DHCS Stakeholder Update - March 3, 2023

Top News 

End of the Public Health Emergency (PHE): Key Medicaid and Children’s Health Insurance Program (CHIP) Dates

The announcement that the federal COVID-19 PHE will end on May 11, 2023, has implications for Medicaid and CHIP programs. Additionally, DHCS is acting to make permanent several flexibilities implemented over the course of the PHE. Below is a summary of end dates for key federal Medicaid provisions, with additional details on how DHCS is unwinding the PHE in the Medi-Cal program.

Regarding Medicaid and CHIP COVID-19 provisions under the American Rescue Plan Act (ARPA):

Optional COVID-19 Group for Uninsured Individuals: California has taken advantage of the “optional COVID-19 group” that provides uninsured individuals with Medi-Cal coverage for COVID-19 vaccines, testing, and treatment. This coverage expires on the last day of the PHE (May 11). In order to prepare individuals in this group for the end of the PHE, DHCS will send member notices on April 24, 2023.
No-Cost Coverage for COVID-19 Vaccines, Testing, and Treatment to Members: Medicaid is required to cover COVID-19 vaccines, testing, and treatment with no cost-sharing for members through the last day of the first calendar quarter that begins one year after the last day of the COVID-19 PHE. DHCS is electing to permanently extend coverage for COVID-19 vaccines, testing, and treatment at no cost beyond the ARPA coverage period.
Enhanced Federal Match for COVID-19 Vaccines and Vaccine Administration: States receive 100 percent federal matching funds for coverage of vaccines and vaccine administration, as enacted by ARPA. These matching funds also end on the last day of the first calendar quarter that begins one year after the last day of the COVID-19 PHE (September 30, 2024). As described above, Medi-Cal will continue to cover COVID-19 vaccine and vaccine administration.

Regarding statutory flexibilities made possible by the PHE:

Section 1135 waivers expire at the end of the PHE (May 11). Medicaid programs are unable to extend flexibilities authorized under 1135 waivers. Additionally, DHCS is electing to discontinue emergency Medi-Cal provider enrollment flexibilities, effective March 29, 2023, as recently announced.
Medicaid Disaster Relief State Plan Amendments (SPAs) typically expire at the end of the PHE (May 11), but DHCS is making permanent many policies authorized under Disaster Relief SPAs. For details on the specific policies that are being made permanent through the traditional SPA process, please see Part I of the Medi-Cal COVID-19 PHE and Continuous Coverage Operational Unwinding Plan.
Section 1915(c) Appendix K or Section 1115 Attachment K termination dates vary by waiver, but typically will be no later than six months after the end of the PHE. Similarly, DHCS intends to make some 1915(c) and 1115 flexibilities permanent Medi-Cal policies beyond the end of the PHE. For details on these policies, please see part I of the Medi-Cal COVID-19 PHE and Continuous Coverage Operational Unwinding Plan.

Program Updates

Now Open: Providing Access and Transforming Health (PATH) Technical Assistance (TA) Marketplace Application

On February 27, DHCS opened the PATH TA Marketplace Project Eligibility Application. Medi-Cal service providers who submitted the Recipient Registration Form and have been approved as a TA recipient may now shop and apply for no-cost TA services through the Marketplace. TA services are being offered by an initial selection of 47 unique vendors. They will assist providers, community-based organizations (CBOs), Medi-Cal Tribal and Designees of Indian Health Programs, counties, and other eligible TA recipients build and deliver successful Enhanced Care Management and Community Supports. To learn more, visit ca-path.com/ta-marketplace.

PATH Capacity and Infrastructure Transition, Expansion, and Development (CITED) Round 2 Application Now Open

On February 28, DHCS opened the PATH CITED Round 2 application window. The PATH CITED initiative provides funding to on-the-ground partners, such as CBOs, public hospitals, county agencies, Tribes, and others to help them successfully participate in the Medi-Cal delivery system. New companies are encouraged to become Medi-Cal providers to deliver Enhanced Care Management and Community Supports. Entities interested in applying for Round 2 are encouraged to join the upcoming informational webinar on March 3, from 10 to 11 a.m., to learn more about CITED funds and the application process. The deadline to apply for CITED Round 2 funding is May 31, 2023.

