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Medi-Cal 續訂數據網路研討會

On August 7, from 3 to 4 p.m., DHCS will virtually host a webinar on the new DHCS continuous coverage unwinding data dashboard (advance registration required) to discuss data for June 2023 Medi-Cal renewals, the first month of California’s redeterminations since the end of the federal continuous coverage requirement on March 31. These data will include initial disenrollments from Medi-Cal eligibility renewals that occurred on July 1. Annual redeterminations will continue monthly, with the last eligibility renewal under the continuous coverage requirement occurring in May 2024, followed by a return to the normal annual renewal process.

BH-CONNECT 和卡拉伊姆過渡性租金服務公開聽證會

On August 11, from 10 to 11:30 a.m., DHCS will host the first public hearing (advance registration required) to solicit stakeholder comments on the California Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) demonstration and proposed amendment to the California Advancing and Innovating Medi-Cal (CalAIM) Section 1115 demonstration related to transitional rent services. The public hearing will take place in person and have online video streaming and telephonic conference capabilities to ensure accessibility. Please view the “In Case You Missed It” section below for additional details on BH-CONNECT and CalAIM transitional rent services. Please email your questions to 1115Waiver@dhcs.ca.gov.

ECM 和社區支持網絡研討會   

DHCS will host two virtual webinars (advance registration required) for all stakeholders to provide an overview of the progress of Enhanced Care Management (ECM) and Community Supports implementation and to discuss important policy refinements and areas of reinforcement. The webinars will cover a range of topics, including eligibility, referrals and authorizations, provider networks, payment, market awareness, and data exchange. Key insights from the ECM and Community Supports calendar year 2022 implementation report will also be unveiled:

• ECM 第一年後：執行進度與政策修訂，8 月 14 日下午 2 點至 3 點。
• 8 月 18 日上午 9:30 至 10:30，「第一年後的社區支援：執行進度與政策修訂」。

如需了解更多信息，請訪問ECM 和社區支援網頁。如有任何疑問，請發送電子郵件至 CalAIMECMILOS@dhcs.ca.gov 。

牙科管理護理（DMC）申請提案（RFP）

On August 3, DHCS released the Medi-Cal DMC RFP for Sacramento and Los Angeles counties, with responses due no later than 4 p.m. on October 6, 2023. This contract will provide positive changes to the Medi-Cal DMC program. Recognizing the historical shortcomings of DMC plan performance, DHCS worked diligently to ensure there is a revised and comprehensive reform of California’s DMC contracts. DHCS is committed to improving Medi-Cal members’ oral health care delivery and experience—ensuring members have access to person-centered, equity-focused, and data-driven dental care. As a result, Medi-Cal’s DMC contracts will include:

• 品質改進和口腔健康公平轉型計劃旨在評估和評估 DMC 計劃的績效和實踐，並根據持續品質改進方法制定建議和實施最佳實踐。該計劃涉及多個層面的參與，包括 Medi-Cal 成員、計劃管理委員會成員、當地口腔健康計劃等。該計劃還將與口腔健康社區諮詢委員會合作，以製定和實施 DMC 計劃活動的最佳實踐。

• 對合規性的責任感和承諾，包括對受委託實體的監控和監督。目標是透過對所有受委託實體進行強有力的合規、監控和監督，確保成員獲得高品質的照護和公平的服務取得。DMC計劃將在各個授權層級對醫療品質負責。這將包括證明使用委託實體和分包商的合理性，以確保成員的體驗和成果始終處於首要位置。
• 更加重視醫療和牙科保健的整合。醫療服務提供者有權向會員普及口腔健康預防服務知識，並使用數據驅動的指標來監測 DMC 計劃和醫療計劃的成效。當醫療計劃收到有關因口腔健康問題而前往急診室就診的數據時，該計劃將向會員提供有針對性的醫療牙科護理協調服務，使會員受益。會員還將收到更多訊息，以幫助他們選擇最適合其家庭和/或個人需求的計劃。計劃將需要定期向公眾報告有關服務取得、品質改進和口腔健康公平活動的情況，包括績效和消費者滿意度。

