November 15, 2019 Edition
of Health Care Services (DHCS) recently issued a series of updates related to
CalAIM, behavioral health integration, and pharmacy services.
As you recall,
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
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.
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.
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.
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.
the CalAIM Website: The
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.
Health Integration Incentive Program
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.
Rx FAQ Document Now Available
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
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
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.
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
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.”
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.
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.
announcement related to the price transparency efforts from DHHS is available here.
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.
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.
key findings include:
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.
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.
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.
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
The full PPIC
report is available here.
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
for the upcoming webinar is available here.