Health Care Access Forum

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Health Care Access Forum –  Thursday, June 9th

Forum Schedule: 

9:00 AM – 10 AM   Networking Breakfast & Registration (9:15 AM Networking Breakout Rooms)
10 AM – Noon        Forum

Location: HYBRID!  In Person at the Center for Healthy Communities (1414 K Street) in Sacramento                   
                                     OR

                                    Virtual via Zoom 

This is a members-only event.  

Or email Andrea at apalladino@hemophiliaca.org

Need to renew your membership for 2022? 

We have options for membership or to purchase extra tickets.

Questions? Email Andrea at apalladino@hemophiliaca.org.

Directions, Parking and Map

Directions

FROM THE NORTH-EAST:
  • Take I-80 West to I-5 South Take the J Street exit toward Downtown Stay on J Street and turn right on 15th Street Turn right on L Street Turn right on 14th Street
FROM THE EAST:
  • Take Highway 50 West Take the 16th Street exit Turn right at 16th Street Turn left at L Street Turn right on 14th Street
FROM THE NORTH or SOUTH:
  • Take I-5  Take the J Street exit toward Downtown Stay on J Street and turn right on 15th Street Turn right on L Street Turn right on 14th Street
FROM THE WEST:
  • Take I-80 East to I-5 North Take the J Street exit toward Downtown Stay on J Street and turn right on 15th Street Turn right on L Street Turn right on 14th Street
FROM SACRAMENTO INTERNATIONAL AIRPORT:
  • Take I-5 South Take J street exit Turn right onto 15th Street Turn right onto L Street Turn right on 14th Street 

The Center for Healthy Communities is located on the corner of 15th and K, across the street from Capitol Garage restaurant and
behind the Convention Center loading docks. You will see a parking lot on the corner of 15th and K, and
adjacent to that, you will see the building. The building is six-story, brick, horseshoe shaped building with a
mural painted on it that says “Health Happens Here.”  The Healthcare Access Forum takes place in the first floor Adelante Room.

Parking Options

Parking is available on a first-come, first-served basis across the street at Capitol Centre parking garage or the Capitol Garage for an hourly fee. Additional parking may also be found in surrounding buildings or on the street for an hourly fee.

Capitol Garage (Next to Capitol Centre)
1500 K Street
Sacramento, CA
Rates: each 20 minutes = $2.00 Hourly: $6.00 Daily max of $24.00 Exact change and all major credit cards

Capitol Centre (Next to Capitol Garage)
1520 K Street
Sacramento, CA
Rates: each 30 minutes = $1.75 Hourly: $6.00 Daily max of $24 Credit card only

Priority Parking
1414 I St.
Sacramento, CA 95814
Flat rate: $10 2 blocks away; exact change and all major credit cards

 

Map

NEWS & UPDATES

Medication Therapy Management (MTM) Updates

 February 14, 2022

MTM services are now a Medi-Cal benefit for pharmacists. MTM pharmacy services may be billed by a Medi-Cal enrolled pharmacy with an approved Medi-Cal Specialty Pharmacy Provider Application (MC 3155), as well as a signed supplemental services agreement with DHCS for MTM services. Providers may refer to part 2 of the Provider Manual for a detailed explanation of MTM benefits. Providers wishing to receive a copy of the contract must send their requests to MTMquestions@dhcs.ca.gov.

MTM pharmacy services are benefits for eligible Medi-Cal beneficiaries who meet certain qualifying conditions (refer to part 2 of the Provider Manual for a full list). In addition, the Medi-Cal beneficiary must be using a drug (or drugs) for the treatment of a diagnostic condition (refer to part 2 of the provider manual for a full list). Initially, DHCS will contract for MTM services related to:

      • HIV/AIDS
      • Serious mental health conditions (psychotic disorders, such as schizophrenia/schizoaffective disorder, bipolar disorder, etc.)
      • Cancer
      • Hemophilia
      • Diabetes

Additional conditions will be added on a flow basis in the coming months. MTM pharmacy services are carved out of Medi-Cal managed care. Questions related to the supplemental agreement, contracting process, or MTM services may be submitted to MTMquestions@dhcs.ca.gov.

