项目更新
不良童年经历 (ACE) 意识
Less than two years after launching, ACEs Aware has reached two key milestones by training more than 20,500 California clinicians to screen for ACEs, thereby facilitating the ACEs screening of more than 500,000 children and adults across the state. Since December 2019, DHCS and the Office of the California Surgeon General (CA-OSG) have co-led the ACEs Aware initiative to train clinical teams to screen children and adults for ACEs in primary care settings; become eligible for directed payments through Medi-Cal; and treat the impacts of toxic stress with trauma-informed care and evidence-based interventions.
在这些成功的基础上，加州大学洛杉矶分校 (UCLA) 和加州大学旧金山分校 (UCSF) 这两所全国排名的医疗中心与 DHCS 和 CA-OSG 合作，建立了UCLA/UCSF ACEs 意识家庭韧性网络 (UCAAN) 。UCAAN 由加州大学洛杉矶分校大卫·格芬医学院儿科系和加州大学旧金山分校创伤知情医疗保健中心 (CTHC)领导和管理，利用加州大学两校区跨学科的丰富多样的专业知识和资源，开发、推广和维持循证方法，以筛查、治疗和治愈儿童时期逆境的影响。
年度网络认证更新
DHCS submitted network adequacy certification documentation, including the assurance of compliance for Medi-Cal MCPs and Dental Managed Care plans to CMS on November 1. Five MCPs were placed under corrective action plans (CAP) for not fully meeting network adequacy standards. DHCS is working with the MCPs on their CAP efforts and is analyzing the most recent network adequacy data to determine MCP compliance. The MCPs will have six months to address and rectify the CAP findings. The network adequacy assurance and certification letters to CMS are available on the DHCS website.
DHCS 于 12 月 1 日向 CMS 提交了网络充足性文件，其中包括精神健康计划 (MHP) 和药物医疗加州组织交付系统 (DMC-ODS) 计划的合规性保证。共有 39 个 MHP 和 31 个 DMC-ODS 因未能完全达到网络充足性标准而被列入 CAP 名单。DHCS 正在与 MHP 和 DMC-ODS 合作，推进其 CAP 解决方案工作，并将每月与各县会面，提供技术援助。MHP 和 DMC-ODS 将有五个月的时间来处理和纠正 CAP 调查结果，所有 CAP 解决方案文件和数据应于 2022 年 3 月提交。向 CMS 提交的网络充足性保证和认证信将于 2022 年 12 月发布在DHCS 网站上。
资产限制 - 非调整后总收入 (MAGI) Medi-Cal
Assembly Bill (AB) 133 (Chapter 143, Statutes of 2021) added Welfare and Institutions Code (WIC) section 14005.62, which authorizes a two-phased approach to eliminating the asset test for all non-MAGI Medi-Cal programs, including long-term care and the Medicare Savings Programs. Phase I will be implemented on July 1, 2022, and will increase asset limits to $130,000 per person and $65,000 per additional person being evaluated. Phase II will be implemented on January 1, 2024, and will eliminate the asset test. In November, DHCS issued policy guidance to the counties regarding the Phase I implementation in an All County Welfare Directors Letter (ACWDL 21-31).
行为健康连续基础设施计划 (BHCIP) 更新
On November 1, DHCS released the Request for Application (RFA) for the BHCIP Round Two County and Tribal Planning Grant. Eligible applicants are county agencies and Tribal entities. These grant funds will allow county and Tribal partners to plan how best to address local behavioral health facility needs, along with developing strategies and action steps to meet these needs. Grant amounts will be up to $150,000. The BHCIP’s goal is to expand behavioral health infrastructure capacity statewide, and this grant is the second in a series of six rounds of available funding. The RFA is available at https://www.infrastructure.buildingcalhhs.com/. For more information, please email BHCIP@dhcs.ca.gov, visit the DHCS website, or go to the BHCIP project website.
