首頁新聞室 - 通訊辦公室DHCS 利益相關者最新資訊 - 一月20 、2023​​ 

DHCS 利益相關者最新資訊 - 一月20 、2023​​ 

熱門新聞​​ 

Medi-Cal 託管護理計劃（MCP）網絡中的醫院關閉協議​​ 

當 DHCS 得知 Medi-Cal MCP 網絡中的醫院關閉時，該部門的重點是保護 Medi-Cal 會員的健康和福利。DHCS 要求 Medi-Cal MCP 採取特定步驟，以確保可能受醫院關閉或服務終止影響的會員能夠繼續獲得醫療必需的承保服務。​​ 

When DHCS was notified of Madera Community Hospital’s closure, DHCS immediately began to work with CalViva Health and Anthem Blue Cross Partnership Plan to identify the impact on Medi-Cal members’ access to care. DHCS also engaged with the California Department of Public Health to transfer Medi-Cal members who required post-acute or long-term care services following hospital discharge (i.e., skilled nursing and home health care) due to the Madera Community Hospital closure.​​ 

Additionally, DHCS reached out to Madera County’s behavioral health agency about their plans to ensure continued access to services for county residents. DHCS also contacted the behavioral health agency of the surrounding counties, including Merced, Mono, Mariposa, and Fresno, to assess the impact of the closure of Madera Community Hospital on their behavioral health systems and related mitigation plans, and to ensure the provision of needed services.​​ 

有關更多信息，包括對於獲得護理有疑問的 Medi-Cal 會員的資源，請訪問 DHC S 網站。​​ 

醫療保險/醫療卡雙重資格的醫療保險 MCP 註冊​​ 

Effective January 1, 2023, members dually eligible for Medicare and Medi-Cal across the state became eligible to be mandatorily enrolled in Medi-Cal MCPs for their Medi-Cal benefits only. As a reminder to our stakeholders, this change in Medi-Cal does not change access to Medicare providers or benefits. Additionally, Medicare providers serving dual eligible patients do not need to enroll in a Medi-Cal MCP to continue receiving reimbursement. More than 70 percent of dual eligible members statewide are already enrolled in Medi-Cal MCPs—this step transfers the remaining 30 percent into Medi-Cal MCPs.​​ 

DHCS 為聯邦醫療保險的醫療服務提供者出版了一份更新的資料說明書和工具包 ，說明加入 Medi-Cal 管理性護理的雙重資格會員的醫療服務提供者帳單程序。本資料說明書說明現行的交叉計費程序，在 CalAIM 下不會改變。​​ 

對於 Original（付費服務）聯邦醫療保險的病人，聯邦醫療保險管理承包商處理聯邦醫療保險付款的主要索賠，然後將索賠轉交 Medi-Cal MCP（或 DHCS），以獲得 Medi-Cal 的次要付款。對於 Medicare Advantage (MA) 的病患，Medicare 提供者會向 MA 計劃收取主要付款。二次付款程序可能取決於病人的 Medi-Cal MCP 是否與 MA 計劃相同或不同。如需詳細資訊，請造訪全州 Medi-Cal 管理性護理雙重合格會員註冊網頁。​​ 

專案更新​​ 

選擇杜拉實施工作小組成員​​ 

1 月 13 日，DHCS 通知 26 位人士他們被選中參加 Doula 實施工作小組。參議院第 65 號法案（2021 年法規第 449 章）要求 DHCS 審查 Medi-Cal 計劃下提供的朵拉福利的實施情況。工作小組預計將於 2023 年 3 月舉行第一次會議，並將持續開會至 2025 年 5 月。工作小組成員名單發佈在朵拉網頁上。Doula 服務於 1 月 1 日成為 Medi-Cal 福利。​​ 

The workgroup consists of doulas, health care providers, consumer and community advocates, health plans, county representatives, and other stakeholders with experience in doula care. The workgroup will provide input on ensuring that doula services are available to Medi-Cal members who are eligible for and want doula services; minimizing barriers and delays in payments to a Medi-Cal doula or in reimbursement to Medi-Cal members for doula services received; and making recommendations for outreach efforts so that all Medi-Cal members within the eligible and other target populations are aware of the option to use doula services. Workgroup recommendations will also help inform a report to the Legislature to reduce any identified barriers.​​ 

加州醫療補助健康保健計劃 Rx​​ 

On January 20, prior authorization (PA) requirements will be reinstated for 39 additional drug classes for new start medications for members age 22 and older. “New starts” are defined as new therapies or medications not previously prescribed to the member during the 15-month lookback period. Historical claims data and PAs will be used to review for grandfathering. New start prescriptions for members age 21 and younger within these 39 drug classes will not be subject to PA reinstatement. On December 20, 2022, a 30-day notice was posted, and weekly reinstatement updates are posted every Friday on the Medi-Cal Rx website.​​ 

加利福尼亞州微笑醫療牙科服務活動​​ 

Smile, California Smile Alert 將於 1 月 23 日當週發送給訂閱每月電子報的合作夥伴、醫療服務 提供者 及利益相關者，內容包括 醫療服務提供者見證影片系列中的第三段影片 ，同時也會宣傳 SmileCalifornia.org 上新推出的雙語 (英語及西班牙語) PowerPoint 簡報。Smile Alert 的收件人也會被提醒，鼓勵 Medi-Cal 會員在 2023 年全年定期看牙醫，以保護他們的牙齒。註冊我們的 Smile Alerts，以隨時瞭解有關微笑，加州活動、新資源和更新的資訊。​​  

