Hla mus rau Cov Ntsiab Lus Tseem Ceeb​​ 

D-SNP Kev Qhia Zoo thiab Cov Ntaub Ntawv​​ 

Mus rau D-SNP Dashboard
Rov qab mus rau Kev Saib Xyuas Kev Sib Txuas rau Cov Neeg Tau Txais Kev Pabcuam Dual
Rov qab mus rau D-SNP Daim Ntawv Cog Lus thiab Txoj Cai Qhia {cph0
Rov qab mus rau D-SNP Cov Ntaub Ntawv thiab Daim Ntawv Qhia Dua
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Dual-Eligible Special Needs Plans (D-SNPs) yog ib hom Medicare Advantage Plan uas tsuas yog muaj rau cov tib neeg uas tsim nyog tau txais Medicare thiab Medi-Cal. Txhua D-SNP yuav tsum muaj daim ntawv cog lus nrog Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) uas qhia txog kev sib koom tes saib xyuas tshwj xeeb hauv lub xeev thiab kev tshaj tawm cov cai, nrog rau lwm cov kev cai.​​ 

California cov kev qhia tshwj xeeb hauv lub xeev rau Exclusively Aligned Enrollment (EAE) D-SNPs, non-EAE D-SNPs, thiab SCAN's Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP) yog ib feem ntawm lub tswv yim zoo hauv DHCS. Qhov no suav nrog Cov Tswv Yim Zoo Tshaj Plaws, Kev Pabcuam Sijhawm Ntev thiab Kev Txhawb Nqa (LTSS) dashboard, thiab Master Plan for Aging.​​ 

D-SNPs muaj qhov yuav tsum tau muaj kev ceeb toom zoo rau Medicare thiab Medi-Cal. CMS xav tau ntau hom kev tshaj tawm zoo rau Medicare Advantage Plans suav nrog D-SNPs. DHCS tseem saib xyuas qhov zoo ntawm kev saib xyuas thiab kev noj qab haus huv muaj vaj huam sib luag rau cov tswv cuab hauv Medi-Cal los ntawm ntau yam kev qhia yuav tsum tau ua, raws li tau piav qhia hauv 2022 DHCS Comprehensive Quality Strategy thiab Medi-Cal cov ntawv cog lus.​​ 

DHCS lub xeev cov kev ua tau zoo thiab kev tshaj tawm cov cai rau EAE D-SNPs, tsis yog-EAE D-SNPs, thiab SCAN's FIDE SNP tau piav qhia hauv 2025 D-SNP Txoj Cai Qhia thiab 2025 D-SNP Kev Qhia Txog Kev Qhia Txog Kev Qhia Txog Kev Qhia.
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Cov peev txheej tseem ceeb rau D-SNPs​​ 

Daim ntawv cog lus xyoo 2025 Cov ntaub ntawv​​ 

Daim ntawv cog lus xyoo 2024 Cov ntaub ntawv​​ 

Daim ntawv cog lus xyoo 2023 Cov ntaub ntawv​​ 

Cov peev txheej ntxiv​​  

2025 Lub Xeev Cov Lus Qhia Tshwj Xeeb Zoo thiab Kev Qhia Txog Kev Xav Tau​​ 

Hauv qab no yog cov npe ntawm lub xeev cov kev ua tau zoo thiab tshaj tawm cov cai rau D-SNPs hauv 2025. Cov ntaub ntawv tshaj tawm muaj nyob rau hauv pej xeem, suav nrog, CMC Cov Lus Qhia Txog Kev Tshawb Fawb, CMC Health Plan Quality and Compliance reports, and CMC Enrollment Status, Quality Measures, and State Costs reports are available on the Cal MediConnect Quality and Data Reporting webpage.​​   

