​​​​​​DHCS Stakeholder News - August 12, 2022

Dear Stakeholders,​

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

Top News

DHCS Issues Request to Federal Partners for Monkeypox Guidance

On August 12, DHCS sent a letter to the Centers for Medicare & Medicaid Services (CMS) requesting immediate guidance for establishing a Medicare rate for the monkeypox vaccine administration.

In an effort to be responsive to our Medi-Cal beneficiaries and providers, California will submit a Disaster State Plan Amendment to seek federal approval to reimburse vaccine administration and applicable laboratory testing at 100 percent of the Medicare rate, once established. As part of this request, DHCS will seek federal approval to reimburse Federally Qualified Health Centers, and similarly situated clinics that are paid an all-inclusive rate, the vaccine administration fee for vaccine-only visits, consistent with how DHCS is reimbursing for COVID-19 vaccine-only visits. The requested federal approvals will also include reimbursement for vaccine administration performed by non-clinic providers.

Additionally, please see the Centers for Disease Control and Prevention's Reducing Stigma in Monkeypox Communication and Community Engagement ​and the California Department of Public Health's toolkit messaging for sharing broadly among your networks.

Medi-Cal Premium Refunds

Senate Bill 184 (Omnibus Health Bill 2022) authorized DHCS to reduce premiums for Medi-Cal programs to zero. Effective July 1, 2022, members enrolled in the following programs are no longer required to pay a premium as a requirement for eligibility: 

• Optional Targeted Low Income Children's Program
  
• Medi-Cal Access Program
  
• Medi-Cal Access Infant Program
  
• County Children's Health Initiative Program
  
• 250 Percent Working Disabled Program
  

DHCS released policy guidance via All County Welfare Directors Letter #22-14 and Medi-Cal Eligibility Division Information Letter #I 22-25, and is seeking federal authority to implement this policy through SPA 22-0042 and SP​A 22-0034, which are pending CMS approval. Furthermore, DHCS has begun the process of issuing refunds to Medi-Cal and Children's Health Insurance Program (CHIP) beneficiaries who overpaid their premiums as of July 1.

U.S. Surgeon General's Comments on the Children and Youth Behavioral Health Initiative (CYBHI)

In a recent SAGE Journals articl​e, U.S. Surgeon General Dr. Vivek H. Murthy highlighted the work that is underway through the CYBHI. The article serves as a call to action for the nation, with a stark reminder of what's at stake in ensuring that children and youth receive the help they need when and where they need it, especially those in our most underserved communities.

The CYBHI, which includes multiple work streams that are led by five departments and offices within the California Health & Human Services Agency (CalHHS) – DHCS, Department of Health Care Access and Information, Department of Managed Health Care, California Department of Public Health, and the Office of the California Surgeon General – focuses on promoting mental, emotional, and behavioral well-being by preventing challenges and providing services, support, and routine screening for all children and youth for emerging and existing needs.

Program Updates

Medi-Cal Outreach and Enrollment Assistance for Older Californians

DHCS is providing outreach and enrollment assistance to 28,000 older adults who are potentially eligible for Medi-Cal health coverage. DHCS awarded $24 million to the California State Association of Counties and the California Coverage & Health Initiatives (CCHI) to partner on enrollment assistance efforts through June 30, 2024. Efforts are targeted to:

• Dual eligible beneficiaries or beneficiaries 65 years of age and older with a pending Medi-Cal eligibility redetermination.
• People 65 years of age and older who are already enrolled in Medi-Cal and need assistance with determining Medicare eligibility. 
• Individuals 65 years of age and older or with disabilities who are eligible for Medi-Cal, but not currently enrolled, including those eligible for the Medicare Savings Programs.
• Individuals newly eligible for Medi-Cal due to the Medi-Cal expansion to adults 50 years of age and older, regardless of immigration status.
• Medi-Cal beneficiaries turning age 65 not already enrolled in Medicare, contingent upon an agreement with one or more Medi-Cal managed care plans (MCP) in that county.

