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Health Entity Seeks Millions from Budget for Modernization, Compliance

In several budget change proposals ahead of the May Revision of Gov. Gavin Newsom’s proposed 2022-2023 Fiscal Year state budget, the California Department of Health Care Services seeks funding to continue IT modernization and compliance initiatives and to do more with data.

Technology Health Care
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The state department charged with making sure residents have access to affordable, high-quality health care is seeking millions this budget cycle to do more with technology and innovation.

In several budget change proposals (BCPs) that are among the 23 filed so far this year, the California Department of Health Care Services (DHCS) looks to make significant progress on modernizations. The BCPs connect to Gov. Gavin Newsom’s $286.4 billion proposed state budget which he released Jan. 10. The governor’s proposed budget will be revised this month in the May Revision. Among the takeaways:

  • In a BCP from April 1, DHCS wants to continue supporting implementation of the proposals that make up its California Advancing and Innovating Medi-Cal (CalAIM) initiative, “including external evaluations and assessments as required by CalAIM waiver Special Terms and Conditions, implementation of the CalAIM Justice Package, Dual Eligible Special Needs Plan plans and new reporting requirements, and the Serious Mental Illness/Serious Emotional Disturbance waiver.” To accomplish this, it is asking for 95 positions, converting two positions from limited term (LT) resources to permanent, LT resources equal to nine positions, contract resources — and “expenditure authority” of nearly $108 million — nearly $54 million of that from the General Fund (GF); nearly $54 million in Federal Fund (FF) monies — for the 2022-2023 Fiscal Year, and nearly $18 million in FY 2023-2024 (nearly $9 million GF and nearly $9 million FF) and ongoing. Eight of the 29 positions are in DHCS’ Data Management and Analytics Division, to support CalAIM waiver evaluations.
  • In a BCP from April 1, DHCS asks for five permanent positions and LT “contract expenditure authority” of nearly $21 million (nearly $3 million GF and $18 million FF) in FY 2022-2023; $14.2 million in FY 2023-2024 ($2.9 million GF with rounding and $11.3 million FF with rounding); and $1 million in FY 2024-2025 ($205,000 GF and $802,000 FF) for “information technology modernization projects.” The funding would support development and implementation of the California Automated Recovery Management (CalARM) solution, design and a project readiness assessment of the Behavioral Health Modernization (BHM) solution as part of the Project Approval Lifecycle; and in the fiscal year beginning July 1, “will continue to utilize the resources approved for Medi-Cal Enterprise Systems Modernization strategy and architecture planning in developing/refining the modernization approach, architecture, road map, and a modernization product/module portfolio.”
  • In a BCP from April 1, DHCS aims to “address increased workload related to departmental data analytics, data provisioning and data reporting functions to improve data management and transparency.” With that goal, it is asking for 13 permanent positions, funding for five current permanent positions, three-year LT resources equal to four positions and conversion of “two LT resource to permanent, LT contract resources.” It’s also seeking expenditure authority of nearly $7.6 million ($3.8 million GF, $3.8 million FF) in FY 2022-2023; $9 million in FY 2023-2024 ($4.5 million GF and $4.5 million FF); $8.5 million in FY 2024-2025 ($4.2 million GF and $4.2 million FF); and $5.4 million in FY 2025-2026 ($2.7 million GF and $2.7 million FF) and ongoing. The workload, per the BCP, is supported by Enterprise Data and Information Management, which is working closely with Enterprise Technology Services and the Office of Legal Services, and partnering with DHCS programs to support “robust data analytics, reporting and management for DHCS.”
  • In a BCP from Jan. 10, DHCS wants to “improve encounter data quality” to assist the department in meeting Transformed Medicaid Statistical Information System (T-MSIS) requirements. The reimbursement, according to the BCP, will be funded via a grant “stemming from the Centene-Health Net merger and leverage 90/10 federal funding.” The department requests “two-year LT resources equivalent to” three positions, LT contract funding and expenditure authority of $17.5 million with rounding ($1.7 million Reimbursement Fund (RF), $15.7 million FF) in FY 2022-2023, and $17.4 million ($1.7 million RF and $15.7 million FF) in FY 2023-2024, to “further advance improvements in data quality in managed care and county behavioral health.” If encounter and claims data don’t meet T-MSIS quality standards, it would jeopardize federal funding.
    As part of the merger of Centene and Health Net, the Department of Managed Health Care directed them to provide $50 million over five years to strengthen the infrastructure of the Medi-Cal health-care delivery system, especially for Medi-Cal providers contracted with managed care plans, to improve the accuracy and completeness of “encounter data and provider directories.” Their investment yielded the Encounter Data Improvement Program, which sets organizational oversight and includes a market research study, immediate improvement funding and provider-level assessment and implementation grants.
Theo Douglas is Assistant Managing Editor of Industry Insider — California.