项目更新
辅助生活豁免 (ALW) 名额扩展
On January 7, CMS approved DHCS’ amendment to the ALW to add 7,000 slots to eliminate the current waitlist and expand waiver capacity. This amendment is retroactive to July 1, 2021. The purpose of the ALW is to keep eligible seniors and persons with disabilities in their communities and out of institutional care settings.
On July 12, 2021, DHCS submitted Medi-Cal’s Home and Community-Based Services (HCBS) Spending Plan, authorized by Section 9817 of the American Rescue Plan Act (ARPA). ARPA includes an additional 10 percent Federal Medical Assistance Percentage (FMAP) on certain HCBS services, which can then be reinvested to expand and improve HCBS. CMS conditionally approved California’s HCBS Spending Plan on January 4, 2022. DHCS intends to fund the ALW slot expansion through the enhanced FMAP available through ARPA.
行为健康连续基础设施计划 (BHCIP) 更新
On January 10, DHCS released the “BHCIP Round 2B: Planning Grant – Request for Application (RFA)” to solicit applications from county behavioral health agencies and tribal entities for DHCS’ BHCIP and the California Department of Social Services’ (CDSS) Community Care Expansion (CCE) program. DHCS and CDSS re-released this non-competitive joint RFA for eligible organizations to receive up to $150,000 each to initiate and support planning efforts, from April 2022 through December 2022, for the acquisition and expansion of behavioral health infrastructure throughout the state. DHCS and CDSS released the initial RFA from November 1-30, 2021, and on January 3 awarded a total of $5,351,756 to 36 entities (nine are tribes). The BHCIP Round 2B: Planning Grant RFA deadline is February 28, 2022.
1 月 31 日，DHCS 与 CDSS 合作发布了 BHCIP：第 3 轮启动准备和 CDSS 社区护理扩展计划联合 RFA。 符合 BHCIP 第三轮：启动准备资格的组织可以申请并获得资金支持，以在为 Medi-Cal 受益人服务的环境中建造、购买和修复房地产资产。 对于 BHCIP，仅接受那些已确定经过规划流程、准备实施且将扩展行为健康连续性的项目的申请。 DHCS 将为 BHCIP 第三轮：启动准备提供高达 5.185 亿美元的赠款资金，并且必须在 2024 年 6 月之前拨付资金，并在 2026 年 12 月之前清算。
BHCIP 第三轮：启动准备将由两个申请部分组成，以平衡能够立即扩展的项目与需要更多时间来开发申请的申请人的需求。 这将为申请人提供两个潜在的提交截止日期。 第一部分未授予的任何剩余资金将提供给第二部分申请人。 所有第一部分申请的截止日期为2022 3 月31日，第二部分申请的截止日期为31年 5 月2022日。
DHCS was authorized through 2021 legislation to establish BHCIP and award $2.1 billion to construct, acquire, and expand properties and invest in mobile crisis infrastructure related to behavioral health. CDSS oversees CCE, which was established through Assembly Bill (AB) 172 (Chapter 20, Statutes of 2021) as a companion effort, totaling $805 million, and focused on the acquisition, construction, and rehabilitation of adult and senior care facilities that serve Supplemental Security Income/State Supplementary Payment and Cash Assistance Program for Immigrants applicants and recipients and other adults who are experiencing or at risk of homelessness.
For more information, please email BHCIP@dhcs.ca.gov or visit the BHCIP project website.
行为健康联邦补助金更新
12 月27日2021 ，DHCS 发布了一份 RFA，该提案于 1 月28 2022完成，向公共和私人非营利组织提供 1100 万美元，用于在 LGBTQ2S+ 社区项目中实施阿片类药物使用和兴奋剂使用预防与恢复服务，项目时间为 3 月1日2022至 2 月28 2023 。 符合条件的实体每个可申请最高 25 万美元，以支持针对加州 LGBTQ2S+ 社区内阿片类药物和兴奋剂使用的预防和康复服务。 符合条件的活动包括：培训和资助药物使用导航员、行为健康顾问、推广员、文化经纪人、社区倡导者、同行工作者和其他人，将阿片类药物使用和兴奋剂使用外展、预防和治疗转诊纳入他们的工作流程；实施减少耻辱感的运动；开发和传播教育预防材料；纳入创伤知情教育和外展；和康复服务。
This initiative is funded by the State Opioid Response 2 grant and the Coronavirus Response and Relief Supplemental Appropriations Act, awarded by the federal Substance Abuse and Mental Health Services Administration, and is administered by Sierra Health Foundation: Center for Health Program Management as the administrative entity on behalf of DHCS. For more information about this funding opportunity, please email DHCSMATExpansion@dhcs.ca.gov or visit the DHCS website.
