11 月17,2023 - 利益相关者新闻
热门新闻
增强护理管理 (ECM) 和社区支持实施数据
DHCS 本周发布了《ECM 和社区支持实施更新：截至 2023 年第二季度的数据》。该计划于 2022 年启动，旨在为具有重大临床、非临床和健康相关社会需求的管理性护理计划 (MCP) 成员提供服务。在《ECM 和社区支持第一年报告》的基础上，实施更新包括 Medi-Cal 成员和医疗服务提供者网络的新数据，并对 2023 年 1 月符合 ECM 资格的两个重点长期护理人群的 ECM 注册情况进行了初步介绍。2023 年第二季度后启动的其他 ECM 重点人群（包括儿童和青年）的数据将在今后的报告中重点介绍。
Both ECM and Community Supports continued to grow and serve more Californians during the first half of 2023, including a 29 percent growth in cumulative ECM enrollment and 108 percent growth in cumulative Community Supports recipients since the end of 2022. To provide further data transparency and visibility around ECM and Community Supports, DHCS will soon release a comprehensive report with MCP- and county-level data through Q2 2023.
2024 年 Medi-Cal MCP 过渡政策指南
On November 15, DHCS released frequently asked questions (FAQs) as a companion resource to version five of the 2024 Medi-Cal MCP Transition Policy Guide that includes DHCS policy and MCP requirements related to member transitions of Medi-Cal MCPs that take effect on January 1, 2024. The latest version includes a summary of communications resources, a transition policy for assessment and screening tools, and updates to the data sharing section and Appendix. Please email questions about the policy guide to MCPTransitionPolicyGuide@dhcs.ca.gov. The policy guide and FAQs will be updated throughout the remainder of this calendar year to keep MCPs informed of new and developing guidance.
项目更新
指导改善痴呆症体验 (GUIDE) 模型和网络研讨会
To help address the needs of Medicare beneficiaries, including those dually eligible for Medicare and Medi-Cal, with Alzheimer’s disease and related dementias, the Centers for Medicare & Medicaid Services (CMS) released a Request for Applications (RFA) for the GUIDE model. This model aims to support people living with dementia and their unpaid caregivers by helping them with care coordination and management, infrastructure building, and higher quality of care. Interested applicants should submit their application via web portal by January 30, 2024.
The GUIDE model begins on July 1, 2024, and will continue for eight years. The goal of the model is to improve the quality of life, reduce the burden and strain on unpaid caregivers of people living with dementia, and prevent or delay long-term nursing home care. The care delivery approach is a person-centered plan that standardizes a set of services, has an interdisciplinary care team, and includes training requirements for the care team to improve care coordination to address the behavioral and functional needs of people living with dementia. Original Medicare providers may apply to participate. Since many Medicare beneficiaries with dementia are also dually eligible for Medi-Cal, DHCS strongly encourages California Medicare providers to participate in the GUIDE model. For more information, please visit the CMS GUIDE webpage.
Also, on December 8, from 11 a.m. to 12 p.m., DHCS, in partnership with the University of California, San Francisco and DHCS’ Dementia Care Aware initiative, will host a webinar on the GUIDE model in California (advance registration required). This webinar will offer Medicare providers and community-based organizations information about what is required to participate in GUIDE, examples of a successful partnership in California that follows the GUIDE model, and resources to help California applicants apply for the GUIDE model. For more information, please visit the Dementia Care Aware webpage.
注：下周 DHCS 将不再发布利益相关者的每周更新。下一次更新将于 12 月 1 日星期五发布。
加入我们的团队
DHCS 正在招聘！ DHCS 提供以下机会：
- 企业技术服务局副局长兼首席信息官，负责领导和管理整个部门的信息技术服务（财务和财务披露日为 12 月 8 日）。负责管理所有 IT 服务、信息安全、企业项目和战略创新工作。
- Behavioral Health Policy Medical Consultant II within Behavioral Health (FFD is November 27). This position provides clinical expertise and strategic advice to DHCS Behavioral Health leadership on the development and implementation of policy and initiatives designed to strengthen behavioral health care access, quality, and service delivery.
