熱門新聞​​ 

州長任命新的 DHCS 計劃首席運營官（COOP）​​ 

On October 10, Governor Newsom announced the appointment of Chris Riesen as DHCS’ new COOP, effective October 16. As part of the Directorate, Chris will provide leadership of Enterprise Data and Information Management, Enterprise Technology Services, and Program Operations. The COOP position expands the Director’s Office to increase capacity to manage the growth and increased complexity of DHCS’ programs, as well as to better support work/life balance. This position will support Erika Sperbeck’s work as Chief Deputy Director for Policy and Program Support, leading Department operations and program integrity functions. Since July 2018, Chris has served as DHCS’ Deputy Director for Enterprise Technology Services and Chief Information Officer.​​ 

醫療保險續約更新​​ 

DHCS today published the August 2023 Medi-Cal continuous coverage unwinding eligibility measures data on the Medi-Cal Enrollment and Renewal Data webpage. The August dashboard includes data on Medi-Cal enrollment, applications in progress, redeterminations, and disenrollments. The data also include demographic details for all redetermination measures, along with the top reasons for disenrollments.​​  

醫療保險公開註冊期間提供的醫療保險計劃​​ 

During the upcoming Medicare open enrollment period (October 15 through December 7), Medicare-Medi-Cal Plans (Medi-Medi Plans) are available for enrollment in twelve counties (Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara currently, as well as five new counties – Fresno, Kings, Madera, Sacramento, and Tulare – beginning on January 1, 2024). Medi-Medi Plans combine Medicare and Medi-Cal benefits and Medicare prescription drug benefits into one plan.​​ 

約有 45% 的雙重資格會員參加了某種類型的Medicare優勢計劃。 截至 2023 年 7 月，參加 Medi-Medi 計畫的會員人數約為 241,105 人。Medi-Medi 計劃的優勢包括整合各種材料，例如一張Health Plan卡和一個電話號碼，可以同時享受Medicare和Medi-Cal福利，從而改善護理協調，並為會員提供支援。​​ 

Medi-Medi 計劃協調兩個計劃中的所有福利和服務，包括所有 Medicare 涵蓋的服務、所有 Medi-Cal 涵蓋的服務、額外的補充福利、單獨列出的福利（例如，居家支持服務、多功能老年人服務計劃、社區成人服務和牙科服務）、一個協調護理的護理管理團隊，以及 Medi-Cal 管理式醫療計劃提供的社區支持。​​ 

專案更新​​ 

額外的連續覆蓋解鎖彈性​​ 

On September 22, the federal Centers for Medicare & Medicaid Services approved DHCS’ request for two flexibilities that leverage existing regulations to help streamline the processing of annual Medi-Cal eligibility renewals and ease burdens on county program administrators and Medi-Cal members. The first flexibility waives the requirement for Medi-Cal members to sign and return a renewal packet that had already been submitted if counties receive verification of missing information after the packet was mailed. The second flexibility allows the use of the explanation submitted by the member within the renewal packet as sufficient verification for a successful redetermination, eliminating the need for additional supporting documentation. These flexibilities will streamline the renewal process for Medi-Cal members, especially individuals experiencing homelessness and elderly or disabled populations. Additionally, the flexibilities will ease burdens to provide additional paperwork or documentation and reduce procedural terminations during the continuous coverage unwinding period.​​ 

The flexibilities will continue throughout the unwinding period. DHCS issued Medi-Cal Eligibility Division Information Letter (MEDIL) I 23-49 to provide counties with immediate guidance on operationalizing these flexibilities.​​ 

託管護理計劃與第三方實體之間的諒解備忘錄​​ 

本週，DHCS 發布了《所有計劃函》（APL）、兩份《行為健康資訊通知》（BHIN）以及相關的諒解備忘錄（MOU）模板，供 Medi-Cal 管理式醫療計劃 (MCP) 使用。根據 2024 年 MCP 合同，MCP 需要與某些第三方實體簽署諒解備忘錄，以確保成員護理得到協調，並且成員能夠獲得社區資源以支持全人護理。這些諒解備忘錄旨在成為明確各方角色和責任的有效工具，並支持當地參與、護理協調、資訊交流、相互問責和透明度。​​ 

The MOU templates include a base template, which contains general provisions required to be included in all MOUs, and a set of bespoke templates tailored for programs or services administered by third-party entities that contain the required general MOU provisions and program-specific provisions. The bespoke templates are for MCPs to enter into MOUs with third-party entities with whom MCPs must make a good faith effort to execute by January 1, 2024, and include: local governmental agencies, such as county behavioral health departments for specialty mental health care and substance use disorder services; other local programs and services, including social services; child welfare departments; Regional Centers; In-Home Supportive Services programs; and Women, Infants, and Children Supplemental Nutrition Programs. DHCS will release additional required MOU templates for use by MCPs and third-party entities as they are finalized, including those required to be executed on July 1, 2024, and January 1, 2025. Additional information and copies of the MOU templates are available on the DHCS MOU webpage.​​ 

