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Medi-Cal RxTransitioning Medi-Cal Pharmacy Services fromManaged Care to Fee-For-ServicePublic ForumDecember 9, 2020, 2:00 – 3:00 p.m.WebEx Meeting1
Today’s Agenda Welcome & Opening RemarksLengthening Transition Time to Medi-Cal RxTransition Supports and ServicesMedi-Cal Rx Outreach & Noticing StrategiesOngoing Stakeholder CommunicationStrategies Project Status and Implementation Updates Key Project Metrics Question & Answer Session2
Lengthening transition timeto Medi-Cal Rx Given the ongoing uncertainties caused by theunprecedented COVID-19 public health emergency(PHE), DHCS has made the decision to lengthen thetransition time to full implementation of Medi-Cal Rx bythree months, until April 1, 2021. Until April 1, 2021, prescription drugs services willcontinue to be delivered under the current system forboth fee-for-service beneficiaries and those served byMedi-Cal managed care plans (MCP).o DHCS is working in partnership with its MCPs toprovide additional guidance and clarification relativeto this three month period.3
Lengthening transition timeto Medi-Cal Rx (Cont.) To support the lengthening of the transition time to Medi-Cal Rx toApril 1, 2021, DHCS has already began, or will soon begin toundertake, certain activities, including but not limited to:o Sending out a revised beneficiary notice to all 13.5 millionindividuals via mail in late December 2020.o Updating and distributing call center scripts to the Medi-Cal Rxand other impacted call centers.o Releasing revised notices/information to providers, MCPs,county mental health/substance use disorder plans, countyCalifornia Children Services’ partners, and other stakeholders.o Updating various websites, including Medi-Cal Rx Transition,Medi-Cal Rx, and Health Care Options, and publishedpolicy/process documents, such as the Pharmacy TransitionPolicy, and others.4
Transition Supports andServices To more completely support and increase familiarity with MediCal Rx for providers and beneficiaries during this three monthperiod, DHCS and Magellan will launch various Medi-Cal Rxcomponents between January and April 2021 to include thefollowing:o Public website - Medi-Cal Rx Pharmacy Locator, DrugLookup, Medi-Cal Rx Contract Drug List (CDL), Medi-Cal RxProvider Manuals and Bulletin/Newsflash Articles, and more.o Secure Health Plan Portal (for MCPs, as well as other countybehavioral health and substance use disorder plans)o Secure Provider Portalo Secure Beneficiary PortalNote: On January 1, 2021, not all components of the secure portalswill be active, but DHCS is planning future forward to phase-in othertransition supports and services.5
Transition Supports andServices (Cont.) In addition, DHCS/Magellan will use the extra time to communicate withand provide additional information to key stakeholders, including:o Allowing Medi-Cal providers, MCPs, and other stakeholders toregister for the Medi-Cal Rx secure portals and participate incomprehensive trainings that ensure greater overall understandingand support operational readiness.o Standing up and mobilizing the Medi-Cal Rx Customer ServiceCenter (CSC) in January. For the rest of December, the Medi-Cal RxCSC line will continue to forward to the Medi-Cal Member Helpline. Starting in January, the Medi-Cal Rx CSC will open to assistbeneficiaries, providers, and other stakeholders with transitionrelated questions. On April 1, 2021, the Medi-Cal Rx CSC will begin handling allpharmacy-related incoming calls, as well as claims and priorauthorization submission and related issues.6
Transition Supports andServices(Cont.) Lastly, DHCS/Magellan will use the extra time tocommunicate with and provide additional information toMCPs, including but not limited to:o Providing additional time for MCPs to interact withand build rapport with dedicated Medi-Cal Rx clinicalliaisons, who will help Magellan build accurate andcomprehensive MCP profiles to ensure that theindividualized needs of the populations served byeach MCP are met. Full portal functionality, including claims processing andPrior Authorization components, will be deployed onApril 1, 2021, to align with full implementation of MediCal Rx.7