加入我們的團隊​​ 

DHCS 正在招聘！DHCS 現正招聘主任特別助理。此職位為最重要、敏感和機密的部門或計畫問題提供行政支援。​​ 

DHCS is also hiring Californians to join 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​​ 

 赫里​​ ng 兒童援助計劃（HACCP）供應商網絡研討會​​ 

1 月 24 日，下午 12 時至 12 時 50 分，DHCS 將舉辦網絡研討會，以協助提供者（需提前註冊）提供信息，以幫助兒童患者及其家人最大限度地利用 HACCP 益。 培訓會議將解決家庭申請保險的計劃要求，以及聽力學家，耳鼻喉科醫生，醫生和其辦公室工作人員的索償提交流程。​​ 

提供獲取和轉型健康（PATH）與正義相關的第二輪資助網絡研討會​​ 

行為健康管理整合概念論文概述網路研討會​​ 

On January 26, from 3 to 4 p.m., DHCS will host a webinar to provide an overview of the concept paper for CalAIM Behavioral Health Administrative Integration (advance registration required). The webinar will include an overview of the initiative’s framework and goals, the phased approach for implementation between now and fiscal year 2027-28, and DHCS’ proposal for ongoing stakeholder engagement and technical assistance. For more information, visit the CalAIM Behavioral Health Initiative webpage.​​ 

California Children’s Services (CCS) Monitoring and Oversight Workgroup Webinar​​ 

On January 30, from 12 to 4 p.m., DHCS will host the CCS Monitoring and Oversight Workgroup meeting (advance registration required) to develop and implement the CCS Compliance, Monitoring, and Oversight Program, a component of the CalAIM initiative. The webinar will cover the Grievance Numbered Letter (NL), Training NL, Surveying NL, Memorandum of Understanding development, compliance activities, and enforcement proposal. Additional information is available on the CCS Compliance, Monitoring, and Oversight Program webpage.​​ 

CalAim 技術護理設施（SNF）培養網絡研討會：Medi-Cal 管理護理如何支持新西蘭基金會居民​​ 

On January 30, from 2 to 3 p.m., DHCS will virtually host the fourth in a series of public educational webinars for the SNF Carve-In (advance registration required) to support Medi-Cal MCPs and SNF providers as they implement Medi-Cal managed care coverage of SNFs statewide that began on January 1. The webinar will provide an overview of key Medi-Cal managed care benefits, services, and programs that support current SNF residents and SNF residents transitioning back to their home or community. Additional details on upcoming webinars are available on the CalAIM LTC Carve-In transition webpage.​​ 

藥物醫療有組織分配系統（DMC-ODS）行為健康信息通知（BHIN）網絡研討會​​ 

1 月 31 日，上午 11 時至下午 12 時，DHCS 將舉辦網絡研討會（需提前註冊），以提供與 DMC-ODS 相關的更新概述。 具體來說，DHCS 將討論 BHIN 21-075 的更新。 網絡研討會的記錄將提供。 有關更多信息，請訪問 CalAIM 行為健康倡議網頁。 如有任何疑問，請電子郵件 BHCalAIM@dhcs.ca.gov。​​ 

護理設施融資改革網絡研討會​​ 

2 月 1 日下午 1:30 至 2:30，DHCS 將舉辦護理設施融資改革網路研討會（需提前報名），討論由眾議院第 186 號法案（2022 年成文法第 46 章）授權的勞動力標準計劃的發展。 如需詳細資訊，請造訪Nursing Facility Financing Reform (AB 186) 網頁。​​ 

如果你錯過了​​ 

診所員工穩定保留金（CWSRP）申請截止日期​​ 

DHCS 提醒所有成功註冊的合格診所在截止日期前提交 CWSRP 申請表。所有付款申請必須在 1 月 27 日下午 5 點之前提交。DHCS 鼓勵及早提交申請，以便在申請提交截止日期後不久就能驗證所有申請。​​ 

如需申請指南、申請視頻教程以及所有其他輔助資訊，請造訪CWSRP 網頁。​​ 

部落行為健康危機和非危機車輛和車輛相關費用 RFA​​ 

1 月 11 日，DHCS 發佈了一份 RFA，向加州部落實體徵求申請，以透過基礎設施資金擴大部落危機和非危機行為健康照護的可及性。此資金必須專門用於車輛及允許的車輛相關費用，以改善行為健康流動危機及非危機服務的存取。專案期間將從 2 月1,2023, 到 6 月30,2025 。提供行為健康服務的合格加州部落實體可申請 50,000 美元至 1,000,000 美元不等的資金。申請截止日期為 2 月 28 日。​​ 

HACCP 資格擴展​​ 

DHCS now welcomes (since January 1) newly eligible young adults ages 18 through 20, who meet other program criteria and need coverage for their hearing aid(s) and related services, to apply for HACCP enrollment. Also effective January 1, applicants under age 21 who meet program eligibility requirements may apply to enroll in HACCP even if they have partial other health coverage for hearing aids, subject to a coverage limit of $1,500 or less per year. Additional program information is available on the HACCP webpage. Families can apply to enroll for coverage through HACCP’s Online Application Portal.​​