- 综合医疗系统副医务主任（FFD 为 11 月 29 日）。该职位负责为加利福尼亚州的重要公共卫生计划提供技术性医疗咨询，并为医疗上脆弱的个人提供必要的医疗服务建议和指导。
- Senior Assistant Chief Counsel for Fiscal and Financing within the Office of Legal Services (FFD is November 28). This position is responsible for complex legal counsel and litigation strategy formulation regarding DHCS fiscal, financial management, and health care policy.
- 法律服务办公室内医疗保健系统高级助理总法律顾问（FFD 为 11 月 30 日）。 该职位负责有关医疗保健系统各个方面的复杂法律咨询和诉讼策略制定。
DHCS is also hiring for our human resources, auditing, health policy, and information technology teams. For more information, please visit the CalCareers website.
即将举行的利益相关方会议和网络研讨会
面向家庭和社区伙伴的儿童助听器覆盖计划 (HACCP) 网络研讨会
11 月 28 日上午 11 点至中午 12 点，DHCS 将举办 HACCP 网络研讨会（需要提前注册），与家庭和社区分享有关申请助听器保险以及帮助儿童最大限度地享受 HACCP 福利的指导。 DHCS 欢迎新感兴趣的家庭、目前参与 HACCP 的家庭以及支持家庭和儿童的社区合作伙伴参加本次网络研讨会，以获取计划更新、提示和问答环节。 欲了解更多信息，请访问www.dhcs.ca.gov/haccp 。
Medi-Cal 资产消除网络研讨会
11 月 29 日下午 1:30 至 2:30，DHCS 将为社区合作伙伴（包括倡导者、提供商、MCP 等）举办一场网络研讨会，讨论非修改后调整后总收入 (non-MAGI) Medi-Cal 计划的资产消除问题，该问题自 1 月1起生效， 2024 。 该计划实施后，将取消所有非 MAGI 计划（包括长期护理和医疗保险储蓄计划）的资产测试。 网络研讨会将提供有关资产消除、实施计划、程序变更和外展材料的背景信息。 更多信息请参阅非 MAGI Medi-Cal 资产限制变化网页。
CalAIM：亚急性护理机构分期付款计费和付款网络研讨会
On November 29, from 3 to 4 p.m., DHCS will virtually host the third in a series of educational webinars on the California Advancing and Innovating Medi-Cal (CalAIM) long-term care (LTC) carve-in of subacute care facilities in Medi-Cal managed care. The goal of these webinars is to provide subacute care facilities and Medi-Cal MCPs with an understanding of the carve-in to operationalize the new benefit, including scope of services and relevant policies, in preparation for the January 1, 2024, carve-in.
该网络研讨会对公众开放，重点是让大家了解支付政策要求以及与多点医疗中心和亚急性护理机构计费有关的可行做法。有关亚健康护理机构 "自列 "的更多详细信息，请访问 CalAIM 亚健康护理机构" 自列 "长期护理服务过渡网页 。
CalAIM：托管长期服务和支持 (MLTSS) 和双重集成工作组虚拟会议
On November 30 at 10 a.m., DHCS will virtually host the CalAIM MLTSS and Duals Integration Workgroup meeting (advance registration required). The workgroup serves as a stakeholder collaboration hub for CalAIM MLTSS and integrated care for dual eligible members, and allows stakeholders to provide feedback and share information about policy, operations, and strategy for upcoming changes to Medi-Cal and Medicare.
Agenda topics will include reminders about the 2024 Medi-Cal transitions and noticing timelines, updates on Medi-Medi Plan outreach and the 2024 Dual Eligible Special Needs Plan Policy Guide development, July 2023 duals enrollment data, a spotlight presentation on the CalAIM recuperative care Community Support, and a presentation on the continuous coverage unwinding.
Background materials, transcripts, and video recordings of previous workgroup meetings, along with additional information about the workgroup, are posted on the CalAIM MLTSS and Duals Integration Workgroup webpage. For questions or comments, please email DHCS at info@calduals.org.