Medi-Cal Rx Outreach& Noticing Strategies In addition to the late December beneficiary noticementioned previously, during the first quarter of 2021,DHCS will send Medi-Cal beneficiaries anotherreminder notice with more information andtools/resources that may be helpful. Medi-Cal MCPs are expected to implement theirpreviously approved outreach campaigns betweenJanuary 1, 2021 and March 31, 2021. Additionally,MCPs are expected provide a revised 30-day notice thatmust be received by beneficiaries by March 1, 2021.8
Ongoing StakeholderCommunication Strategies DHCS is in the process of revisiting stakeholder engagementstrategies and associated timelines, including revisingdates/times for some planned sessions and adding additionalsessions for key stakeholder groups including but not limitedto: this meeting series (Public Forums), MCP Workgroup, AllPlan Report Out, Medi-Cal Rx Advisory Workgroup , andmore. DHCS remains committed to working with its external partnersto ensure a smooth and successful transition on April 1, 2021.As needed, DHCS will also continue to host ad hoc, breakoutsessions with other key partners at the state and local/countylevel. In addition, DHCS will continue to leverage existing meetingsand workgroups (e.g., CCS Advisory Group, PharmacyDirectors, DUR Board, etc.) to provide status updates onimplementation efforts and activities related to Medi-Cal Rx.9
Project Status & ImplementationUpdates DHCS/Magellan continue planning and strategy sessionsfor operational readiness and full implementation of MediCal Rx – including claims and prior authorizationadministration – on April 1, 2021. DHCS/Magellan will continue to encourage providerparticipation in key Medi-Cal Rx training opportunitiesbetween now and April 1, 2021. Magellan and DHCS continue to work closely with theMCPs in developing, testing, and implementing theprocesses for exchanging claim data.o Data coming into Magellan to support the TransitionPolicyo Daily data feeds going to the MCPs to support member10care coordination
Key Project Metrics Status of Provider Enrollment:o As of late November, Medi-Cal hasenrolled 6,315 (96%) out of 6,581licensed outpatient pharmacies inCaliforniao DHCS is continuing to activelyconduct outreach activities toidentify and enroll pharmacies notcurrently in Medi-Cal11
Key Project Metrics (cont.) Provider Portal Registration and Training:o As of December 1, 3,240 Pharmacies and 708prescribers have registered.o DHCS/Magellan and other stakeholders are continuingtargeted efforts to continue increasing these figures. Contract Drug List (CDL) and Managed Care Plan(MCP) Formularies:o In January 2020, DHCS identified the aggregate gap ofdrugs available on MCP formularies and the CDL.o As a product of DHCS’ analysis, and in an effort to drivedown the total number of required PAs, 81 medicationshave been added to the CDL since January 2020.o DHCS continues to review the CDL, and looks foropportunities to add new medications on a monthlybasis.12
Key Project Metrics (cont.)Figure 1: Total Medi-Cal Member Helpline Call Volume sinceOctober 2020Total Incoming Medi-Cal Rx Calls25020015010050013
Helpful Information & Resources For more information about Medi-Cal Rx, please visit DHCS’ dedicatedMedi-Cal Rx Transition website: Medi-Cal Rx: Transition The Resources and Reference Materials section contains links tohelpful information: Medi-Cal Rx Frequently Asked Questions (FAQs) Medi-Cal Rx Pharmacy Transition Policy Medi-Cal Rx Complaints and GrievancesMedi-Cal Rx Website and Pharmacy Portal PolicyMedi-Cal Rx Clinical Liaison PolicyMedi-Cal Rx ScopeMedi-Cal Rx Beneficiary Notice Medi-Cal Rx Website: https://medi-calrx.dhcs.ca.gov/home/ For questions and/or comments regarding Medi-Cal Rx, DHCS invitesstakeholders to submit those via email to RxCarveOut@dhcs.ca.gov14
Questions15
Medi-al Rx Website and Pharmacy Portal PolicyC Medi-al Rx Clinical Liaison PolicyC Medi-al Rx ScopeC Medi-al Rx Beneficiary NoticeC Medi-Cal Rx Website: https://medi-calrx.dhcs.ca.gov/home/ For tions and/or comments regarding Mediques -Cal Rx, DHCS invites stakeholders to submit those via email to RxCarveOut@dhcs.ca.gov. 14. Helpful Information .