行为健康联邦补助金更新
10 月 25 日，DHCS 向 Sierra Health Foundation：健康项目管理中心拨款近 7730 万美元，用于实施恢复服务项目 (RSP)。 该中心将通过 RFA 提供超过 7,350 万美元，以支持全州范围内患有严重精神疾病 (SMI)、严重情绪障碍 (SED) 和物质使用障碍 (SUD) 的个人的康复服务。 DHCS 和中心将与不同的利益相关者进行广泛的社区参与，以确定恢复服务计划并更好地了解当地社区独特的恢复服务需求。 DHCS 和中心随后会将社区反馈整合到 RFA 流程中，以确定最能反映社区需求的赠款资金的最佳用途。 根据社区参与过程的结果，受助者可以：
- 支持当地康复社区支持机构的发展。
- 制定策略和教育活动、培训和活动，以减少地方层面与康复相关的耻辱和歧视。
- 扩大针对 SMI、SED 和 SUD 的循证康复模型的使用。
- 提供SMI、SED、SUD恢复资源并支持系统导航。
- 提高不同人群获得同伴康复支持服务的可及性。
- 与当地私人和非营利性临床医疗保健提供者、宗教团体、市、县、州和联邦公共卫生机构以及刑事司法响应机构合作并协调，以扩大康复服务。
有关 RSP 的更多信息，请发送电子邮件至 BHRRP@dhcs.ca.gov 或访问 DHCS 网站。
CalHOPE
CalHOPE危机咨询援助和培训计划（CCP）获得联邦政府批准延长服务期限，该计划将持续到2月9 , 2022 ，为所有加州人提供情感支持。CalHOPE Connect通过聊天功能提供 CCP 服务。CalHOPE 还继续与Together for Wellness和Juntos por Nuestro Bienestar合作，这两个组织提供基于实证的社区资源，帮助人们应对压力和焦虑；CalHOPE 热线 (800) 317-HOPE (4673) 将来电者与其他曾与压力、焦虑和抑郁作斗争的人联系起来； CalHOPE Redline将城市中的美洲原住民和阿拉斯加原住民与资源联系起来，并通过电话、聊天和面对面服务提供外展服务；以及 CalHOPE 学生支持，该支持开发课程，培训教师和学校工作人员识别遭受心理困扰的学生，提供简短干预，并将儿童及其家庭转介给心理健康服务提供者。
The IndieFlix Foundation, in partnership with CalHOPE, Blue Shield of California, and the California Department of Education, developed ANGST: Building Resilience, a film based on a mental health support program, endorsed by educators, psychiatrists, and mental health advocates. The film includes Olympic swimmer Michael Phelps, who spoke of his own challenges with anxiety. The kick-off event was held on October 19, and the film aired on Sacramento PBS affiliate KVIE on October 20. The program will be provided to all California public middle and high schools during the 2021-2022 academic year.
合规证明 – 转院、出院和拒绝重新入院听证决定
12月，DHCS将在其网站上发布一份合规证明。根据AB 133号法案（第143章， 2021年法规第143章）的规定，WIC新增了第14126.029条，要求长期护理机构及时遵守DHCS行政听证与上诉办公室的听证裁决，该裁决认定某长期护理机构不当转移、出院或拒绝重新收治某位住户。公告发布后，长期护理机构须按照所提供的说明提交该认证。每份决定书中都将附有认证表格。
为了证明合规性，长期医疗保健机构必须在听证决定下达之日起三个日历日内向 DHCS 提交合规证明。 如果机构未能及时提交证明或及时遵守听证会决定，DHCS 可能会对该机构未能遵守规定的每一天处以 750 美元的罚款，最高可达 75,000 美元。
连续血糖监测仪
DHCS will add Therapeutic Continuous Glucose Monitoring Systems as a pharmacy-billed medical supply benefit through Medi-Cal Rx, effective January 1, 2022. The coverage criteria and provider bulletins will be available on the Medi-Cal Rx website the first week of December 2021.
Dental Integration – Health Plan of San Mateo (HPSM)
Senate Bill (SB) 849 (Chapter 47, Statutes of 2018) authorized DHCS to establish a dental integration program in San Mateo County to include Medi-Cal dental services as a covered benefit under HPSM. The purpose of this effort is to test the impact on oral care access, quality, utilization, and medical costs by delivering covered dental services under the Medi-Cal managed care delivery system. The integration of the dental benefit into HPSM will take effect on January 1, 2022, and will be authorized for no more than six years, ending on December 31, 2027. All Medi-Cal members enrolled in HPSM will receive their dental care through HPSM in addition to their medical services. HPSM members were mailed notices in October, November, and December to inform them of this benefit change. Provider bulletins are also posted on the Medi-Cal Dental website.
