DHCS Stakeholder News - July 22, 2022
The Department of Health Care Services (DHCS) is providing this update of significant developments regarding DHCS programs, as well as guidance related to the COVID-19 public health emergency (PHE).
Top News
DHCS Budget and Major Program Initiatives
For fiscal year (FY) 2022-23, the DHCS budget includes a total of $144.2 billion. Of that amount, $1.6 billion funds state operations (DHCS operations), while $142.6 billion supports local assistance (funding for program costs, partners, and administration). From California Advancing and Innovating Medi-Cal (CalAIM) to transforming the state's behavioral health programs, the Department's initiatives are working together to transform the state's Medi-Cal system and improve the overall health and well-being of all Californians. View DHCS' budget highlights document.
The updated links below reflect DHCS major program initiatives and anticipated go-live dates, pending readiness and federal approvals.
DHCS also updated the CalAIM Initiatives Launch Timeline and Milestone Calendar, which detail key dates and milestones for CalAIM initiatives to reflect the latest implementation status. Because milestone and go-live dates may shift as policies are finalized and federal approvals secured, the documents will be updated regularly to reflect any changes.
Several of DHCS' major program initiatives were implemented in July 2022, including:
- Enhanced Care Management (ECM): On July 1, DHCS expanded ECM for populations of focus including individuals and families experiencing homelessness, high utilizer adults, and adults with serious mental illness and/or substance use disorders (SUD) in counties where the Whole Person Care (WPC) and Health Homes Program (HHP) did not previously operate. These same populations implemented in WPC and HHP counties on January 1, 2024. ECM addresses clinical and non-clinical needs of the highest-need enrollees through intensive coordination of health and health-related services, meeting beneficiaries where they are. For more information on ECM, visit the ECM webpage.
- No Wrong Door (NWD): On July 1, the CalAIM NWD for Mental Health Services policy was implemented. The purpose of the policy is to ensure that Medi-Cal beneficiaries receive mental health services immediately regardless of where they initially seek care, and that beneficiaries can continue to see the provider with whom they have built a trusted relationship. In March, DHCS released the NWD for Mental Health Services policy via Behavioral Health Information Notice (BHIN 22-011) and All Plan Letter (APL 22-005), which became effective on July 1. County mental health plans (MHPs) and Medi-Cal managed care plans (MCPs) have joint responsibility for implementing the NWD policy.
- As of July 1, Medi-Cal beneficiaries are able to receive covered mental health services provided during the assessment period, even prior to a diagnosis and even if the assessment ultimately indicates they are best served in another delivery system; access mental health care even if they have a co-occurring substance use disorder; and receive mental health services concurrently from both MCP and MHP providers, provided the services are coordinated and not duplicative.
- Dual Eligible Special Needs Plans (D-SNP) Feasibility Study: DHCS completed a feasibility study report of D-SNPs for Medi-Cal MCPs in select non-Coordinated Care Initiative counties, pursuant to Welfare and Institutions Code (WIC) section 14184.208(c)(5). The feasibility study will help inform the transition under the CalAIM initiative to a statewide D-SNP structure for dual eligible beneficiaries. It will also help DHCS establish processes and refine criteria for evaluating potential MCP exemption requests from the D-SNP requirement.
- Medi-Cal Asset Test: Assembly Bill (AB) 133 (Chapter 143, Statutes of 2021) authorizes a two-phased approach to eliminating the asset test for all non-Modified Adjusted Gross Income (MAGI) Medi-Cal programs, including long-term care and the Medicare Savings Programs. Phase I was implemented on July 1, which increased asset limits to $130,000 per person and $65,000 per additional person being evaluated. DHCS published Medi-Cal Eligibility Division Information Letter (MEDIL) (22-02), which provides counties, advocacy groups, and other partners with global outreach messaging to use in their outreach activities regarding the increased asset limits. Phase II is scheduled for implementation on January 1, 2024, and will eliminate the asset test.
