خانه شعبه نظارت بر کفایت شبکه سلامت رفتاری​​ 

شعبه نظارت بر کفایت شبکه بهداشت رفتاری​​ 

بازگشت به صفحه اصلی خدمات سلامت رفتاری.​​  

The Behavioral Health Network Adequacy Oversight Branch (BHNAOB) is structurally within the Behavioral Health Oversight and Monitoring Division (BHOMD), which is a part of the Behavioral Health program of the Department of Health Care Services. Information about BHOMD can be found via the Behavioral Health Services homepage link at the top of this document. BHNAOB is responsible for the Medi-Cal Behavioral Health network adequacy program, the Behavioral Health Services Act network adequacy program, and formerly had administrative responsibility for the Behavioral Health Quality Improvement Program (BHQIP), which was sunset on June 30, 2024. The Network Adequacy Oversight Sections are responsible for the oversight and monitoring all behavioral health components of the Specialty Mental Health Services (SMHS) and Drug Medi-Cal Organized Delivery System (DMC-ODS) program, as well as timely access requirements for Drug Medi-Cal state plans due to parity requirements​​ 

بخش نظارت بر کفایت شبکه​​ 

The Network Adequacy Oversight Section (NAOS) is found within the BHNAOB. BHNAOB is found within BHOMD and is a part of the Behavioral Health program of DHCS.​​  

DHCS contracts with counties that either provide, or arrange for the provision of, specialty mental health services and substance use treatment services to eligible Medi-Cal members.​​  

NAOS performs compliance oversight and monitoring of the MHPs and DMC-ODS programs to ensure compliance with the network adequacy requirements set forth in Title 42 of the Code of Federal Regulations (CFR) and the network adequacy requirements of the Behavioral Health Services Act. NAOS primarily assesses the compliance of MHPs and DMC-ODS programs through its reviews of required submissions from these entities as part of an annual network certification process. NAOS, as necessary to ensure the adequacy of each provider network, identifies any deficiencies with current standards, including timely access standards as prescribed by WIC 14197 and provides technical assistance to the MHPs and DMC-ODS programs to resolve compliance issues. Where technical assistance is not effective, NAOS implements corrective measures such as corrective action plans and administrative or monetary sanctions.​​  

NAOS also performs oversight, technical assistance, and monitoring related to improving access to care, which includes timely access requirements as defined in Welfare and Institutions Code 14197. These requirements include an initial request for first appointment or first specialty mental health service for new members, non-urgent follow-up appointments, and ensuring language assistance services are coordinated with scheduled appointments for health care services.​​  

فعالیت‌های مربوط به رعایت کفایت شبکه و نظارت بر آنها که در اینجا شناسایی شده‌اند، مختص MHPها، برنامه‌های DMC-ODS و طرح‌های ایالتی DMC هستند که به‌طور خاص برای الزامات دسترسی به‌موقع طراحی شده‌اند. بخش کیفیت و نظارت بر مراقبت‌های مدیریت‌شده، الزامات کفایت شبکه برای طرح‌های مراقبت‌های مدیریت‌شده را نظارت می‌کند. برای اطلاعات بیشتر در مورد کفایت شبکه، از جمله گزارش‌های صدور گواهینامه سالانه، استانداردهای دسترسی جایگزین مصوب و برنامه‌های اقدام اصلاحی، لطفاً به صفحه وب کفایت شبکه وزارت خدمات مراقبت‌های بهداشتی مراجعه کنید.​​  

Provided below are some federal and state laws applicable to NAOS. These laws are found within the CFR, and Welfare and Institutions Code (WIC).​​  

قوانین قابل اجرا​​  

فدرال:​​  

  • 42 CFR 438.206 در دسترس بودن خدمات​​  
  • 42 CFR 438.207 تضمین ظرفیت و خدمات کافی​​  
  • 42 CFR 438.68 استانداردهای کفایت شبکه​​  

ایالت (اساسنامه):​​  

  • بخش HSC 1367.03​​  
  • WIC بخش 14197​​  

ایالت (مقررات):​​  

  • 28 CCR بخش 1300.67.04​​  
  • 28 CCR بخش 1300.67.2.2​​  

منابع اضافی​​ 

Medi-Cal پیشرفت و نوآوری کالیفرنیا (CalAIM):​​ 

Medicaid و Medi-Cal General:​​ 

اطلاعات تماس​​