Tsev Cov Lus Nug Feem Ntau Txog Kev Pib Kho Mob Kev coj cwj pwm ntawm CalAIM​​ 

CalAIM Behavioral Health Initiative Cov lus nug nquag nug​​ 

Rov qab mus rau CalAIM FAQs​​ 

Hauv qab no yog cov npe ntawm cov lus nug uas nquag nug tau raug sau los ntawm kev pab cuam thiab cov ntaub ntawv webinars thiab xa mus rau BHCalAIM@dhcs.ca.gov email. DHCS yuav hloov kho cov npe no nyob rau peb lub hlis twg.​​ 

DMC-ODS​​ 

Kev Sib Tham Hauv Tsev Kho Mob puas tuaj yeem tshwm sim ntawm cov neeg ua haujlwm muaj ntawv tso cai nyob hauv tib lub koom haum, lossis yuav tsum muaj kev sib tham no ntawm cov neeg ua haujlwm muaj ntawv tso cai thiab cov kws pab tswv yim sab nraud uas tau cog lus los ntawm lub nroog?​​ 

Siv BHIN 24-001 & DMC-ODS Service Table​​ 

Clinician Consultations may occur between licensed agency staff within the same agency as well as between licensed agency staff and consultants outside of their agency, given both clinicians are qualified to provide Drug Medi-Cal Organized Delivery System (DMC-ODS) services. Page 22 of Behavioral Health Information Notice (BHIN) 24-001 provides authority for Clinician Consultation under the DMC-ODS program. This includes consultations between clinicians designed to assist Drug Medi-Cal (DMC) clinicians with seeking expert advice on treatment needs for specific DMC-ODS members while also permitting DMC-ODS plans to contract with one or more physicians, clinicians, or pharmacists specializing in addiction in order to provide consultation services. Enclosure 5 of BHIN 24-001 lists the types of providers that are qualified to deliver each DMC-ODS service.​​ 

Cov Kev Pabcuam Kev Sib Tham Hauv Tsev Khomob tau them nqi li cas hauv Drug Medi-Cal Organized Delivery System (DMC-ODS)?​​ 

Reference: BHIN 24-001, BHIN 23-017, DMC-ODS Billing Manual, DMC-ODS Service Table.​​ 

Clinician Consultation tsis yog ib qho kev pabcuam ncaj qha rau DMC-ODS cov tswvcuab. Qhov kev pabcuam no tso cai rau cov kws kho mob nrhiav kev kho mob thiab cov kws tshaj lij los ntawm lwm cov kws tshaj lij uas muaj ntawv tso cai los txhawb kev saib xyuas rau cov tswv cuab DMC-ODS tshwj xeeb.​​ 

Tsuas yog cov kws kho mob DMC-ODS uas tab tom nrhiav kev pab tswv yim thiab muab kev saib xyuas ncaj qha rau tus tswv cuab tuaj yeem sau nqi rau Clinician Consultation. Tus neeg muab kev pabcuam DMC-ODS tuaj yeem siv cov txheej txheem kev sib tham hauv Clinician Consultation codes (99367, 99368, lossis 99451) los thov rau qhov haujlwm. Tus kws kho mob muab cov lus qhia tsis tuaj yeem sau nqi rau Clinician Consultation.​​ 

Thov saib phau ntawv qhia txog kev them nqi ntawm DMC-ODS thiab daim ntawv teev kev pabcuam DMC-ODS sib cais kom paub cov lus qhia txog kev them nqi rau cov kev pabcuam sab laj ntawm kws kho mob.​​ 

Puas yog kev sab laj ntawm Tus Kws Kho Mob Uas Muaj Daim Ntawv Tso Cai (LPHA) thiab Tus Kws Pab Tswv Yim Kho Mob Uas Muaj Daim Ntawv Tso Cai (LPCC) rau kev txiav txim siab txog kev kuaj mob thiab kev tsim nyog kho mob uas yuav tsum tau them nqi siv cov lej ntsuas?​​ 

Siv: BHIN 24-001, BHIN 23-068, Phau Ntawv Qhia Txog Kev Them Nqi DMC-ODS, Rooj Kev Pabcuam DMC-ODS.​​ 

