热门新闻

州长任命新任 DHCS 项目首席运营官 (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.

Medi-Cal 续保更新

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. 

医疗保险开放注册期间提供 Medi-Medi 计划

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.

Medi-Medi Plans coordinate all benefits and services across both programs, including all Medicare-covered services, all Medi-Cal covered services, additional supplemental benefits, carved-out benefits (i.e., In-Home Supportive Services, Multipurpose Senior Services Program, Community-Based Adult Services, and dental), one care management team to coordinate care, and community supports offered by the Medi-Cal managed care plan.

项目更新

额外的连续覆盖解除灵活性

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.

管理式医疗计划与第三方实体之间的谅解备忘录

DHCS this week released an All Plan Letter (APL), two Behavioral Health Information Notices (BHIN), and associated Memoranda of Understandings (MOU) templates for Medi-Cal managed care plans (MCP) required by the 2024 MCP contract to execute MOUs with certain third-party entities to ensure member care is coordinated and members have access to community-based resources to support whole-person care. The MOUs are intended to be effective vehicles to clarify roles and responsibilities among parties and support local engagement, care coordination, information exchange, mutual accountability, and 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.

联邦医疗保险 (Medicare) 和加州医疗保险 (Medi-Cal) 牙科福利

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.

医疗补助计划

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.

到 10 月 17 日，DHCS 一直与之接触的所有 Medi-Cal Rx 利益相关者都将收到《推进 Medi-Cal Rx》的沟通文件，该文件宣布结束对成年人的恢复工作，并且在 2024 年之前不会对儿童群体做出任何改变。利益相关者包括加州地方健康计划协会、加州健康计划协会、加州健康协会、Medi-Cal 管理式医疗计划药房主任、加州儿童医院协会、儿童专科护理联盟、儿童区域综合服务系统、加州医学协会、加州零售商协会、全国连锁药店协会、加州药剂师协会、加州初级保健协会、加州行为健康指导协会、加州医疗产品供应商协会和加州血友病委员会。

加入我们的团队

DHCS 正在招聘财务、人力资源、法律、审计、卫生政策和信息技术团队的人员。 欲了解更多信息，请访问CalCareers 网站。

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.

即将举行的利益相关方会议和网络研讨会

成人拓展网络研讨会

10 月 18 日，DHCS 将为地方县政府和其他利益相关者举办两场关于 Medi-Cal 成人（26-49 岁）扩展的网络研讨会中的第一场。第二次网络研讨会暂定于12月初举行。本次网络研讨会将提供有关扩展、实施计划、通知、宣传等方面的背景信息。注册信息将发布在 26 至 49 岁成人全面 Medi-Cal 扩展网页上。个人可以通过发送电子邮件至 AdultExpansion@dhcs.ca.gov 注册参加网络研讨会。

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.

利益相关者咨询委员会 (SAC) 和行为健康-SAC (BH-SAC) 会议

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.

提供机会和转型健康 (PATH) 司法相关计划办公时间

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.

未成年人同意和性健康服务保密网络研讨会

10 月 25 日中午 12 点至下午 1 点 30 分，DHCS 和加州预防培训中心将举办“性健康服务中的未成年人同意和保密”网络研讨会（需要提前注册）。本次网络研讨会将概述加州影响未成年人及其获取保密性健康和计划生育服务的法律。研讨会将回顾保密性的重要例外情况，包括强制性儿童虐待报告，并分享一些在复杂情况下实施这些法律的最佳实践案例。参与者将了解支持未成年人同意法律实施的资源，并有机会通过案例研究检验自己的知识。

对于无法参加现场网络研讨会的人，研讨会的文字稿和录音以及其他资源将在Family PACT 网站上提供。

PATH 协作规划与实施 (CPI) 最佳实践网络研讨会

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.

如果你错过了

加州向行为健康服务提供者提供数百万美元资金以抗击 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.

牙科管理护理计划平价

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. 

从 2023 年 11 月开始，DHCS 将向萨克拉门托县目前参加 DMC 计划的约 614,000 名成员发送通知，告知他们可以选择继续参加当前的计划，或者取消注册并加入 FFS，生效日期为 12 月1 , 2023 。该通知将提供有关会员如何获得牙科服务的信息，如果他们选择按服务付费 (FFS) 计划，或者如果会员能够在按服务付费 (FFS) 计划中证明其获得护理服务存在问题，则可以选择其他牙科医疗服务计划 (DMC)。此外，自 12 月 1 日起，新符合 Medi-Cal 资格的成员将默认加入牙科 FFS 计划。要查看牙科 FFS 和 DMC 绩效报告，请访问牙科数据报告网页。