​DHCS Stakeholder Updates -​​ July 8, 2022

Dear Stakeholders,

The Department of Health Care Services (DHCS) is providing this update of significant developments regarding DHCS programs.

July is Disability Pride Month

DHCS celebrates the culture, diversity, and contributions of people with disabilities during Disability Pride Month. The Americans with Disabilities Act (ADA) was passed on July 26, 1990, prohibiting discrimination against people with disabilities, and giving rise to this important celebration. DHCS is committed to work toward a healthier California where all individuals can live with purpose and dignity and are supported and valued.  

DHCS provides Californians with disabilities access to affordable, integrated, high-quality health care to preserve and support their overall health and well-being, and strives toward health equity to ensure equal opportunities for all Californians. DHCS, in collaboration with sister departments, oversees a variety of programs serving persons with disabilities, including: California Children's Services, the Genetically Handicapped Persons Program for adults, the Home and Community-Based Alternatives Waiver, and Home and Community-Based Services for individuals with intellectual and developmental disabilities. DHCS also makes available many other resources to support persons with disabilities. DHCS will continue to support Californians with disabilities through high-quality and person-centered care.

Final Population Health Management (PHM) Strategy and Roadmap

On July 5, 2022, DHCS released the Final PHM Strategy and Roadmap, which incorporates stakeholder feedback on all components of the PHM Framework. DHCS appreciates the thoughtful comments provided by stakeholders that helped to improve the Department's vision for PHM. As a reminder, DHCS will launch the PHM Program, a cornerstone of California Advancing and Innovating Medi-Cal (CalAIM), in January 2023. The PHM Program will establish a cohesive, statewide approach that ensures all Medi-Cal members have access to a comprehensive program that leads to longer and healthier lives, improved health outcomes, and health equity. The roadmap outlines key policy initiatives and accountability mechanisms, defines and describes PHM concepts and terminology, and details requirements for Medi-Cal managed care plans (MCPs) for 2023 and 2024. The Final PHM Strategy and Roadmap is available on the DHCS CalAIM Pop ulation Health Management webpage . If you have any questions, please email CalAIM@dhcs.ca.gov.

Dual Eligibles Policy Update

As a component of CalAIM, DHCS is implementing policies to promote integrated care for beneficiaries dually eligible for Medicare and Medi-Cal. Under this effort, for contract year 2023, DHCS will limit new Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) and expanded county service areas to only those D-SNPs with an ongoing affiliation with Medi-Cal MCPs. This policy, which is in line with the federal approach and in other states, is being implemented because when a county has separate health plans for Medicare and Medi-Cal benefits, there can be beneficiary and provider confusion, duplication of care managers, and more complexity for hospital and nursing home discharge planners.

This approach in 2023 will not result in any members needing to disenroll from their existing Medicare plans. To avoid Medicare provider network disruption, DHCS will continue any existing D-SNP contracts and service areas so members in existing D-SNPs will not be required to disenroll.   

Having Medicare and Medi-Cal benefits managed by the same organization is an important component of CalAIM, and aligns with DHCS' Managed Long-Term Services and Supports (MLTSS) strategy. In 2023, CalAIM policies will provide a more robust Medi-Cal managed care delivery system for dual eligible beneficiaries statewide, including: mandatory Medi-Cal managed care enrollment; Medi-Cal managed care carve-in of skilled nursing facility care; and Enhanced Care Management for populations who are at risk for long-term skilled nursing facility care, or who reside in a nursing facility and want to transition to the community. In addition, Community Supports services designed to address social drivers of health will continue to be implemented by Medi-Cal MCPs. 

Children and Youth Behavioral Health Initiative (CYBHI) Request for Information (RFI)

On July 6, DHCS released a RFI for the CYBHI, inviting vendors to provide information to DHCS to help inform the planning, design, development, and launch of the Behavioral Health Virtual Services platform by January 2024. DHCS will host a vendor conference on July 13 for prospective vendors.

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 support 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 adoption of a Behavioral Health Virtual Services platform to 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.