州老年居民 Medi-Cal 外展和登记网页。
CHIP 注册和重新认定政策更新
On August 3, CMS approved DHCS’ State Plan Amendment (SPA) CA-22-0035 submission, allowing DHCS to implement provisions for temporary adjustments to enrollment and redetermination policies. Effective July 1, 2022, DHCS is able to use a regulatory timeliness exception for the timely processing of CHIP applications and renewals for children in families living and/or working in state- or federally-declared disaster areas.
通过该 SPA，加州正在进行技术变更，以使其通过 SPA CA-17-0043 批准的救灾条款与 2022 年 3 月发布的最新救灾 SPA 模板保持一致。 这些 SPA 条款可以在未来州或联邦宣布的灾难期间实施，只需通知 CMS 条款的生效日期和受灾难影响的区域即可。
移动危机服务信息请求 (RFI) 发布
On August 8, DHCS released a RFI for the mobile crisis services benefit. The RFI invites vendors to provide DHCS with information to support training for and implementation of mobile crisis services. DHCS intends to submit a SPA to add qualifying community-based mobile crisis intervention services as a new Medi-Cal benefit, effective no sooner than January 2023. Implementing mobile crisis services is an integral part of California’s broader efforts to strengthen the continuum of community-based care for Medi-Cal beneficiaries who are experiencing a mental health or substance use disorder crisis.
DHCS 正在开发Medi-Cal 移动危机服务福利，其中将包括与培训、准备情况评估和技术援助相关的材料和指导。
医院和专业护理机构 COVID-19 员工保留付款计划
DHCS 正在提供有关该计划的记录日期和最终提交日期的最新指南：
- 就记录日期而言，符合条件的员工必须在28年2022月 11 日之前受雇于符合条件的机构的涵盖实体或涵盖服务雇主，才有资格获得保留金。
- 作为提交的最后期限，涵盖实体和涵盖服务雇主必须在2022年 12 月30日下午 5 点之前提交申请，包括符合条件的员工名单。
在接下来的几周内，DHCS 将通过每周的利益相关者公告以及医院和专业护理机构 COVID-19 工人保留支付网页提供有关提交流程和一般更新的更多指导。
儿童助听器覆盖计划 (HACCP) 更新
DHCS 扩大了援助代码 A1 的覆盖福利，以包括与骨传导听力设备 (BCHD) 相关的新 HACCP 福利，该福利追溯生效，适用于 7 月1日、 2021日或之后的服务日期。
For more information about HACCP coverage of BCHDs, please see the Medi-Cal Provider Newsflash. For information about the program more broadly, please see DHCS’ HACCP webpage, which was recently expanded to include additional resources for families and providers, including a secure chat option for communicating with the HACCP Call Center or uploading additional materials for an application that has already been submitted. Additionally, families seeking to apply for HACCP coverage may now submit their application electronically through the HACCP Online Application Portal.
Medi-Cal Rx 实施更新
DHCS 和 Magellan (MMA) 参与了密集的规划过程，以分阶段恢复索赔编辑和事先授权 (PA) 要求。
- 第一阶段第一波于 7 月22日2022实施，旨在恢复对国家处方药计划委员会 (NCPDP) 拒绝代码 88 - 药物利用审查 (DUR) 拒绝错误的索赔编辑，用于 DUR 警报，例如药物间相互作用、高剂量、提前补充等。 恢复方法是渐进且重复的，重点关注利益相关者的准备情况和绩效监控。 它将根据数据分析、运营经验和利益相关者的反馈，随着时间的推移进行必要的改进。
- 第一阶段第二波现已生效，重点是推广 CoverMyMeds (CMM) 的使用。
- Phase one, wave three is slated to begin on September 16 with the reinstatement of PA requirements for 11 drug classes for new start prescriptions for beneficiaries 22 years of age and older. Stakeholders are encouraged to continue submitting comments and feedback on the reinstatement approach via Reinstatement@dhcs.ca.gov.
社区卫生工作者 (CHW) SPA 批准
On July 26, DHCS received CMS approval for SPA 22-0001, which adds CHW as a preventive service. Developed in consultation with stakeholders, this SPA created CHW services as a Medi-Cal benefit, effective July 1, 2022, for both fee-for-service and managed care delivery systems. For more information about CHW services, including a link to the provider manual, please see the CHW webpage.
已发布的 COVID-19 信息
即将举行的利益相关方会议和网络研讨会
加州推进和创新 Medi-Cal (CalAIM) 豁免续签网络研讨会
On August 22 at 10 a.m., DHCS will virtually host a public hearing to receive stakeholder feedback on the proposed amendments to the CalAIM Section 1115 demonstration and Section 1915(b) waiver. Please register for this webinar in advance.
DHCS launched 30-day public comment and Tribal public comment periods on August 12. DHCS is seeking the CalAIM Section 1115 and 1915(b) amendment approvals from CMS to implement county-based model changes in the Medi-Cal Managed Care (MCMC) program. Through the Section 1915(b) waiver amendment, DHCS also plans to add or update language on policies or programs in the approved CalAIM 1915(b) waiver, including to reflect the MCMC model changes in select counties and direct contracts with the Kaiser Foundation Health Plan available for enrollment of certain Medi-Cal beneficiary populations in select counties. Additional information about the CalAIM Section 1115 demonstration application and Section 1915(b) overview are available on the CalAIM 1115 Demonstration & 1915(b) Waiver webpage. The 30-day public comment and Tribal public comment periods end on September 12.
