DHCS Issues Updates on CalAIM, Behavioral Health, and Pharmacy Initiatives

The Department of Health Care Services (DHCS) recently issued a series of updates related to CalAIM, behavioral health integration, and pharmacy services.

CalAIM Stakeholder Process

As you recall, DHCS recently revealed its California Advancing and Innovating Medi-Cal (CalAIM) proposal, the multi-year initiative by DHCS to improve the quality of life and health outcomes of Medi-Cal beneficiaries by implementing broad delivery system, program, and payment reforms. DHCS encourages stakeholder engagement through the CalAIM planning and policy development initiative process through a variety of means:

  • Submit Comments via Email: DHCS is soliciting public comments by December 16, 2019, in order to incorporate considerations into future CalAIM workgroups and early discussions with stakeholders. DHCS will continue to accept comments until February 29, 2020, but comments may not be incorporated into CalAIM workgroup discussions. Comments may be submitted to CalAIM@dhcs.ca.gov.
  • Engage in CalAIM Workgroup Meetings: DHCS has established five topic-specific stakeholder workgroups to further explore specific components of the CalAIM proposal. Workgroups will be meeting between November 2019 and February 2020. Workgroup schedules, materials, and in-person and phone attendance information is available on the CalAIM webpage. Each workgroup meeting includes a public comment period for in-person attendees, and written comments may be submitted to CalAIM@dhcs.ca.gov up to seven calendar days following each meeting.
  • Attend DHCS Stakeholder Meetings: While the bulk of CalAIM issues will be discussed through CalAIM workgroups, some topics will be presented for discussion during the Stakeholder Advisory Committee (SAC), Behavioral Health Stakeholder Advisory Committee (BH-SAC), and other DHCS-sponsored stakeholder meetings. Stakeholders are welcome to attend the stakeholder meetings in-person or via phone. Each meeting includes a public comment period for in-person attendees.
  • Subscribe to Receive Email Updates: DHCS established a CalAIM newsletter to alert stakeholders about important announcements and to highlight upcoming stakeholder events focused on CalAIM. Stakeholders may subscribe to DHCS’ email service here.
  • Visit the CalAIM Website: The CalAIM page on the DHCS website hosts information and materials regarding the CalAIM proposal, and is updated on a real-time basis to include the latest developments and information about CalAIM workgroup meetings.

Behavioral Health Integration Incentive Program

DHCS announced that applications for its Behavioral Health Integration (BHI) Incentive Program are due on January 21, 2020. The BHI Incentive Program incentivizes Medi-Cal managed care plans (MCPs) to improve physical and behavioral health outcomes, care delivery efficiency, and patient experience by establishing or expanding fully integrated care into their networks. The goal of the program is to increase MCP network integration for providers at all levels of integration, focus on new target populations or health disparities, and improve the overall level of integration or impact.

In order to apply, providers must complete and sign an application and submit it directly to their local MCP. Providers should not send the application directly to DHCS. If a provider is awarded BHI funding by the MCP, the selected MCP will be responsible for oversight and payment to the provider meeting the BHI program milestones, based upon the approved application. DHCS will host an informational webinar on Friday, November 22 at 1:00 pm to provide further information and answer questions. Additional information, including a process guide and scoring tool, will be made available on DHCS’ website here.

Medi-Cal Rx FAQ Document Now Available

DHCS recently posted a frequently asked questions (FAQ) document titled, “Medi-Cal Rx: Transitioning Medi-Cal Pharmacy Services from Managed Care to Fee-For-Service.” The FAQ document provides guidance and clarification to Medi-Cal beneficiaries, providers, plan partners, tribal health programs, and other interested parties regarding the January 1, 2021, transition of the Medi-Cal pharmacy document. DHCS will update the FAQ document as it receives additional questions. Questions or comments may be submitted to RxCarveOut@dhcs.ca.gov. The FAQ document is available here.