聯邦醫療保險和中醫牙科保障​​ 

10 月 11 日，DHCS 發布了一份新的牙科服務提供者情況說明書，內容涉及符合雙重資格（Medicare 和 Medi-Cal）成員的牙科福利。該情況說明書提供了有關聯邦Medicare和Medi-Cal計劃提供的牙科福利的信息，以及醫療服務提供者如何為會員提供的牙科服務收費。 聯邦醫療保險（Medicare）是符合雙重資格患者的主要支付方，但它不涵蓋大多數牙科護理。Medi-Cal涵蓋由Medi-Cal牙科服務提供者管理的各種牙科福利。符合雙重資格的患者也可以透過其聯邦Medicare優勢計劃獲得牙科福利。 對於由聯邦Medicare或聯邦Medicare優勢計劃承保的牙科服務，必須先向聯邦Medicare或聯邦Medicare優勢計劃收取費用。​​ 

加州醫療補助健康保健計劃 Rx​​ 

On October 13, reinstatement Phase 3/Lift 3 will reinstate Quantity Restriction Edits for members 22 years of age and older. Quantity Limit restrictions will be applied to all (new and continuing) pharmacy claims. Some commonly prescribed Code I medications on the Medi-Cal Rx Contract Drugs List (CDL) have quantity limits based on the U.S. Food and Drug Administration-approved or clinically sound dosing guidelines. Claims may reject if billed incorrectly.​​ 

Also, a 30-day countdown alert was released on October 10 for the final reinstatement action. On November 10, implementation of Phase 4/Lift 4 of reinstatement will retire the transition policy for all pharmacy benefits for members 22 years of age and older; reinstate prior authorization (PA) requirements for all therapies for standard therapeutic classes 68, 86, and 87, which includes enteral nutrition products; reinstate utilization management claim edits for Reject Code 80 – Diagnosis Code Submitted Does Not Meet Drug Coverage Criteria; and reinstate Brand Medically Necessary PA requirements for all claims.​​ 

到 10 月 17 日，DHCS 一直與之接觸的所有 Medi-Cal Rx 利益相關者都將收到《推進 Medi-Cal Rx》的溝通文件，該文件宣布結束對成年人的恢復工作，並且在 2024 年之前不會對兒童群體做出任何改變。利害關係人包括加州地方健康計劃協會、加州健康計劃協會、加州健康協會、Medi-Cal 管理式醫療計劃藥房主任、加州兒童醫院協會、兒童專科護理聯盟、兒童區域綜合服務系統、加州醫學協會、加州零售商協會、全國連鎖藥局協會、加州藥師協會、加州初級保健協會、加州行為健康指導協會、加州醫療產品供應協會、加州醫療產品供應協會。​​ 

加入我們的團隊​​ 

DHCS 正在招聘我們的財政、人力資源、法律、審計、健康政策和資訊科技團隊。 有關更多信息，請訪問 CalCareers 網站。​​ 

DHCS’ purpose is to provide equitable access to quality health care leading to a healthy California for all. DHCS’ goals and objectives reflect DHCS’ tremendous work to transform the state’s health care system and strengthen organizational excellence.​​ 

即將舉行的利害關係人會議和網絡​​ 

成人擴展網絡研討會​​ 

10 月 18 日，DHCS 將為地方縣政府和其他利益相關者舉辦兩場關於 Medi-Cal 成人（26-49 歲）擴展的網路研討會中的第一場。第二次網路研討會暫定於12月初舉行。本次網路研討會將提供有關擴展、實施計劃、通知、宣傳等方面的背景資訊。註冊資訊將發佈在 26 至 49 歲成人全面 Medi-Cal 擴展網頁上。個人可以透過電子郵件至 AdultExpansion@dhcs.ca.gov 註冊參加網路研討會。​​ 

DHCS will implement this expansion pursuant to Senate Bill 184 (Chapter 47, Statutes of 2022) on January 1, 2024. When implemented, the expansion will provide individuals 26-49 years of age with full scope Medi-Cal benefits, regardless of citizenship or immigration status, if they meet all other Medi-Cal eligibility criteria.​​ 