Tsis yog. Tus lej ntsuas yuav tsis raug siv los them nqi rau kev sab laj. Kev sab laj ntawm LPHA thiab LPCC uas tshwm sim thaum lub sijhawm ntsuam xyuas tus tswv cuab DMC-ODS yuav raug sau npe ua Kev Sab Laj Kws Kho Mob siv tus lej sib cais.​​ 

Clinician Consultation tsis yog ib qho kev pabcuam ncaj qha rau DMC-ODS cov tswvcuab. Qhov kev pabcuam no tso cai rau cov kws kho mob nrhiav kev kho mob thiab cov kws tshaj lij los ntawm lwm cov kws tshaj lij uas muaj ntawv tso cai los txhawb kev saib xyuas rau cov tswv cuab DMC-ODS tshwj xeeb.​​ 

Tsuas yog cov kws kho mob DMC-ODS uas tab tom nrhiav kev pab tswv yim thiab muab kev saib xyuas ncaj qha rau tus tswv cuab tuaj yeem sau nqi rau Clinician Consultation. Tus neeg muab kev pabcuam DMC-ODS tuaj yeem siv cov txheej txheem kev sib tham hauv Clinician Consultation codes (99367, 99368, lossis 99451) los thov rau qhov haujlwm. Tus kws kho mob muab cov lus qhia tsis tuaj yeem sau nqi rau Clinician Consultation.​​ 

Thov saib phau ntawv qhia txog kev them nqi ntawm DMC-ODS thiab daim ntawv teev kev pabcuam DMC-ODS sib cais kom paub cov lus qhia txog kev them nqi rau cov kev pabcuam sab laj ntawm kws kho mob.​​ 

Thaum twg tus kws kho mob hauv chaw kho mob yuav them nqi rau Cov Kev Pabcuam Rov Qab Hauv Cov Tshuaj Medi-Cal Organized Delivery System (DMC-ODS)?​​ 

Siv: BHIN 24-001, BHIN 22-005, Phau Ntawv Qhia Txog Kev Them Nqi DMC-ODS, Rooj Kev Pabcuam DMC-ODS.​​ 

Tus nqi them txhua hnub rau Kev Pabcuam Kev Khomob Nyob Hauv Tsev muaj xws li:​​ 

  • Kev soj ntsuam​​ 
  • Kev sab laj (tus kheej thiab pab pawg)​​ 
  • Kev Kho Mob Tsev Neeg​​ 
  • Kev Pab Kho Mob​​ 
  • Kev Kawm Tus Neeg Mob​​ 
  • Kev Pabcuam Kev Siv Tshuaj Tsis Txaus Siab Kev Pabcuam​​ 

Cov tswv cuab yuav tau txais Kev Pabcuam Rov Qab Zoo hauv DMC-ODS hauv peb txoj kev: ua ib qho kev pabcuam uas sawv ntawm nws tus kheej, sib cais tab sis ua ke nrog lwm qib kev saib xyuas DMC-ODS uas teev nyob rau hauv BHIN 24-001's "Cov Kev Pabcuam DMC-ODS uas Tau Them" (suav nrog Cov Kev Pabcuam Nyob Hauv Tsev), lossis ua ib feem ntawm cov qib kev saib xyuas DMC-ODS no.​​ 

Yog tias ib tus tswvcuab tau txais Kev Pabcuam Rov Qab los ua ib feem ntawm lawv Cov Kev Pabcuam Kev Khomob nyob hauv tsev, cov neeg muab kev pabcuam nyob hauv yuav tsum xa cov ntaub ntawv sib cais rau Cov Kev Pabcuam Rov Qab. Cov Kev Pabcuam Rov Qab tuaj yeem thov rau tib hnub raws li Kev Pabcuam Kev Khomob hauv Chaw Nyob thiab rau tib tus tswvcuab los ntawm Cov Kev Pabcuam Kev Khomob Sab Nraud thiab Cov Chaw Pabcuam Kev Khomob nyob.​​ 

Please see the DMC-ODS Billing Manual and separate DMC-ODS Service Table for directions on billing Recovery Services.​​ 

Yuav ua li cas tus neeg muab kev pab them nqi kho mob nyob rau hauv cov kev pab cuam bundled tus nqi rau ib hnub uas tsis muaj kev pab them nqi nyob rau hauv lub hnub ntawm kev thov?​​ 

