DHCS Stakeholder News - July 29, 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
Announcement Regarding Bimonthly Stakeholder Updates
DHCS is consolidating its stakeholder updates and going forward will issue weekly Stakeholder News emails instead of bimonthly updates. This change will allow stakeholders to receive timelier news on a more frequent basis.
ACEs Aware
The ACEs Aware initiative
released a new quarterly data report detailing the number of Adverse Childhood Experience (ACE) screenings conducted for children and adults in California between January 1, 2020, and September 30, 2021. The data show that Medi-Cal clinicians – primarily pediatric, family medicine, and behavioral health professionals – conducted approximately 987,500 ACE screenings of more than 793,000 unique Medi-Cal beneficiaries.
The report also tracks the number of clinical team members that completed the “Becoming ACEs Aware in California" online training between December 4, 2019, and May 31, 2022. The data show that more than 23,400 individuals have taken the ACEs Aware training, 11,900 of whom are Medi-Cal clinicians who are ACEs Aware-certified and eligible to receive Medi-Cal payment for conducting ACE screenings.
Behavioral Health Continuum Infrastructure Program (BHCIP) Update
DHCS was authorized through 2021
legislation to establish BHCIP and award $2.1 billion to construct, acquire, and expand properties and invest in mobile crisis infrastructure related to behavioral health. Funding is being released through several rounds for the expansion of behavioral health facilities, here is an update on upcoming rounds:
- BHCIP Round 4: Children and Youth
Round 4 focuses on children and youth ages 25 and younger, including pregnant and postpartum people and their children, children, and transition-age youth, as well as their families. All applicants must demonstrate how their infrastructure project will expand behavioral health services for this population exclusively. DHCS will award $480.5 million for children- and youth-focused behavioral health infrastructure projects in this fourth round of competitive grants. The deadline to submit applications for the Request for Application (RFA) for
Round 4: Children and Youth is August 31, 2022. Applicants will be expected to demonstrate “project readiness", as detailed in the posted RFA, and will be funded according to which of three pre-construction phases their project is in. Full project funding will be contingent upon completion of all three phases of development planning.
- BHCIP Round 5 and Round 6: Rounds 5 and 6 are currently in the planning phases. A listening session for Round 5: Crisis Continuum is scheduled for August 4, from 1 p.m. to 2 p.m., and provides an opportunity for eligible applicants to offer input directly to DHCS to inform BHCIP Round 5 planning and implementation. Round 5 listening session registration is required. For more information about BHCIP, please visit the BHCIP project website or email BHCIP@dhcs.ca.gov.
Dental Transformation Initiative
On August 1, DHCS will begin issuing final
Dental Transformation Initiative (DTI) payments for specific domains. The Budget Act of 2022 included $30.2 million to make DTI payments in fiscal year (FY) 2022-23 and $1.5 million in FY 2023-24. The DTI consisted of four domains to improve dental health for Medi-Cal children by focusing on high-value care, improved access, and utilization of performance measures to drive delivery system reform.
Domain 1 compensated service office locations with incentive payments for select preventive services if the provider increased enrolled Medi-Cal beneficiary utilization. Domain 2 allowed participating Medi-Cal Dental providers to receive payments for providing services to enrolled Medi-Cal beneficiaries, ages 6 and under, for a bundled service that included a caries risk assessment, treatment plan, nutritional counseling, and motivational interviewing. Domain 3 provided annual incentive payments to service office locations that maintained continuity of care for enrolled Medi-Cal beneficiaries. Dental managed care plans are not offered these incentive payments given the inherent requirement that managed care delivery systems provide continuity of care for their covered populations.
Domains 1 and 2 payments will be made to all eligible Medi-Cal Dental providers in the statewide Medi-Cal Dental fee-for-service (FFS) delivery system, including eligible safety net clinics (e.g., Federally Qualified Health Centers, Rural Health Clinics, and Indian Health Services/Memorandum of Agreement Clinics (community health centers)), and in the Dental Managed Care delivery system in Sacramento and Los Angeles counties. Domain 1 payments will be issued the week of August 1, and Domain 2 payments will be issued the week of August 8. Domain 3 payments will also be made to FFS providers during the week of August 1.
DHCS anticipates this payment cycle to be the last for Domains 1 and 2 and an additional Domain 3 payment to be processed on July 3, 2023. A Special Provider Bulletin will be released and published on July 29 on the
Medi-Cal Dental Provider Bulletin website to inform providers.
Domain 4, Local Dental Pilot Projects (LDPP), addressed Domains 1-3 through local pilot programs aimed at specific demographics. The goals were to address one or more of the three domains through alternative programs and potentially use strategies focused on rural areas, including local case management initiatives and education partnerships. As of December 31, 2020, all 13 LDPPs concluded their operations and began their administrative closeout phase.
Heightened Scrutiny Settings Public Comment Period
On July 29, DHCS posted Home and Community-Based Services (HCBS) Settings Final Rule documents for a 30-day public comment period. This includes summary sheets for 115 assisted living and congregate living health facilities that were identified for heightened scrutiny by DHCS, and were subsequently determined by DHCS to meet the HCB Settings Final Rule criteria.
