November 15, 2019 Edition

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
  • 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 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 The FAQ document is available here.

CDPH Releases 2018-19 Childcare Immunization Report

The California Department of Public Health (CDPH) this week released a report and listing of schools summarizing fall immunization rates at childcare facilities for the previous 2018-19 school year. The most recent report found that 95.9 percent of children attending childcare facilities in 2018-19 were reported to have received all required vaccinations, a 0.3 percentage point increase from the 2017-18 school year and a 6.7 percentage point over a five-year period since 2013-14. The 2018-19 rate is the highest reported rate for the current set of immunization requirements for childcare facilities which began in the 2001-02 school year.

Further, in 2018-19, five (9%) counties reported fewer than 95 percent of their children as having received one or more doses of MMR vaccinate, compared to three (5%) counties in 2017-18 and 17 (29%) counties in 2015-16. The proportion of children in 2018-19 reported as having a permanent medical exemption increased from 0.6 percent to 0.7 percent compared to 2017-18.

The full report from CDPH is available here.

Trump Administration Finalizes Rule, Proposes Another Related to Price Transparency Requirements For Hospitals and Insurers

Following an executive order issued by President Donald Trump in June, the Trump Administration today announced two actions to compel hospitals and insurers to provide patients with more information on the cost of health services prior to their utilization. The Trump Administration finalized a rule that requires hospitals to make public their secret, negotiated rates beginning in January 2021. By disclosing hospital standard charges, the Trump Administration contends, the public will have information necessary to make more informed decisions about their care, in turn increasing market competition, and ultimately driving down the cost of health services.

The finalized rule specifies that costs to be disclosed include negotiated prices as part of an insurer’s network, the amount hospitals are paid if care is out-of-network, and what the hospital would accept for the treatment if paid in cash. In announcing the finalized rule, Secretary of the U.S. Department of Health and Human Services (DHHS) Alex Azar claimed, “American patients have been at the mercy of a shadowy system. This shadowy system has to change. Today’s transparency announcement may be a more significant change to American health care markets than any other single thing we’ve done.”

The hospital industry has long kept cost information private, and hospital entities contend they should not be required to disclose what they consider proprietary information. In public comments, hospitals largely argued that disclosing their negotiated rates may backfire, leading hospitals that are charging less than a nearby hospital to raise their prices to more closely match the price of their competitor. Included in the rule for hospitals that do not comply with the regulation is a maximum fine of $300 per day, an amount that many experts find to be low. Legal challenges by hospital entities to the mandated price disclosures are widely expected.

The second component of today’s announcement by the Trump Administration is a proposed rule to require most employer-based group health plans and health insurers offering group and individual coverage to disclose to patients expected price and cost-sharing information through an online tool. The proposed rule, according to DHHS, is intended to drive more price-conscious decision-making among consumers and would encourage health insurers to offer new or different plan designs to incentivize consumers to shop for services form lower-cost, high-value providers. The proposed rule must undergo a 60-day public comment period, and it is unclear when the rule may take effect.

The full announcement related to the price transparency efforts from DHHS is available here.

Reminder: Public Health Accreditation Readiness Survey

Last week, CHEAC sent out our annual survey to assess California local health department readiness to apply for national public health accreditation. Currently 16 local health departments, as well as the California Department of Public Health, have completed the public health accreditation process and been awarded. CHEAC’s survey is intended to track California’s progress statewide. If you have not yet completed the survey for your jurisdiction, please do so here.

PPIC Publishes Report on Medi-Cal Expansion and Children’s Well-Being

The Public Policy Institute of California (PPIC) recently published a report exploring trends in health insurance coverage for California children and the adults they live and interact with, as well as recent research on the effects of Medicaid expansion related to family well-being. The report seeks to gain a better understanding of the impact of adult Medi-Cal expansion and coverage on child well-being and improvements in outcomes for low-income children and families.

The report’s key findings include:

  • Since the Affordable Care Act (ACA) coverage expansion, uninsured rates among California’s low-income children have declined by more than 60 percent. The share of children living with uninsured parents or other adults in their household also declined substantially.
  • Despite the coverage gains, approximately 20 percent of low-income children continue to live with an uninsured parent. Among low-income children in households headed by non-citizen Latinos, these shares are substantially higher with more than 40 percent continuing to live with an uninsured parent.
  • Strong evidence from national research shows that Medicaid expansion improved adults’ financial and behavioral health. Medicaid participants experienced fewer negative financial shocks such as “catastrophic” medical expenses, bills in collection, bankruptcy, and evictions. Broader financial health indicators, such as credit scores, also improved.
  • Research also finds a reduction in depression symptoms. Medicaid covers the cost of additional behavioral health-related prescription drugs and treatment, including medications for depression and substance use disorder.

PPIC points to the longstanding associations of adult financial security, mental well-being, and the absence of addiction with positive child outcomes to suggest that children are benefitting from the ACA’s Medicaid expansion. Further research is needed to determine whether California’s Medi-Cal expansion is indeed leading to improvements in child mental health and welfare, particularly among Latinos and non-citizens.

The full PPIC report is available here.

Upcoming Webinar to Feature Value of CHWs and Peer Providers

Families USA Health Action Network will host a webinar next Wednesday, November 20 from 11:00 am to 12:00 pm to feature new research and recommendations related to the value of community health workers (CHWs) and peer providers (PPs) as versatile health equity change agents. During the webinar, presenters will discuss equity-focused policy recommendations from the recent report, “Advancing Health Equity through Community Health Workers and Peer Providers: Mounting Evidence and Policy Recommendations.”

Registration for the upcoming webinar is available here.