Siv MHSUDS 19-010; MHSUDS 18-058; Phau Ntawv Qhia Txog Kev Them Nqi DMC-ODS; Phau Ntawv Qhia Txog Txoj Cai SUBG; § 1915(c) ntawm Txoj Cai Kev Ruaj Ntseg Hauv Zej Zog​​ 

Cov kws kho mob tuaj yeem sau tus nqi txhua hnub rau Cov Kev Pab Kho Mob Nyob Hauv Tsev thaum tsawg kawg yog ib qho ntawm cov kev pabcuam uas suav nrog hauv tus nqi pob khoom raug muab rau tus tswvcuab rau hnub thov Medi-Cal. Tus nqi niaj hnub no suav nrog cov kev pabcuam / kev pabcuam hauv qab no:​​ 

  • Kev soj ntsuam​​ 
  • Kev sab laj (tus kheej thiab pab pawg)​​ 
  • Kev Kho Mob Tsev Neeg​​ 
  • Kev Pab Kho Mob​​ 
  • Kev Kawm Tus Neeg Mob​​ 
  • Kev Pabcuam Kev Siv Tshuaj Tsis Txaus Siab Kev Pabcuam​​ 

Thov saib phau ntawv qhia txog kev them nqi rau DMC-ODS thiab daim ntawv teev kev pabcuam kom paub cov lus qhia txog kev them nqi rau cov kev pabcuam kho mob hauv tsev.​​ 

Medi-Cal tsis them rov qab rau chav nyob thiab khoom noj (piv txwv li. cov nuj nqis vaj tse thiab kev siv nyiaj niaj hnub) raws li § 1915(c) ntawm Social Security Act. California muaj cov nyiaj pab sib cais uas cov nroog tuaj yeem siv los them rov qab rau chav tsev thiab khoom noj rau Cov Kev Pabcuam Kho Mob Hauv Tsev, suav nrog Cov Nyiaj Pab Tiv Thaiv Kev Siv Tshuaj Yeeb, Kev Kho Mob thiab Kev Rov Qab Zoo (SUBG). Txawm li cas los xij, cov nroog yuav tsum tsim cov lus qhia rau thiab saib xyuas lawv siv cov nyiaj pab dawb kom ntseeg tau tias siv tau zoo. Raws li tau hais tseg hauv MHSUDS 18-058, cov nyiaj pab los ntawm SUBG yuav siv tau rau cov kev pabcuam hauv qab no:​​ 

  • Chav thiab lub rooj tsavxwm rau Kev Pabcuam Kev Khomob Nyob Hauv Tsev muaj nyob hauv DMC-ODS,​​ 
  • Cov kev pab cuam Recovery Residences1 hauv Drug Medi-Cal Organized Delivery System (DMC-ODS) cov phiaj xwm (txog li 24 lub hlis), lossis​​ 
  • Chav thiab khoom noj rau cov tswv cuab uas tau txais kev pabcuam hauv Transitional Housing2 hauv Drug Medi-Cal (DMC) counties (txog li 24 lub hlis).​​ 

Txawm hais tias tsis yog ib feem ntawm DMC-ODS, Cov Kev Pabcuam Rau Cov Menyuam Thaum Muaj Xwm Ceev (CCRP) yog California Department of Social Services cov kev pabcuam Kho Mob Thaum Muaj Xwm Ceev uas tau txais daim ntawv tso cai los ntawm DHCS los muab cov kev pabcuam uas Medicaid them, feem ntau yog cov kev pabcuam kho mob thaum muaj xwm ceev. CCRPs yog ib feem ntawm lub zej zog kev saib xyuas uas muab kev saib xyuas tsis yog kev kho mob rau cov menyuam yaus uas muaj teeb meem kev noj qab haus huv ntawm lub hlwb uas tuaj yeem ua lwm txoj hauv kev rau kev pw hauv tsev kho mob puas siab puas ntsws.​​ 