Medi-Cal Rx Coverage of Over-the-Counter COVID-19 Antigen Test Kits

 January 26, 2022

Effective February 1, 2022, Over-the-Counter (OTC) Emergency Use of Authorization (EUA) U.S.
Federal Drug Administration (FDA)-authorized, self-administered COVID-19 antigen test kits can be billed and reimbursed as a pharmacy-billed medical supply benefit through Medi-Cal Rx in accordance with current Centers for Disease Control and Prevention (CDC) recommendations.

Coverage is restricted to specific 1-test-per-kit or 2-tests-per-kit OTC EUA COVID-19 FDAauthorized, self-administered COVID-19 antigen tests listed in the List of Covered Emergency Use Authorization (EUA) COVID-19 Antigen Tests, which can be found on the Medi-Cal Rx Web Portal under “Forms and Information,” and require dispensing from a pharmacy, written (or electronic equivalent) on a prescription pad signed by a licensed prescriber or a pharmacist. Packages/kits cannot be broken or sold as individual tests.

The following coverage criteria applies:

  • Restricted to EUA for the diagnostic condition of suspected COVID-19 (Code I Restriction).
  • Restricted to up to 8 tests (4 kits for 2 tests/kit) per 30 days per beneficiary.
  • No refills allowed; the beneficiary would need to obtain a new prescription for each
    dispensing

Click here to read the entire article

Centene Corporation’s Acquisition of Magellan Health

December 30, 2021

On December 30, the California Department of Managed Health Care (DMHC) announced the approval of Centene Corporation’s acquisition of Magellan Health, Inc., with conditions to ensure the merger does not adversely impact enrollees or the stability of California’s health care delivery system.

Magellan is DHCS’ Medi-Cal Rx vendor. DHCS had previously identified two areas of conflict if Centene were to acquire Magellan in relation to Medi-Cal Rx.  At DHCS’ direction, Centene developed a conflict avoidance plan to address these issues, and DHCS determined that Centene’s plan addressed such concerns.

Medi-Cal Rx launches on January 1, 2022, and will standardize the Medi-Cal pharmacy benefit under one statewide delivery system.

California Advancing and Innovating Medi-Cal (CalAIM) Waiver Applications Approved by CMS

December 29, 2021

On December 29, 2021, the Department of Health Care Services (DHCS) received approval of the CalAIM Section 1115 demonstration waiver, CalAIM Section 1915(b) waiver, and Medi-Cal State Plan Amendments from the federal Centers for Medicare & Medicaid Services (CMS). This approval provides the authority to launch California Advancing and Innovating Medi-Cal or CalAIM, a long-term commitment to transform and strengthen Medi-Cal – the cornerstone of California’s health care system.

CalAIM shifts Medi-Cal to a population health approach, prioritizing prevention, addressing social drivers of health, and transforming services for communities who historically have been under-resourced and faced structural racism in the health care system. CalAIM is a bold transformation, putting people’s needs at the center of care and setting the pace for transformation of the entire health care sector.

Read the background and key provisions here.

CalAIM Managed Long-Term Services and Supports (MLTSS) and Duals Integration Workgroup Meeting

December 9, 2021

On January 20, 2022, DHCS will hold the CalAIM MLTSS and Duals Workgroup meeting via webinar. Agenda items may include Dual Eligible Special Needs Plan network guidance, including network adequacy, aligned networks, and continuity of care. Other topics may include reporting requirements and quality measures. This workgroup meeting is open to the public. Background materials, transcripts, and video recordings of the previous workgroup meetings, along with additional information about the workgroup, are posted on the DHCS website.  

California Advancing and Innovating Medi-Cal (CalAIM) Updates

December 9, 2021

Mandatory Managed Care Enrollment
Mandatory managed care enrollment will standardize enrollment processes to help ensure populations moving between counties are subject to the same requirements, thereby eliminating variances in benefits according to aid code, population, and geographic location. There are two phases to mandatory managed care enrollment:

Read the entire update here

Managed Care Benefit Standardization
Managed care benefit standardization will help ensure consistency in the benefits delivered by managed care and FFS statewide, reducing complexity and county-to-county differences. The Multipurpose Senior Services Program (MSSP) will be carved out to FFS and operate as a 1915(c) MSSP waiver benefit in all Coordinated Care Initiative (CCI) demonstration counties, effective January 1, 2022. 

