热门新闻​​ 

Medi-Cal 续保数据网络研讨会​​ 

On August 7, from 3 to 4 p.m., DHCS will virtually host a webinar on the new DHCS continuous coverage unwinding data dashboard (advance registration required) to discuss data for June 2023 Medi-Cal renewals, the first month of California’s redeterminations since the end of the federal continuous coverage requirement on March 31. These data will include initial disenrollments from Medi-Cal eligibility renewals that occurred on July 1. Annual redeterminations will continue monthly, with the last eligibility renewal under the continuous coverage requirement occurring in May 2024, followed by a return to the normal annual renewal process.​​ 

BH-CONNECT 和 CalAIM 过渡性租金服务公开听证会​​ 

On August 11, from 10 to 11:30 a.m., DHCS will host the first public hearing (advance registration required) to solicit stakeholder comments on the California Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) demonstration and proposed amendment to the California Advancing and Innovating Medi-Cal (CalAIM) Section 1115 demonstration related to transitional rent services. The public hearing will take place in person and have online video streaming and telephonic conference capabilities to ensure accessibility. Please view the “In Case You Missed It” section below for additional details on BH-CONNECT and CalAIM transitional rent services. Please email your questions to 1115Waiver@dhcs.ca.gov.​​ 

ECM 和社区支持网络研讨会​​    

DHCS will host two virtual webinars (advance registration required) for all stakeholders to provide an overview of the progress of Enhanced Care Management (ECM) and Community Supports implementation and to discuss important policy refinements and areas of reinforcement. The webinars will cover a range of topics, including eligibility, referrals and authorizations, provider networks, payment, market awareness, and data exchange. Key insights from the ECM and Community Supports calendar year 2022 implementation report will also be unveiled:​​ 

• 第一年后的企业内容管理：实施进展和政策修订，8 月 14 日下午 2 时至 3 时。​​ 
• 第一年后的社区支持：实施进展和政策修订，8 月 18 日上午 9:30 至 10:30。​​ 

For more information, visit the ECM and Community Supports webpage. For questions, please email CalAIMECMILOS@dhcs.ca.gov.​​ 

牙科管理护理 (DMC) 提案请求 (RFP)​​ 

On August 3, DHCS released the Medi-Cal DMC RFP for Sacramento and Los Angeles counties, with responses due no later than 4 p.m. on October 6, 2023. This contract will provide positive changes to the Medi-Cal DMC program. Recognizing the historical shortcomings of DMC plan performance, DHCS worked diligently to ensure there is a revised and comprehensive reform of California’s DMC contracts. DHCS is committed to improving Medi-Cal members’ oral health care delivery and experience—ensuring members have access to person-centered, equity-focused, and data-driven dental care. As a result, Medi-Cal’s DMC contracts will include:​​ 

• The Quality Improvement and Oral Health Equity Transformation Program to assess and evaluate DMC plan performance and practices and develop recommendations and implement best practices under a continuous quality improvement methodology. There is engagement at multiple levels of the plan, including Medi-Cal members, plan governing board members, local oral health programs, and others. The program will also engage oral health community advisory committees to develop and implement best practices for the DMC plans’ activities.​​ 

• Accountability and commitment to compliance, including monitoring and overseeing delegated entities. The goal is to ensure that members receive high-quality care and have equitable access to services through robust compliance, monitoring, and oversight of all delegated entities. DMC plans will be held accountable for quality of care at all levels of delegation. This will include justifying the use of delegated entities and subcontractors to ensure that the member’s experience and outcomes are front and center.​​ 
• Increased focus on integrating medical and dental care. Providers are empowered to educate members about preventive services for oral health, using data-driven metrics to monitor the efficacy of the DMC plan’s and medical plan’s efforts. Members will benefit from medical-dental care coordination of focused member outreach from a plan to a member when the plan receives data that an emergency room visit related to oral health has occurred. Members will also receive more information to help them choose the best plan for their families and/or individual needs. Plans will be required to regularly report publicly on access, quality improvement, and oral health equity activities, including performance and consumer satisfaction.​​ 

DHCS 目前已与洛杉矶县的三家 DMC 计划签订了预付医疗计划 (PHP) 合同，并已与萨克拉门托县的三家 DMC 计划签订了地理管理医疗 (GMC) 合同。 该 RFP 针对 DMC 计划继续在萨克拉门托县运营 GMC 并在洛杉矶县运营 PHP。 该 RFP 预计的合同执行日期为 2024 年 1 月，随后合同准备期将开始。 DHCS 将为合同运营期 54 个月设定按人头计费，该运营期预计将于2024年 8 月1开始。​​ 

