Interoperabilidad
Guiado por la normativa federal y estatal, el Proyecto de Interoperabilidad garantiza el cumplimiento Department of Health Care Services (DHCS)); con regulaciones; facilitando el acceso a datos de pacientes, el intercambio de datos de los pagadores y actualizaciones Provider Directory . La interoperabilidad permite un intercambio fluido de datos de pacientes entre sistemas sanitarios, promoviendo la coordinación de la atención y mejorando los resultados. DHCS está comprometido con el desarrollo de interfaces de programación de aplicaciones (APIs) seguras para ofrecer a los californianos un acceso fácil a sus datos de salud y tiene como objetivo capacitar a las personas para gestionar su salud y fomentar un ecosistema sanitario conectado para una California más saludable.
Medi-Cal Fee-for-Service Reportes de Métricas de Autorización Previa
DHCS está obligada a informar anualmente métricas agregadas de Medi-Cal y Children's Health Insurance Program (CHIP) de tarifa por servicio (FFS) para cumplir con la Norma Final de Interoperabilidad y Autorización Previa de CMS (CMS-0057-F). La publicación de estas métricas fomenta la transparencia y la rendición de cuentas, ayuda a los afiliados a Medi-Cal y CHIP FFS a comprender los procesos de autorización previa y permite a proveedores y partes interesadas evaluar el desempeño de los pagadores y la eficiencia administrativa. El reporte incluye acceso a información para todos los artículos y servicios FFS de Medi-Cal y CHIP (excluyendo medicamentos) que requieren autorización previa, así como datos sobre solicitudes de autorización previa para dichos artículos y servicios durante el año natural anterior.
Por favor, contacte con el equipo de Interoperabilidad del DHCS para cualquier pregunta o comentario sobre los reportes de métricas de autorización previa en interoperability@dhcs.ca.gov.
Reportes de Métricas de Autorización Previa 2025
- Medi-Cal – Métricas de autorización previa para Medi-Cal Fee-for-Service artículos y servicios de salud médica y conductual
- Medi-Cal Dental – Métricas de autorización previa para Medi-Cal Fee-for-Service artículos y servicios dentales
- California Children's Services – Métricas de Autorización Previa para California Children's Services (CCS) Elementos y Servicios
Desarrolladores de aplicaciones de terceros
Los desarrolladores de aplicaciones de terceros interesados en proporcionar datos de salud a través de la API de acceso para pacientes deben registrarse y obtener la certificación del DHCS.
Para aplicar el registro, envíe un email a interop-api@dhcs.ca.gov .
Orientación federal
- Centros de Medicare y Medicaid (CMS): Interoperabilidad
- Regla Final de Interoperabilidad y Acceso de Pacientes de CMS (CMS-9115-F)
- Hoja informativa de la regla final de interoperabilidad y acceso del paciente de los CMS
- Regla Final de Interoperabilidad y Autorización Previa de CMS (CMS-0057-F)
- Hoja informativa de la regla final de interoperabilidad y autorización previa de CMS
- Guías y estándares de implementación de CMS
- Botón azul CMS 2.0
Guía para los planes de atención administrada
- All Plan Letter 22-026: Interoperability and Patient Access Final Rule This All Plan Letter (APL) notifies all Medi-Cal managed care health plans (MCPs) of the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access final rule requirements as required by federal law.
- All Plan Letter 22-013: Interoperability and Patient Access Final Rule This APL notified all Dental Managed Care (DMC) Plans about the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access final rule requirements.
Guía para el Plan Mental de salud
- Behavioral Health Information Notice No: 22-068 This Behavioral Health Information Notice was used to notify all Mental Health Plans (MHPs) and Drug Medi-Cal Organized Delivery System (DMC-ODS) counties about the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access final rule requirements.
Guía para Planes de Atención Administrada y Planes/Condados de Salud Conductual
- Managed Care Plans and Behavioral Health Plans/Counties This site provides additional information for Managed Care Plans and Behavioral Health Plans/Counties regarding California’s Data Exchange Framework, CalAIM Data Sharing Authorization Guidance, Consent Forms and Consent Management, Data Submission Requirements, and other topics.
Orientación Estatal
- Data Exchange Framework – CDII (ca.gov) California’s Data Exchange Framework (DxF) is the first-ever, statewide data-sharing agreement that will accelerate and expand the exchange of information among healthcare entities across the state. Beginning in January 2024, the DxF includes a single data sharing agreement and a common set of policies and procedures to govern and require the exchange of health and human services information in California. The DxF builds upon the federal Trusted Exchange Framework and Common Agreement (TEFCA), which establishes a foundation for nationwide interoperability.
- State Health Information Guidance (SHIG) The SHIG is a collaboration of the Center for Data Insights and Innovation with various organizations to develop specific materials to help clarify federal and state laws that affect disclosure and sharing of health information.
- Data Exchange and Sharing The Department of Health Care Services (DHCS) is advancing health information exchange and data sharing to improve the care and outcomes for Medi-Cal Members as California continues its journey into data-driven, value-based health care. Data sharing is foundational to care coordination and is essential to supporting whole-person care programs such as Enhanced Care Management, Community Supports, Population Health management, and other Medi-Cal initiatives.
Programa de Precursores
- State Medicaid Health Information Plan (March 2022) The final State Medicaid Health Information Technology Plan (SMHP) presents the impact of the Medi-Cal Promoting Interoperability Program, formerly known as the Medi-Cal Electronic Health Record Incentive Program. The SMHP includes the findings of a health information technology assessment completed by researchers at the University of California, San Francisco in February 2022.
- Medi-Cal Promoting Interoperability Program The Health Information Management Division (HIMD), formerly the Office of Health Information Technolgy, was established in DHCS to develop goals and metrics for for the program, establish policies and procedures, and to implement systems to disburse, track, and report the incentive payments. The Promoting Interoperability Program officially ended in December 2021.
- California Health Information Exchange Onboarding Program (Cal-HOP) All Cal-HOP project activity concluded effective September 30, 2021. Cal-HOP provided up to $50 million in state and federal funding to Qualified Health Information Organizations (QHIOs) to support Medi-Cal providers’ access and use health information exchange (HIE) technology to improve the quality and effectiveness of care for Medi-Cal beneficiaries.
- California Technical Assistance Program In November 2015, the California Technical Assistance Program (CTAP) was launched with $37.5 million in federal and state funds. This program was designed to provide assistance to professionals in adopting, implementing, upgrading and meaningfully using certified electronic health record technology. CTAP concluded in November 2020.