DHCS Stakeholder Updates - June 24, 2022
Dear Stakeholders,
The Department of Health Care Services (DHCS) is providing this update on significant developments regarding DHCS programs, as well as guidance related to the COVID-19 public health emergency.
Abortion Access and Coverage Still Secure for Medi-Cal Beneficiaries
Despite today's U.S. Supreme Court ruling striking down the constitutional right to an abortion, Medi-Cal will continue to cover abortion services, uninterrupted, for all Medi-Cal beneficiaries. Although this decision allows states to impose restrictions or ban abortion, California has not pursued any restrictions or bans, and the ruling did not invalidate any California laws or protections that ensure access to abortion in California.
DHCS' policies regarding how abortion services are delivered and reimbursed have not changed, nor has the Department's commitment to providing quality care equitably, and with the goal of reducing health disparities. DHCS remains committed to offering a broad and comprehensive package of reproductive health care services, including abortion, in Medi-Cal, and without judgment or undue restrictions. Medi-Cal beneficiaries can still go to any Medi-Cal provider of their choice for abortion services, at any time and for any reason.
As a covered Medi-Cal benefit, Medi-Cal managed care plans (MCPs) must cover abortion services, including medical services and supplies incidental or preliminary to an abortion, consistent with the requirements outlined in the Medi-Cal provider manual. All MCPs must implement and maintain procedures that ensure confidentiality and access. Members may go to any provider of their choice for abortion services, at any time and for any reason, regardless of network affiliation. MCPs will offer alternatives (e.g., coverage by fee-for-service or by an out-of-network health plan) if a provider refuses to provide abortion services.
Regardless of today's federal court ruling, DHCS will continue to ensure coverage of and access to comprehensive reproductive health care, including abortion, for Medi-Cal beneficiaries.
DHCS Leadership Change
Governor Gavin Newsom appointed Tyler Sadwith to serve as Deputy Director (DD) for DHCS Behavioral Health (BH). Sadwith has served as Assistant Deputy Director (ADD) for BH since July 2021, and Acting DD for BH since June 1, 2022. The DD for BH plays a key leadership role in implementing Medi-Cal BH initiatives designed to achieve equitable health care outcomes, ensure consistent access to high-quality care, and facilitate administrative and clinical integration of mental health care, substance use disorder care, and medical care, wherever feasible.
DHCS is recruiting for a second ADD for BH, and will begin recruiting to backfill the ADD for the Medi-Cal BH position that Sadwith is vacating. We encourage you to please share these positions with your networks widely.
Medi-Cal Rx Reinstatement of Reject Codes
On June 22, Medi-Cal Rx released a 30-day notice of reinstatement to prescribers, providers, managed care plans, pharmacies, and other stakeholders. Two National Council for Prescription Drug Programs (NCPDP) claim edits for diagnosis and Drug Utilization Review (DUR) requirements (Reject Code 80 and DUR NCPDP Reject Code 88) will be reinstated on July 22.
Medi-Cal Rx recently conducted an operational readiness checkpoint for its reinstatement efforts related to select claim edits as well as select prior authorization requirements that have been temporarily lifted. Based on the data and metrics, it was determined that Medi-Cal Rx is ready to proceed and issued the 30-day notice of reinstatement.
For claims or prior authorization assistance, please call the Medi-Cal Rx Customer Service Center, which is available 24 hours a day, 7 days a week, 365 days per year, at (800) 977-2273, or email MediCalRxEducationOutreach@magellanhealth.com.
COVID-19 Vaccination Update and Reminder
On June 22, the Centers for Medicare & Medicaid Services (CMS) announced that children ages 6 months to 5 years with Medicaid and Children's Health Insurance Program (CHIP) coverage are eligible for COVID-19 vaccinations without cost-sharing. Nearly all people with Medicaid, CHIP, Basic Health Program coverage, self-insured employer-sponsored coverage, and group and individual health insurance coverage can get COVID-19 vaccinations, including boosters, at no cost. People with Medicare pay nothing to receive a COVID-19 vaccination, and there is no applicable copayment, coinsurance, or deductible. Through DHCS' COVID-19 Uninsured Group Program, COVID-19 diagnostic testing, testing-related services, and treatment services, including hospitalization and all medically necessary care, are available at no cost to the individual for up to 12 months or the end of the public health emergency, whichever comes first. As a reminder, all Californians can receive COVID-19 vaccines at no cost.