Cov nqi tsim nyog rau kev kho mob thaum muaj xwm txheej ceev yog cov nqi rau cov kws kho mob ncaj qha, cov khoom siv kho mob, cov khoom siv kho mob, thiab cov nqi siv ua haujlwm; cov nqi tsim nyog tsis suav nrog chav tsev thiab khoom noj. Cov nroog muaj lub luag haujlwm them tus nqi chav tsev thiab khoom noj thaum CCRP lees txais ib tus tswv cuab Medi-Cal. Cov nroog yuav them tus nqi chav thiab khoom noj nrog cov nyiaj uas lub nroog tau txais los ntawm Lub Xeev los muab cov kev pabcuam kev noj qab haus huv ntawm lub hlwb hauv zej zog los ntawm Kev Hloov Kho Xyoo 1991 lossis Txoj Cai Kev Noj Qab Haus Huv ntawm Lub Siab (MHSA). Cov nroog yuav tsum tsim cov lus qhia rau thiab saib xyuas lawv siv cov nyiaj MHSA. Raws li tau hais tseg rau ntawm nplooj ntawv 3 thiab 4 ntawm MHSUDS 19-010, Cov nroog yuav siv cov nyiaj rov qab los ntawm xyoo 1991 lossis cov nyiaj ntawm Txoj Cai Kev Noj Qab Haus Huv ntawm Lub Siab los them rau cov kev pabcuam hauv qab no:​​ 

  • 1991 Cov nyiaj rov qab kho dua tuaj yeem them rau cov kev kho mob hauv tsev kho mob, chav tsev thiab lub rooj tsav xwm, thiab kev saib xyuas 24-teev thiab saib xyuas rau cov neeg tsim nyog, suav nrog cov neeg tau txais txiaj ntsig Medi-Cal, hauv STRTP kev ua haujlwm raws li CCRP.​​ 
  • Cov nyiaj MHSA tuaj yeem them cov nqi kho mob hauv tsev kho mob thiab chav tsev thiab pawg thawj coj saib hauv CCRP rau cov menyuam yaus nyob rau hauv Pawg Pabcuam Kev Pabcuam Tag Nrho ntawm Cov Kev Pabcuam Hauv Zej Zog thiab Kev Txhawb Nqa. General Service Development cov nyiaj yuav them rau cov nqi kho mob hauv tsev kho mob, tab sis tsis yog tus nqi ntawm chav tsev thiab lub rooj tsavxwm. Lub nroog yuav tsum siv nyiaj MHSA raws li txoj kev npaj npaj ua raws li cov txheej txheem muaj feem cuam tshuam, tau pom zoo los ntawm lawv Pawg Neeg Saib Xyuas, thiab xa mus rau DHCS thiab Pawg Saib Xyuas Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv thiab Kev Saib Xyuas Kev Ua Haujlwm.​​ 

Hauv cov ntsiab lus, tus nqi bundled rau cov kev pab kho mob hauv tsev tsuas yog muaj nyob rau hnub uas muaj kev pab them nqi kho mob. Kev thov rau DMC-ODS Cov Kev Pabcuam Kev Khomob nyob hauv tsev raug them rov qab cais los ntawm SUBG thiab MHSA cov nyiaj kwj, uas muaj rau cov nuj nqis hauv chav tsev thiab pawg thawj coj thaum kho vaj tse. Txhua lub nroog yuav tsum tsim cov lus qhia thiab saib xyuas lawv cov kev siv nyiaj rau cov hom phiaj no.​​ 

1 Thov mus saib MHSUDS IN 18-058 yog xav paub ntxiv txog cov nyiaj pab rau cov chaw nyob rov qab.​​ 

2 Thov saib MHSUDS IN 18-058 kom paub ntxiv txog cov nyiaj pab rau Transitional Housing.​​ 

Cov Lus Nug luv luv rau Qhov Kev Tso Cai Ua Ntej (BQuIP) puas tuaj yeem siv los ua kom tiav qhov kev ntsuam xyuas ntau yam kev saib xyuas (LOC)?​​ 

Reference: BHIN 24-001, BHIN 23-068​​ 

Tsis tau. Cov cuab yeej BQuIP siv tsis tau los ua kom tiav qhov kev ntsuam xyuas ntau theem ntawm kev saib xyuas (LOC). Cov kws kho mob yuav tsum siv kev ntsuam xyuas ntawm American Society of Addiction Medicine (ASAM) los txiav txim siab seb cov tswv cuab ntawm DMC-ODS yuav muab tso rau hauv qib kev saib xyuas uas tsim nyog.​​ 