CalHealthCares 贷款偿还计划
2018 年预算法案从第 56 号提案中拨款 2.2 亿美元给 DHCS。 参议院法案 (SB) 849（2018 年法规第 47 章）设立了第 56 号提案 Medi-Cal 医生和牙医贷款偿还法案计划 (LRP)（通常称为 CalHealthCares）。 2019 年预算法案从第 56 号提案中额外拨款 1.2 亿美元给 DHCS，总计 3.4 亿美元，分五个阶段管理。 符合条件的医生可以申请最高 30 万美元的贷款偿还，以换取五年的服务义务。 符合条件的牙医可以申请最高 30 万美元的贷款偿还以换取五年的服务义务，或者申请最高 30 万美元的执业支持补助以换取十年的服务义务。
The Fiscal Year (FY) 2021-22 Cohort 4 application cycle for CalHealthCares opened on January 24 and will close on February 25. Approximately $54 million is available for physicians and $9 million for dentists who are committed to seeing Medi-Cal patients in California over five years. Please visit CalHealthCares.org for specific eligibility requirements, application information, and informational webinar dates.
CalHOPE
CalHOPE 继续为加州各地难以接触到的人群提供情感支持服务。 2021 年 12 月，CalHOPE 和 Media Solutions 在便利店、美国退伍军人协会和海外退伍军人协会等机构推出了新一轮 CalHOPE 海报。 此外，Media Solutions 还推出了以节日为主题的特别 CalHOPE 创意，用于数字显示、社交、广播和印刷，总共提供 59,000 个媒体广告。
In January 2022, All It Takes, in partnership with CalHOPE and the California Department of Education, launched A Trusted Space, a film-based program aimed at training educators to help mitigate the effects of emotional stressors on students and their families. This program will be provided to all California public middle and high schools during the 2021-2022 academic year. Lastly, CalHOPE collaborated with the NBA’s Sacramento Kings to provide messaging outside and inside of Golden 1 Center during their game against the Cleveland Cavaliers on January 10.
由于 COVID-19 的不确定性持续存在，CalHOPE 于 1 月向联邦政府提交了 30 天的延期申请，并获得批准将该计划延长至 3 月 11 日。 CalHOPE 还提交了额外 60 天的延期申请，以便在 2022 年春季之前提供危机咨询服务和情感支持。
连续血糖监测仪
DHCS added Therapeutic Continuous Glucose Monitoring Systems as a pharmacy-billed medical supply benefit through Medi-Cal Rx, effective January 1. The coverage criteria and provider bulletins are available on the Medi-Cal Rx website.
痴呆症意识倡议和 SB 48
As part of the HCBS Spending Plan, DHCS is developing the Dementia Aware initiative that will leverage $25 million in one-time enhanced federal funding to establish a statewide provider training program in culturally competent dementia care as well as a referral protocol on cognitive health and dementia for Medi-Cal beneficiaries. This is consistent with the standards for detecting cognitive impairment under Medicare and the recommendations by the American Academy of Neurology, the California Department of Public Health’s (CDPH’s) Alzheimer’s Disease Program, and CDPH’s ten California Alzheimer’s Disease Centers (CADC).
与此举措相一致，SB 48（2021 年法规第 484 章）将年度认知健康评估确立为 Medi-Cal 承保的福利，仅提供给 65 岁或以上且不符合 Medicare 类似评估资格的 Medi-Cal 受益人。 SB 48 规定，只有当 Medi-Cal 提供者完成 DHCS 规定的认知健康评估培训时，该提供者才有资格获得此项福利的付款。 该福利的目标实施日期为1年2022月。
DHCS met with CDPH’s Alzheimer’s Disease Program, the CADCs, the Alzheimer’s Association, the California Academy of Family Physicians, the California Health & Human Services Agency Alzheimer’s Disease and Related Disorders Advisory Committee, and other stakeholders during the last quarter of 2021 to further establish the needs of the provider training program and to collect clinical and training resources to review and potentially incorporate into the initiative. In collaboration with a University of California (UC) contractor, DHCS will review resources and develop an online provider training. DHCS issued a Request for Information to potential UC collaborators, with the goal of executing a contract in March. DHCS will continue to solicit feedback from stakeholders as the initiative unfolds.
牙科转型计划 (DTI)
As of December 31, 2021, Domain 2 payments issued total approximately $228 million, and 3,512 providers have opted in to participate. The goal of Domain 2 is to diagnose early childhood caries by using caries risk assessments to treat it as a chronic disease and to introduce a model that prevents and mitigates oral disease. In accordance with the Medi-Cal 2020 waiver extension, DTI concluded on December 31, 2021. For more information, please visit the DHCS website.
全面怀孕
On December 16, 2021, CMS approved SPA 21-0066 to provide full-scope Medicaid coverage to all beneficiaries in the Medicaid pregnancy eligibility group with incomes up to and including 213 percent of the federal poverty level, effective January 1. The targeted population for this policy is citizens and lawfully residing individuals. DHCS will issue an All County Welfare Directors Letter to notify partners, publish provider bulletins and newsflashes, and update the DHCS pregnancy webpage.