DHCS 目前與洛杉磯縣的三個 DMC 計劃根據預付健康計劃（PHP）計劃，在薩克拉門托縣根據地理託管護理（GMC）計劃下簽訂合同。 RFP 適用於 DMC 計劃繼續在薩克拉門托縣營運 GMC 和洛杉磯縣的 PHP。 RFP 的預期合同執行日期為 2024 年 1 月，其後即將開始合同準備期。 DHCS 將為合約營運期限設定 54 個月的資本利率，預計將於 1 月 2024 開始。

專案更新

兒童和青少年行為健康倡議（CYBHI）撥款可獲得

On August 7, DHCS will release a Request for Application (RFA) seeking proposals from various individuals, organizations, and agencies for the third round of grant funding, totaling $60 million, to scale evidence-based practices and community-defined evidence practices (EBP/CDEP) for early childhood wraparound services. The application deadline is October 6 at 5 p.m. Details are posted on the DHCS EBP/CDEP website.

Also, on July 31, the Mental Health Services Oversight and Accountability Commission (MHSOAC), in partnership with DHCS, released a separate RFA seeking proposals for the fourth round of grant funding, totaling $50 million, to scale youth-driven EBPs and CDEPs. MHSOAC will host a Bidders Conference webinar on August 9, from 11 a.m. to 12:30 p.m. to walk through the RFA and provide applicants the opportunity to ask questions about the procurement process and to obtain clarification on any component of the RFA. For this RFA, applications must be submitted electronically to the MHSOAC via e-mail to procurements@mhsoac.ca.gov by September 15 at 3 p.m. Please email any questions to procurements@mhsoac.ca.gov.

對於 CYBHI EBP/CDEP 撥款的所有其他問題，請聯絡 DHCS，信箱為CYBHI@dhcs.ca.gov 。如需了解更多信息，請參閱 DHCS 的CYBHI 網頁，其中包含CYBHI EBP/CDEP 撥款戰略，重點介紹 DHCS 在多個資助輪次中擴大 EBP/CDEP 的總體戰略。

公共衛生緊急事故後對藥物流產政策澄清

8月1日，DHCS更新了藥物流產政策。根據這項新政策，對於 7 月 1 日或之後提供的懷孕 77 天內的藥物流產服務，醫療服務提供者可以獲得報銷。此外，DHCS 還制定了永久性的 COVID-19 靈活措施，包括允許在提供藥物流產服務時使用遠距醫療方式而不減少支付。有關 Medi-Cal 墮胎政策的更多信息，請參閱 Medi-Cal 墮胎提供者手冊和關於藥物流產的 PHE 後政策澄清新聞文章。

人口健康管理倡議：建立基礎實施指南系列現已上載

DHCS is pleased to share progress updates on the Population Health Management Initiative (PHMI), a California partnership between DHCS, Kaiser Permanente, and community health centers. The goal is that each participating community health center will focus on a common set of priority measures and specific populations, including children, pregnant people, people with behavioral health conditions, and adults living with chronic conditions and preventive care needs. The common set of priority measures directly align with the Federally Qualified Health Center (FQHC) Alternative Payment Methodology, which is a new payment system that seeks to transform the care provided through community health centers.

As of July 31, PHMI has launched the executive summaries of the Building the Foundation Implementation Guide series, which previews four implementation guides for primary care practices in California. These guides serve as an organized quality improvement strategy, with the goal of supporting substantive cultural, technological, and process changes that improve population-based care. The first version of these guides will be made available this fall.

For more information about PHMI, visit www.phminitiative.com. To receive quarterly newsletter updates about PHMI, sign up here.

加州醫療補助健康保健計劃 Rx

8月4日，下一波復職潮將到來。在第四階段，第一階段將首次對 22 歲及以上會員的理賠利用管理產生影響。對於「產品/服務不適用於患者年齡」、「產品/服務不適用於患者性別」以及「需要品牌藥品/特定標籤代碼」的索賠編輯將恢復。藥局服務商還將收到包含拒收代碼的補充資訊。

加入我們的團隊 

DHCS is hiring for 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. 

即將舉行的利害關係人會議和網絡

健康註冊導航者項目利益相關者會議

On August 7, from 1 to 2:30 pm, the DHCS Medi-Cal Health Enrollment Navigators Project will host their next quarterly stakeholder meeting. The Navigators Project team will provide updates on project activities. For more information, visit the Navigators Project website.

