主页新闻室 - 传播办公室DHCS 利益相关者最新情况 - 一月20 、2023​​ 

DHCS 利益相关者最新情况 - 1 月20 、2023​​ 

热门新闻​​ 

Medi-Cal 管理式医疗计划 (MCP) 网络中的医院关闭协议​​ 

当 DHCS 得知 Medi-Cal MCP 网络中的一家医院关闭时，该部的工作重点是保护 Medi-Cal 会员的健康和福利。DHCS 要求 Medi-Cal MCP 采取具体步骤，确保可能受医院关闭或服务终止影响的会员能够继续获得医疗必需的承保服务。​​ 

When DHCS was notified of Madera Community Hospital’s closure, DHCS immediately began to work with CalViva Health and Anthem Blue Cross Partnership Plan to identify the impact on Medi-Cal members’ access to care. DHCS also engaged with the California Department of Public Health to transfer Medi-Cal members who required post-acute or long-term care services following hospital discharge (i.e., skilled nursing and home health care) due to the Madera Community Hospital closure.​​ 

Additionally, DHCS reached out to Madera County’s behavioral health agency about their plans to ensure continued access to services for county residents. DHCS also contacted the behavioral health agency of the surrounding counties, including Merced, Mono, Mariposa, and Fresno, to assess the impact of the closure of Madera Community Hospital on their behavioral health systems and related mitigation plans, and to ensure the provision of needed services.​​ 

如需更多信息，包括针对获得医疗服务方面有疑问的 Medi-Cal 会员的资源，请访问DHCS 网站。​​ 

Medicare/Medi-Cal 双重合格者的 Medi-Cal MCP 注册​​ 

Effective January 1, 2023, members dually eligible for Medicare and Medi-Cal across the state became eligible to be mandatorily enrolled in Medi-Cal MCPs for their Medi-Cal benefits only. As a reminder to our stakeholders, this change in Medi-Cal does not change access to Medicare providers or benefits. Additionally, Medicare providers serving dual eligible patients do not need to enroll in a Medi-Cal MCP to continue receiving reimbursement. More than 70 percent of dual eligible members statewide are already enrolled in Medi-Cal MCPs—this step transfers the remaining 30 percent into Medi-Cal MCPs.​​ 

健康与社会服务部为医疗保险提供方发布了最新的情况说明书和工具包 ，以解释参加 Medi-Cal 管理性护理的双重资格成员的提供方计费流程。本资料介绍了现有的交叉计费流程，在 CalAIM 下该流程不会改变。​​ 

对于原始（收费服务）医疗保险的患者，医疗保险管理承包商处理主要的医疗保险付款申请，然后将申请转发给 Medi-Cal MCP（或 DHCS），由 Medi-Cal 支付次要费用。对于参加联邦医疗保险优势计划 (MA) 的患者，联邦医疗保险医疗服务提供者向 MA 计划收取主要费用。二次付款程序可能取决于患者的 Medi-Cal MCP 与 MA 计划是相同还是不同。如需更多信息，请访问全州 Medi-Cal 双重合格会员管理式护理注册网页。​​ 

项目更新​​ 

选定 Doula 实施工作组的成员​​ 

1 月 13 日，DHCS 通知 26 人他们被选中参加 Doula 实施工作组。参议院第 65 号法案（第 449 章，2021 年法规）要求 DHCS 审查 Medi-Cal 计划下提供的朵拉福利的实施情况。工作组预计将于 2023 年 3 月召开第一次会议，并将一直持续到 2025 年 5 月。工作组成员名单公布在奶妈网页上。1 月 1 日，Doula 服务成为 Medi-Cal 福利。​​ 

The workgroup consists of doulas, health care providers, consumer and community advocates, health plans, county representatives, and other stakeholders with experience in doula care. The workgroup will provide input on ensuring that doula services are available to Medi-Cal members who are eligible for and want doula services; minimizing barriers and delays in payments to a Medi-Cal doula or in reimbursement to Medi-Cal members for doula services received; and making recommendations for outreach efforts so that all Medi-Cal members within the eligible and other target populations are aware of the option to use doula services. Workgroup recommendations will also help inform a report to the Legislature to reduce any identified barriers.​​ 

医疗补助计划​​ 

On January 20, prior authorization (PA) requirements will be reinstated for 39 additional drug classes for new start medications for members age 22 and older. “New starts” are defined as new therapies or medications not previously prescribed to the member during the 15-month lookback period. Historical claims data and PAs will be used to review for grandfathering. New start prescriptions for members age 21 and younger within these 39 drug classes will not be subject to PA reinstatement. On December 20, 2022, a 30-day notice was posted, and weekly reinstatement updates are posted every Friday on the Medi-Cal Rx website.​​ 

微笑，加州 Medi-Cal 牙科服务运动​​ 

Smile, California Smile Alert 将在 1 月 23 日的一周内发送给合作伙伴、医疗服务提供者和订阅了每月电子通讯的利益相关者，其中包括医疗服务提供者推荐视频系列中的第三个视频，同时还将宣传 SmileCalifornia.org 上的新双语（英语和西班牙语）PowerPoint 演示。2023 年，"微笑警示 "的收件人还将被提醒鼓励加州医疗保险会员全年定期去看牙医，保护自己的牙齿。注册我们的 "微笑快讯"，随时了解 "微笑，加州 "活动、新资源和更新信息。​​  