Read the entire update here

Dental Initiatives
On September 28, DHCS submitted State Plan Amendment (SPA) 21-0019 to the Centers for Medicare & Medicaid Services (CMS) for federal approval of CalAIM dental initiatives. The SPA is under review; the public comment period ended on September 6. The FFS and safety net clinic (SNC) provider bulletins are published on the Medi-Cal and Medi-Cal Dental websites. Please visit the DHCS website for more information about each CalAIM dental initiative, including required forms and SNC billing requirements.

Medi-Cal Rx Readiness Links

December 3, 2021

Please see below for additional links to support your understanding and readiness for Medi-Cal Rx.

As of January 1, 2022, all pharmacy benefits will transition away from CA-MMIS and the Medi-Cal managed care plans to Medi-Cal Rx. This transition will create a uniform process for pharmacy providers and prescribers and applies to everyone in Medi-Cal FFS and managed care. All benefits that are billed on a pharmacy claim will be transitioned to Medi-Cal Rx and all Prior Authorizations (PA) will be reviewed by Medi-Cal Rx starting on January 1.  

To prepare for Medi-Cal Rx, we encourage you to visit the robust Medi-Cal Rx Education & Outreach page on the Medi-Cal Rx Web Portal to unlock all the training opportunities and informative materials that are currently available. The Medi-Cal Rx YouTube Channel offers training videos, including a video on the transition and the resources that directly impact pharmacy providers and prescribers. We also offer live, instructor-led trainings or join us for an Office Hour Luncheon Session available Monday-Friday, 12 p.m. to 1 p.m. PST (excluding holidays).  Please note that if you use CoverMyMeds® or the fax system to submit Prior Authorizations today, there is no change for you as of January 1. And if your EHR is compatible and configured with CoverMyMeds®, you will continue to do business as usual.

 Read the entire Medi-Cal Rx readiness links document here

Medi-Cal Rx Mailing

November 29, 2021

On or about December 1, all Medi-Cal beneficiaries were sent a 30-day notice regarding the implementation of Medi-Cal Rx on January 1, 2022. This is part of a broader outreach campaign by DHCS to educate Medi-Cal beneficiaries about the pharmacy carve out.

On January 7, 2019, Governor Gavin Newsom issued Executive Order (EO) N-01-19, requiring, among other things, that all Medi-Cal pharmacy services be transitioned from managed care to the fee-for-service delivery system by January 1, 2021 (full implementation was lengthened to January 1, 2022). This transition is a critical step for the success of the CalAIM initiatives proposed by DHCS. Medi-Cal Rx will:

  • Standardize the Medi-Cal pharmacy benefit under one statewide delivery system. This means that no matter what county a person lives in, the same access to their prescriptions is possible.
  • Improve access to pharmacy services.
  • Centralize pharmacy policy, transactions, and reimbursements, leading to greater efficiency for pharmacies and the Medi-Cal program.
  • Strengthen California’s ability to negotiate state supplemental drug rebates with drug manufacturers as the largest Medicaid program in the nation, with more than 14 million beneficiaries.

Please email any questions to RxCarveOut@dhcs.ca.gov.

Contract Drugs List (CDL)

October 22, 2021

What is the Contract Drugs List (CDL)?

The CDL is found on the Medi-Cal Rx Web Portal and contains the searchable Medi-Cal Formulary.  The CDL displays drugs covered by Medi-Cal without a prior authorization (PA).

How Does It Affect Prescribers?

The searchable CDL allows prescribers to easily identify all covered drugs.

What Should I Do?

Registering for the Medi-Cal Rx Web Portal allows for easy access to the Provider Portal, where the CDL can be found through the Forms & Information link on the left-hand side of the screen.

The CDL may also be found in the Tools & Resources drop-down menu on the Education & Outreach page.

Read entire guide here

Medi-Cal Rx Pharmacy Providers Electronic Fund Transfer Set Up and Opt Out

Original Published October 12, 2020; Update Published October 11, 2021


Read the entire letter here

Excerpt below-

The Department of Health Care Services (DHCS) continues to make significant progress and movement toward a full assumption of operations of all pharmacy services on January 1, 2022, to Medi-Cal Rx. To help facilitate a smooth and effective transition for Medi-Cal pharmacy providers, DHCS will be transferring previously established Electronic Fund Transfer (EFT) account information from the existing Medi-Cal fee-for-service (FFS) Fiscal Intermediary to Medi-Cal Rx. However, for those pharmacy providers that do not wish to have their EFT account information transferred over to Medi-Cal Rx for use after the January 1, 2022 assumption of operations, an option to ‘Opt Out’ is available.