CalAIM：行为健康工作组会议
On December 1, DHCS will virtually convene the CalAIM Behavioral Health Workgroup meeting to provide updates on and discussion of the California Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) and CalAIM behavioral health documentation redesign initiatives. Workgroup members may provide feedback on implementation and operational considerations. The meeting is open to the public. Please email questions to BHCalAIM@dhcs.ca.gov.
Medi-Cal 成人扩展网络研讨会
12 月 4 日上午 11:00 至中午 12:00，DHCS 将为社区组织、MCP、医疗服务提供者和其他感兴趣的利益相关者（包括代表消费者、移民、医疗保健、法律援助和成年移民的利益相关者）举办一次有关Medi-Cal 成人扩展的网络研讨会（需提前注册）。DHCS 正在根据参议院第 184 号法案（第 47 章，2022 年法规）于 1 月1 ，2024 。扩展计划实施后，26-49 岁的个人，只要符合 Medi-Cal 的所有其他资格标准，无论其公民身份或移民身份如何，都将享受 Medi-Cal 的全面福利。
The webinar, which will be live interpreted in Spanish, will provide background information about the expansion, implementation planning, noticing, outreach, and more. Individuals may also submit questions or request to register for the webinar by sending an email to AdultExpansion@dhcs.ca.gov.
提供访问和转变健康 (PATH) 协作规划和实施 (CPI) 最佳实践网络研讨会
On December 7, from 12:30 to 1:30 p.m., DHCS will host a statewide webinar, Relationship Building with Organizations in the CalAIM Environment (advance registration required) for community-based organizations, county, city, and local government agencies, federally qualified health centers, MCPs, Medi-Cal tribal and designees of Indian Health Programs, and providers. The webinar is part of a biannual series of PATH CPI webinars designed to highlight best practices for implementing ECM and Community Supports, increasing providers’ successful participation in CalAIM, and improving collaboration with MCPs, state and local government agencies, and others to build and deliver quality support services to Medi-Cal members. For more information, please visit the PATH CPI webpage.
面向医疗服务提供者和听力专业人士的 HACCP 网络研讨会
On December 19, 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. For more information, please visit www.dhcs.ca.gov/haccp.
如果你错过了
加州继续推进 Medi-Cal 改革，转向以人为本、注重公平的医疗服务
On November 15, DHCS issued a news release about how the Department is transforming Medi-Cal to ensure Californians can get the care they need to live healthier lives. As a result of the new Medi-Cal managed care contract, Medi-Cal members will have access to new and improved services to get person-centered, whole-person care that goes beyond the doctor’s office or hospital and addresses their physical and behavioral health and health care-related social needs.
第 1115 条示威活动：BH-CONNECT 和 CalAIM 过渡性租金修正案
10 月 20 日，DHCS 向 CMS 提交了新的第 1115 款示范申请--BH-CONNECT 示范，以及与过渡性租房服务有关的 CalAIM 第 1115 款示范的拟议修正案。此外，联邦公众意见征集期将于 10 月 27 日至 11 月 26 日开放，用于 BH-CONNECT 和CalAIM 过渡性租房服务。
2024 年 1 月 Medi-Cal MCP 过渡期
As part of Medi-Cal transformation, some MCPs are changing on January 1, 2024, and approximately 1.2 million members will have new health plan options and/or will need to transition to new MCPs. Changing MCPs will not affect Medi-Cal member coverage or benefits. Members who transition to a new MCP are receiving notices about the transition. DHCS developed several resources to support members, providers, and other stakeholders with the transition, including the Managed Care Plan Transition Member webpage with a county “lookup” tool, links to member notices sent by Medi-Cal about MCP changes, frequently asked questions, and a Contact Us page for members to learn more about health plans and provider choices. There are also transition resources for providers and MCPs and stakeholders. More information about the transition is available in the 2024 Managed Care Plan Transition Policy Guide and Medi-Cal Eligibility Division Information Letter Number I 23-54.