CCHI will be assisted by community-based organizations that have years of experience performing outreach and enrollment assistance to Medi-Cal beneficiaries to ensure those eligible for Medi-Cal have increased access to health services to improve outcomes and reduce health disparities. For more information, please visit the Medi-Cal Outreach and Enrollment for Older Californians webpage.

CHIP Enrollment and Redetermination Policy Update

On August 3, CMS approved DHCS' State Plan Amendment (SPA) CA-22-0035 submission, allowing DHCS to implement provisions for temporary adjustments to enrollment and redetermination policies. Effective July 1, 2022, DHCS is able to use a regulatory timeliness exception for the timely processing of CHIP applications and renewals for children in families living and/or working in state- or federally-declared disaster areas.

Through this SPA, California is making technical changes to align its disaster relief provisions approved through SPA CA-17-0043 with the updated disaster relief SPA template released in March 2022. These SPA provisions can be implemented during future state- or federally-declared disasters by notifying CMS of the effective dates of the provisions and areas impacted by a disaster.

Mobile Crisis Services Request for Information (RFI) Released

On August 8, DHCS released a RFI for the mobile crisis services benefit. The RFI invites vendors to provide DHCS with information to support training for and implementation of mobile crisis services. DHCS intends to submit a SPA to add qualifying community-based mobile crisis intervention services as a new Medi-Cal benefit, effective no sooner than January 2023. Implementing mobile crisis services is an integral part of California's broader efforts to strengthen the continuum of community-based care for Medi-Cal beneficiaries who are experiencing a mental health or substance use disorder crisis.

DHCS is developing the Medi-Cal mobile crisis services benefit, which will include materials and guidance related to training, readiness reviews, and technical assistance.

Hospital and Skilled Nursing Facility COVID-19 Worker Retention Payments Program

DHCS is providing updated guidance regarding the date of record and final date of submission for this program:

• For the date of record, eligible employees must be employed by a covered entity or covered services employer at a qualifying facility by November 28, 2022, to be eligible for a retention payment.
• For final date of submission, covered entities and covered services employers must submit their applications, including a list of eligible employees, no later than 5 p.m. on December 30, 2022.

In the coming weeks, DHCS will provide additional guidance on the submission process and general updates through weekly stakeholder announcements and on the Hospital and Skilled Nursing Facility COVID-19 Worker Retention Payments webpage.

Hearing Aid Coverage for Children Program (HACCP) Update

DHCS expanded covered benefits for aid code A1 to include new HACCP benefits related to bone conduction hearing devices (BCHDs), effective retroactively for dates of service on or after July 1, 2021.

For more information about HACCP coverage of BCHDs, please see the Medi-Cal Provider Newsfla​sh. For information about the program more broadly, please see DHCS' HACCP webpage, which was recently expanded to include additional resources for families and providers, including a secure chat option for communicating with the HACCP Call Center or uploading additional materials for an application that has already been submitted. Additionally, families seeking to apply for HACCP coverage may now submit their application electronically through the HACCP Online Application Portal.​

Medi-Cal Rx Implementation Update

DHCS and Magellan (MMA) engaged in an intensive planning process for the phased reinstatement of claim edits and prior authorization (PA) requirements.

• Phase one, wave one, was implemented on July 22, 2022, to reinstate claim edits for National Council for Prescription Drug Programs (NCPDP) Reject Code 88 – Drug Utilization Review (DUR) Reject Error for DUR alerts, such as drug-drug interactions, high dose, early refill, etc. The reinstatement approach is gradual and repetitive, with intense focus on stakeholder preparedness and performance monitoring. It will be refined as necessary over time based on data analytics, operational experience, and stakeholder feedback.
• Phase one, wave two, now in effect, focuses on the promotion of the use of CoverMyMeds (CMM).
• Phase one, wave three is slated to begin on September 16 with the reinstatement of PA requirements for 11 drug classes for new start prescriptions for beneficiaries 22 years of age and older. Stakeholders are encouraged to continue submitting comments and feedback on the reinstatement approach via Reinstatement@dhcs.ca.gov. 
  

