Cov Txheej Txheem Xa Ntawv Rau Cov MOU Uas Tau Ua Tiav Thiab Cov Lus Nug Txog Daim Ntawv Qhia Txhua Peb Hlis
1. Cov txheej txheem xa daim ntawv thov Managed Care Plan (MCP) Memorandum of Understanding (MOUs) yog dab tsi?
Cov Qauv MOU Pib thiab Cov Qauv MOU Bespoke suav nrog cov kev cai tsawg kawg nkaus uas cov tog neeg yuav tsum suav nrog hauv lawv cov MOUs uas tau ua tiav nrog rau cov kev cai xaiv tau uas cov tog neeg xaiv los suav nrog. Yog tias ob tog tau ua tiav daim MOU yam tsis tau hloov lossis tshem tawm ib qho ntawm cov kev cai tsawg kawg nkaus, txawm tias lawv puas suav nrog cov kev cai xaiv tau los xij, MCPs yuav tsum xa daim MOU uas tau ua tiav mus rau Managed Care Operations Division (MCOD)-MCP Submissions Portal ntawm SharePoint rau cov ntaub ntawv thiab siv. Hauv nws daim ntawv xa mus, MCPs yuav tsum ua pov thawj tias lawv tsis tau hloov kho lossis tshem tawm ib qho ntawm cov kev cai yuav tsum tau ua uas tau teev tseg hauv Daim Ntawv Qhia Txog MOU tshwj tsis yog ntxiv cov kev cai uas tsis sib haum nrog lossis hloov pauv tseem ceeb rau ib tog neeg lub luag haujlwm raws li MOU.
Yog tias cov tog neeg hloov kho lossis tshem tawm ib qho ntawm cov kev cai yuav tsum tau ua ntawm lawv daim ntawv cog lus MOU uas tau sib tham uas tau teev tseg hauv daim ntawv MOU Template, MCP yuav tsum xa ib daim ntawv hloov pauv uas tau hais tseg rau MOU mus rau MCOD-MCP Submissions Portal kom tau kev tshuaj xyuas thiab kev pom zoo ua ntej ua tiav. Hauv cov xwm txheej uas ntau lub MPCs tab tom nkag mus rau hauv MOU thiab tab tom thov kom hloov kho cov kab liab rau MOU, tsuas yog ib lub MCP xwb thiaj li yuav tsum xa daim MOU kab liab mus rau Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) kom lawv tshuaj xyuas thiab pom zoo. Yog tias MCP xaiv ntxiv cov kev cai ntxiv lossis xaiv tau, tsis tas yuav muaj kab liab tsuav yog cov kev cai ntxiv lossis xaiv tau tsis sib haum nrog Daim Ntawv Qhia MOU.
Yog tias ob tog pom zoo muab ntau daim Qauv Bespoke ua ke rau hauv ib daim MOU, yam tsis hloov lossis tshem tawm ib qho ntawm cov kev cai tsawg kawg nkaus, daim MOU ua ke tuaj yeem xa mus yam tsis muaj kab liab rau cov ntaub ntawv thiab siv, raws li tau piav qhia saum toj no. Yog tias cov tog neeg hloov kho lossis tshem tawm ib qho ntawm cov kev cai yuav tsum tau ua, MCP yuav tsum xa ib daim ntawv MOU uas tau muab tso rau kev tshuaj xyuas thiab kev pom zoo, raws li tau piav qhia saum toj no, ua ntej kev ua tiav.
Vim muaj ntau yam khoom cuav no, DHCS tau tsim ib qho MCP MOU View tshwj xeeb hauv Submissions Portal los pab MCPs nrhiav tau lawv yooj yim. Cov khoom cuav no tsuas pom tau ntawm MCP MOU View xwb; lawv yuav tsis tshwm sim ntawm MCP View ib txwm muaj. Nws yog lub luag haujlwm ntawm MCP los xyuas kom meej tias lawv xa cov ntaub ntawv raws li DHCS cov cai. Yog xav tau kev pab ntxiv txog kev xa cov ntaub ntawv MOU mus rau MCOD-MCP Submission Portal, thov mus saib MOU Quick Reference Guides (QRG) folder.