Yuav tsum siv cov lej kuaj mob twg rau cov tswv cuab uas tau txais kev pabcuam nyob thiab pw hauv tsev kho mob ntawm Drug Medi-Cal Organized Delivery System (DMC-ODS) uas tseem tsis tau ua tiav kev ntsuam xyuas kom meej kom tau txais kev kuaj mob tseeb txog kev siv tshuaj yeeb dej cawv?​​ 

Siv: BHIN 24-001, Phau Ntawv Qhia Txog Kev Them Nqi DMC-ODS.​​ 

Cov kev thov rau DMC-ODS cov kev pabcuam hauv tsev kho mob thiab chaw nyob yuav tsum muaj tsawg kawg ib tus lej kuaj mob ICD-10 uas DMC them raws li tau teev tseg hauv phau ntawv DMC-ODS Billing Manual uas nyuam qhuav luam tawm tshiab tshaj plaws uas muaj nyob rau ntawm nplooj ntawv web MedCCC. Thaum lub sijhawm pib ntawm kev nkag mus rau hauv tsev kho mob lossis pw hauv tsev kho mob, cov kws kho mob yuav siv kev kuaj mob tsis tau teev tseg, xws li F19.9 (Lwm yam kev siv tshuaj psychoactive, tsis tau teev tseg), thaum daim duab kuaj mob tag nrho tseem tsis tau meej. Qhov no yog ib feem uas lees paub ntawm cov txheej txheem ntsuam xyuas thaum cov tsos mob tab tom hloov pauv, lossis xav tau cov ntaub ntawv ntxiv. Txawm li cas los xij, kev siv qhov kev kuaj mob uas tsis tau teev tseg rau nws tus kheej tsis ua rau muaj kev tsim nyog kho mob lossis lav qhov kev tso cai rau kev kho mob hauv tsev lossis hauv tsev kho mob.​​ 

Cov kev txiav txim siab txog kev nkag mus thiab kev nyob txuas ntxiv yog ua los ntawm txhua txoj kev tso cai ntawm txoj kev npaj DMC-ODS raws li tus tswv cuab qhov kev nthuav qhia kev kho mob, qib kev saib xyuas, thiab cov ntaub ntawv xav tau kev kho mob.​​ 

Txhua yam kev pabcuam DMC-ODS yuav tsum yog qhov tsim nyog rau kev kho mob thiab tsim nyog rau kev kho mob. Cov kws kho mob yuav tsum siv lawv txoj kev txiav txim siab hauv kev kho mob los txiav txim siab seb qib kev saib xyuas twg tsawg tshaj plaws los kho cov kev xav tau ntawm tus tswv cuab, suav nrog thaum qhov ntawd xav tau kev pabcuam hnyav dua li muab rau hauv qhov chaw kho mob sab nraud. Cov kev ntsuam xyuas thiab lwm cov ntaub ntawv hauv cov ntaub ntawv kho mob yuav tsum ua pov thawj tias siv F19.9. Txawm li cas los xij, qhov kev txiav txim siab zaum kawg ntawm kev sau code yog nyob ntawm txhua tus kws tshwj xeeb ntawm BHP.​​ 

Z-codes puas tuaj yeem siv los ua qhov kev kuaj mob thawj zaug rau Cov Kev Pabcuam Medi-Cal Organized Delivery System (DMC-ODS)?​​ 

Reference BHIN 24-001, BHIN 22-013​​ 

Raws li BHIN 22-013, qee cov lej Z yuav siv tau thaum muab cov kev pabcuam sab nraud DMC-ODS thaum lub sijhawm soj ntsuam ua ntej kev kuaj mob tau tsim. Cov lej Z ua tau raws li tsoomfwv txoj cai rau cov kev thov nyiaj pab. Cov ntaub ntawv kho mob yuav tsum txhawb nqa txhua tus lej Z uas siv rau hauv kev ntsuam xyuas. Cov lus thov DMC-ODS yuav tsum suav nrog cov lej International Classification of Diseases, Tenth Revision (ICD-10) uas tsim nyog rau kev kho mob uas cuam tshuam nrog txhua qhov kev pabcuam. Cov lej ICD yog qhov yuav tsum muaj rau cov kev thov kom DHCS tau txais kev koom tes nyiaj txiag ntawm tsoomfwv.​​ 