项目更新​​ 

儿童和青少年行为健康倡议 (CYBHI) 拨款可用​​ 

On August 7, DHCS will release a Request for Application (RFA) seeking proposals from various individuals, organizations, and agencies for the third round of grant funding, totaling $60 million, to scale evidence-based practices and community-defined evidence practices (EBP/CDEP) for early childhood wraparound services. The application deadline is October 6 at 5 p.m. Details are posted on the DHCS EBP/CDEP website.​​ 

Also, on July 31, the Mental Health Services Oversight and Accountability Commission (MHSOAC), in partnership with DHCS, released a separate RFA seeking proposals for the fourth round of grant funding, totaling $50 million, to scale youth-driven EBPs and CDEPs. MHSOAC will host a Bidders Conference webinar on August 9, from 11 a.m. to 12:30 p.m. to walk through the RFA and provide applicants the opportunity to ask questions about the procurement process and to obtain clarification on any component of the RFA. For this RFA, applications must be submitted electronically to the MHSOAC via e-mail to procurements@mhsoac.ca.gov by September 15 at 3 p.m. Please email any questions to procurements@mhsoac.ca.gov.​​ 

For all other questions about CYBHI EBP/CDEP grants, please contact DHCS at CYBHI@dhcs.ca.gov. For additional information, please see DHCS’ CYBHI webpage, which includes the CYBHI EBP/CDEP Grant Strategy that highlights DHCS’ overall strategy to scale EBPs/CDEPs across multiple funding rounds.​​ 

公共卫生紧急事件 (PHE) 后药物流产政策说明​​ 

On August 1, DHCS updated its policies on medication abortions. Under this new policy, providers may be reimbursed for medication abortions through 77 gestational days for services provided on or after July 1. In addition, DHCS made permanent COVID-19 flexibilities, including those that allowed the use of telehealth modalities for services without payment reduction when providing medication abortions. For more information about Medi-Cal’s abortion policies, please see the Medi-Cal Provider Manual for Abortion and the Post-PHE Policy Clarification for Medication Abortion news article.​​ 

人口健康管理倡议：构建基础实施指南系列现已推出​​ 

DHCS is pleased to share progress updates on the Population Health Management Initiative (PHMI), a California partnership between DHCS, Kaiser Permanente, and community health centers. The goal is that each participating community health center will focus on a common set of priority measures and specific populations, including children, pregnant people, people with behavioral health conditions, and adults living with chronic conditions and preventive care needs. The common set of priority measures directly align with the Federally Qualified Health Center (FQHC) Alternative Payment Methodology, which is a new payment system that seeks to transform the care provided through community health centers.​​ 

As of July 31, PHMI has launched the executive summaries of the Building the Foundation Implementation Guide series, which previews four implementation guides for primary care practices in California. These guides serve as an organized quality improvement strategy, with the goal of supporting substantive cultural, technological, and process changes that improve population-based care. The first version of these guides will be made available this fall.​​ 

For more information about PHMI, visit www.phminitiative.com. To receive quarterly newsletter updates about PHMI, sign up here.​​ 

医疗补助计划​​ 

On August 4, the next wave of reinstatement will occur. Phase IV, Lift 1 will be the first lift impacting claims utilization management for members 22 years of age and older. The claim edits will be reinstated for Product/Service Not Covered for Patient Age, Product/Service Not Covered for Patient Gender, and Brand Drug/Specific Labeler Code Required. Pharmacy providers will also receive supplemental messaging with the reject codes.​​ 

加入我们的团队​​  

DHCS is hiring for 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 is currently transforming the Medi-Cal program to make sure it provides the care Californians need to live healthier, happier lives.​​  

即将举行的利益相关方会议和网络研讨会​​ 

健康登记导航项目利益相关者会议​​ 

On August 7, from 1 to 2:30 pm, the DHCS Medi-Cal Health Enrollment Navigators Project will host their next quarterly stakeholder meeting. The Navigators Project team will provide updates on project activities. For more information, visit the Navigators Project website.​​ 