2. Cov MCP puas yuav tsum xa tag nrho cov kev hloov kho rau MOUs ua cov MOUs kab liab rau kev tshuaj xyuas thiab kev pom zoo?
Tsis yog. Cov MCPs tsis tas yuav xa txhua qhov kev hloov kho rau kev tshuaj xyuas thiab kev pom zoo. Cov MCPs tsuas yog yuav tsum xa cov kev hloov kho raws li cov lus cog tseg rau DHCS kev tshuaj xyuas thiab kev pom zoo yog tias cov kev hloov kho hloov kho lossis tshem tawm ib qho ntawm cov kev cai yuav tsum tau ua los ntawm lawv cov lus cog tseg MOU uas tau sib tham uas tau teev tseg hauv Daim Ntawv Qauv MOU uas siv tau. Thaum ua tiav, MCPs yuav tsum xa txhua qhov kev hloov kho rau MOUs rau MCOD-MCP Submissions Portal ntawm SharePoint.
3. Cov txheej txheem xa daim ntawv MOU rau Kev Noj Qab Haus Huv Tus Cwj Pwm yog dab tsi?
Cov MCPs thiab Cov Kev Npaj Kho Mob Hlwb (MHPs), Drug Medi-Cal Organizaed Delivery System (DMC-ODS) thiab Drug Medi-Cal (DMC) cov nroog yuav tsum ua pov thawj tias lawv muaj kev rau siab ua raws li cov cai ntawm MOU ntawm
APL 23-029 thiab Behavioral Health Information Notices (BHINs)
23-056,
23-057, thiab
24-016.
Cov MCPs yuav tsum xa tag nrho cov MOUs uas tau ua tiav thiab teeb tsa kab lus tshiab, suav nrog Cov MOUs Kev Noj Qab Haus Huv raws li tau piav qhia saum toj no.
Cov MHPs, DMC-ODS thiab DMC cov nroog yuav tsum xa tag nrho cov MOUs uas tau ua tiav thiab muaj cov kab liab liab mus rau BHOMDMonitoring@dhcs.ca.gov. 4. Cov kev cai ntawm Subcontractor rau MCPs yog dab tsi thiab puas yog txhua tus SubContractor yuav tsum kos npe rau MOU? Ua ib tug "tog neeg uas hais lus sai sai" rau hauv MOU txhais li cas?
Daim Ntawv Cog Lus MCP teev tseg cov haujlwm twg uas MCP tuaj yeem muab thiab tsis tuaj yeem muab faib rau. Tsuas yog thaum MCP muaj Tus Neeg Cog Lus Ua Haujlwm Pab Cuam lossis Tus Neeg Cog Lus Ua Haujlwm Pab Cuam uas muab ib feem lossis tag nrho cov luag haujlwm ntsig txog kev ua tiav daim ntawv cog lus rau Knox-Keene cov phiaj xwm kev pabcuam kev noj qab haus huv uas tau tso cai, daim ntawv cog lus yuav tsum tau kos npe los ntawm MCP, Tus Neeg Cog Lus Ua Haujlwm Pab Cuam lossis Tus Neeg Cog Lus Ua Haujlwm Pab Cuam, thiab Lub Koom Haum Thib Peb. Hauv qhov xwm txheej zoo li no, Tus Neeg Cog Lus Ua Haujlwm lossis Tus Neeg Cog Lus Ua Haujlwm Hauv Qab yuav raug suav hais tias yog "tog neeg hais lus sai" hauv qhov xwm txheej no thiab kuj yuav tsum lees paub thiab pom zoo rau cov lus cog tseg ntawm MOU ntawm Lub Koom Haum Thib Peb thiab MCP. Yuav kom tsis txhob muaj kev tsis ntseeg, Tus Neeg Cog Lus Ua Haujlwm lossis Tus Neeg Cog Lus Ua Haujlwm yuav tsis nkag mus rau hauv MOU sib cais nrog Lub Koom Haum Sab Nraud, tab sis kuj yuav los ua tus neeg kos npe rau MOU ntawm MCP thiab Lub Koom Haum Sab Nraud. Qhov laj thawj uas yuav tsum tau kom Cov Neeg Cog Lus thiab/lossis Cov Neeg Cog Lus Hauv Qab uas yog cov phiaj xwm kev pabcuam kho mob uas tau tso cai los ntawm Knox-Keene kos npe rau MOU yog vim lawv muab cov kev pabcuam saib xyuas cov tswv cuab thiab yuav tsum koom nrog kev sib koom tes saib xyuas thiab cov txheej txheem xa mus rau lwm tus neeg cog lus thiab/lossis Cov Neeg Cog Lus Hauv Qab uas muab cov haujlwm tswj hwm xwb.