Yam kev ntsuas twg yuav tsum tau ua thaum tso cai rau Drug Medi-Cal Organized Delivery System (DMC-ODS) cov neeg siv khoom rau American Society of Addiction Medicine (ASAM) 3.1 thiab 3.5 Qib Kev Kho Mob?​​ 

BHIN 24-001, Exhibit A ntawm BHIN 21-001, BHIN 23-068​​ 

DMC-ODS ASAM 3.1 and 3.5 Levels of Care require a multidimensional assessment to be conducted and completed within 72 hours following the member’s admission to the program, per Exhibit A of BHIN 21-001.​​ 

Cov tswvcuab tau txais kev pabcuam detoxification thaum nkag tau raug zam los ntawm ntau qhov kev ntsuas kev ntsuas yog tias kev ntsuas ua ntej ua tiav tsis pub dhau 72 teev tom qab nkag mus rau cov kev pabcuam detoxification thiab muaj cov phiaj xwm xwm txheej hloov cov tswvcuab mus rau Qib Kev Kho Mob uas yuav muaj kev ntsuas tag nrho.​​ 

Puas yog yuav tsum muaj kev tso cai ua ntej rau Kev Siv Tshuaj Kho Mob Medi-Cal Organized Delivery System (DMC-ODS) Kev Kho Mob thiab Kev Pabcuam Hauv Tsev?​​ 

Reference: BHIN 24-001​​ 

Yog. Cov phiaj xwm DMC-ODS yuav tsum muab kev tshuaj xyuas ywj pheej ntawm cov kev thov tso cai rau cov kev pabcuam nyob hauv tsev kho mob thiab cov kev pabcuam hauv tsev kho mob (tsis suav nrog cov kev pabcuam tswj kev rho tawm) thiab ceeb toom rau tus kws kho mob txog qhov kev txiav txim siab ntawm txoj kev npaj hauv 24 teev ntawm kev xa daim ntawv thov los ntawm tus kws kho mob.​​ 

Thov nco ntsoov tias cov phiaj xwm DMC-ODS yuav tsis yuam kom muaj kev tso cai ua ntej rau cov kev pabcuam ntsuam xyuas thiab kho mob uas tsis yog nyob hauv tsev kho mob thiab tsis yog pw hauv tsev kho mob, uas suav nrog cov kev pabcuam tswj kev rho tawm.​​ 

Puas yog qhov kev ntsuam xyuas thoob ntiaj teb American Society of Addiction Medicine (ASAM) xav tau rau cov tswv cuab kom tau txais Kev Pabcuam Rov Qab?​​ 

Reference: BHIN 24-001, BHIN 22-005, BHIN 23-068​​ 

Cov Kev Pabcuam Rov Qab tsis tas yuav muaj kev ntsuam xyuas ASAM rau cov tswvcuab kom tau txais kev pabcuam, tsis hais hom kev xa khoom.​​ 

Cov tswv cuab yuav tau txais Cov Kev Pabcuam Rov Qab Zoo raws li kev ntsuam xyuas tus kheej lossis kev ntsuam xyuas ntawm tus kws kho mob txog kev pheej hmoo rov qab los. Cov tswv cuab tsis tas yuav raug kuaj pom tias tau zoo lawm thiaj li yuav tau txais kev pab cuam rov zoo.​​ 

Recovery Services under DMC-ODS can be delivered in three ways: as a standalone service; separately but concurrently with the other DMC-ODS levels of care listed in BHIN 24-001’s “Covered DMC-ODS Services” section; or as a component of these DMC-ODS levels of care. DMC-ODS providers should use their clinical expertise, in accordance with each member’s clinical needs and generally accepted standards of practice, to determine the appropriate delivery method of Recovery Services for their members.​​ 

Thov nco ntsoov tias qhov kev ntsuam xyuas ASAM tsis tas yuav tsum muaj rau ib tus tswv cuab pib tau txais kev pabcuam DMC-ODS.​​ 

Qhov yuav tsum tau nyob ntev npaum li cas rau Medi-Cal cov tswv cuab hauv cov kev pab cuam kho mob siv tshuaj nyob hauv tsev (SUD)? Puas yog cov kev cai no txawv rau cov neeg cev xeeb tub thiab tom qab yug menyuam?​​ 