 Note: Pharmacy providers that submitted their opt out requests during the first and second opportunities in October 2020 and January 2021 need not opt out a third time.

 EFT allows pharmacy providers the option of receiving Medi-Cal payments via direct deposit. Through EFT, pharmacy providers may have their payments electronically deposited into their bank accounts and eliminate the need for paper warrants.

For those Medi-Cal pharmacy providers that have an established EFT account with the existing Medi-Cal FFS Fiscal Intermediary, as of October 11, 2021, no action is required if those Medi-Cal pharmacy providers do not Opt Out of the transfer. EFT account information for those providers will be used after assumption of operations for Medi-Cal Rx on January 1, 2022.

Click here to read the entire letter

 

Medi-Cal Managed Care All Plan Letter 20-022 Released on COVID-19 Vaccine Administration

August 9, 2021

Ex

Excerpt below-

Consistent with the approach being taken by Medicare through Medicare Advantage Plans, DHCS will carve out the COVID-19 vaccines and associated administration fees from the Medi-Cal managed care delivery system and will reimburse providers under Medi-Cal fee-for-service (FFS) for medical, pharmacy, and outpatient claims. This approach will ease program administration, eliminate challenges with out-of-network provider reimbursements, and keep vaccine administration fee rates consistent for providers regardless of delivery system. […]

Although both the COVID-19 vaccines and associated administration fees will be carved out of the Medi-Cal managed care delivery system to Medi-Cal FFS, including in-home vaccinations, MCPs are reminded that they remain contractually responsible for providing case management and care coordination for their members regardless of whether or not they are financially responsible for the payment of services.

MCPs are encouraged to identify opportunities to use their existing communication pathways to support dissemination of CDPH COVID-19 public health education materials and provider education resources. MCPs should utilize their existing data sources to help identify members who qualify to receive the COVID-19 vaccine in accordance with CDPH guidelines, and attempt outreach to qualifying members and their providers to encourage receipt of the COVID-19 vaccines. MCPs are responsible for coordinating medically necessary care. Care coordination may involve, but is not limited to, assisting members with accessing COVID-19 vaccine administration locations, including non-emergency medical transportation and non-medical transportation as needed, and helping members receive the required number of doses for the COVID-19 vaccines in a timely fashion.

 

Medi-Cal News: Update to Allowable Specialized Services

July 8, 2021

Effective for dates of service on or after July 1, 2021, the list of specialized services that can be billed on an outpatient claim, even when provided on an inpatient basis, is updated. Existing policy currently in place for other allowable specialized services shall remain in place. 

 

Medi-Cal Rx Operational Updates

May 5, 2022

Since February 2022, Medi-Cal Rx has stabilized the Medi-Cal Rx Customer Service Center (CSC) and prior authorization (PA) operations. The Department of Health Care Services (DHCS)
and Magellan Medicaid Administration, Inc. (MMA) have also engaged in an intensive planning process for phased reinstatement of claim edits and PA requirements. As previously communicated, claim edits originally proposed to be reinstated May 1, 2022, will not occur until the education and outreach efforts have been completed. DHCS and MMA are evaluating the appropriate time to terminate this transition policy and will provide detailed information in the coming weeks. Stakeholders will be notified 90 days prior to the retirement of the 180-day transition policy.  Utilizing feedback from various stakeholders, Medi-Cal Rx has created a Special Populations Clinical Liaison (SPCL) Team within the (CSC) that has been trained to serve the specific needs of populations enrolled in California Children’s Services, the Genetically Handicapped Persons Program, and those who have specialty behavioral health conditions. This team is  comprised of pharmacy technicians and pharmacists. 

Read more about the extension of the 180 day transition and the new Special Populations Clinician Liaison Team here

Requirements for Medi-Cal Rx Claims

January 6, 2022

What do Pharmacies Need to Fill Prescriptions?

Important changes for dispensing prescriptions to Medi-Cal Rx beneficiaries include the following:

Pharmacies must have the beneficiary’s Benefits Identification Card (BIC), Client Index Number (CIN), or Health Access Program (HAP) card number to successfully bill for the medication. See the following examples:

  • Beneficiaries will NOT be able to utilize their Managed Care Plan (MCP) ID card
  • If beneficiaries do not currently have a BIC or CIN, they can obtain a new card by contacting their local county office.
  • Providers can look up beneficiary eligibility by logging in to the secured Medi-Cal Rx

Read the entire article here

Pharmacy Claims Denial Issue

January 3, 2022

Medi-Cal Rx has identified a Pharmacy claims denial related to beneficiary eligibility and is working to resolve the problem. 