牙科转型计划 (DTI)
截至10月31 ，2021 ，域名2计划已发放的款项总额约为2.1亿美元，共有3,461家服务提供商选择参与该计划。领域2的目标是通过龋病风险评估来诊断幼儿龋齿，将其视为一种慢性疾病进行治疗，并引入一种预防和缓解口腔疾病的模式。如需了解更多信息，请访问DHCS网站。根据Medi-Cal 2020豁免延期规定，DTI计划将于12月31日结束，但针对截至12月的服务日期，付款将持续进行。31,2021 。
药物 Medi-Cal 有序配送系统 (DMC-ODS)
The DMC-ODS 1115 demonstration waiver is active in 37 counties, covering 96 percent of California’s population. DHCS is in negotiations with CMS for approval of the DMC-ODS program in the new waiver period, from 2022-2026; DHCS developed the policies included in the new waiver through multiple stakeholder engagement meetings and stakeholder comments on a draft information notice posted in November. The final information notice outlining updated DMC-ODS policy will be released in December.
此外，DHCS 通过行为健康通知第 21-001 号实施了 SB 823（2018 年第 781 号法令），该通知要求 DHCS 获得许可的酒精和其他药物 (AOD) 康复治疗机构获得至少一个 DHCS 护理级别 (LOC) 指定和/或至少一个与所有项目服务相一致的 ASAM 住宿 LOC 认证。截至 2021 年 10 月，DHCS 已处理了加州 1,527 家 AOD 服务提供商的指定申请。在这些称号中，有 1,227 个称号对 437 家提供商有效。有关 DMC-ODS 的更多信息，请访问DHCS 网站。
此外，DHCS 还与一家外部质量审查机构（EQRO）签订合同，每年对 DMC-ODS 县的医疗可及性、及时就医情况及医疗质量进行审查。这些审查结果汇总在年度县报告中，并发布在EQRO网站上。通过与加州大学洛杉矶分校（UCLA）综合药物滥用项目（ISAP）签订的合同，加州卫生与人类服务部（DHCS）每年开展DMC-ODS豁免计划评估工作，以衡量和监测项目成效；DMC-ODS豁免计划评估报告已发布在UCLA ISAP网站上。
家庭和社区替代计划 (HCBA) 豁免修正案
根据《2021年法规》第143章（AB 133号法案），DHCS将向CMS提交一项技术修正案，以提高针对“发育障碍者HCBA豁免中间护理机构——持续护理”（ICF/DD-CNC）的每日服务提供商报销标准。费率调整将在获得CMS批准后生效，批准流程可能在提交申请后长达90天。
HCBA 豁免为符合 Medi-Cal 资格的受益人在他们选择的社区环境中提供长期的、以社区为基础的服务和支持。 这些服务包括私人护理、病例管理和个人护理服务，这些服务对于在社区环境（而非机构）中维护需要护理级别护理的个人的健康和安全是必要的。
MCP采购——模型变更更新
DHCS completed its review of the approved county ordinances that were required to be submitted to DHCS by October 10. A final list of counties approved to move forward with a Plan Model change was posted on the DHCS website.
Additionally, by December 3, MCPs were each required to submit for DHCS review a network contracting strategy; those strategies are being reviewed. Final approval to implement on January 1, 2024, will be based upon MCP operational readiness and CMS approval. Additional information is available on the DHCS website.
Medi-Cal 健康登记导航项目
DHCS is expanding and extending efforts to enroll hard-to-reach Medi-Cal populations. Effective July 1, 2019, AB 74 (Chapter 23, Statutes of 2019) appropriated $59.7 million for DHCS to partner with counties and community-based organizations (CBOs) to conduct Medi-Cal outreach, enrollment, retention, and navigation services for hard-to-reach Medi-Cal and potentially eligible Medi-Cal populations. Due to the community health impacts of COVID-19, navigator services are now more critical than ever. Project partners have implemented innovative and creative approaches to contact and enroll eligible populations in their local communities, provided vaccine information and outreach at the local level, and engaged college students at all levels. The current phase of the project allows CBOs and counties to incorporate new or expand existing activities for all participants, and continue adjusting their outreach and enrollment approaches to overcome challenges presented by COVID-19. As of November 2021, all remaining funding was allocated to project partners, enabling them to extend their project performance period to June 30, 2022. Information and updates related to the project are available on the DHCS website.
