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Medi-Cal COVID-19 公共卫生紧急事件 (PHE) 运营解除计划
On May 17, DHCS released the Medi-Cal COVID-19 PHE Operational Unwinding Plan. The two primary purposes of the plan are to: 1) describe DHCS’ approach to unwinding or making permanent the temporary flexibilities implemented across the Medi-Cal program during the PHE; and 2) describe DHCS’ approach to resuming normal Medi-Cal eligibility operations following the end of the PHE. The PHE is currently set to expire on July 15, 2022, and the U.S. Department of Health and Human Services (HHS) has committed to providing at least a 60-day notice prior to the official PHE end date.
Since the initiation of the PHE, DHCS implemented more than 100 programmatic flexibilities to help minimize the strain to the Medi-Cal program, its beneficiaries, and California’s health care providers and systems. While many of these programmatic flexibilities will terminate on or around the end of the PHE, some will continue due to the positive impact they have made on the Medi-Cal program. Additionally, under the continuous coverage requirement in the Families First Coronavirus Response Act, states are required to maintain enrollment of nearly all Medicaid enrollees through the end of the month in which the PHE ends. When continuous coverage requirements expire, states must conduct a full redetermination for all beneficiaries who would otherwise have been subject to redetermination.
The Operational Unwinding Plan is intended to inform the public of DHCS’ approach to return Medi-Cal to a normal state of operations. The document also includes additional resources, including information about the DHCS Coverage Ambassadors campaign and links to the Centers for Medicare & Medicaid Services’ (CMS) guidance documents.
Governor’s May Revision
On May 13, Governor Newsom unveiled his $300 billion fiscal year (FY) 2022-23 May Revision budget proposal, which is an increase of approximately $14 billion compared to the budget released on January 10, 2022. The state now has a projected surplus in excess of $86 billion that is reflected in increased budgetary reserves as well as an increased use of discretionary surplus amounts to fund one-time projects. The Governor’s May Revision proposes a $141.8 billion total funds ($37 billion General Fund) budget for DHCS programs and services. The total amount is allocated between $1.6 billion in DHCS state operations and $140.2 billion that supports funding for program costs, partners, and administration.
COVID-19 PHE 继续对 DHCS 预算产生重大影响，这反映了与 PHE 相关的总体净成本为 115 亿美元。 这一影响包括近期 PHE 延长至 7 月15 、 2022 。 对 COVID-19 预计影响的主要更新包括与 PHE 取消相关的成本（包括资格重新确定）；联邦合格医疗中心继续对疫苗接种进行单独计费；继续对 65 岁以上、盲人或残疾人士推定资格；以及与增加联邦医疗援助百分比 (FMAP) 相关的额外四分之一收入。
The May Revision includes a significant additional investment in the Equity and Practice Transformation Payment program ($700 million total funds) to advance equity, address gaps in preventive, maternity, and behavioral health care measures, reduce disparities driven by COVID-19, and support practices to transition from fee-for-service reimbursement (where providers are paid for visits/volume and not quality/outcomes) to value-based payments/alternative payment models (e.g., capitated payments tied to quality outcomes)). This aligns with the goals of the Medi-Cal Comprehensive Quality and Equity Strategy and the Bold Goals of 50×2025 initiative. Preparing practices for value-based care also includes implementing practice infrastructure, such as electronic health records and improved data collection and exchange.
The May Revision also proposes $933 million for one-time retention payments to approximately 600,000 California hospital and nursing facility workers who have been at the frontlines delivering care to the most acute patients during the COVID-19 Pandemic. The ongoing response to COVID-19 has significantly impacted California’s workforce in hospitals and nursing facilities. Retaining essential workers in these settings is a priority of the Administration, and these payments are designed to help retain this critical workforce in an environment of high vacancies and turnover. The state will provide a baseline payment and will increase the payment up to $1,500 if employers commit to fully matching the additional amount, subject to available funding.
