Tsev Lub Chaw Saib Xyuas Kev Noj Qab Haus Huv Txog Kev Coj Tus Cwj Pwm

Tus Cwj Pwm Saib Xyuas Kev Noj Qab Haus Huv Network Adequacy Oversight Branch

Rov qab mus rau nplooj ntawv tseem ceeb ntawm Cov Kev Pabcuam Kev Noj Qab Haus Huv Tus Kheej. 

Lub Chaw Saib Xyuas Kev Noj Qab Haus Huv Txog Kev Coj Tus Cwj Pwm (BHNAOB) yog ib lub koom haum hauv Behavioral Health Oversight and Monitoring Division (BHOMD), uas yog ib feem ntawm Behavioral Health program ntawm Department of Health Care Services. Cov ntaub ntawv hais txog BHOMD tuaj yeem nrhiav tau los ntawm qhov txuas ntawm Behavioral Health Services homepage nyob rau sab saum toj ntawm daim ntawv no. BHNAOB yog lub luag haujlwm rau qhov kev pab cuam txaus ntawm Medi-Cal Behavioral Health, qhov kev pab cuam txaus ntawm Behavioral Health Services Act, thiab yav dhau los muaj lub luag haujlwm tswj hwm rau Behavioral Health Quality Improvement Program (BHQIP), uas tau xaus rau lub Rau Hli 30, 2024. Cov Chaw Saib Xyuas Kev Txaus ntawm Network muaj lub luag haujlwm rau kev saib xyuas thiab saib xyuas txhua yam kev noj qab haus huv ntawm Specialty Mental Health Services (SMHS) thiab Drug Medi-Cal Organized Delivery System (DMC-ODS), nrog rau cov kev cai nkag mus rau cov phiaj xwm Drug Medi-Cal hauv xeev raws sijhawm vim muaj kev sib npaug.

Kev Saib Xyuas Kev Ncaj Ncees Network

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. 

Cov kev ua raws li kev txaus siab ntawm lub network thiab kev saib xyuas cov haujlwm uas tau txheeb xyuas ntawm no yog tshwj xeeb rau MHPs, DMC-ODS cov kev pab cuam, thiab DMC lub xeev cov phiaj xwm tshwj xeeb rau cov kev cai nkag mus raws sijhawm. Lub Chaw Saib Xyuas Kev Kho Mob Zoo thiab Kev Saib Xyuas saib xyuas cov kev cai txaus ntawm lub network rau Cov Phiaj Xwm Kev Kho Mob Tswj. Thov mus saib lub vev xaib ntawm Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv kom paub ntau ntxiv txog kev txaus ntawm lub network, suav nrog Cov Ntawv Qhia Txog Kev Pom Zoo Txhua Xyoo, Cov Qauv Kev Nkag Mus Rau Lwm Txoj Kev, thiab Cov Phiaj Xwm Kho Kom Zoo. 

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

Cov Cai Siv Tau 

Tsoom Fwv Teb Chaws: 

  • 42 CFR 438.206 Muaj Kev Pabcuam 
  • 42 CFR 438.207 Assurance of txaus peev xwm thiab kev pab cuam 
  • 42 CFR 438.68 Network Adequacy Standards 

Xeev (Statutes): 

  • HSC Tshooj 1367.03 
  • WIC Tshooj 14197 

Xeev (Txoj Cai): 

  • 28 CCR Tshooj 1300.67.04 
  • 28 CCR Tshooj 1300.67.2.2 

Cov peev txheej ntxiv

California Advancing and Innovation Medi-Cal (CalAIM):

Medicaid thiab Medi-Cal General:

Cov ntaub ntawv tiv tauj