CYBHI 网络研讨会​​ 

On August 7, from 2 to 3:30 p.m., DHCS will virtually host a CYBHI webinar (advance registration required) to keep stakeholders apprised of DHCS’ progress in implementing various CYBHI work streams and to share CYBHI updates, including a walkthrough of the EBP/CDEP Round 3 RFA. Key attendees include youth, parents, family members, behavioral health providers, Medi-Cal managed care plans, county behavioral health departments, commercial health plans, education, and other cross-sector partners.​​ 

面向医疗服务提供者和听力专业人士的儿童助听器覆盖计划 (HACCP) 网络研讨会​​ 

On September 14, from 12 to 1 p.m., DHCS will host a HACCP webinar (advance registration required) to share information with providers to help pediatric patients and their families maximize HACCP benefits. The training session will address program requirements for families to apply for coverage and the claims submission process for audiologists, otolaryngologists, physicians, and their office staff.​​ 

如果你错过了​​ 

BH-CONNECT 和 CalAIM 过渡租赁服务​​ 

年 8 月1日， 2023 ，DHCS 启动了为期 30 天的公众意见征询期，以就新的第 1115 条演示请求（名为 BH-CONNECT 演示）征询反馈。 DHCS 还开始了为期 30 天的公众意见征询期，以征询对与过渡性租金服务相关的 CalAIM 第 1115 条示范拟议修正案的反馈。 两项政策的公众意见征询期均为 8 月31至2023 。​​ 

BH-CONNECT 背景​​ 

The BH-CONNECT demonstration builds upon unprecedented investments and policy transformations currently underway in California that are designed to expand access to community-based behavioral health care and improve outcomes for Medi-Cal members living with the most significant mental health and substance use needs. California has invested more than $10 billion and is implementing landmark policy reforms to strengthen the behavioral health care continuum. California’s proposed goal for the BH-CONNECT demonstration is to complement and amplify these major behavioral health initiatives to establish a robust continuum of community-based behavioral health care services and improve access, equity, and quality for Medi-Cal members living with SMI and SED, particularly populations experiencing disparities in behavioral health care and outcomes. The BH-CONNECT demonstration aims to expand Medi-Cal service coverage, drive performance improvement, and support fidelity implementation for key interventions proven to improve outcomes for Medi-Cal members experiencing the greatest inequities, including children and youth involved in child welfare, individuals with lived experience with the criminal justice system, and individuals at risk of or experiencing homelessness.​​ 

CALAIM 过渡性租金修正案背景​​ 

为了改善处于关键过渡期或符合高风险标准的 Medi-Cal 成员的福祉和健康状况，DHCS 正在寻求对 CalAIM 第 1115 条示范进行修订，为无家可归或面临无家可归风险并正在从机构护理级别、集体居住环境、惩教设施、儿童福利系统、康复护理设施、短期住院后住房、过渡住房、无家可归者收容所或临时住房过渡出来的合格个人，以及符合无庇护所无家可归者或全方位服务合作伙伴 (FSP) 计划标准的人员提供长达六个月的过渡性租金服务。 过渡性租赁服务的提供期限不超过六个月；必须具有成本效益；并且只有在使用临床和其他与健康相关的社会需求标准确定其在医学上合适时才会提供。 过渡性租赁服务将由 Medi-Cal 管理医疗计划自愿提供，并供 Medi-Cal 会员自愿使用。​​ 

Please visit the DHCS BH-CONNECT webpage and DHCS CalAIM 1115 Demonstration & 1915(b) Waiver webpage for background information, links to public comment materials, and information about how to provide feedback during the public comment period.​​ 

微笑，加州Medi-Cal 牙科服务运动​​ 

On July 25, DHCS issued a news release in English and Spanish to promote the Sealants for a Healthy Smile (SHS) statewide push to encourage parents and guardians to protect their children’s dental health by utilizing their Medi-Cal Dental benefits and scheduling dental checkups for sealant applications. Subsequent stops of the mobile van tour will continue on August 11 in Trinity County, August 17-18 in Mono County, and August 29 in Colusa County. To reach and inform parents in the Central Valley, Smile, California partnered with Radio Bilingüe, a leading Latino public radio network, to run promotional programming through September.​​ 

To disseminate resources and information (fact sheet, infographic, and coloring sheet) to Medi-Cal members statewide, Smile, California outreach representatives are identifying and participating in in-person opportunities within their assigned regions during the promotion period. Representatives will assist with provider referrals, distribute relevant Smile, California resources, and promote Medi-Cal Dental covered services at community events, such as health fairs, parent nights, and back-to-school/open house events.​​