利害關係人諮詢委員會（SAC）和行為健康-SAC（BH-SAC）會議​​ 

10 月 19 日上午 9:30 至下午 3:30，DHCS 將舉辦下一次SAC 和 BH-SAC 混合會議（需提前註冊）。本次會議將以聯合會議的形式召開，議題由SAC和BH-SAC共同討論。聯合會議之後將舉行一次僅由 BH-SAC 參加的會議；不會舉行僅由 SAC 參加的會議。參與者可以親自前往位於Sacramento市中心 K 街 1414 號的California捐贈基金會參加，也可以在線上參加。 如需了解更多信息，請訪問SAC和BH-SAC網頁。​​ 

提供訪問和轉型健康（PATH）與正義相關計劃辦公時間​​ 

10 月 23 日， DHCS將為第三輪獲獎者舉辦下一期 PATH 司法介入Program虛擬辦公時間會議（需提前註冊）。 從即日起至 12 月 18 日，每隔一個星期一上午 11:30 將舉行辦公時間，以協助第三輪機構，包括支援實施計畫提交。如需了解更多信息，請訪問司法介入Program網站。​​ 

性健康服務網絡研討會的未成年人同意和保密​​ 

10 月 25 日中午 12 點至下午 1 點 30 分，DHCS 和加州預防培訓中心將舉辦「性健康服務中的未成年人同意和保密」網路研討會（需要提前註冊）。本次網路研討會將概述加州影響未成年人及其獲取保密性健康和計劃生育服務的法律。研討會將回顧保密性的重要例外情況，包括強制性兒童虐待報告，並分享一些在複雜情況下實施這些法律的最佳實踐案例。參與者將了解支持未成年人同意法律實施的資源，並有機會透過案例研究檢驗自己的知識。​​ 

對於無法參加現場網路研討會的人，研討會的文字稿和錄音以及其他資源將在Family PACT 網站上提供。​​ 

PATH 協作規劃與實施 (CPI) 最佳實踐網路研討會​​ 

10 月 27 日上午 10 點至 11 點，DHCS 將舉辦一場全州範圍的網路研討會，主題為「強化護理管理 (ECM) 和社區支持提供者同儕支持和合約自我評估」（需提前註冊）。本次虛擬會議是每半年舉辦一次的最佳實踐網路研討會系列的第一場，旨在重點介紹實施 ECM 和社區支持的最佳實踐，提高醫療服務提供者成功參與California推進和創新Medi-Cal ( CalAIM ) 的程度，並加強與 MCP、州和地方政府機構以及其他機構的合作，從而為Medi-Cal成員建立和提供高質量的支持服務。 如需了解更多資訊和註冊，請造訪PATH CPI 網頁。​​ 

如果你錯過了​​ 

加利福尼亞為行為健康提供者頒發數百萬人獎勵以打​​ 

DHCS awarded nearly $5.2 million to 36 mental health and/or substance use disorder providers through the COVID-19 Substance Use and Mental Health Disorder Mitigation Project to support community mitigation measures that prevent the spread of COVID-19 and protect those who are at increased risk for severe illness. From September 15, 2023, through March 31, 2025, providers will receive up to $500,000 to expand services to provide education about COVID-19 testing, implement onsite COVID-19 testing, collaborate with community partners to prevent infectious disease transmission, and expand COVID-19 response services to individuals connected to the behavioral health system.​​ 

牙科管理護理計劃平等​​ 

As part of the CalAIM 1915(b) waiver Special Terms and Conditions, DHCS conducted a parity evaluation to assess the performance (utilization) of Sacramento County dental managed care (DMC) plans compared to the statewide dental fee-for-service (FFS) delivery system. The evaluation was based on utilization measures for calendar year 2022 in the following categories: annual dental visits, preventive dental services, and use of sealants for children and adults. Based on the evaluations, DHCS determined that none of the three DMC plans operating in Sacramento County – Access Dental Plan, Health Net Dental, and Liberty Dental Plan – met parity with statewide FFS utilization averages in all required measures. As a result, members currently enrolled in DMC plans will have the option to enroll in FFS.​​  

從 2023 年 11 月開始， DHCS將向Sacramento縣目前參加 DMC 計劃的約 614,000 名成員發送通知，告知他們可以選擇繼續參加當前的計劃，或者取消註冊並加入FFS ，生效日期為 12 月1 、 2023日。 該通知將提供有關會員如何獲得牙科服務的信息，如果他們選擇按服務付費 (FFS) 計劃，或者如果會員能夠在按服務付費 (FFS) 計劃中證明其獲得護理服務存在問題，則可以選擇其他牙科醫療服務計劃 (DMC)。此外，自 12 月 1 日起，新符合 Medi-Cal 資格的成員將預設加入牙科 FFS 計畫。若要查看牙科 FFS 和 DMC 績效報告，請造訪牙科資料報告網頁。​​