If you are a pharmacy provider and received Reject Code 65, please see below for next steps:

1. Verify beneficiary eligibility through the following:

a. Log in to Transaction Services via the Medi-Cal Web Portal at: 
https://www.medical.ca.gov/mcwebpub/login.aspx?ReturnUrl=%2fCommon%2fMenu.aspx. 
Refer to the following for available services:

https://files.medi-cal.ca.gov/pubsdoco/Services .aspx.

b. A valid Provider Identification Number (PIN) is needed for access. The PIN is issued when providers enroll in Medi-Cal. In the instance when a provider does not remember their PIN, the Medi-Cal Telephone Service Center (TSC) technical help desk agents are authorized to release the existing PIN once caller validation protocols have been completed. The Medi-Cal TSC phone number is 1-800-541-5555; follow the prompts for the Technical Help Desk.

c. Look up the beneficiary and review the response.

2. If the beneficiary is eligible, retain a screenshot of the eligibility verification results as documentation for later use. 

Read the entire article here 

DHCS Release of CalAIM Community Supports Services

January 1, 2022

 On January 1, 2022, Medi-Cal managed care plans (MCPs) will begin implementing CalAIM Community Supports services in select counties. Subject to approval by DHCS, MCPs may add Community Supports at defined six-month intervals. DHCS will post the elected Community Supports offerings by county and MCP to the DHCS CalAIM Enhanced Care Management (ECM) and Community Supports webpage

Community Supports are medically appropriate and cost-effective alternatives to services covered under the State Plan; are optional services for Medi-Cal MCPs to provide. The 14 pre-approved Community Supports comprehensively address the needs of members, including those with the most complex challenges affecting health, such as homelessness, unstable and unsafe housing, food insecurity, and/or other social needs.

The CalAIM Community Supports elections table identifies (by county and MCP) the 14 Community Supports offerings by MCP in the counties they operate, and specifies the date of implementation for each Community Supports service. 

The table, which will be posted to the DHCS CalAIM ECM and Community Supports webpage, will be updated as needed with new and revised elections approved by DHCS. For more information, please email CalAIMECMILOS@dhcs.ca.gov.

Governor Newsom Appoints Autumn Boylan as Deputy Director in Office of Strategic Partnerships at DHCS

December 21, 2021

Autumn Boylan, 45, of Carmichael, has been appointed Deputy Director in the Office of Strategic Partnerships at the California Department of Health Care Services. Boylan has been Assistant Deputy Director of Integrated Systems at the California Department of Health Care Services since 2020. She was Branch Chief of Program Monitoring and Compliance at the California Department of Health Care Services from 2015 to 2020, Program Manager for the Center for Health Equity at the California Institute for Behavioral health Solutions from 2011 to 2015 and Staff Mental Health Specialist for the Office of Multicultural Services at the California Department of Mental Health from 2007 to 2011. Boylan earned a Master of Public Health degree from the Drexel University School of Public Health. This position does not require Senate confirmation and the compensation is $177,744. Boylan is a Democrat.

CalAIM Communications Resources

December 6, 2021

.DHCS is pleased to announce new communications resources that are designed to share updates on our collective efforts to launch and implement CalAIM. 

CalAIM is a long-term commitment to transform Medi-Cal to make the program more equitable, coordinated, and person-centered to help people maximize their health and life trajectory. As we make progress on its implementation, DHCS recently launched a new webpage that provides accessible and timely information about CalAIM and the latest news and progress.

DHCS also recently launched CalAIM-specific social media channels designed to share key information. Follow for updates on all things CalAIM-related on Facebook and Twitter. Both web and social profiles will provide key updates on the program, its initiatives, stakeholder meetings and implementation.

The success of CalAIM will be a model for transformation of the entire health care sector and DHCS appreciates your continued engagement.