5. Vim li cas MCPs thiaj yuav tsum tshaj tawm cov MOUs thiab Daim Ntawv Qhia Txhua Xyoo uas tau ua tiav?
Cov MCPs yuav tsum tshaj tawm cov MOUs thiab Daim Ntawv Qhia Txhua Xyoo uas tau ua tiav rau ntawm nws lub vev xaib hauv 30 Hnub ntawm MOU ua tiav thiab hnub kawg ntawm daim ntawv qhia. Qhov yuav tsum tau ua rau MCPs tshaj tawm cov MOUs uas tau ua tiav thiab daim ntawv qhia txhua xyoo rau nws lub vev xaib yog los muab kev pom tseeb ntawm kev ua raws li txoj cai rau cov neeg koom nrog thiab xyuas kom meej tias kev tshuaj xyuas txhua xyoo ntawm MOU uas tau ua tiav lawm. DHCS tsuas muaj cai yuam kom qee Lub Chaw Haujlwm Sab Nraud tshaj tawm cov MOUs rau ntawm lawv lub vev xaib xwb. Lub sijhawm no, DHCS yuav tsis khaws tag nrho cov MOUs uas tau ua tiav rau hauv qhov chaw lossis lub vev xaib.
6. Daim Ntawv Qhia Txhua Xyoo ntawm MOU yog dab tsi?
Daim ntawv qhia txhua xyoo ntawm MOU yog daim ntawv qhia uas suav nrog cov kev hloov tshiab los ntawm cov rooj sib tham txhua peb lub hlis nrog Cov Chaw Sab Nraud thiab cov txiaj ntsig ntawm lawv cov kev tshuaj xyuas MOU txhua xyoo. Cov MCPs yuav tsum xa daim ntawv tshaj tawm no txhua xyoo los ntawm MCOD-MCP Submission Portal. DHCS tau tsim thiab tso tawm Daim Ntawv Qhia Txog Txhua Xyoo ntawm MOU, uas pab npaj cov ntaub ntawv xav tau rau daim ntawv qhia. Cov ntsiab lus xav tau tuaj yeem pom hauv APL
23-029.
7. Hnub kawg rau daim ntawv qhia txhua xyoo ntawm MOU yog hnub twg?
Daim Ntawv Qhia Txog Txhua Xyoo ntawm MOU yuav tsum xa tuaj rau hnub ua haujlwm kawg ntawm lub Ib Hlis txhua xyoo. Cov MCPs yuav tsum tshaj tawm txog txhua daim ntawv cog lus MOU uas tau siv thaum lub xyoo tshaj tawm. Rau cov MOUs uas yuav siv tau thaum lub xyoo tshaj tawm, MCPs yuav tsum tshaj tawm txog cov haujlwm ntsig txog MOU thaum lub sijhawm uas MOU tau siv. Piv txwv li, yog tias MOU raug ua tiav rau lub Xya Hli 1, 2024, MCP yuav tsum tshaj tawm txij lub Xya Hli 1, 2024, mus txog rau lub Kaum Ob Hlis 31, 2024. Yog tias koj muaj lus nug ntxiv txog daim ntawv qhia txhua xyoo ntawm MOU, thov xa email rau
MCPMOUS@dhcs.ca.gov.
