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.

The Board of Pharmacy voted to pursue legislation in 2021-22 to make the Department of Consumer Affairs (DCA) temporary waiver allowing pharmacists to order and administer CLIA-waived tests for COVID and influenza permanent.

Also in California. The Department of Health Care Services (DHCS) continues to make significant progress and movement toward a full assumption of operations of all pharmacy services on April 1, 2021, to Medi-Cal Rx.

• To facilitate the transition for Medi-Cal pharmacy providers, DHCS will be transferring previously established Electronic Fund Transfer (EFT) account information from the existing Medi-Cal fee-for-service (FFS) Fiscal Intermediary to Medi-Cal Rx. For those pharmacy providers that do not wish to have their EFT account information transferred over to Medi-Cal Rx for use after April 1, 2021, assumption of operations, an option to “opt-out” is available. Registered users who wish to provide new or modified EFT account information to Medi-Cal Rx for use after the Medi-Cal Rx assumption of operations may do so at the following link: https://medi-calrx.dhcs.ca.gov/.
• The Medi-Cal Rx website will be fully operational by April 1, 2021. DHCS encourages Medi-Cal providers to sign up for the Medi-Cal Rx Subscription Service (MCRxSS) so that interested parties can receive Medi-Cal Rx updates.

Also in California. Pharmacies can submit batch and hard copy claims for COVID-19 vaccine administration. More information can be found about claims submission can be found here.

Also in California. In 2019, the Department of Health Care Services (DHCS) had temporarily suspended retroactive pharmacy claim adjustments. DHCS will resume retroactive pharmacy claim adjustments beginning in February of 2021. Refer to Frequently Asked Questions on the Medi-Cal Website for additional information.

Also in California. In response to members’ requests, NACDS submitted a joint letter with the California Retailers Association to the San Diego County Health and Human Services Agency urging them to remove the Vaccines-for-Children enrollment barrier so citizens can receive COVID vaccines at their local convenient community pharmacies.

Also in California. The Department of Managed Care provided notice and guidance on Covid-19 vaccine coverage and administration for the Medi-Cal managed care program. Please visit the above link for more information.

Also in California. Gov. Gavin Newsom (D) issued an Executive Order extending liability protections for healthcare providers during state and local emergencies to healthcare providers participating in the state’s vaccine administration program.  The Order applies to both pharmacists and pharmacy technicians.  More information can be found here.

Also in California. The DHCS issued guidance reminding Medi-Cal providers that they are prohibited from illegally discriminating against Medi-Cal members. Also, in the context of the COVID-19 PHE, providers are prohibited from illegally discriminating against Medi-Cal members in determining how to allocate scarce resources for the treatment of COVID-19. DHCS’ Office of Civil Rights has an established discrimination complaint process for Medi-Cal consumers to file grievances of alleged discrimination. More information is available on the DHCS website.

Lastly, in California. The DHCS held a webinar to provide an overview of the relaunch of the California Advancing and Innovating Medi-Cal (CalAIM) initiative.  CalAIM builds upon prior successes in health care delivery and proposes to provide more services and supports for patients with complex needs. Key goals of CalAIM include promoting whole-person care, reducing program complexity, and modernizing systems. For more information, please visit the CalAIM webpage.

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

The Department of Health Care Services (DHCS) Medi-Cal is on track for April 1, 2021, to move from managed care to fee-for-service. DHCS has received approval from the Centers for Medicare & Medicaid Services (CMS) for numerous projects, including the transition of the Medi-Cal pharmacy benefit from managed care to fee-for-service. For more information about Medi-Cal Rx, please visit DHCS’ dedicated Medi-Cal Rx Transition website: Medi-Cal Rx: Transition

Also in California. DHCS submitted a State Plan Amendment (SPA) 20-0046 to CMS, which seeks to set reimbursement for COVID-19 testing administered to Medi-Cal students in schools at 70 percent of the Medicare reimbursement rates. The effective date of this SPA is February 1, 2021.

Also in California. The California Department of Public Health released new guidance on vaccine prioritization on January 7. The guidance recognizes the need to balance the prioritization of scarce vaccine resources to achieve community immunity for all Californians by noting situations in which the health departments and providers may offer doses promptly to people in lower priority groups, including provider flexibility to eliminate vaccine spoilage.

Also in California. The Board of Pharmacy reminded pharmacies that they must register their mobile vaccination clinics/hubs where their pharmacist and pharmacy technicians are providing vaccinations outside the pharmacy. All that is required is the pharmacy name and license, and records related to vaccinations should be kept at the pharmacy to be made available if needed for an inspection. Chain companies can provide one list of all their licensed pharmacies in California where there is a mobile COVID vaccine clinic or COVID vaccine administration outside the pharmacy. For more information contact Amber Dillon at Amber.Dillon@dca.ca.gov.

Also in California. The Board of Pharmacy provided guidance on new compliant security prescription forms for instances where a prescriber may not have utilized a compliant security prescription form for a controlled substance on and after January 1, 2021, as required by Assembly Bill 149 (Statutes of 2019). For additional information, go to the Joint Statement and FAQs from the California Department of Justice, the California State Board of Pharmacy, and the Medical Board of California.

Also in California. On January 7, the Office of Administrative Law (OAL) approved the Pharmaceutical and Sharps Waste Stewardship Program Regulations, which are effective immediately.

Also in California. The Administration’s Medi-Cal reform initiative that got delayed last year due to COVID was revised and released last week. The CalAIM executive summary is attached and here is a link to the website.

Lastly in California. In case you missed it, before the holidays, the California Department of Consumer Affairs (DCA) issued an order waiving restrictions on pharmacy technicians related to administering COVID-19 vaccinations with specific conditions: DCA Waiver DCA-20-103 Order Waiving Restrictions on Pharmacy Technicians Relating to Administering COVID-19 Vaccines.

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