Community Health Workers (CHW) SPA Approval

​On July 26, DHCS received CMS approval for SPA 22-0001, which adds CHW as a preventive service. Developed in consultation with stakeholders, this SPA created CHW services as a Medi-Cal benefit, effective July 1, 2022, for both fee-for-service and managed care delivery systems. For more information about CHW services, including a link to the provider manual, please see the CHW webpage.

Published COVID-19 Information

• Appendix K for 1915(c) Waiver  Approval Letter: HCBS Self-Directed Support Services 
• Appendix K for 1915(c) Waiver: HCBS Self-Directed Support Services 

Upcoming Stakeholder Meetings and Webinars

California Advancing and Innovating Medi-Cal (CalAIM) Waiver Renewals Webinar

On August 22 at 10 a.m., DHCS will virtually host a public hearing to receive stakeholder feedback on the proposed amendments to the CalAIM Section 1115 demonstration and Section 1915(b) waiver. Please register for this webinar in adva​nce.

DHCS launched 30-day public comment and Tribal public comment periods on August 12. DHCS is seeking the CalAIM Section 1115 and 1915(b) amendment approvals from CMS to implement county-based model changes in the Medi-Cal Managed Care (MCMC) program. Through the Section 1915(b) waiver amendment, DHCS also plans to add or update language on policies or programs in the approved CalAIM 1915(b) waiver, including to reflect the MCMC model changes in select counties and direct contracts with the Kaiser Foundation Health Plan available for enrollment of certain Medi-Cal beneficiary populations in select counties. Additional information about the CalAIM Section 1115 demonstration application and Section 1915(b) overview are available on the CalAIM 1115 Demonstration & 1915(b) Waiver webpage. The 30-day public comment and Tribal public comment periods end on September 12.

Talking to Family PACT Clients About HPV Immunization

On August 17, DHCS and the California Prevention Training Center will hold a webinar to provide information about the effectiveness and safety of the human papillomavirus (HPV) vaccine, review current Centers for Disease Control and Prevention recommendations for the use of the HPV vaccine, and provide advice on how to have effective shared decision-making conversations with clients about being immunized. Advance registration for PACT webinar​ is required. Effective July 1, 2022, the Family PACT program added HPV vaccination as a clinic benefit for individuals ages 19 through 45. For those unable to attend the live webinar, a transcript and recording of the webinar, along with additional resources, will be available on the Family PACT website.

Medi-Cal Dental Statewide Stakeholder Meeting

On August 18 at 10 a.m., DHCS will host a virtual Medi-Cal Dental Statewide Stakeholder meeting. The purpose of this meeting is to give dental stakeholders throughout the state a forum to share feedback on the Medi-Cal Dental program, and for DHCS to share important updates and information on new and/or upcoming work efforts. Additional information is available on the Medi-Cal Dental Statewide Stakeholder meeting webpage.

DHCS CalAIM MLTSS and Duals Integration Workgroup Meeting

On August 18 at 10 a.m., DHCS will virtually host the CalAIM Managed Long-Term Services and Supports (MLTSS) and Duals Integration Workgroup meeting. Please register for the mee​ting, which is open to the public.

The meeting will serve as a stakeholder collaboration hub for CalAIM MLTSS and integrated care for dual eligible beneficiaries. It will also give stakeholders an opportunity to provide feedback and share information about policy, operations, and strategy for upcoming changes to Medicare and Medi-Cal. Agenda items include a summary of January 2023 enrollment changes; a presentation on the January 2023 transitions impacting dual eligible beneficiaries, including noticing, monitoring, and timelines; and an update on the Dementia Care Aware initiative.

