Provider Digest | Issue 18

Funding for CBI improvements, updates to Medi-Cal Rx prior auths

Feedback Session: Proposals for 2024 Care-Based Incentive program and Provider Portal

Rescheduled! Wednesday, March 1, 2023

Noon to 1 p.m. on Microsoft Teams (online)

Register

If you have already registered for the previous session, please re-register for the new session date.

Find more information on our website.

New: Care-Based Quality Improvement Program

The Alliance is offering a one-time Care-Based Quality Improvement Program (CB QIP) providing financial investment in practices to make quality improvement interventions. The CB QIP will help practices make sustained improvements in staffing, processes and technology that will help improve quality metrics.

This program is for participating sites with quality metrics below the 50^th percentile, which as a result are set to lose 25-100% of the 2022 Care-Based Incentive (CBI) payment.

Payment

Payment will be based on:

• Linked member months.
• Effort to complete the measure for a member.
• Gap between current performance and the 50^th percentile for the minimum performance level (MPL).

Prioritized measures

• Well-Child Visits in the First 15 Months.
• Immunizations: Children.
• Child and Adolescent Well-Care Visits (3-21 years).
• Immunizations: Adolescents.
• Diabetic HbA1c Poor Control >9.0%.
• Cervical Cancer Screening.
• Breast Cancer Screening.
• Chlamydia Screening in Women.

Application coming soon

The application will open in March, with application decisions following the validation of the 2022 CBI quarter four performance. Following initial application approval, your practice must complete a letter of agreement to participate in the program and receive funding. We will share application links soon.

The application will include:

• Measure Selection, Best Practice Checklist, and a SMART (Specific, Measurable, Achievable, Realistic, Timebound) AIM Statement.
• Supplemental Program Details Document outlining:
  • Program Overview.
  • Expectations for Involvement (How funding can be used, meeting and feedback participation, etc.).
  • Program Resources (best practices, Alliance practice coaching).

If you’d like to participate in quality improvement activities before the CB QIP starts, we have year-round practice coaching support available. Please reach out to your Alliance Provider Services Representative at 800-700-3874, ext. 5504 or email [email protected].

If you have questions regarding the CBI program, please email [email protected].

As of Feb. 24, Medi-Cal Rx PA requirements reinstated for 46 Standard Therapeutic Classes

Beginning Feb. 24, 2023, prior authorization (PA) requirements will be reinstated for 46 additional Standard Therapeutic Classes (STCs) for beneficiaries 22 and older (Phase II, Wave 2).

For full details, please review the Jan. 24 notification from DHCS. You can also keep up to date on Medi-Cal reinstatement on the Medi-Cal Rx Education and Outreach webpage.

Additional resources

• Medi-Cal Rx Phase II – Frequently Asked Questions
• How to Prepare for Retirement of the Transition Policy

You can attend a Medi-Cal Rx Reinstatement Webinar every Friday at noon or watch a recording of the webinar at your convenience.

Important upcoming dates

• March 24, 2023: DHCS will begin to lift transition policies that were in place for beneficiaries ages 22 years and older (Phase III).

Questions?

Call the Medi-Cal Rx Customer Service Center at 800-977-2273 (available 24/7) or email Medi-Cal Rx Education & Outreach at [email protected].