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›› ITUP BlogCalAIM Summary and TimelineAll Things CalAIM!June 2021What is CalAIM?California Advancing and Innovating Medi-Cal (CalAIM) is a multi-year initiative by the Department of Health CareServices (DHCS) to improve the quality of care provided to Medi-Cal members by implementing broad deliverysystem, program, and payment reform across the Medi-Cal program. The major components of CalAIM build uponthe lessons learned of various pilots (including, but not limited to, the Whole Person Care Pilots (WPC), HealthHomes Program (HHP), and the Coordinated Care Initiative (CCI)/Cal MediConnect).Three Primary CalAIM Goals1. Identify and manage member risk and need through whole-person care approaches and addressing socialdeterminants of health;2. Move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility;and,3. Improve quality outcomes, reduce health disparities, and drive delivery system transformation andinnovation through value-based initiatives, modernization of systems, and payment reform.ResourcesThere is a wealth of information online around CalAIM. ITUP has categorized informational webpages and provideddirect links below to help stakeholders navigate the many available resources.Additionally, CalAIM, as an initiative, will work in concert with other DHCS initiatives as well as items in the statebudget and bills in the Legislature. It is important to track these other items alongside CalAIM to understand howeach of these works separately and together. These include: Medi-Cal managed care plan procurement; Medi-Cal1115 waiver and 1915(b) waiver renewals; the CA state budget; and the CA state Legislature/bills. Direct links tothose are included here and more context is provided at the end of this document.1. CalAIM and Medi-Cal Waiversa. DHCS CalAIM Webpageb. DHCS Revised CalAIM Proposalc. CalAIM Executive Summary and Updatesd. DHCS 2021 CalAIM Proposal Overview Presentation, January 2021e. Enhanced Care Management and In Lieu of Services Webpagef. CalAIM 1115 and 1915(b) Waiver Renewal Webpageg. Foster Care Model of Care Workgroup

2.3.4.5.6.Insure the Uninsured Project CalAIM Summary and Timelineh. Medi-Cal 2020 1115 Waiver Webpagei. Medi-Cal 1915(b) Specialty Mental Health Waiver Webpagej. Medi-Cal Specialty Mental Healthk. DHCS Whole Person Care Pilotsl. DHCS Health Homes Programm. DHCS Dental Transformation Initiativen. PRIME Webpageo. Cal MediConnect Webpage and CalDuals.orgp. Drug Medi-Cal Organized Delivery SystemDHCS Medi-Cal Managed Carea. DHCS Medi-Cal Managed Care Plan Procurement Webpageb. DHCS Medi-Cal Managed Care Resourcesc. Medi-Cal Managed Care County Mapd. Medi-Cal Managed Care Plan Models Fact SheetSubscribe to DHCS Stakeholder UpdatesCA State Budgeta. State Budget Webpageb. May Revision 2021 Health and Human Services Budget Summaryc. DHCS May Revision 2021 Budget Highlightsd. CA State Senate Budget Subcommittee #3 on Health and Human Servicese. CA State Assembly Budget Subcommittee #1 on Health and Human ServicesCA State Legislative Billsa. Legislative Bills and Committee Analyses Look-Up Toolb. Senate Legislative Committeesc. Assembly Legislative CommitteesITUP Resourcesa. ITUP May Revision Budget Blogb. ITUP Legislative Bills Blogc. ITUP CalAIM Brief February 2020d. ITUP Medi-Cal 1115 and 1915(b) Waivers Discussion Guide October 2019CalAIM Timeline and Major ElementsCalAIM Delayed Due to PandemicIn February 2020, ITUP published a CalAIM Issue Brief detailing the initial CalAIM proposal put forth by DHCS in Fall2019. Originally, DHCS intended to implement CalAIM January 2021; however, due to the COVID-19 public healthemergency, DHCS delayed initial implementation to January 1, 2022.Revised CalAIM Proposal and New Start Date/Phased-In ImplementationDHCS published a revised CalAIM proposal, updated based on their extensive stakeholder feedback process, and a25-page Executive Summary on January 8, 2021. Much of the revised proposal remained the same as in theoriginal; however, starting on page 18 in the Executive Summary, you can find a chart with key changes since theoriginal release.2

Insure the Uninsured Project CalAIM Summary and TimelineMajor Elements and Timing of CalAIMCalAIM InitiativeHospital Quality IncentiveProgram1115 Waiver Medi-Cal 202012-Month ExtensionFoster Care StakeholderWorkgroupSubmit 1115 and 1915(b)Waiver Renewals to CMSCMS Approval of WaiverRenewal RequestsNew Dental BenefitsEnhanced Care Management(ECM)In Lieu of Services (ILOS)Drug Medi-Cal OrganizedDescriptionPRIME Program transitions to theQuality Incentive Program.The Centers for Medicare andMedicaid Services (CMS) approvedthe state’s request for a 12-monthextension of its 1115 waiver “MediCal 2020”.Workgroup meets to discussimplementing a long-term plan forimproving quality of servicesprovided to foster youth.DHCS submits its requests to renewthe 1115 and 1915(b) waivers toCMS.DHCS anticipates CMS approval of1115 and 1915(b) waiver requests.Adds new benefits: silver diaminefluoride for children and high-riskindividuals and caries bundle forchildren. Continues existing andenhances pay for performanceinitiatives.New Medi-Cal managed care plan(MCP) benefit would provideintensive care management for bothmedical and non-medical needs forhigh-need Medi-Cal members.Target populations include childrenwith complex medical conditions,people experiencing homelessness,and people at risk ofinstitutionalization. The new ECMbenefit builds upon both the HealthHomes and Whole-Person Care PilotPrograms.New MCP option for high-risk/highneed Medi-Cal members to providewrap-around services to help themavoid hospital or skilled nursingfacility services, among others. ILOSinclude: housing services, soberingcenters, and medically-tailoredmeals. ILOS builds upon the WholePerson Care Pilot Program.Renew and update the DMC-ODS3Implementation DateJuly 1, 2020January 1, 2021 – December 31, 2021Stakeholder workgroup concludes June2021. Subsequent policy/plan will beforthcoming.Summer 2021December 2021Implementation date TBD; dependenton CMS waiver renewal approval.January 1, 2022—Counties withexisting Health Homes and WholePerson Care Pilot Programs transitioncurrent target populations.July 1, 2022—Counties with existingHealth Homes and Whole Person CarePilot Programs add new populations;other counties begin implementation.January 1, 2023—Full implementationof ECM in all counties.January 1, 2022DHCS requesting a five-year renewal