- Behavioral Health Peers: Effective July 1, Peer Support Services are an optional behavioral health Medi-Cal benefit in California. The benefit adds Peer Support Services as a distinct service type under the Specialty Mental Health Services System, Drug Medi-Cal (DMC), and Drug Medi-Cal Organized Delivery System (DMC-ODS) programs for counties that opt in to cover the service. In addition, the benefit adds Peer Support Specialists as a distinct Medi-Cal provider type. Peer Support Specialists are individuals with lived experience who receive Peer Support Specialist Certification consistent with DHCS guidance and deliver the new Peer Support Services Medi-Cal benefit.
- Community Health Worker (CHW): The CHW benefit, which includes violence prevention services, became available on July 1, and the provider manual for CHW services and asthma preventive service published on July 15. More information about the CHW benefit and previous stakeholder meetings is available on the CHW webpage.
Disaster 1115 Demonstration Waiver Approval – Continuous Coverage for the Children's Health Insurance Program (CHIP) during COVID-19 PHE
On July 19, 2022, DHCS received the Centers for Medicare & Medicaid Services (CMS) approval of the Disaster Section 1115 demonstration waiver, which enables the state to claim federal financial participation (FFP) for CHIP beneficiaries who were retained in coverage from March 8, 2020, through the end of the COVID-19 PHE unwinding period.
On March 3, 2022, CMS issued State Health Officer (SHO) Letter 22-001, which updated guidance to states that continued to cover CHIP beneficiaries found ineligible for coverage during the COVID-19 PHE using state-only funds. CMS indicated that states may submit a COVID-19 Section 1115 demonstration application to obtain expenditure authority to claim FFP for such CHIP beneficiaries through the end of the PHE unwinding period, or until a redetermination is conducted during the unwinding period.
Coming Soon: Hospital and Skilled Nursing Facility COVID-19 Worker Retention Payments
On June 30, Governor Newsom signed legislation aimed at stabilizing and retaining California's health care workforce and managing the COVID-19 pandemic through the issuance of worker retention payments. As a result, many workers in qualifying facilities will soon be eligible to receive a retention payment. To be eligible, workers must be employed at least part-time during the qualifying period of July 30, 2022, through October 28, 2022.
In the coming weeks, DHCS will provide updates through various channels, including weekly stakeholder announcements and DHCS' Worker Retention Payments webpage.
COVID-19 PHE Communications and Outreach Campaign Request for Information (RFI)
On July 20, DHCS released a RFI to interested parties to provide input on the DHCS COVID-19 PHE Communications and Outreach Campaign. DHCS is seeking an experienced communications vendor to implement a broad and targeted communications and outreach campaign for Medi-Cal beneficiaries during and after the end of the COVID-19 PHE. The campaign would be presented in a phased way that aligns with the Medi-Cal COVID-19 PHE Operational Unwinding Plan. Initial questions from interested parties are due to DHCS on July 27, and final RFI responses are due to DHCS on August 19.
The campaign is expected to launch no later than October 1, and will be completed no later than March 31, 2024.
DHCS Announces New Name for Dual Eligible Health Plans
DHCS recently announced a California-specific program name, Medicare Medi-Cal Plans (MMPs or Medi-Medi plans), for Exclusively Aligned Enrollment (EAE) D-SNPs. These are health plans that provide integrated Medicare and Medi-Cal benefits to dual eligible beneficiaries. Members of Cal MediConnect plans will automatically transition to MMPs on January 1, 2023, as part of the CalAIM initiative to continue providing integrated and coordinated care to dual eligible beneficiaries.
Medi-Cal Rx Update
On July 22, DHCS initiated the first step in reinstating Medi-Cal Rx claim edits and prior authorizations (PA), which ultimately will be completed in three phases over multiple months. In January, Medi-Cal Rx identified a large volume of pharmacy claims denials related to various claim edits. DHCS recognized the implementation challenges faced by the provider community and made the decision in early February to stop select claim edits and lift PA requirements. This enabled Medi-Cal Rx to stabilize operations and facilitate the safe and timely delivery of pharmacy benefits and services.