与家庭 PACT 客户讨论 HPV 免疫接种
On August 17, DHCS and the California Prevention Training Center will hold a webinar to provide information about the effectiveness and safety of the human papillomavirus (HPV) vaccine, review current Centers for Disease Control and Prevention recommendations for the use of the HPV vaccine, and provide advice on how to have effective shared decision-making conversations with clients about being immunized. Advance registration for PACT webinar is required. Effective July 1, 2022, the Family PACT program added HPV vaccination as a clinic benefit for individuals ages 19 through 45. For those unable to attend the live webinar, a transcript and recording of the webinar, along with additional resources, will be available on the Family PACT website.
Medi-Cal Dental 全州利益相关方会议
8 月 18 日上午 10 点，DHCS 将举办虚拟 Medi-Cal Dental 全州利益相关者会议。 这次会议的目的是给全州的牙科利益相关者一个论坛，分享对 Medi-Cal 牙科计划的反馈，并让 DHCS 分享有关新的和/或即将开展的工作的重要更新和信息。 更多信息请参阅Medi-Cal Dental 全州利益相关者会议网页。
DHCS CalAIM MLTSS 和 Duals 集成工作组会议
On August 18 at 10 a.m., DHCS will virtually host the CalAIM Managed Long-Term Services and Supports (MLTSS) and Duals Integration Workgroup meeting. Please register for the meeting, which is open to the public.
The meeting will serve as a stakeholder collaboration hub for CalAIM MLTSS and integrated care for dual eligible beneficiaries. It will also give stakeholders an opportunity to provide feedback and share information about policy, operations, and strategy for upcoming changes to Medicare and Medi-Cal. Agenda items include a summary of January 2023 enrollment changes; a presentation on the January 2023 transitions impacting dual eligible beneficiaries, including noticing, monitoring, and timelines; and an update on the Dementia Care Aware initiative.
Background materials, transcripts, and video recordings of the previous workgroup meetings, along with additional information about the workgroup, are posted on the CalAIM MLTSS and Duals Integration Workgroup webpage.
微笑，加州Medi-Cal 牙科服务运动
Smile, California is hosting Facebook Live presentations for Medi-Cal members in Spanish and English. The Spanish presentation will be held on August 24 at 1 p.m.; RSVP on Facebook. The English presentation will be held on August 26 at 1 p.m.; RSVP on Facebook. A Smile, California member outreach representative will deliver the Smile, your Medi-Cal benefits include dental! presentation, and a provider relations trainer will assist with answering audience questions.
面向牙科服务提供商的 PAVE 门户培训
On August 24 at 11 a.m., DHCS will host a webinar introduction to PAVE for dental providers. Beginning on October 31, DHCS will implement the PAVE portal for dental providers, offering a new mode for submitting dental provider enrollment applications and required documentation to DHCS. This allows applicants to use the Medi-Cal Provider e-Form Application, as DHCS will no longer accept paper applications once PAVE is implemented. For more information about the webinar, including the registration link for the August 24 training, please view this Medi-Cal Dental Provider Bulletin. The PAVE demonstrations will be recorded and posted on the DHCS PAVE webpage.
DHCS 计划生育办公室利益相关者会议
On August 24, DHCS will host a virtual family planning stakeholder meeting. The link to the meeting will be available on the Office of Family Planning webpage prior to the meeting.
导乐福利利益相关者会议
On August 24, DHCS will host a virtual stakeholder workgroup meeting about adding doula services as a covered Medi-Cal benefit. The meeting is open to the public. DHCS will engage with workgroup members on policy development details that will be reflected in the Medi-Cal provider manual and other policy guidance documents. All interested stakeholders may listen to the workgroup discussion regarding stakeholder feedback and provide input via email. DHCS will also share an update on the status of formal submission of the SPA to CMS. The link for the stakeholder meeting will be available on the doula webpage prior to the meeting.
CalAIM 网络研讨会：增强护理管理 (ECM) 和社区支持会员参与
On August 25 at 1:30 p.m., DHCS will host an all-comers webinar on CalAIM ECM and Community Supports member engagement. Topics for this session will include provider and member communications, referrals, outreach, and enrollment. This event is part of a series of technical assistance and informational sessions focused on supporting implementation of ECM and Community Supports. Throughout the series, DHCS leaders will be joined by presenters from MCPs, providers, and CBOs implementing CalAIM.
Advance registration for CalAIM webinar is required. Participants are invited to submit questions by August 22 to CalAIMECMILOS@dhcs.ca.gov. Attendees will also have the opportunity to ask questions during the webinar. An additional “Office Hours” event will be held on September 1 at 2 p.m. (see below) for attendees to ask any other questions not covered during the webinar.
CYBHI 每月网络研讨会
On August 29 at 3 p.m., DHCS will virtually host a webinar to keep stakeholders apprised of DHCS’ progress in implementing various work streams of the CYBHI. Key attendees include, but are not limited to, youth, parents, family members, behavioral health providers, Medi-Cal MCPs, county behavioral health departments, and commercial health plans, as well as education and other cross-sector partners. CYBHI Monthly Webinar advance registration is required.
CalAIM 办公时间：ECM 和社区支持会员参与
On September 1 at 2 p.m., DHCS will virtually host an “Office Hours” discussion on CalAIM ECM and Community Supports member engagement. As a follow-up to the August 25 webinar on this topic, this question and answer session will cover provider and member communications, referrals, outreach, and enrollment. This event is part of a series of “Office Hours” events focused on answering implementation questions from the field.
Advance registration is required. Participants are invited to submit questions by August 29 to CalAIMECMILOS@dhcs.ca.gov. Attendees will also have an opportunity to ask questions during the session.