NACDS, jointly with the California Retailers Association and the California Pharmacists Association sent Gov. Gavin Newsome (D) a letter requesting no further delays in the April 1, 2021, planned implementation of the Medi-Cal Rx program. In the letter, we questioned why some providers continue to seem ill-prepared given the nearly two years of lead time given all the collaboration and planning that has been taking place. Further, we stated that both patients and providers are counting on a benefit that is easier to navigate, improves access to pharmacies, and improves California’s drug-price negotiating power. Despite these efforts, the Department of Health Care Services (DHCS) subsequently announced that the transition of Medi-Cal pharmacy services from managed care to fee-for-service is being delayed again and will NOT occur on April 1, 2021, due to the need to review conflict avoidance protocols with respect to the Centene acquisition of Magellan. DHCS stated that they plan to announce further info in May. More information on the announcement can be found here.

Also in California, CalAIM is a multi-year initiative by the Department of Health Care Services (DHCS) to improve the quality of life and health outcomes of Californians by implementing broad delivery system, program, and payment reform across Medi-Cal. The DHCS released for public comment draft requirements documents for two components of CalAIM, (1) Enhanced Care Management (ECM) and (2) In Lieu of Services (ILOS). More information can be found on the CalAIM webpage. The public comment ends on March 12, 2021. Comments should be submitted to CalAIMECMILOS@dhcs.ca.gov.

Also in California, The Board of Pharmacy’s Enforcement and Compounding Committee held a virtual meeting on February 18 on white bagging. More information on the meeting can be found here.

Lastly in California, effective February 2, the state Department of Justice issued a final rule amending provisions on access to and use of the Controlled Substance Utilization Review and Evaluation System (CURES), a database of Schedule II, III, and IV controlled substance prescriptions dispensed in the state.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The Department of Health Care Services (DHCS) submitted a disaster relief SPA to the Centers for Medicare & Medicaid Services requesting an increase in reimbursement rates for DME oxygen and respiratory equipment, retroactively effective for dates of service beginning on or after March 1, 2020, or at a later date when DHCS implements the new procedure code. DHCS seeks reimbursement rates for 100 percent of the corresponding Medicare rate. The federal fiscal impact for the rate increase is estimated at $3.4 million.

Also in California. The Department of Health Care Services (DHCS) will not resume retroactive pharmacy claim adjustments on February 11. The retroactive pharmacy claim adjustments due to a change in the reimbursement methodology for covered outpatient drugs in 2017 will continue to be paused until further notice. This pause will apply to all pharmacy claims billed through the Medi-Cal fee-for-service Fiscal Intermediary and includes those claims that were also subject to an alternative payment arrangement.

Also in California. The Board of Pharmacy issued a proposed rule establishing training requirements for pharmacists to independently initiate and provide to patients HIV preexposure and postexposure prophylaxis. The rule also would establish related recordkeeping requirements.

Lastly in California. NACDS co-signed a Coalition letter supporting Gov. Gavin Newsom’s (D) budget proposal authorizing Medi-Cal coverage for Continuous Glucose Monitoring Systems.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The Department of Public Health issued new guidance regarding COVID-19 vaccine administration and a notice from the Board of Pharmacy about the new guidance was posted in the “COVID-19 Information Box” on the Board’s website.

Also in California. CalAIM is a multi-year initiative by the Department of Health Care Services (DHCS) to improve the quality of life and health outcomes of our Medi-Cal population by implementing a broad delivery system, program, and payment reform. The major components are (1) the Whole Person Care Pilots, (2) Health Homes, and the (3) Coordinated Care Initiative, and will result in a better quality of life for Medi-Cal members as well as long-term cost savings. At the January 28 virtual meeting, DHCS presented a revised CalAIM proposal. DHCS also released a revised Executive Summary that includes a summary of major changes from the original proposal.

Also in California. DHCS, the California Department of Public Health (CDPH), and the California Department of Social Services (CDSS) are co-facilitating a new all-behavioral health provider call that is held every Wednesday at 8 AM PT to discuss topics such as COVID-19 vaccination updates, emergency staffing, and facility flexibilities. It also includes updates from DHCS, CDPH, CDSS, and the California Health and Human Services Agency. More information about the behavioral health all-provider call, including call-in information, meeting notes, and frequently asked questions (FAQs), can be found on the DHCS website.

Also in California. The DHCS released its telehealth policy recommendations consisting of broad-based telehealth policy changes that would remain permanent fixtures following the eventual termination of the COVID-19 public health emergency (PHE). DHCS is seeking to modify or expand the use of synchronous telehealth, asynchronous telehealth, telephonic/audio-only, other virtual communication and to add remote patient monitoring to create greater alignment and standardization across delivery systems, as indicated. DHCS’ proposal includes advancing the following telehealth policy recommendations effective July 1, 2021. For more information relative to DHCS’ full post-PHE telehealth policy recommendations, please review the telehealth policy recommendations document, which is available on both DHCS’ Telehealth webpage and DHCS’ COVID-19 Response page. DHCS is also proposing trailer bill legislation (TBL), which will be posted on the Department of Finance’s TBL webpage.

Also in California. The DHCS released the “Medi-Cal Specialty Disease Pharmacy Reimbursement Study” aimed at analyzing specialty disease state drug reimbursement to Medi-Cal fee-for-service (FFS) pharmacy providers. The purpose of the two-part survey was to compare the National Average Drug Acquisition Cost (NADAC) price benchmark against Average Acquisition Cost (AAC) in California for a select group of specialty drugs. Additionally, the survey asked specialty pharmacy providers to list specialized services provided to Medi-Cal beneficiaries to ensure adherence and compliance and to monitor positive and negative outcomes from the drug therapy. The survey report memo, report, and appendices are available on the DHCS website.

Lastly in California. Gov. Gavin Newsom (D) signed an Executive Order aimed at bolstering efforts to vaccinate as many Californians as possible as quickly as possible by protecting certain health care professionals and providers from legal liability when they render services at the request of state or local officials during a state of emergency.

For more information, contact NACDS’ Mary Staples at 817-442-1155.