Medi-Cal Rx 实施更新
Medi-Cal Rx 计划于 1 月1 ，2022 正式上线。宣传和教育活动正在进行中，并将持续至12月。DHCS 已向所有 Medi-Cal 受益人发送了 60 天通知，并将向所有按服务收费（FFS）受益人发送 30 天通知。作为一项更广泛宣传活动的一部分，MCPs还将向其成员发送一份30天通知。此外，DHCS 继续举办 Medi-Cal Rx 利益相关方交流活动和会议。即将举行的公开论坛网络研讨会将在DHCS网站上发布。如对Medi-Cal Rx有任何疑问或意见，请发送电子邮件至 RxCarveOut@dhcs.ca.gov。
药物治疗管理 (MTM)
On September 15, DHCS received CMS approval of SPA 21-0028, which adds MTM as a payable FFS pharmacy service provided in conjunction with certain complex chronic medical conditions. DHCS is finalizing provider contracts and expects to initiate the program in December. To participate in the program, Medi-Cal-enrolled pharmacies will be required to enter into a contract with DHCS. The contract will outline the requirements and guidelines necessary to receive reimbursement under this methodology.
多用途老年服务计划 (MSSP) 豁免修正案
11 月 19 日，DHCS 向 CMS 提交了一份修正案，将 MSSP 计划从被称为协调护理计划 (CCI) 的 1115 改革桥梁示范豁免中分离出来，并修改了 1915(c) 豁免。 10 月 1 日，DHCS 与加州老龄化部门合作，发布了为期 30 天的豁免公众意见征询期。 1915(c) 豁免的更新将使所有 CCI 县（圣马特奥县除外）恢复到 FFS 交付系统。 豁免的其他变化包括对已服务县的地理服务区域进行更新、预期实施电子访问验证 (EVV)，以及增加与 2021 年预算法案相关的参与者名额。
MSSP 豁免为有资格进入护理机构但希望留在社区的体弱老年客户提供社会和医疗保健管理。 MSSP 的目标是避免过早将人们安置在护理机构中，同时促进社区中的独立生活。
老年人拓展
AB 133（2021 年第 143 号法令）扩大了 Medi-Cal 全范围资格，允许 50 岁或以上，且没有令人满意的移民身份或无法建立令人满意的移民身份的个人享受该福利，即使他们符合其他资格。DHCS的目标是在5月1 、 2022做好系统准备并实施老年人扩展计划。DHCS 已向ACWDL 21-13中的各县提供了政策指导。在本次扩容计划实施过程中，DHCS 将每月举行倡导者和县级工作组会议。DHCS将在未来几个月内在其网站上发布更多项目详情。
产后护理保障
根据 2021 年美国救援计划法案 (ARPA) 的规定，DHCS 正在扩大 Medi-Cal 的覆盖范围，以惠及符合条件和新近符合条件的孕妇。Medi-Cal 将在怀孕和产后期间提供全面的医疗必需服务，在目前的 60 天产后期基础上增加 10 个月的保障，总共提供 12 个月的保障。为了使 Medi-Cal 准入计划 (MCAP) 与上述 Medi-Cal 产后护理延期政策保持一致，DHCS 提交了儿童健康保险计划 (CHIP) SPA，CA-21-0032，提议创建健康服务计划 (HSI)，以将 ARPA 中允许的条款扩展到 MCAP。9 月 14 日，DHCS获得联邦政府对 HSI 的批准，允许追溯生效日期为 7 月1 、 2020 。根据 ARPA 和 HSI 的规定，无论收入变化、公民身份或移民身份如何，个人在怀孕期间和 12 个月的产后延长保险期内都将保持保险。这项针对 Medi-Cal 的 ARPA 政策计划于 4 月1 、 2022实施。
Quality Improvement Awards – 2021
DHCS每年都会表彰那些在提升医疗质量方面表现卓越的Medi-Cal管理式医疗计划（MCPs），这些计划通过管理式医疗服务体系，为近1200万享受Medi-Cal福利和服务的参保人提供医疗服务。DHCS 向所有获奖者表示祝贺，感谢他们的辛勤付出，并鼓励他们与服务于 Medi-Cal 参保人的其他医疗保险计划分享这些行之有效的做法。如需查看获奖名单及奖项详情，请访问DHCS网站。
微笑，加州 Medi-Cal 牙科服务运动
Five “Behind the Smiles” Medi-Cal Dental provider testimonial videos were published to the Smile, California website and posted to Smile, California’s Instagram and Facebook accounts, highlighting why dentists enjoy participating in the Medi-Cal Dental program. Smile, California also developed a new educational brochure that highlights important information on aging and oral health. The new “A Healthy Smile Never Gets Old!” brochure explains common dental problems and symptoms associated with older adults, information on how to access and pay for dental care, tips for good oral health, and details on non-medical transportation services.
此外， Smile, California与九家服务于 Medi-Cal 会员人口最多的偏远社区的食品银行合作，在其计划的节日食品分发活动中分发“健康笑容始于健康食品”宣传单和Smile, California品牌的牙线卡。