CYBHI 網絡研討會

On August 7, from 2 to 3:30 p.m., DHCS will virtually host a CYBHI webinar (advance registration required) to keep stakeholders apprised of DHCS’ progress in implementing various CYBHI work streams and to share CYBHI updates, including a walkthrough of the EBP/CDEP Round 3 RFA. Key attendees include youth, parents, family members, behavioral health providers, Medi-Cal managed care plans, county behavioral health departments, commercial health plans, education, and other cross-sector partners.

兒童助聽器覆蓋專案 (HACCP) 醫療服務提供者和聽力專業人員的網路研討會

On September 14, 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.

如果你錯過了

BH-CONNECT 和卡拉伊姆過渡性租金服務

在 1 月 2023，DHCS 開始了 30 天的公眾評論期，以尋求新的第 1115 節示範請求，名為「BH-CONNECT 示範」的反饋。 DHCS 也開始了 30 天的公眾意見期，以徵求對與過渡性租金服務有關的《CalAIM 第 1115 條示範》的修訂建議徵詢意見。 兩者的公開評論期間為止至 8 月 31, 2023。

BH 連接背景

The BH-CONNECT demonstration builds upon unprecedented investments and policy transformations currently underway in California that are designed to expand access to community-based behavioral health care and improve outcomes for Medi-Cal members living with the most significant mental health and substance use needs. California has invested more than $10 billion and is implementing landmark policy reforms to strengthen the behavioral health care continuum. California’s proposed goal for the BH-CONNECT demonstration is to complement and amplify these major behavioral health initiatives to establish a robust continuum of community-based behavioral health care services and improve access, equity, and quality for Medi-Cal members living with SMI and SED, particularly populations experiencing disparities in behavioral health care and outcomes. The BH-CONNECT demonstration aims to expand Medi-Cal service coverage, drive performance improvement, and support fidelity implementation for key interventions proven to improve outcomes for Medi-Cal members experiencing the greatest inequities, including children and youth involved in child welfare, individuals with lived experience with the criminal justice system, and individuals at risk of or experiencing homelessness.

卡拉伊姆過渡性租金修訂背景

為改善嚴重過渡期或符合高風險標準的 Medi-Cal 成員的福祉和健康成果，DHCS 正尋求修訂 CalAIM 第 1115 條示範，為無家可歸或無家可歸風險的合資格人士提供長達六個月的過渡租服務服務，集體住宿設施，懲教設施，過渡兒童福利系統，康復服務設施，短期住院後住房，住房, 無家可歸庇護所或臨時住房，以及符合無庇無家可歸或全方位服務合作夥伴計劃標準的人。 過渡性租金服務將提供的期間不超過六個月；必須具有成本效益；並且只有在根據臨床和其他與健康相關的社會需求標準確定醫療合適的情況下才提供。 過渡性租金服務將為 Medi-Cal 管理護理計劃提供自願性提供和 Medi-Cal 會員使用。

Please visit the DHCS BH-CONNECT webpage and DHCS CalAIM 1115 Demonstration & 1915(b) Waiver webpage for background information, links to public comment materials, and information about how to provide feedback during the public comment period.

加利福尼亞州微笑醫療牙科服務活動

On July 25, DHCS issued a news release in English and Spanish to promote the Sealants for a Healthy Smile (SHS) statewide push to encourage parents and guardians to protect their children’s dental health by utilizing their Medi-Cal Dental benefits and scheduling dental checkups for sealant applications. Subsequent stops of the mobile van tour will continue on August 11 in Trinity County, August 17-18 in Mono County, and August 29 in Colusa County. To reach and inform parents in the Central Valley, Smile, California partnered with Radio Bilingüe, a leading Latino public radio network, to run promotional programming through September.

To disseminate resources and information (fact sheet, infographic, and coloring sheet) to Medi-Cal members statewide, Smile, California outreach representatives are identifying and participating in in-person opportunities within their assigned regions during the promotion period. Representatives will assist with provider referrals, distribute relevant Smile, California resources, and promote Medi-Cal Dental covered services at community events, such as health fairs, parent nights, and back-to-school/open house events.