أهم الأخبار
العودة إلى تحديث اتصالات أصحاب المصلحة لشهر فبراير 2022
تحديث طلب تقديم عروض خطة الرعاية المُدارة (RFP)
On February 9, DHCS released a RFP for its commercial Medi-Cal managed care plan (MCP) contractors that will redefine how care is delivered to more than 12 million Californians. The RFP raises the state’s expectations of MCPs in the Medi-Cal program through a new and strengthened contract that will apply to all plans. This unprecedented Medi-Cal plan procurement, when implemented, will transform health care delivery for Californians enrolled in Medi-Cal managed care.
تبحث إدارة خدمات الرعاية الصحية في DHCS عن شركاء في برنامج الرعاية الصحية متعددة التخصصات الملتزمين بتعزيز المساواة والجودة والوصول والمساءلة والشفافية للحد من الفوارق الصحية وتحسين نتائج الرعاية الصحية لأعضاء برنامج Medi-Cal. ستلتزم مراكز الرعاية الصحية المختارة بمتطلبات جديدة ومعززة لضمان حصول الأعضاء على خدمات الرعاية الصحية المناسبة عند الحاجة، بما في ذلك دعم الخدمات الاجتماعية وخدمات إدارة الرعاية التي تعتبر ضرورية لتحسين صحة السكان والمساواة في الصحة. من خلال عملية طلب تقديم العروض، تعمل إدارة خدمات الرعاية الصحية في DHCS على تحسين رقابتها على شركاء الخطة ومقاوليها من الباطن لضمان قدر أكبر من الشفافية والمساءلة.
The RFP procurement is part of a larger set of state investments in the health and well-being of all Californians that includes CalAIM. Proposals from MCPs are due on April 11, 2022. DHCS will award contracts by fall 2022, and new contracts are scheduled to begin on January 1, 2024.
On February 15, DHCS hosted an all-comers webinar for members, advocates, providers, health plans, and other stakeholders to share how DHCS will leverage the MCP RFP and managed care contracts to further DHCS’ goals to enhance how care is delivered to Medi-Cal members.
On February 24, DHCS will host a voluntary pre-proposal web conference from 1 – 2:30 p.m. specifically for the MCP procurement and the RFP released on February 9; Register for the RFP web conference
قم بزيارة صفحة مشتريات MCP على الويب لمزيد من المعلومات. Visit the RFP webpage to view the RFP.
تحديث تنفيذ برنامج Medi-Cal Rxx
On January 1, DHCS transitioned the Medi-Cal pharmacy benefit of more than 14 million Medi-Cal members to a single delivery system, a change that will benefit members and result in substantial savings. As is the case with any large project, some implementation issues were to be expected, and DHCS’ vendor, Magellan, is addressing those as quickly as possible. DHCS is also ensuring that providers are kept updated, and that relevant information is communicated to them via e-mail blasts, provider newsflashes, information on the DHCS and Medi-Cal Rx websites, and direct provider outreach. Our actions are designed to ensure that Medi-Cal members can get the prescription drugs they need when they need them. For questions or comments related to Medi-Cal Rx, please email RxCarveOut@dhcs.ca.gov.
مستجدات برنامج كاليفورنيا للتطوير والابتكار في الرعاية الطبية (CalAIM)
On December 29, 2021, DHCS received approval of the CalAIM Section 1115 Demonstration, CalAIM Section 1915(b) waiver, and Medi-Cal State Plan Amendments from the federal Centers for Medicare & Medicaid Services (CMS). These approvals provide the authority to launch CalAIM, a long-term commitment to transform and strengthen Medi-Cal – the cornerstone of California’s health care system.
CalAIM shifts Medi-Cal to a population health approach, prioritizing prevention, addressing social drivers of health, and transforming services for communities who historically have been under-resourced and faced structural racism in the health care system. CalAIM is a bold transformation, putting people’s needs at the center of care and setting the pace for transformation of the entire health care sector.
On January 14, DHCS hosted a webinar to provide an overview of the recently approved CalAIM Section 1115 Demonstration and 1915(b) waiver. View the January 14 CalAIM Section 1115 demonstration 1915(b) waiver presentation.
برنامج Medi-Cal لتحفيز التطعيم ضد فيروس كورونا المستجد (كوفيد-19)
تخصص إدارة خدمات الرعاية الصحية في DHCS ما يصل إلى 350 مليون دولار لتحفيز جهود التطعيم ضد كوفيد-19 في نظام تقديم الرعاية المدارة من Medi-Cal من سبتمبر 1، 2021 حتى فبراير 28، 2022. إن مراكز ميدي-كال للرعاية الطبية الشاملة مؤهلة لكسب مدفوعات تحفيزية للأنشطة المصممة لسد فجوات التطعيم مع أعضائها المسجلين لديها، ولمعالجة التفاوتات في امتصاص اللقاحات بالنسبة لفئات عمرية وعرقية/إثنية محددة. يمكن لمراكز الرعاية الصحية متعددة التخصصات كسب ما يصل إلى 50 مليون دولار لتحقيق مقاييس عملية محددة و200 مليون دولار لمقاييس النتائج، مع إتاحة 100 مليون دولار لمراكز الرعاية الصحية متعددة التخصصات لاستخدامها في الحوافز المباشرة للأعضاء.
Effective September 1, 2021, all 25 full-service MCPs and one population-specific health plan were approved for participation in the program. The first outcome ascertainment period ended on October 31. Between September 1 and October 31, all plans reported improvement in all three intermediate outcome measures and all seven vaccine uptake outcome measures. Statewide, the target for Measure 3 was exceeded, improving the percentage of primary care providers in MCP networks providing COVID-19 vaccine in their office from 49.3 percent to 56.8 percent. In addition, almost one-third of the gap in COVID-19 vaccination rates between the Medi-Cal and overall California populations ages 12-25 was closed, and almost one-third of the gap in COVID-19 vaccination rates between the overall Medi-Cal population and both the Black/African American and American Indian/Alaska Native Medi-Cal populations was closed. Vaccination rates continued to improve through the second outcome ascertainment date of January 2, 2022, but statewide did not meet DHCS’ goal of closing two-thirds of the gap for any of the seven vaccine update outcome measures. January 2 data for the three intermediate outcome measures are being compiled.