  1. Emergency Department (ED) Behavioral Health Services Utilization (ED BH)​​ 
  2. Care Coordinator to Member Ratio (CCMR)​​ 
  3. Kev ntsuam xyuas kev paub txog kev noj qab haus huv (CHA)​​ 
  4. Cov Tswv Cuab Nrog Txoj Kev Npaj Kho Mob Ua tiav hauv 90 Hnub ntawm Kev Sau Npe (ICP)​​ 
  5. ECM-zoo li Services (ECM)​​ 
  6. Palliative Care (PAL)​​ 
  7. Long-Term Care (LTC)​​ 
    1. N​​ ote: Tsis yog-EAE D-SNPs tsis tas yuav tsum tau tshaj tawm txog kev ntsuas LTSS.​​ 
  8. Cov Ntaub Ntawv Txog Kev Noj Qab Haus Huv thiab Cov Ntaub Ntawv Teeb Meem (HEDIS) Cov Neeg Laus Kev Nkag Mus Rau Kev Tiv Thaiv / Ambulatory Health Services (AAP)​​ 
  9. HEDIS Tswj Cov Ntshav Siab (CBP)​​ 
  10. HEDIS Glycemic Status Assessment rau Cov Neeg Mob Ntshav Qab Zib (> 9.0%) (GSD)​​ 
  11. HEDIS Kev Rov Qab Los Tom Qab Lub Tuam Tsev Saib Xyuas Kev Kub Ntxhov Mus Saib Xyuas Kev Mob Puas Siab (FUM)​​ 
  12. HEDIS Plan All-Cause Readmissions (PCR)​​ 
    1. Nco tseg: 2025 lub xeev tshwj xeeb D-SNP tshaj tawm rau HEDIS AAP, CBP, GSD, FUM, thiab PCR tsuas yog xav tau rau D-SNPs yam tsis muaj lub xeev tshwj xeeb D-SNP nkaus xwb H Daim Ntawv Cog Lus.​​ 

2024 Lub Xeev Cov Lus Qhia Tshwj Xeeb Zoo thiab Kev Tshaj Tawm Txog Kev Xav Tau​​ 

Hauv qab no yog cov npe ntawm lub xeev cov kev ua tau zoo thiab tshaj tawm cov cai rau D-SNPs hauv 2024.​​ 

Nkag mus tau / Muaj Kev Kho Mob​​ 

1. Cov Ntaub Ntawv Txog Kev Noj Qab Haus Huv thiab Cov Ntaub Ntawv Teeb Meem (HEDIS) Cov Neeg Laus Kev Nkag Mus Rau Kev Tiv Thaiv / Ambulatory Health Services (AAP)​​ 

Kev saib xyuas zoo​​ 

  1. HEDIS Tswj Cov Ntshav Siab (CBP)​​ 
  2. HEDIS Glycemic Status Assessment rau Cov Neeg Mob Ntshav Qab Zib (> 9.0%) (GSD, yav tas los HBD-H9)​​ 
  3. HEDIS Kev Rov Qab Los Tom Qab Lub Tuam Tsev Saib Xyuas Kev Kub Ntxhov Mus Saib Xyuas Kev Mob Puas Siab (FUM)​​ 

Kev siv thiab Risk Adjusted Siv​​ 

  1. HEDIS Plan All-Cause Readmissions (PCR)​​ 
  2. Emergency Department (ED) Behavioral Health Services Utilization (ED BH)​​ 

Kev Sib Koom Tes​​ 

  1. Cov tswv cuab nrog Kev Ntsuam Xyuas Kev Nyab Xeeb Kev Nyab Xeeb (HRA) ua tiav hauv 90 hnub ntawm kev tso npe (HRA1)​​ 
  2. Cov tswv cuab nrog Kev Ntsuam Xyuas Txhua Xyoo (HRA2)​​ 
  3. Cov tswvcuab nrog Txoj Kev Npaj Kho Mob Ua tiav hauv 90 Hnub ntawm Kev Sau Npe (ICP1)​​ 
  4. Cov tswvcuab nrog Txoj Kev Npaj Khomob tam sim no (tsim lossis hloov kho tshiab xyoo tas los) (ICP2)​​ 
  5. Cov tswvcuab nrog Cov Ntaub Ntawv Sib Tham Txog Cov Hom Phiaj Kho Mob (GOC)​​ 

Lub Koom Haum Kev Ua Haujlwm thiab Kev Ua Haujlwm​​ 

  1. Care Coordinator to Member Ratio (CCMR)​​ 

Medi-Cal Long-Term Services and Supports (LTSS)​​ 

  1. Community-Based Adult Services (CBAS).​​ 
  2. In-Home Supportive Services (IHSS)​​ 
  3. Multipurpose Senior Services Program (MSSP)​​ 
  4. Long-Term Care (LTC)​​ 

Nco tseg: Tsis yog-EAE D-SNPs tsis tas yuav tsum tau tshaj tawm txog LTSS ntsuas.​​ 

Alzheimer's / Dementia Kev Saib Xyuas Zoo​​ 

  1. Kev soj ntsuam kev paub txog kev noj qab haus huv (CHA)​​ 

Txhim Kho Kev Tswj Xyuas Zoo Zoo (ECM-zoo li) Kev Pabcuam​​ 

18. ECM-like Services (ECM)​​ 

Palliative Care​​ 

19. Palliative Care (PAL)​​ 

Hnub hloov tshiab kawg: 7/11/2025 1:30 PM​​