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News & Updates

CMS Approval SPA 19-0015 Reimbursement Methodology for Clotting Factor Drugs

February 13, 2020 at 1:49:11 PM PST

The Centers for Medicare & Medicaid Services (CMS) published its Final Rule on Covered Outpatient Drugs (CODs) on February 1, 2016, (81 Fed.Reg. 5170). This rule implements provisions of the 2010 Patient Protection and Affordable Care Act pertaining to Medicaid reimbursement for CODs, and requires states to document the blood factor reimbursement methodology as part of the State Plan.

On February 11, 2019, the Department of Health Care Services (DHCS) received CMS approval of State Plan Amendment (SPA) 19-0015 with an effective date of July 1, 2020. This SPA establishes reimbursement for clotting factor drugs (defined as coagulation factors and their recombinant analogs) as follows: Click here for the rest of the update.

Governor Newsom Announces Jacey Cooper Appointment as Medi-Cal Director and Chief Deputy Director of DHCS

Jacey Cooper will replace Mari Cantwell, who is stepping down from the Medi-Cal Director post. 

Jacey K. Cooper, 37, of Bakersfield, has been appointed state Medicaid director and chief deputy director of health care programs at the Department of Health Care Services. Cooper has been assistant deputy director of health care delivery systems at the Department of Health Care Services since 2016. She was vice president at Meridian Healthcare Partners and vice president of administrative services at the Kern Medical Center from 2014 to 2016. She held several positions at Kern Medical Center from 2010 to 2014, including special projects manager and executive director of managed care. Cooper was a senior project manager at COPE Health Solutions from 2009 to 2010 and held several positions at Marsh ClearSight LLC from 2005 to 2009, including quality assurance analyst and product manager. 

 For the link or information about the other DHCS appointees,  Click here.

Greater Transparency on Deferred Blood Donations the Focus of New Bill

California Senate President pro Tempore Toni G. Atkins (D-San Diego) today introduced SB 851, calling for greater transparency when an individual’s blood donation is deferred.

“Many blood banks and plasma centers in California are experiencing shortages, including in my own community. That’s why I am proud to author SB 851, which will help Californians better understand the circumstances if they are told they are unable to donate blood, and which will also help prevent arbitrary discrimination from blocking safe blood donations,” Atkins said. “SB 851 requires blood banks and plasma centers to provide potential donors with legitimate reasons if they are deemed unable to donate. With SB 851 we can maximize the number of Californians who know if and when they are able to donate blood, and we can ensure that science and safety, not someone’s personal prejudice, are behind decisions affecting the blood donations our communities so badly need.”  

 For the link or more information,  Click here.

Healthy California for All Stakeholder Advisory

Healthy California for All Commission to Hold Inaugural Meeting 

The Healthy California for All Commission will hold its first meeting January 27, beginning its work to develop a plan for advancing progress toward achieving a health care delivery system for California that provides coverage and access through a unified financing system, including, but not limited to a single payer financing system.

The Commission’s 13 voting members include California Health and Human Services Secretary Mark Ghaly, eight gubernatorial appointees and four legislative appointees. There are also five ex-officio, non-voting members.  At the first meeting, Commission members will consider the history of health reform in California and take stock of health care in the state today. The Commission’s agenda is here. And more information is available on the Healthy California for All website

 For the link and more information, Click here

Medi-Cal Rx Frequently Asked Questions

Medi-Cal Rx: Transitioning Medi-Cal Pharmacy Services From Managed Care To Fee-For-Service Frequently Asked Questions
The linked Frequently Asked Questions document provides additional guidance and clarification to Medi-Cal beneficiaries, providers, plan partners, and other interested parties, regarding the January 2021 transition of Medi-Cal’s pharmacy benefit (collectively referred to as “Medi-Cal Rx”).  For the link and more information, Click here.

