Health Plan Of San Joaquin Jpa

The meeting covered CalAIM program updates, including coding and billing requirements for claims and the process for adding new CS or ECM services through a screening committee. Reporting updates included a transition from quarterly to monthly reporting for specific files and the introduction of new required fields for Closed Loop Referrals. The meeting also addressed Transition of Care policies for pregnant and postpartum members, focusing on high-intensity criteria, birthing support checklists, and key postpartum milestones. Additionally, there was a review of Medicare Advantage DSNP eligibility and the transition to the California Integrated Care Management (CICM) program for DSNP members. Operational discussions included guidance on member outreach, enrollment barriers, and the availability of various community support services such as housing navigation, home modifications, medically tailored meals, and sobering centers.

The meeting agenda covers a wide range of administrative, financial, and operational topics. Key items include the review of finance and investment reports, the contract with The Periscope Group, human resources policies regarding medical and military leave, and an update on the QIHEC committee. The commission will discuss FY 2026 financial reports, a leadership update, the 2026 DMHC audit, and various subcommittee reports spanning audit and oversight, quality improvement, peer review, and clinical operations. Information items include a preview of the FY 2027 budget, CEO and COO reports, compliance and legislative updates, and a closed session regarding trade secrets and executive performance evaluation.

The commission reviewed and approved several committee reports and strategic plans, including the HPSJ/MVHP Strategic Plans for fiscal year 2026-2027 and the January 2026 financial report. Discussion topics included an overview of federal guidance on emergency Medicaid, increased federal oversight of Medi-Cal programs, and the current Medi-Cal fiscal outlook. The commission received updates on regulatory audits, compliance activities, privacy and security incidents, fraud investigations, and legislative updates regarding the budget cycle and priority bills. Additionally, the chair provided an update on the Be Well campus construction progress and the addition of a behavioral substance use treatment program.

The agenda includes discussion and action on financial reports, operational performance, and legislative updates, specifically regarding budget outlooks and priority bills. Informational topics cover medical frailty implementation, unemployment-related work requirements, federal fraud efforts, and information security. Additionally, the commission will address the appointment of a committee member for the Human Resources Committee, the formation of an ad-hoc CEO evaluation committee, and a closed session regarding corporate objectives and trade secrets.