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醫療新型冠狀病毒病公共衛生緊急情況（PHE）運作解散計劃
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 繼續對 DHCS 預算產生重大影響，這反映了與 PHE 相關的總資金總成本為 11.5 億美元。 這種影響包括最近的 PHE 延長至 7 月 15 2022。 對 COVID-19 預計影響的主要更新包括與 PHE 解除相關的成本（包括資格重新確定）；聯邦合格衛生中心繼續分開計費疫苗管理；65 歲以上、盲人或殘疾人士的假設資格；以及增加聯邦醫療援助百分比（FMAP）有關的額外一四分之一的收入。
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 還與加州衛生 & 人類服務局合作，提供補助金（85 億美元通用基金），以支持兒童，青少年和父母的健康並建立恢復力。 這些計劃將幫助受到 PHE 引起的創傷、壓力和社會孤立影響的年輕人，將為學校，城市，縣，部落和社區組織（CBO）提供額外的兒童和青年行為健康倡議撥款。
DHCS 建議為健康註冊導航員提供更多資金（總資金 6 億美元），以繼續項目活動，重點是 COVID-19 PHE 相關的活動，特別是幫助受益人保持 Medi-Cal 保障，通過協助年度續訂、報告更新的聯繫信息，並參與對難以觸及的目標人群進行外展。
五月修訂包括要求提供一次性阿片類藥物結算基金，以增加納洛克遜分配給無家可歸服務提供商來增加 1 月份藥物輔助治療擴展計劃提案。 此外，DHCS 還建議將一月與藥物使用障礙提供者勞動力培訓相關的建議增加 29.1 萬美元。
View the DHCS May Revision budget highlights and the Medi-Cal and Family Health Local Assistance Estimates.
醫用卡 Rx 實作更新
自 2022 年 2 月以來，Medi-Cal Rx 已經穩定了呼叫中心和預先授權（PA）操作。 從那時起，DHCS 和 Magellan (MMA) 已經進行密集的計劃過程，以逐步恢復索賠編輯和 PA 要求。 根據利害關係人反饋的三階段方法開始，由按藥物類別恢復一小部分精選的索賠編輯和 PA；繼續恢復所有受到 2022 年 2 月初採取緩解措施的保護措施；並在最終階段退出過渡政策。 恢復的方法是逐步且反覆性的，密切關注利益相關者的準備和績效監控。 隨著時間的推移，它將根據數據分析，營運經驗和利益相關者反饋進行改進。 鼓勵利益相關者通過專用的電子郵件收件箱 Reinstatement@dhcs.ca.gov 對此方法發表意見並提供反饋。
特別人口臨床醫生聯絡小組
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.
從 5 月 9 日起，特殊人口臨床聯絡小組在星期一至星期五上午 8 時至晚上 8 點（例假日除外）提供服務，並為能夠驗證和討論給定受益人的受益人身份驗證和討論受保護健康信息的受益人，提供者和縣用戶服務。 Medi-Cal Rx 致力於為加利福尼亞州的 Medi-Cal 受益人和提供商提供及時且安全的藥房服務。
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.
血壓袖口和監測器
自 6 月 1 日起，為 Medi-Cal Rx 局部分分開放藥房的醫療保障添加了個人使用血壓計和血壓袖口。 這些項目僅限於建議的設備和袖口清單，並在仔細審查和利害關係人和提供者的意見後選擇。 將這些項目加入為藥房補償保障，將改善醫療服務的機會，而這些福利將繼續作為醫療索償計費的持久醫療設備提供。 Medi-Cal Rx 涵蓋醫療用品產品說明和帳單信息清單以及 Medi-Cal Rx 提供商手冊將更新以反映這些新增。 如有任何問題或意見，請電子郵件 medicalsupplies@dhcs.ca.gov。
中醫新冠肺炎疫苗接種激勵計劃
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.