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DHCS releases 2021 timeline for CalAIM initiative - State of Reform

DHCS releases 2021 timeline for CalAIM initiative
Emily Boerger | Feb 2, 2021
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The California Department of Health Care Services (DHCS) offered stakeholders a timeline of 2021 “implementation milestones” to support the CalAIM initiative during a relaunching webinar last week.
The agency released an updated CalAIM proposal last month, introducing key changes following stakeholder feedback and adjustments due to the COVID-19 pandemic. DHCS’s release of the updated initiative is the latest step in the department’s effort to implement broad program, delivery system, and payment reform for the Medi-Cal program.

During the first few months of 2021, DHCS will release a handful of draft documents related to the Enhanced Care Management (ECM) and In Lieu of Services (ILOS) components of CalAIM. As part of Medi-Cal reform, DHCS is proposing an enhanced care management benefit that builds off of the current Health Homes Program ....

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Medi-Cal Pharmacy Benefits Transferring to Fee-For-Service

Monday, January 11, 2021
DHCS”) will be transitioning all Medi-Cal pharmacy benefits from managed care to fee-for-service (“
FFS”). This new system to administer FFS pharmacy benefits is being called “Medi-Cal Rx” and was developed by DHCS in response California Governor Gavin Newsom’s January 7, 2019 executive order (the “
Order”), which instructed DHCS to transition all Medi-Cal pharmacy benefits to FFS by January 1, 2021. The rationale behind the Order is to combat rising prices for prescription drugs by increasing the State’s bargaining power in negotiating prescription drug prices with pharmaceutical companies. The date of transition was subsequently pushed back to April 1, 2021 so currently no pharmacy managed care benefits have been impacted. ....

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