此外，DHCS 还与加州卫生与公众服务局合作，提供补助金（8500 万美元普通基金）来支持儿童、青少年和父母的健康并增强他们的适应力。 这些项目将帮助那些受到 PHE 造成的创伤、压力和社会孤立影响的年轻人，并将向学校、城市、县、部落和社区组织 (CBO) 提供额外的儿童和青少年行为健康计划补助金。
DHCS 提议为健康登记导航员提供更多资金（总计 6000 万美元）以继续开展项目活动，重点关注与 COVID-19 PHE 相关的活动，具体通过协助年度续签、报告更新的联系信息和接触难以接触的目标人群来帮助受益人保留 Medi-Cal 保险。
五月份的修订版本包括要求提供 1000 万美元的一次性阿片类药物和解基金，以通过增加向无家可归者服务提供者分发纳洛酮来增强一月份药物辅助治疗扩展项目的提案。 此外，DHCS 还提议在 1 月份与物质滥用提供者劳动力培训相关的提案中增加 2910 万美元。
View the DHCS May Revision budget highlights and the Medi-Cal and Family Health Local Assistance Estimates.
Medi-Cal Rx 实施更新
自 2022 年 2 月起，Medi-Cal Rx 已稳定了呼叫中心和事先授权 (PA) 运营。 自那时起，DHCS 和 Magellan (MMA) 就开始了密集的规划过程，以分阶段恢复索赔编辑和 PA 要求。 该三阶段方法由 利益相关者的反馈，首先恢复一小部分按药物类别选定的声明编辑和 PA；然后恢复所有受 2022 年 2 月初采取的缓解措施影响的 PA；并在最后阶段退出过渡政策。 恢复方法是渐进和迭代的，重点关注利益相关者的准备情况和绩效监控。 它将根据数据分析、运营经验和利益相关者的反馈，随着时间的推移进行必要的改进。 鼓励利益相关者通过专用电子邮件收件箱Reinstatement@dhcs.ca.gov对此方法进行评论并提供反馈。
特殊人群临床医生联络小组
Using feedback from various stakeholders, Medi-Cal Rx has created a Special Populations Clinical Liaison Team within the Customer Service Center that is trained to serve the specific needs of populations enrolled in California Children’s Services, the Genetically Handicapped Persons Program, and those who have specialty behavioral health conditions. This team is comprised of pharmacy technicians and pharmacists.
从 5 月 9 日开始，特殊人群临床联络小组的工作时间为周一至周五，上午 8 点至晚上 8 点（节假日除外），为受益人、提供者和县用户提供服务，他们可以验证和讨论特定受益人的受保护健康信息。 Medi-Cal Rx 致力于为加州各地的 Medi-Cal 受益人和提供者提供及时、安全的药房服务。
DHCS is also ensuring that providers are kept updated and that relevant information is communicated to them via e-mail blasts, provider newsflashes, information on the DHCS and Medi-Cal Rx websites, and direct provider outreach. These actions are designed to ensure that Medi-Cal beneficiaries can get the prescription drugs they need when they need them. For questions or comments related to Medi-Cal Rx, please email RxCarveOut@dhcs.ca.gov.
血压袖带和监测仪
自 6 月 1 日起，个人用血压监测仪和血压袖带被添加为 Medi-Cal Rx 部分豁免药房福利。 这些项目仅限于拟议的设备和袖口清单，并且是经过仔细审查以及利益相关者和提供商的意见后选定的。 将这些物品添加为药房报销福利将改善获得医疗服务的机会，并且这些福利将继续作为医疗索赔中计费的耐用医疗设备提供。 Medi-Cal Rx 承保医疗用品产品说明和账单信息清单以及 Medi-Cal Rx 提供商手册将会更新以反映这些新增内容。 如有问题或意见，请发送电子邮件至 medicalsupplies@dhcs.ca.gov 。
Medi-Cal COVID-19 疫苗接种激励计划
DHCS allocated up to $350 million to incentivize COVID-19 vaccination efforts in the Medi-Cal managed care delivery system from September 1, 2021, through February 28, 2022. Medi-Cal managed care plans (MCPs) were eligible to earn incentive payments for activities designed to close vaccination gaps with their enrolled members, and to address vaccine uptake disparities for specific age and race/ethnicity groups. The third outcome ascertainment period for the program ended on March 6. Between January 3 and March 6, the total vaccination rates showed improvement in all reported measures. On March 6, target goals for all vaccine outcome measures increased to closing 100 percent of the gap between Medi-Cal and county rates, which was a challenge for plans to meet. Three beneficiary sub-groups (ages 12-25 years, African Americans, and American Indian/Alaska Natives) were within 5 percent of closing two-thirds of the gap. For the high performance pool measures, preliminary data demonstrate that eight MCPs achieved targets of at least one dose for members age 5-11 years, and two MCPs achieved targets for fully vaccinated and boosted members age 12 years and older. For more information, please refer to All Plan Letter (APL) 21-010, Attachment A.