加入我们的团队​​ 

DHCS 正在招聘！健康与安全部（DHCS）立即招聘主任特别助理。该职位为最关键、敏感和机密的部门或计划问题提供行政支持。​​ 

DHCS is also hiring Californians to join 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​​ 

 赫里​​ 儿童援助覆盖计划 (HACCP) 提供商网络研讨会​​ 

1 月 24 日，中午 12 点至下午 12 点 50 分，DHCS 将举办一场网络研讨会，为服务提供商（需要提前注册）提供信息，帮助儿科患者及其家人最大限度地利用 HACCP 带来的好处。 培训课程将讨论家庭申请保险的计划要求以及听力学家、耳鼻喉科医生、医生及其办公室工作人员的索赔提交流程。​​ 

提供获取途径和转型健康 (PATH) 司法相关第二轮融资网络研讨会​​ 

行为健康行政整合概念文件概览网络研讨会​​ 

On January 26, from 3 to 4 p.m., DHCS will host a webinar to provide an overview of the concept paper for CalAIM Behavioral Health Administrative Integration (advance registration required). The webinar will include an overview of the initiative’s framework and goals, the phased approach for implementation between now and fiscal year 2027-28, and DHCS’ proposal for ongoing stakeholder engagement and technical assistance. For more information, visit the CalAIM Behavioral Health Initiative webpage.​​ 

California Children’s Services (CCS) Monitoring and Oversight Workgroup Webinar​​ 

On January 30, from 12 to 4 p.m., DHCS will host the CCS Monitoring and Oversight Workgroup meeting (advance registration required) to develop and implement the CCS Compliance, Monitoring, and Oversight Program, a component of the CalAIM initiative. The webinar will cover the Grievance Numbered Letter (NL), Training NL, Surveying NL, Memorandum of Understanding development, compliance activities, and enforcement proposal. Additional information is available on the CCS Compliance, Monitoring, and Oversight Program webpage.​​ 

CalAIM 专业护理机构 (SNF) 加入网络研讨会：Medi-Cal 管理式医疗如何支持 SNF 居民​​ 

On January 30, from 2 to 3 p.m., DHCS will virtually host the fourth in a series of public educational webinars for the SNF Carve-In (advance registration required) to support Medi-Cal MCPs and SNF providers as they implement Medi-Cal managed care coverage of SNFs statewide that began on January 1. The webinar will provide an overview of key Medi-Cal managed care benefits, services, and programs that support current SNF residents and SNF residents transitioning back to their home or community. Additional details on upcoming webinars are available on the CalAIM LTC Carve-In transition webpage.​​ 

药物 Medi-Cal 有组织配送系统 (DMC-ODS) 行为健康信息通知 (BHIN) 网络研讨会​​ 

1 月 31 日上午 11 点至中午 12 点，DHCS 将举办网络研讨会（需要提前注册），概述与 DMC-ODS 相关的更新。 具体来说，DHCS 将讨论BHIN 21-075的更新。 网络研讨会的录音将提供。 如需了解更多信息，请访问CalAIM 行为健康计划网页。 如有任何问题，请发送电子邮件至 BHCalAIM@dhcs.ca.gov 。​​ 

护理机构融资改革网络研讨会​​ 

2月1日下午1:30至2:30，DHCS将举办护理机构融资改革网络研讨会（需提前注册），讨论186号议会法案（2022年法规第46章）授权的劳动力标准计划的发展。 欲了解更多信息，请访问护理机构融资改革（AB 186）网页。​​ 

如果你错过了​​ 

诊所员工稳定保留补助金 (CWSRP) 申请截止日期​​ 

DHCS 提醒所有成功注册的合格诊所在截止日期前提交其 CWSRP 申请。所有付款申请必须在 1 月 27 日下午 5 点之前提交。DHCS 鼓励尽早递交申请，以便在申请递交截止日期后不久验证所有申请。​​ 

有关申请指南、申请视频教程和所有其他支持信息，请访问CWSRP 网页。​​ 

部落行为健康危机和非危机车辆以及与车辆相关的费用 RFA​​ 

1 月 11 日，DHCS 发布了一份 RFA 征求加州部落实体的申请，以通过基础设施资金扩大部落危机和非危机行为健康护理的可及性。这笔资金必须专门用于车辆和允许的车辆相关费用，以改善行为健康流动危机和非危机服务的获取。项目期为 2 月1,2023, 至 6 月30,2025 。提供行为健康服务的合格加州部落实体可申请 5 万至 100 万美元不等的资金。申请截止日期为 2 月 28 日。​​ 

HACCP 资格扩展​​ 

DHCS now welcomes (since January 1) newly eligible young adults ages 18 through 20, who meet other program criteria and need coverage for their hearing aid(s) and related services, to apply for HACCP enrollment. Also effective January 1, applicants under age 21 who meet program eligibility requirements may apply to enroll in HACCP even if they have partial other health coverage for hearing aids, subject to a coverage limit of $1,500 or less per year. Additional program information is available on the HACCP webpage. Families can apply to enroll for coverage through HACCP’s Online Application Portal.​​