آیا Medi-Cal Connect قرار است از اتخاذ سیاستها و رویههای داخلی پشتیبانی کند، یا به مرتبط کردن شیوههای پیشگیرانه با رفتار اعضا نیز کمک میکند؟ مدی-کال کانکت (Medi-Cal Connect) به گونهای طراحی شده است که از هر دو مورد، یعنی اتخاذ سیاستها و رویههای داخلی، و کمک به مرتبط کردن شیوههای پیشگیرانه با رفتار اعضا، پشتیبانی کند. این امر هماهنگی بهتر مراقبتهای کامل فردی را ممکن میسازد و قرار است توسط طرحهای مراقبت مدیریتشده (MCPs) در سیاستها و رویههای داخلی ادغام شود.
What identifier is used to determine the correct member in an application programming interface (API) request? MCPs will be issued secure authentication tokens by DHCS to identify their organization. Upon verification, data access will be granted based on attributed members. Detailed instructions will be provided to Technical Representatives during onboarding.
آیا داشبورد معیارهای کیفیت شامل تمام معیارهای دسترسی و استانداردهای سلامت رفتاری (BHAS) که طرحهای سلامت رفتاری (BHP) مسئول آنها هستند (مثلاً پیگیری پس از مراجعه به اورژانس برای سوءمصرف یا وابستگی به الکل و سایر مواد مخدر (FUA)، پیگیری پس از مراجعه به اورژانس برای بیماریهای روانی (FUM)، دارودرمانی برای اختلال مصرف مواد افیونی (POD)) خواهد بود؟ در ابتدا همه معیارهای BHAS گنجانده نخواهند شد؛ با این حال، بسیاری از آنها ارائه خواهند شد. فهرست کاملی از اقدامات انجام شده در طول جلسات آتی با ذینفعان در دسترس قرار خواهد گرفت.
آیاdashboards include measures from the California Technical Specifications (CaTS) recently introduced to align HEDIS-like measures across DHCS programs? The inclusion of CaTS measures is currently under development and is being considered for a future release.
Will delegated entities of MCPs be permitted access to dashboards, specifically the Longitudinal Member Record (LMR) dashboard? No. Access will be limited to prime plans beginning in July 2025. Delegated entities will not have access at this time.
When will Medi-Cal Connect be required for specialty Mental Health Services? طرحهای سلامت رفتاری شهرستان (BHP) قرار است در نسخه ۴، که برای پاییز ۲۰۲۵ در نظر گرفته شده است، به اجرا درآیند. در حالی که فقط MCPها موظف به استفاده از Medi-Cal Connect برای شناسایی و رسیدگی به اعضای پرخطر هستند، این پلتفرم شامل ویژگیهایی است که به BHPها در ارائه مراقبت و سنجش عملکرد کمک خواهد کرد.
When will API connection instructions be made available? API configuration will not be available until July 18, 2025. Technical Representatives will receive detailed implementation guidance during onboarding.
Will updates continue to be made to the existing MCP Monitoring Dashboard? No changes to the current public-facing dashboards are planned as a result of Medi-Cal Connect. The existing MCP Monitoring Dashboard will remain unchanged.
What are the plans for Behavioral Health Plans’ access to and use of Medi-Cal Connect? DHCS is working to integrate Behavioral Health Transformation (BHT) and BH-CONNECT into Medi-Cal Connect. Additional features, such as the Quality Measures Dashboard and the Longitudinal Member Record, are designed to support BHPs in service delivery and data reporting.
Will Medi-Cal Connect provide APIs for 834 Eligibility/Enrollment data exchange? At this time, there are no definitive plans to implement an API for 834/ Eligibility/Enrollment data. Should such an API become available, it would adhere to the Fast Healthcare Interoperability Resources (FHIR) standard. For now, the 834 will remain in use. Updates will be shared as they become available.
Will the quality measures required for BHPs be National Committee for Quality Assurance (NCQA) certified? Medi-Cal Connect utilizes a HEDIS-certified engine, operated by Arcadia, to produce quality rates for measures included in the BH-CONNECT Incentive Program.
Are onboarding dates scheduled for MCPs? Specific onboarding dates have not yet been finalized. Additional information will be provided during upcoming All Plan Engagements in June 2025.
How does Medi-Cal Connect align with the Data Exchange Framework (DxF)? Medi-Cal Connect operates within the parameters of the DxF. As the framework continues to evolve, Medi-Cal Connect will play a key role in facilitating secure, standardized data exchange.
Will there be changes to existing data exchange mechanisms with DHCS, including 834, 274, and All-Payer Claims Database Common Data Layout (APCD-CDL) files? Will APIs be adopted for all formats? While the transition to API-based data exchange is under consideration across the healthcare industry, several factors influence this shift—particularly for HIPAA-mandated transactions such as the X12 834 and 837. These transactions are governed by federal requirements, including the CORE Operating Rules, which complicate immediate conversion to API formats. For data files that are not federally mandated—such as APCD-CDL—API-based exchange may be more feasible over time. However, DHCS currently has no definitive plans to implement APIs for any of the formats mentioned. Should such a transition occur, DHCS will provide advance notice, detailed guidance, and implementation timelines. At this time, any move to API-based exchange is expected to be several years away.