Insure the Uninsured Project CalAIM Summary and TimelineDelivery System (DMC-ODS)program to improve quality andfrom January 1, 2022 – December 31,Program Renewalaccess.2026. Dependent on CMS waiverapproval.Update Behavioral HealthUpdate medical necessity criteria for January 1, 2022Medical Necessity Criteriaeligibility for behavioral healthservices to clearly delineate andstandardize requirements and toimprove access for members toappropriate services statewide.Mandatory MCP EnrollmentRequires all non-dual eligible MediJanuary 1, 2022Cal members to enroll in managedcare. (NOTE: some populations willnot be subject to this requirement)Regional Rate-SettingImplement regional rate-setting forJanuary 1, 2022—BeginMCPs instead of county-based rate- implementation in targeted counties.setting.No sooner than January 1, 2024—Fullstatewide implementation.Behavioral Health PaymentTransition county behavioral health No sooner than July 1, 2022Reformpayments from a cost-based systemto payments based on quality andvalue.Serious Mental IllnessPermits counties to exploreDevelop proposal no sooner than July(SMI)/Serious Emotionalreceiving Medi-Cal funding for2022. CMS must approve proposal.Disturbance (SED)treating people with a SMI or a SEDDemonstration Opportunityin an institution for mental disease(IMD) with more than 16 beds.Population HealthMCPs required to develop andJanuary 1, 2023Management (PHM)implement a PHM plan, incoordination with county publichealth and behavioral healthdepartments.Justice-Involved Re-EntryRequires jails to have inmates apply January 1, 2023Population Medi-Calfor Medi-Cal prior to their releaseEnrollmentback into the community and toactively coordinate with MCPs,county behavioral healthdepartments, and DMC-ODSprograms.MCP Standard Benefit Package Requires all MCPs to provide theJanuary 1, 2023same benefit package, includinglong-term care and organtransplants carved into managedcare in all counties.Dual Eligible Mandatory MCPRequires all partial and full-scopeJanuary 1, 2023Enrollment/Cal MediConnectdually eligible Medi-Cal /MedicareEndsmembers to enroll in managed care.Cal MediConnect demonstration4

Insure the Uninsured Project CalAIM Summary and Timelineends December 31, 2022, and thosecounties transition to Dual EligibleSpecial Needs Plans (D-SNPs).Non-Cal MediConnectMCPs in non-Cal MediConnectJanuary 2025Counties Transition to D-SNPs counties required to operate DSNPs.MCP National Committee forRequire all MCPs to be accredited by January 2026Quality Assurance (NCQA)the NCQA.Accreditation RequirementIntegrate County MentalAllow counties to simplifyJanuary 2027Health and Substance Useadministrative activities for mentalTreatment Administrativehealth and substance use treatmentServicesservices that they manage.Full-Integration PilotAllows counties to apply to bringNo sooner than January 1, 2027together physical, behavioral, andoral health benefits under a singleentity contracted with DHCS.*Please note, this is not an exhaustive list. For full details, please see the Revised CalAIM Proposal.CalAIM Additionally Interacts With:As discussed above, CalAIM interacts with other DHCS initiatives, the CA State budget, and bills introduced in theCA State Legislature. Below is more information and context on each of these four categories. Medi-Cal Managed Care Plan ProcurementMedi-Cal 1115 Waiver and 1915(b) Waiver RenewalsCA State BudgetCA State Legislature/BillsMedi-Cal Managed Care Plan Procurement Context and TimelineIn many California counties, there are multiple managed care plans that contract with DHCS to provide Medi-Calhealth care coverage to Medi-Cal members. Commercial managed care plans “compete” with each other and applyto DHCS through a “request for proposal” process to be selected as a Medi-Cal managed care plan. This“competitive bidding process” is referred to as “procurement”.DHCS will put out a request for proposal to allow health plans to apply/bid to become a Medi-Cal managed careplan in those counties where there is more than one Medi-Cal managed care plan (see below). DHCS released itsdraft Request For Proposal (RFP) on Tuesday, June 1, 2021, and is seeking comments from interested stakeholdersby July 1, 2021. DHCS will process that stakeholder feedback and then release a final RFP through which plans willapply to become a Medi-Cal managed care plan later in 2021.5

Insure the Uninsured Project CalAIM Summary and TimelineMedi-Cal Procurement6