CalAIM Justice-Involved Meeting

December 9, 2021

On November 16, DHCS held a CalAIM Justice-Involved sub-workgroup meeting via webinar on Medi-Cal pre-release application processes. This sub-workgroup will meet monthly from November 2021 through July 2023 to discuss the county inmate Medi-Cal pre-release application mandate and to recommend any enhancements to existing state inmate pre-release application processes. Sub-workgroup members provide regular input on key policies and implementation issues to support the launch and ongoing success of CalAIM justice-involved initiatives. More information is available on the DHCS website. Please email CalAIMJusticeAdvisoryGroup@dhcs.ca.gov with any questions.

Medication Therapy Management (MTM) Update

December 9, 2021

On September 15, DHCS received CMS approval of SPA 21-0028, which adds MTM as a payable FFS pharmacy service provided in conjunction with certain complex chronic medical conditions. DHCS is finalizing provider contracts and expects to initiate the program in December. To participate in the program, Medi-Cal-enrolled pharmacies will be required to enter into a contract with DHCS. The contract will outline the requirements and guidelines necessary to receive reimbursement under this methodology.

MCRxSS Announcement

December 3, 2021

A new alert, CoverMyMeds® and Registration, has been posted to the Medi-Cal Rx Web Portal on 12/03/2021.

If the above link does not take you to this document, simply copy and paste the following link into your browser to access the Bulletins and News page: https://medi-calrx.dhcs.ca.gov/provider/pharmacy-news.

For more information, contact MediCalRxEducationOutreach@magellanhealth.com.

Behavioral Health Justice Intervention Services (BHJIS) Project

November 29, 2021

On November 29, DHCS released a Request for Application (RFA) for $16.25 million to public and private nonprofit organizations to implement the BHJIS Project from February 15, 2022, through February 14, 2023.

Entities may apply for a minimum of $50,000 and no more than $700,000 each to support local and statewide efforts to improve first responder, law enforcement, and other community efforts to address behavioral health crises and divert individuals from criminal justice involvement. Funds may be used to support collaborative planning, hiring, or contracting with behavioral health clinicians and/or peers to be embedded with law enforcement, emergency medical technicians, and other first responders when responding to community situations, training, integration of harm reduction, reentry support, and diversion strategies.

BHJIS is funded by the Coronavirus Response and Relief Supplemental Appropriations Act and awarded by the Substance Abuse and Mental Health Services Administration. Advocates for Human Potential, Inc. will serve as the administrative entity assisting DHCS with overseeing and implementing BHJIS.

Please email any questions to the Behavioral Health Response and Rescue Project at BHRRP@dhcs.ca.gov.

Medi-Cal Rx begins January 1st, Are you ready?

October 29, 2021

As of January 1, 2022, all pharmacy benefits will transition away from CA-MMIS and the Medi-Cal managed care plans to Medi-Cal Rx. This transition will create a uniform process for pharmacy providers and prescribers and applies to everyone in Medi-Cal FFS and managed care. All benefits that are billed on a pharmacy claim will be transitioned to Medi-Cal Rx and all Prior Authorizations (PA) will be reviewed by Medi-Cal Rx starting on January 1.

To prepare for Medi-Cal Rx, we encourage you to visit the robust Medi-Cal Rx Education & Outreach page on the Medi-Cal Rx Web Portal to unlock all the training opportunities and informative materials that are currently available. The Medi-Cal Rx YouTube Channel offers training videos, including a video on the  transition and the resources that directly impact pharmacy providers and prescribers. We also offer live, instructor-led trainings or join us for an Office Hour Luncheon Session available Monday-Friday, 12 p.m. to 1 p.m. PST (excluding holidays).

Read entire letter here

California Rolling Out Incentives to Boost Medi-Cal Vaccination Rates

August 6, 2021

SACRAMENTO — The California Department of Health Care Services (DHCS) today announced the availability of $350 million in incentive payments to encourage vaccinations among Medi-Cal’s 14 million beneficiaries. The vaccination incentive program will also encourage significantly expanded outreach in underserved communities. […]

The new program to boost vaccination rates will allow Medi-Cal managed care plans (MCPs) to earn incentive payments for activities that are designed to close vaccination gaps with their members, based upon lessons learned thus far in the pandemic. Funding will incentivize outreach programs and activities by MCPs and their providers, particularly primary care providers and pharmacies, as well as engage with trusted community organizations, such as food banks, advocacy groups, and faith-based organizations. After an initial payment for start-up costs, additional MCP payments will be conditional upon meeting specific vaccination goals. There will also be funding for MCPs to provide direct member incentives, such as grocery store gift cards, to Medi-Cal beneficiaries.  […]

The incentive program will run from September 2021 through February 2022. DHCS is using $175 million in state General Funds and an additional $175 million in federal funds.  […]

This vaccination incentive program to support local, community-based providers through MCPs can be coupled to the current CalVaxGrant program, which offers up to $55,000 in grant funding to help physician practices vaccinate their communities against COVID-19.Funding for the CalVaxGrant program is awarded on a first-come, first-served basis, so early application submissions are encouraged. Applications will be accepted until September 10, 2021.