Please visit ca-path.com/cited to apply and for more information. For questions, please email cited@ca-path.com.

Hearing Aid Coverage for Children Program (HACCP) Action Plan and Communications Toolkit

On March 1, DHCS released the HACCP Action Plan, which provides an overview of DHCS’ comprehensive strategy on HACCP improvements in 2023 with actionable tactics to improve provider participation and increase program enrollment.

Also, on February 28, DHCS published the HACCP Communications Toolkit and Program Data dashboard to support these objectives. The toolkit includes social media messaging and printable outreach materials for HACCP-eligible families and medical providers, and DHCS’ HACCP Program Data webpage. Additional program information is available at DHCS’ HACCP webpage.

Monkeypox (Mpox) Vaccine Administration

The Centers for Medicare & Medicaid Services (CMS) recently approved SPA 22-0062 to reimburse Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Indian Health Services Memorandum of Agreement (IHS-MOA,) and Tribal FQHC clinic providers at the fee-for-service (FFS) rate for vaccine-only encounters. It is retroactive to August 17, 2022, and extends through the end of the Mpox state public health emergency (January 31, 2023).

Mpox vaccines administered during a qualifying office visit to eligible providers are entitled to reimbursement at their individual Prospective Payment System or All-Inclusive rates. Providers are reminded that each administration of the Mpox vaccine either falls under a qualifying office visit or vaccine-only encounter, not both.

Eligible providers may begin submitting claims for members enrolled in Medi-Cal managed care plans for Mpox vaccine-only encounters. Effective March 10, 2023, providers may submit claims for FFS members pursuant to instructions published in the December 13, 2022, article “Mpox Vaccines Reimbursement at the Medicare Rate”. Providers will receive a 120-day timeliness override to submit the Mpox vaccine-only encounters.

Medi-Cal Rx

On February 24, 2023, Phase II, Wave 2 of the Medi-Cal Rx Reinstatement Plan was successfully implemented. Providers are required to submit prior authorizations for 46 additional drug classes, including medical supplies, and for new start medications for members ages 22 and older.

A 30-day countdown alert, entitled Phase III Lift 1: Retirement of the Transition Policy for Beneficiaries 22 Years of Age and Older, was also released to announce the next phase of the Medi-Cal Rx Reinstatement Plan. This is a reminder that Medi-Cal Rx will initiate the first of a series of transition policy lifts for members ages 22 and older starting on March 24, 2023.

Join Our Team

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. 

Upcoming Stakeholder Meetings and Webinars

Nursing Facility Financing Reform Webinar

On March 10, from 1:30 to 2:30 p.m., DHCS will host a stakeholder webinar (advance registration required) to discuss the development of the Workforce Standards Program and present an update on the Workforce and Quality Incentive Program. Additional information is posted on the Nursing Facility Financing Reform (AB 186) webpage.

In Case You Missed It

California Awards $4.6 Million to Emergency Departments (EDs) to Train Behavioral Health Navigators

On March 1, DHCS awarded more than $4.6 million to 39 hospitals with EDs, each receiving $120,000 to train behavioral health navigators to help expand access to substance use disorder and mental health services. The awards are part of DHCS’ CalBridge Behavioral Health Navigator Program. CalBridge is funded by the American Rescue Plan Act of 2021 under key initiatives for Medi-Cal’s Home and Community-Based Services, and aims to train and expand the ED workforce to address the urgent need for behavioral health patient care. These awards are part of a larger effort by CalHHS to strengthen California’s health and human services workforce.

Published COVID-19 Information

SPA 22-0067: Rescission to the State's Disaster Relief Policies for the COVID-19 National Emergency

Last modified date: 3/10/2023 4:15 PM