Information about the CDC COVID-19 Vaccination Program Provider Requirements and how the COVID-19 vaccines are provided through that program at no cost to recipients is available on the CMS website and through the COVID-19 Vaccine Policies & Guidance page. Information about DHCS' COVID-19 vaccine administration for beneficiaries and providers is posted on the DHCS' COVID-19 Response webpage. DHCS is in the process of updating systems and policy guidance for COVID-19 vaccine administration for children under age 5 and will post the updated guidance on the DHCS COVID-19 Response webpage once finalized.
Children and Youth Behavioral Health Initiative (CYBHI) Request for Information (RFI)
During the week of June 27, DHCS will release an RFI for the CYBHI. The purpose of the RFI is to invite vendors to review and respond to this non-binding RFI, which will provide information to DHCS to inform the planning, design, development, and launch of the Behavioral Health Virtual Services platform by January 2024.
Established as part of the Budget Act of 2021, the CYBHI is a multiyear, multi-department package of investments that seeks to reimagine the systems, regardless of payer, that supports behavioral health for all California's children, youth, and their families. Efforts will focus on promoting social and emotional well-being, preventing behavioral health challenges, and providing equitable, appropriate, timely, and accessible services for emerging and existing behavioral health (mental health and substance use) needs for children and youth ages 0-25. CYBHI is grounded in focusing on equity; centering efforts around children and youth voices, strengths, needs, priorities, and experiences; driving transformative systems change, and using ongoing learning as the basis for change and improvement in outcomes for children and youth.
One workstream of the CYBHI is to build and drive the adoption of a Behavioral Health Virtual Services platform for all children, youth, and families in California. It would support the delivery of equitable, appropriate, and timely behavioral health services from prevention to treatment to recovery, and provide an e-consult platform for pediatric and primary care providers to e-consult with behavioral health providers.
Providing Access and Transforming Health (PATH) Webinar
On June 29, DHCS will host a webinar to provide interested stakeholders with detailed updates on the following PATH initiatives: Collaborative Planning and Implementation; Capacity and Infrastructure Transition, Expansion, and Development (CITED); and Technical Assistance Marketplace. The webinar will also serve as a venue to answer general questions from stakeholders about PATH initiatives. Interested stakeholders are encouraged to submit questions in advance to 1115path@dhcs.ca.gov. Attendees will also have an opportunity to ask questions. Advance registration is required.
PATH is a five-year initiative to build and expand the capacity and infrastructure of city, county, and other government agencies and county and community-based providers, including public hospitals, community-based organizations, tribes and designees of Indian health programs, and others to successfully participate in the delivery of Enhanced Care Management, Community Supports, and justice-involved services under CalAIM.
Asset Limits Changes for Non-MAGI Medi-Cal
On July 1, DHCS will implement a change to the asset limits for Non-Modified Adjusted Gross Income (Non-MAGI) Medi-Cal programs. These changes, enacted through Assembly Bill 133 (Chapter 143, Statutes of 2021), increase the asset limits for Non-MAGI programs to $130,000 per person and $65,000 for each additional person (up to a maximum of 10 people). These revised asset limits supersede all previous asset limits for Non-MAGI Medi-Cal programs ($2,000 per person and $3,000 for two people).
Additionally, DHCS submitted a Section 1115 waiver for this policy change to also cover individuals eligible for the Pickle, Disabled Adult Child(ren), and Disabled Widow(ers) programs, also known as Social Security income-deemed groups, and anticipates receiving approval from CMS by July 1.
DHCS will launch an updated beneficiary-friendly webpage on July 1. This webpage will include frequently asked questions and answers and information about programs affected by the asset limit changes.
Published COVID-19 Information
Additional updates will be posted on the DHCS COVID-19 Response page.