Per HCB Settings Final Rule requirements, the state must identify settings that are presumed to have institutional qualities. These settings include those: 1) in a publicly or privately-owned facility that provides inpatient institutional treatment; 2) on the grounds of, or immediately adjacent to, a public institution; or 3) that have the effect of isolating individuals receiving Medi-Cal funded HCBS services from the broader community. The heightened scrutiny process is initiated only if the state determines the setting overcomes the institutional presumption; therefore, any settings the state presents to the Centers for Medicare & Medicaid Services (CMS) for heightened scrutiny are those that have demonstrated they are not institutional in nature.
For each facility setting, a summary sheet describing the setting, the reason it is subject to heightened scrutiny, and the available evidence supporting DHCS' determination the setting met HCB Settings Final Rule criteria is available for public comment from July 29 to August 28.
Instructions for submitting public comments are available on the
DHCS HCBS Statewide Transition Plan webpage. DHCS will collect this information and update the final Statewide Transition Plan for an additional public comment period prior to submission to CMS. DHCS encourages stakeholders to continue to visit the website for additional information and to email
STP@dhcs.ca.gov with any questions.
Monkeypox Update: Laboratory Billing
On July 26, 2022, the American Medical Association Current Procedural Terminology (CPT) Editorial Panel created and released CPT
codes to streamline the reporting of orthopoxvirus and monkeypox testing currently available in the United States, including a code for laboratory testing:
- 87593: Infectious agent detection by nucleic acid (DNA or RNA); orthopoxvirus (e.g., monkeypox virus, cowpox virus, vaccinia virus), amplified probe technique, each.
This new code is currently not programmed for billing in FFS Medi-Cal. Medi-Cal will announce when the claims adjudication system is ready, and release additional instructions providers should use when billing for a monkeypox testing code. Until then, providers are advised to administer the test when medically indicated and hold the Medi-Cal claim submission until further notice.
Testing is becoming more available, with several large commercial laboratories, including Labcorp, Quest, Aegis, Mayo Clinic Labs, and Sonic Healthcare, offering testing. Testing is also available by some local public health laboratories. There is no fee for public health testing, and commercial testing should be billed as indicated above. At this time, the federal government has allocated a limited number of monkeypox vaccine doses to California, and the California Department of Public Health (CDPH) is working with local health departments to make available these doses.
DHCS will continue to update and inform all Medi-Cal providers about testing and vaccinations related to monkeypox as guidance becomes available.
Both the
CDPH and the
Centers for Disease Control and Prevention websites provide further guidance on monkeypox symptoms, testing, treatment, and vaccination.
Provider Application and Validation for Enrollment (PAVE) Portal for Dental Providers
On October 31, DHCS will implement the PAVE portal for dental providers. The PAVE portal is a web-based application designed to simplify and accelerate enrollment processes. PAVE will provide a new mode for submitting dental provider enrollment applications and required documentation to DHCS, allowing applicants to use the Medi-Cal Provider e-Form Application. DHCS will no longer accept paper applications once PAVE is implemented.
Dental providers are invited to attend an online demonstration. The two-part series will begin with an introduction to PAVE on August 24, and an overview of key features to be scheduled for October. A more in-depth training session will be scheduled for November, following the implementation of PAVE. Each session is one hour. The demonstrations will be recorded and made accessible for future reference on the DHCS
PAVE webpage. DHCS will release a Special Provider Bulletin by August 8 to notify providers about the upcoming trainings.
Statewide HCBS Gap Analysis and Multiyear Roadmap – Contractor Selection
In March 2022, DHCS released a Request for Information (RFI) soliciting information from interested parties to assist DHCS in launching a major project to conduct a statewide
Gap Analysis and Multiyear Roadmap of California's HCBS and Managed Medi-Cal Long-Term Supports and Services (MLTSS) programs and networks. DHCS received multiple competitive bids, and through its robust selection process, determined Mathematica is best suited to meet the goals of the Money Follows the Person (MFP) Supplemental Funding – Gap Analysis and Multiyear Roadmap. DHCS plans to finalize the contract/Scope of Work with Mathematica in August, with the contractor beginning work immediately after contract execution. Submission of the gap analysis will occur by September 30, 2023, and the multiyear roadmap will be submitted by March 31, 2024. DHCS will present final deliverables to stakeholders and legislators by June 30, 2024.
Published COVID-19 Information
Additional updates will be posted on the DHCS COVID-19 Response page.
Upcoming Stakeholder Meetings and Webinars
CalAIM Webinar and Office Hours: Enhanced Care Management (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 ECM and Community Supports, intended especially for managed care plans (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, with a focus on the exchange of information that occurs between MCPs and ECM and Community Supports providers. The webinar is for ECM and Community Supports Providers, MCPs, and others engaged in the implementation of ECM and Community Supports.
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, from 2 p.m. to 3 p.m. Advance registration is required for the ECM webinar and the office hours session. Please email
CalAIMECMILOS@dhcs.ca.gov with any questions.
Medi-Cal Consumer-Focused Stakeholder Workgroup (CFSW) Meeting
On August 5, DHCS will host the next CFSW meeting via webinar. Additional information about the workgroup is available on the CFSW webpage. Please email DHCSCFSW@dhcs.ca.gov with any questions.