DHCS’ Behavioral Health Organizational Change
February 20, 2020

The Department of Health Care Services (DHCS) recently completed a departmental reorganization of our Behavioral Health (formerly known as Mental Health/Substance Use Disorder) functions. Specifically, as of July 1, 2019, the divisions under the former Mental Health and Substance Use Disorder Services, now known as Behavioral Health, reorganized and formed new divisions: Community Services and Licensing and Certification (under Behavioral Health); Medi-Cal Behavioral Health (under Health Care Programs); and Local Governmental Financing (under Health Care Programs’ Health Care Financing). The purpose of the reorganization was to preserve the unique policy/program area of Behavioral Health while better integrating it with the Department’s overall health care system to improve outcomes and increase efficiencies department-wide.
For the link to the organization chart or to view the entire update.

Medi-Cal Rx Public Forum meeting – February 18, 2020

Please mark your calendars for the February 18, 2020, Medi-Cal Rx Public Forum, which will be held in the Department of Health Care Services (DHCS) Auditorium at 1500 Capitol Avenue in Sacramento, California. This will be the third meeting in a series of meetings that began in July 2019 and will continue throughout 2020. The meetings are related to DHCS’ ongoing stakeholder engagement efforts for the Governor’s Executive Order N-01-19, which requires DHCS to, in part, transition pharmacy services for Medi-Cal managed care to fee-for-service (FFS) by January 1, 2021.

All interested organizations and entities, including hospitals, clinics, health plans, counties, pharmacies, tribal health programs, and consumer advocates, are invited to participate in the one-hour forum either in person or via webinar. During this meeting, DHCS will provide status updates to help ensure that the broader stakeholder community is kept up to date about Medi-Cal Rx implementation activities and timelines. Please note that DHCS will only take questions and comments from those participants attending in person. Click here for links and to view the entire press release.

Governor Newsom Announces Bradley P. Gilbert as Director of the California Department of Health Care Services

Bradley P. Gilbert, 63, of Irvine, has been appointed director of the California Department of Health Care Services. Gilbert has been a retired annuitant at the Inland Empire Health Plan since 2019, where he has held several positions since 1996, including medical director, chief medical officer and chief executive officer. He was director of public health at the County of Riverside Health Services Agency Department of Public Health from 1993 to 1996. Gilbert was director of public health at the San Mateo County Department of Health Services Division of Public Health. He is a board member of the California Healthcare Foundation, Planned Parenthood and Manifest Medex. Gilbert earned a Master of Public Policy degree from the University of California, Berkeley and a Doctor of Medicine degree from the University of California, San Diego School of Medicine. This position requires Senate confirmation and the compensation is $215,124. Gilbert is a Democrat.  For links to the press release and additional biographies.

Medi-Cal Healthier California for All — BH Workgroup Meetings Schedule

The schedule for the Medi-Cal Healthier California for All and the BH Payment Reform Workgroup recently changed.

The BH Workgroup meeting scheduled on January 24, 2020, has been CANCELED.

Below is a summary of remaining BH Workgroup and BH Payment Reform Workgroup meetings. The public is welcome to attend all meetings by phone in listen-only mode or in person. For more information about how to attend a meeting by phone or in person, visit the BH Workgroup webpage:

  • January 29, 10 a.m. to 3:30 p.m.
    • Topic: Medical Necessity
  • January 30, 10 a.m. to 3 p.m.
    • Topic: BH Integration
      To see the rest of the schedule, click here.

Medi-Cal Healthier California for All:  Updates and Announcements

Based upon the thoughtful discussions occurring through the Medi-Cal Healthier California for All Workgroups, DHCS has made the following changes to the proposals under consideration:

  • Annual Health Plan Open Enrollment. The state has decided not to continue to pursue the Annual Health Plan Open Enrollment policy. This proposal will no longer be a topic of discussion in the Population Health Management workgroup meetings. 

  • Targeted Case Management. DHCS has clarified its policy regarding the proposal to discontinue Targeted Case Management for Medi-Cal managed care members. The state will no longer pursue the policy change, but will be asking managed care plans to take steps to ensure that enrollees do not simultaneously receive Targeted Case Management and Enhanced Care Management services.

  • Frequently Asked Questions. A Frequently Asked Questions document has been released to address questions regarding the Long-Term Care Carve-In.

For the rest of the update and links, Click here