Background materials, transcripts, and video recordings of the previous workgroup meetings, along with additional information about the workgroup, are posted on the CalAIM MLTSS and Duals Integration Workgroup webpage.

Smile, California Campaign for Medi-Cal Dental Services

Smile, California is hosting Facebook Live presentations for Medi-Cal members in Spanish and English. The Spanish presentation will be held on August 24 at 1 p.m.; ​ RSVP on ​Facebook. ​The English presentation will be held on August 26 at 1 p.m.; RSVP on Facebook. A Smile, California member outreach representative will deliver the Smile, your Medi-Cal benefits include dental! presentation, and a provider relations trainer will assist with answering audience questions.

PAVE Portal Training for Dental Providers

On August 24 at 11 a.m., DHCS will host a webinar introduction to PAVE for dental providers. Beginning on October 31, DHCS will implement the PAVE portal for dental providers, offering a new mode for submitting dental provider enrollment applications and required documentation to DHCS. This allows applicants to use the Medi-Cal Provider e-Form Application, as DHCS will no longer accept paper applications once PAVE is implemented. For more information about the webinar, including the registration link for the August 24 training, please view this Medi-Cal Dental Provider Bulletin. The PAVE demonstrations will be recorded and posted on the DHCS PAVE webpage. ​

DHCS Office of Family Planning Stakeholder Meeting  

On August 24, DHCS will host a virtual family planning stakeholder meeting. The link to the meeting will be available on the Office of Family Planning webpage prior to the meeting.

Doula Benefit Stakeholder Meeting

On August 24, DHCS will host a virtual stakeholder workgroup meeting about adding doula services as a covered Medi-Cal benefit. The meeting is open to the public. DHCS will engage with workgroup members on policy development details that will be reflected in the Medi-Cal provider manual and other policy guidance documents. All interested stakeholders may listen to the workgroup discussion regarding stakeholder feedback and provide input via email. DHCS will also share an update on the status of formal submission of the SPA to CMS. The link for the stakeholder meeting will be available on the doula webpage prior to the meeting.

CalAIM Webinar: Enhanced Care Management (ECM) and Community Supports Member Engagement

On August 25 at 1:30 p.m., DHCS will host an all-comers webinar on CalAIM ECM and Community Supports member engagement. Topics for this session will include provider and member communications, referrals, outreach, and enrollment. This event is part of a series of technical assistance and informational sessions focused on supporting implementation of ECM and Community Supports. Throughout the series, DHCS leaders will be joined by presenters from MCPs, providers, and CBOs implementing CalAIM.

Advance registration for ​CalAIM webinar is required. Participants are invited to submit questions by August 22 to CalAIMECMILOS@dhcs.ca.gov. Attendees will also have the opportunity to ask questions during the webinar. An additional “Office Hours" event will be held on September 1 at 2 p.m. (see below) for attendees to ask any other questions not covered during the webinar.

CYBHI Monthly Webinar

On August 29 at 3 p.m., DHCS will virtually host a webinar to keep stakeholders apprised of DHCS' progress in implementing various work streams of the CYBHI. Key attendees include, but are not limited to, youth, parents, family members, beoavioral health providers, Medi-Cal MCPs, county behavioral health departments, and commercial health plans, as well as education and other cross-sector partners. CYBHI Monthly Webinar advance registration is required​.

CalAIM Office Hours: ECM and Community Supports Member Engagement

On September 1 at 2 p.m., DHCS will virtually host an “Office Hours" discussion on CalAIM ECM and Community Supports member engagement. As a follow-up to the August 25 webinar on this topic, this question and answer session will cover provider and member communications, referrals, outreach, and enrollment. This event is part of a series of “Office Hours" events focused on answering implementation questions from the field.
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A​​dvance registration is required. Participants are invited to submit questions by August 29 to CalAIMECMILOS@dhcs.ca.gov. Attendees will also have an opportunity to ask questions during the session.​​