Medi-Cal 健康登记导航项目
由于 COVID-19 对社区健康的影响，健康注册导航员服务现在比以往任何时候都更加重要。根据 AB 74（2019 年法规第 23 章），向 DHCS 拨款 5970 万美元，用于与各县和社区组织（CBOs）合作，为难以接触到的 Medi-Cal 和可能符合 Medi-Cal 资格的人群开展 Medi-Cal 外联、注册、保留和导航服务。项目合作伙伴采用了创新和创造性的方法来联系当地社区中符合条件的人群并为其注册，在地方一级提供疫苗信息和外联活动，并让各级大学生参与其中。该项目现阶段允许社区组织和各县为所有参与者开展新的活动或扩大现有活动，并继续调整其外联和注册方法，以克服 COVID-19 带来的挑战。截至 2022 年 1 月，有五个项目合作伙伴发放了未用资金，这些资金将尽早重新分配给现有的合作伙伴。
药物治疗管理 (MTM)
MTM services are now a Medi-Cal benefit for pharmacists. MTM pharmacy services may be billed by a Medi-Cal enrolled pharmacy with an approved Medi-Cal Specialty Pharmacy Provider Application (MC 3155), as well as a signed supplemental services agreement with DHCS for MTM services. Providers may refer to part 2 of the Provider Manual for a detailed explanation of MTM benefits. Providers wishing to receive a copy of the contract must send their requests to MTMquestions@dhcs.ca.gov.
MTM 药房服务是针对符合特定资格条件的 Medi-Cal 受益人的福利（请参阅《提供者手册》第 2 部分以获取完整列表）。 此外，Medi-Cal 受益人必须使用一种或多种药物来治疗诊断病症（请参阅提供者手册第 2 部分以获取完整列表）。 最初，DHCS 将签订与以下方面相关的 MTM 服务合同：
- 艾滋病毒/艾滋病
- 严重的精神健康问题（精神病，如精神分裂症/分裂情感性障碍、躁郁症等）
- 癌症
- 血友病
- 糖尿病
未来几个月内将会根据流量添加附加条件。 MTM 药房服务是从 Medi-Cal 管理式医疗中分离出来的。 与补充协议、签约流程或 MTM 服务相关的问题可以提交至 MTMquestions@dhcs.ca.gov。
多用途老年服务计划 (MSSP) 豁免修正案
11 月19日， 2021 ，DHCS 向 CMS 提交了一份修正案，要求将 MSSP 计划从 1115 改革之桥示范中分离出来，并修改 1915(c) 豁免条款。 10 月 1 日，DHCS 与加州老龄化部门合作，公布了豁免修正案，并启动了为期 30 天的公众意见征询期。 对 1915(c) 豁免的修正案将使所有协调护理计划县（圣马特奥县除外）恢复到 MSSP 豁免按服务收费交付系统。 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、预期的电子访问验证实施以及增加参与者名额。 DHCS 正在等待 CMS 对豁免修正案的最终批准。
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。
关于指定药物 Medi-Cal 提供者类别风险等级的公开听证会
On February 24, DHCS is holding a virtual public hearing to discuss changes to the designation of categorical risk levels for Drug Medi-Cal applicants. In accordance with CMS’ newly designated categorical risk levels for newly enrolling and revalidating opioid treatment programs, DHCS is issuing a provider bulletin to update the designation of categorical risk levels for Drug Medi-Cal applicants with Narcotic Treatment Program or Heroin Detoxification Program services modalities. Stakeholders will have the opportunity to submit questions and suggestions during the hearing; written comments will be accepted on the day of the hearing until 5 p.m. After reviewing the public comments received, DHCS will publish the final bulletin on the Medi-Cal and DHCS websites. The changes will become effective 30 days after publication.
微笑，加州 Medi-Cal 牙科服务运动
2021 年 11 月，加利福尼亚州 Smile在 Facebook Live 上用英语和西班牙语举办了两场虚拟会员演讲。 这些介绍概述了 Medi-Cal 覆盖的所有年龄组的牙科服务，并强调了有关福利和覆盖范围的常见问题。演讲总计获得了 228 次观看。
Also in November, a Smile, California outreach representative participated in a live radio segment. The segment was translated into Mixteco, an indigenous language spoken by tens of thousands of California migrants. The interview was broadcast throughout Ventura County. The interview received more than 10,000 radio impressions. The outreach representative discussed the Medi-Cal Dental Program, the program’s covered services, the importance of regular dental visits, and how to find a Medi-Cal dentist.
In December, the social media gallery on SmileCalifornia.org was updated with five new social media images and suggested captions for partners and providers to post to their social media accounts featuring the following topics:
- 疼痛意识
- 磨牙封闭剂
- Caring for loved ones’ oral health
- Medi-Cal 牙科福利
- 儿童牙科检查的重要性
Smile, California is supporting National Children’s Dental Health Month (NCDHM) in February. Two virtual informational webinars were held on January 19 and 20 to empower local health champions statewide to motivate Medi-Cal enrolled and eligible members in their communities to learn about the Medi-Cal Dental Program and schedule dental appointments for themselves and their children. The webinars were recorded and posted on SmileCalifornia.org under “Partners and Providers.”
Also, a new webpage dedicated to NCDHM is published on SmileCalifornia.org and SonrieCalifornia.org, which feature educational resources about children’s oral health, activity sheets, and a new dental health superhero coloring sheet available for download