When DHCS learns of the closure of a hospital in the Medi-Cal MCP network, the Department's focus is to protect the health and well-being of Medi-Cal members. DHCS requires Medi-Cal MCPs to take specific steps to ensure that members who are likely to be affected by the closure of a hospital or termination of services maintain continued access to medically necessary covered services.
When DHCS was notified of Madera Community Hospital's closure, DHCS immediately began to work with
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.
For more information, including resources for Medi-Cal members who have questions regarding access to care, please visit the DHCS website.
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.
for Medicare providers to explain the provider billing process for dual eligible members enrolled in Medi-Cal managed care. This fact sheet describes the existing crossover billing process, which does not change under CalAIM.
For patients in Original (fee-for-service) Medicare, the Medicare Administrative Contractor processes the primary claim for Medicare payment, and then forwards the claim to the Medi-Cal MCP (or DHCS) for secondary Medi-Cal payment. For patients in Medicare Advantage (MA), the Medicare provider bills the MA plan for primary payment. The secondary payment process may depend upon whether the patient's Medi-Cal MCP is the same as or different than the MA plan. For more information, please visit the
.
Program Updates
Members Selected for Doula Implementation Workgroup
On January 13, DHCS notified 26 individuals that they had been selected to participate in the Doula Implementation Workgroup. Senate Bill 65 (Chapter 449, Statutes of 2021) requires DHCS to examine the implementation of the doula benefit provided under the Medi-Cal program. The workgroup is expected to hold its first meeting in March 2023 and will continue meeting through May 2025. A list of workgroup members is posted on the
doula webpage. Doula services became a Medi-Cal benefit on January 1.
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.
Medi-Cal 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.
Smile, California Campaign for Medi-Cal Dental Services
A Smile, California Smile Alert will be sent during the week of January 23 to partners, providers, and stakeholders who are subscribed to receive the monthly e-newsletter featuring the
third video of the provider testimonial video series and will also promote the new bilingual (English and Spanish) PowerPoint presentation that is available on
SmileCalifornia.org. Recipients of the Smile Alert will also be reminded to encourage Medi-Cal members to protect their teeth all year long by visiting the dentist regularly in 2023.
Sign up for our Smile Alerts to stay informed about the Smile, California campaign, new resources, and updates.
Join Our Team
DHCS is hiring! DHCS has an immediate opening for the
Special Assistant to the Director. This position provides administrative support for the most critical, sensitive, and confidential departmental or program issues.
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.
Upcoming Stakeholder Meetings and Webinars
Hearing Aid Coverage for Children Program (HACCP) Webinar for ProvidersOn January 24, from 12 to 12:50 p.m., DHCS will host a webinar session to assist providers (advance registration required) with information to help pediatric patients and their families to maximize the HACCP benefits. The training session will address the program requirements for families to apply for coverage and the claims submission process for audiologists, otolaryngologists, physicians, and their office staff.
Providing Access and Transforming Health (PATH) Justice-Involved Round 2 Funding Webinars
Overview Webinar for Behavioral Health Administrative Integration Concept Paper
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 Skilled Nursing Facility (SNF) Carve-In Webinar: How Medi-Cal Managed Care Supports SNF Residents
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.Drug Medi-Cal Organized Delivery System (DMC-ODS) Behavioral Health Information Notice (BHIN) Webinar
On January 31, from 11 a.m. to 12 p.m., DHCS will host a webinar (advance registration required) to provide an overview of updates related to the DMC-ODS. Specifically, DHCS will discuss updates to BHIN 21-075. A recording of the webinar will be available. For more information, visit the CalAIM Behavioral Health Initiative webpage. For questions, email BHCalAIM@dhcs.ca.gov.
Nursing Facility Financing Reform Webinar
On February 1, from 1:30 to 2:30 p.m., DHCS will host a nursing facility financing reform webinar (advance registration required) discussing the development of the Workforce Standards Program authorized by Assembly Bill 186 (Chapter 46, Statutes of 2022). For more information, visit the Nursing Facility Financing Reform (AB 186) webpage.
In Case You Missed It
Application Deadline for Clinic Workforce Stabilization Retention Payments (CWSRP)
DHCS is reminding all
successfully registered qualified clinics to submit their CWSRP applications before the deadline. All requests for payment must be submitted no later than 5 p.m. on January 27. DHCS encourages early submissions so all applications can be validated shortly after the application submission deadline.
For
application guidance, an
application video tutorial, and all other supporting information, please visit the
CWSRP webpage.
Tribal Behavioral Health Crisis and Non-Crisis Vehicles and Vehicle-Related Costs RFA
On January 11, DHCS
released a RFA to solicit applications from California Tribal entities to expand access to Tribal crisis and non-crisis behavioral health care through the infrastructure funding. This funding must be used exclusively for vehicles and allowable vehicle-related costs to improve access to behavioral health mobile crisis and non-crisis services. The project period will be from February 1, 2023, through June 30, 2025. Eligible California Tribal entities providing behavioral health services can apply for funding ranging from $50,000 to $1,000,000. The deadline to apply is February 28.
HACCP Eligibility Expansion
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.