8. DHCS yuav saib xyuas thiab ua kom MCPs lav ris li cas rau kev ua thiab ua tiav cov luag haujlwm teev tseg hauv MOUs?
Cov MCPs raug xav tau raws li Daim Ntawv Cog Lus MCP, Daim Ntawv Qhia A, Daim Ntawv Ntxiv III, kom ua qhov kev rau siab zoo los nkag mus rau hauv MOUs nrog Cov Chaw Sab Nraud, kom ntseeg tau tias Cov Tswv Cuab muaj peev xwm nkag mus rau thiab/lossis tau txais cov kev pabcuam hauv txoj kev sib koom tes los ntawm MCPs thiab Cov Chaw Sab Nraud. DHCS tab tom saib xyuas MCPs txoj kev nce qib mus rau lub hom phiaj no los ntawm MOU Cov Ntawv Qhia Txog Peb Lub Hlis ntawm qhov xwm txheej ntawm kev ua tiav ntawm txhua MOU uas xav tau thiab hauv cov ntawv qhia txhua xyoo uas piav qhia txog kev koom tes ntawm cov tog neeg.
Ntxiv rau, MCPs muaj lub luag haujlwm los xyuas kom meej tias lawv cov Subcontractors, Downstream Subcontractors, thiab Network Providers ua raws li txhua txoj cai lij choj thiab kev cai lij choj ntawm Lub Xeev thiab tsoomfwv tebchaws, cov kev cai ntawm daim ntawv cog lus, thiab lwm cov lus qhia ntawm DHCS, suav nrog APLs thiab Cov Ntawv Txoj Cai. Yog xav paub ntxiv txog Cov Neeg Cog Lus thiab Cov Neeg Muab Kev Pabcuam Hauv Network, suav nrog cov lus txhais thiab cov kev cai siv tau, saib
APL 19-001, thiab lwm yam APL tom qab ntawd txog qhov teeb meem no.
9. Cov txheej txheem xa cov ntawv qhia txhua peb lub hlis rau DHCS yog dab tsi?
DHCS paub tias kev koom nrog kev sib tham kom ua tiav cov MOUs yuav siv sijhawm thiab cov Chaw Haujlwm Sab Nraud muaj qee cov txheej txheem uas yuav tsum tau ua raws. Cov MCPs yuav tsum ua pov thawj tias lawv muaj kev rau siab ua raws li cov cai ntawm MOU ntawm Daim Ntawv Cog Lus MCP thiab
APL 23-029. Cov MCPs uas tsis tuaj yeem ua tiav cov MOUs uas yuav tsum tau ua raws li hnub ua tiav yuav tsum xa cov kev nce qib txhua peb lub hlis rau DHCS uas qhia txog pov thawj ntawm lawv txoj kev rau siab ua tiav cov MOUs siv DHCS's MOU Quarterly Reporting Template rau MCPs. Cov Chaw Ua Haujlwm Sab Nraud tsis tas yuav xa lossis kos npe rau cov ntawv qhia txhua peb lub hlis, vim tias cov ntawv qhia txhua peb lub hlis yog tshwj xeeb rau MCPs ua raws li cov cai ntawm MOU.
Cov MHPs thiab DMC-ODS, thiab cov nroog DMC yuav tsum ua pov thawj tias lawv muaj kev rau siab ua raws li cov cai ntawm MOU ntawm BHINs
24-016, 23-056, thiab
23-057 raws li. Yog xav paub ntxiv txog cov txheej txheem xa cov MOUs no los ntawm MHP, DMC-ODS thiab DMC counties, thov saib ntu rau cov MOUs tshwj xeeb. Cov MCPs raug txhawb kom koom tes nrog Cov Chaw Sab Nraud thiab koom tes nrog Cov Chaw Sab Nraud los tshuaj xyuas thiab pom zoo rau kev ua tiav MOUs kom ua tiav MOU hauv txoj kev sib hwm, muaj txiaj ntsig thiab sib pom zoo.