Read the entire press release here

California Advancing and Innovating Medi-Cal (CalAIM) Behavioral Health Timeline

August 2, 2021

Based on stakeholder feedback and internal analysis, DHCS will stagger certain CalAIM behavioral health implementation dates. This delay will allow DHCS to continue discussions with stakeholders and allow time for counties to implement and test the policies prior to the official go-live dates. The table below reflects the new go-live dates:

Medi-Cal News: In-Person Signature Requirement for Delivered Medications

June 21, 2021

In an April 28, 2020 article titled, “Temporary Suspension of In-Person Signature Requirement for Delivered Medications,” the Welfare and Institutions Code, Section 14043.341 requirement that “providers who dispense controlled drugs, dangerous drugs or dangerous devices to a Medi-Cal beneficiary to maintain a record of the signature of the person receiving the drug or device” was waived pursuant to Executive Order (EO) N-55-20 in response to the coronavirus disease 2019 (COVID-19) public health emergency.

EO N-55-20 will expire on June 30, 2021 per Governor Newsom’s most recent EO N-08-21 (issued June 11, 2021) to lift specific COVID-19-related executive orders that were put in place since March 2020. The Department of Health Care Services will end this policy change effective July 1, 2021 for all programs. Beneficiaries and clients, or their representatives, will need to sign for medications in person from their home or sign onsite at their provider location.

State of California Accelerates Health Coverage for Medi-Cal Applicants

From CalMatters’ Barbara Feder Ostrov

Californians who sign up for Medi-Cal will now receive immediate health coverage instead of remaining uninsured for months while waiting for their applications to be approved, according to the terms of a settlement finalized Monday.

Unwinding of the COVID-19 Public Health Emergency (PHE)

April 2021

In March 2020, based on the federally declared COVID-19 PHE and Executive Order N-29-20, DHCS directed counties to delay processing of Medi-Cal annual renewals and defer discontinuances and negative actions for Medi-Cal programs to ensure that Californians continued to receive Medi-Cal coverage for the duration of the COVID-19 PHE. In preparation for the resumption of normal Medi-Cal operations after the end of the COVID-19 PHE, DHCS is engaging with the County Welfare Directors Association (CWDA) of California, county Medi-Cal eligibility staff, and Statewide Automated Welfare System (SAWS) representatives to explore ways to address the backlog of renewals and other pending casework resulting from the March 2020 order to suspend these activities. This foundational pre-work is essential to informing the creation of a viable statewide work plan for unwinding the PHE. DHCS will engage with stakeholders in the coming months to communicate the groundwork being established for the work plan, and to solicit feedback that further informs county eligibility operations planning in preparation for the end of the PHE. 

Additional COVID-19 updates

For updated guidance, check the DHCS COVID-19 Response page. The COVID-19 website also has information about local resources, including links to county COVID-19 websites.

CMS Approval of COVID-19 Vaccine Administration Carve-out
Updated: DHCS COVID-19 Vaccine Administration FAQs for Beneficiaries
Updated: DHCS COVID-19 Vaccine Administration FAQs for Providers
Updated: COVID-19 Cases Reported at Licensed or Certified Behavioral Health Facilities 

About the Health Care Access Forums

HCC hosts quarterly Health Care Access Forums each year, connecting stakeholders to discuss and address solutions to potential threats and significant changes to public and private health insurance, state programs, therapies and services, and provider relationships that affect quality of care for people with bleeding disorders.  HCC’s Health Care Access Forums help solve patient access issues and improve collaboration among healthcare providers, pharmacies, and state health care departments.

 

2022 Health Care Access Forum Dates

  Thursday, February 17 (online)
Thursday, June 9 (HYBRID!  – In person Sacramento OR via Zoom)
Thursday, September 8 (TBD)
Thursday, December 8 (TBD)

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