Phase I, Wave 1 reinstates Drug Utilization Review (DUR) Reject Code 88, which alerts pharmacists to such things as drug-to-drug interactions, high dose, and early refill. Initially, Wave 1 was to reinstate two claim edits, DUR Reject Codes 88 and 80 (diagnosis code submitted does not meet drug criteria), and a 30-day stakeholder notice was issued on June 22. However, because of stakeholder feedback, which DHCS was able to confirm through claims data analysis, DHCS has elected to postpone the reinstatement of Reject Code 80 since it will trigger PAs in some cases, which is not the intent of Wave 1.
The decision to postpone activation of Reject Code 80 aligns with DHCS' commitment to ongoing engagement with the stakeholder community and to ensure the timely delivery of safe pharmacy services. Revised provider alerts and other informing materials have been issued and posted to the Medi-Cal Rx website.
COVID-19 Information
Additional updates will be posted on the DHCS COVID-19 response page.
Upcoming Stakeholder Meetings and Webinars
Coordinated Care Initiative (CCI) Stakeholder Webinar
On July 27, at 12 p.m., DHCS will host the next quarterly CCI stakeholder update webinar. Agenda items include a summary of January 2023 enrollment changes, an update of the June Cal MediConnect (CMC) Dashboard, and a case study presentation on Community Supports for seniors and persons with disabilities. CCI Stakeholder Webinar advance registration is required. Materials from the March 17 CCI quarterly meeting, including the webinar recording, slides, and transcript, are now available on the CCI webpage.
CalAIM Population Health Management (PHM) Advisory Group – July Meeting
On July 27, DHCS will host the next meeting of the PHM Advisory Group from 10:30 a.m. to 12 p.m. DHCS established the PHM Advisory Group to provide input to support the design and implementation of the PHM Program and Service. Members, which include representatives from health plans, providers, counties, state departments, consumer organizations, and other groups, will participate in Advisory Group meetings and provide real-time feedback and recommendations. The meetings are open to the public, and meeting information and materials will be available on the PHM webpage.
The July meeting will focus on a discussion of transitional care and intersections with behavioral health, as well as a presentation of highlights from the recently finalized PHM Strategy and Roadmap. Stakeholders are encouraged to submit questions in advance of the webinar to CalAIM@dhcs.ca.gov. PHM advance registration is required.
Screening and Transition of Care Tools Initiative Webinar
On July 28, at 3 p.m., DHCS will conduct a webinar for stakeholders to learn about the Screening and Transition of Care Tools initiative, scheduled to implement on January 1, 2023, as part of CalAIM. This initiative is focused on developing statewide screening and transition of care tools for both adults and youth under age 21 for use by county MHPs and Medi-Cal MCPs. The webinar will present an overview of the initiative's purpose and the robust stakeholder process underway to develop standardized tools, highlight draft adult tools and guidance released for public comment, and preview upcoming milestones and plans for technical assistance.
More information is available at the registration and agenda links. For additional information, please visit here.
Dementia Care Aware Initiative
On August 1, from 12 p.m. to 1 p.m., DHCS and its partners will host a webinar, “Cognitive Health Assessment Basics", the first in the Dementia Care Aware series. Dementia Care Aware Executive Director Dr. Anna Chodos from the University of California, San Francisco (UCSF) will introduce the cognitive health assessment. Participants of the webinar are eligible to receive one Continuing Medical Education credit. Dementia Care Aware webinar advance registration is required. For more information, visit www.dementiacareaware.org.
CalAIM Webinar: ECM and Community Supports Program Data Exchange Overview
On August 4, from 10:30 a.m. to 12 p.m., DHCS will host a webinar on data exchange necessary for the implementation of ECM and Community Supports.
Intended especially for MCPs and providers in counties where ECM launched in July 2022, but open to all as a refresher, DHCS will provide an overview of the guidance documents that were released last year and corresponding data flows. This webinar will focus on the exchange of information that occurs between MCPs and ECM and Community Supports providers.
There will be time reserved during the webinar for participant questions and answers, as well as a follow-up “office hours" session for further questions on August 11. Advance registration for this CalAIM webinar is required. Please email CalAIMECMILOS@dhcs.ca.gov with any questions.