Reference BHIN 21-021; BHIN 24-001​​ 

Medi-Cal cov tswvcuab, suav nrog cov tswvcuab cev xeeb tub thiab tomqab yug menyuam, tuaj yeem nyob hauv SUD cov kev pabcuam khomob hauv tsev kom ntev npaum li kev khomob tsim nyog raws li tau txiav txim los ntawm Tus Kws Lij Choj Kev Kho Mob (LPHA). Txawm hais tias lub hom phiaj thoob plaws lub xeev rau qhov nruab nrab ntev ntawm kev nyob twj ywm rau cov kev pab cuam kho mob hauv cheeb tsam uas muab los ntawm Drug Medi-Cal Organized Delivery System (DMC-ODS) counties yog 30 hnub lossis tsawg dua, tsis muaj kev txwv rau cov hnub ntau tshaj plaws uas tus tswv cuab tuaj yeem nyob hauv kev kho vaj tse.​​ 

Please see BHIN 21-021 for additional information on the removal of a former length of stay requirement.​​ 

Yog tias ib tug tswvcuab tab tom nqis los ntawm thaj chaw nyob mus rau tus neeg mob sab nraud Cov Kev Pabcuam Kev Noj Qab Haus Huv Medi-Cal Organized Delivery System (DMC-ODS), tus kws khomob sab nraud thiab tus kws khomob puas tuaj yeem them nqi rau Kev Pabcuam Kev Khomob thaum tus tswvcuab tseem muaj npe hauv cov kev pabcuam hauv tsev?​​ 

Siv: BHIN 24-001, Phau Ntawv Qhia Txog Kev Them Nqi DMC-ODS, Rooj Kev Pabcuam DMC-ODS​​ 

Cov Kev Pabcuam Kev Khomob Nyob Hauv Lub Nroog tsis suav nrog Kev Pabcuam Saib Xyuas Kev Khomob. Yog li, Kev Kho Mob Nyob Hauv Tsev lossis Tus Kws Kho Mob Sab Nraud tuaj yeem sau nqi thiab them rov qab rau Kev Saib Xyuas Kev Kho Mob raws li qhov kev pabcuam tsis tau muab cais tawm ntawm kev them nqi rau Kev Khomob Hauv Tsev lossis cov kev pabcuam sab nraud.​​ 

Yog tias tus kws kho mob nyob hauv tsev tau ntawv pov thawj los muab Kev Pabcuam Sab Nraud, tus kws kho mob tuaj yeem thov Kev Pabcuam Kev Khomob raws li kev pabcuam khomob sab nraud (siv tus hloov kho U7 lossis U8) thiab yuav raug them rov qab rau qhov kev pabcuam ntawm tus neeg mob sab nraud. Tus kws kho mob nyob hauv tsev kuj tuaj yeem thov rau Kev Saib Xyuas Kev Kho Mob los ntawm daim ntawv pov thawj qhov kev pab cuam nyob (ie modifier U1) tsis yog tus neeg mob sab nraud thiab muaj cai rau tib tus neeg mob sab nraud.​​ 

Cov Kev Pabcuam Kev Khomob Nyob Hauv Tsev Kho Mob bundled tus nqi suav nrog cov hauv qab no:​​ 

  • Kev soj ntsuam​​ 
  • Kev sab laj​​ 
  • Kev Kho Mob Tsev Neeg​​ 
  • Kev Pab Kho Mob​​ 
  • Kev Kawm Tus Neeg Mob​​ 

Please see the DMC-ODS Billing Manual and separate DMC-ODS Service Table for directions on billing Care Coordination services.​​ 

Rau Cov Tshuaj Kho Mob Medi-Cal Organized Delivery System (DMC-ODS), puas tseem xav tau cov phiaj xwm tso tawm thiab cov ntsiab lus tso tawm?​​ 

Siv: BHIN 19-003; BHIN 23-068, BHIN 24-001​​ 

Cov phiaj xwm DMC-ODS thiab cov chaw muab kev pab yuav tsum ua raws li cov ntaub ntawv teev tseg hauv BHIN 23-068, uas tsis suav nrog cov phiaj xwm tso tawm thiab cov ntsiab lus luv luv ntawm kev tso tawm. Kev npaj tso tawm yog ib feem ntawm cov kev pabcuam Care Coordination rau DMC-ODS thiab yuav tsum muab raws li qhov xav tau ntawm cov tswv cuab. Kev npaj tso tawm hauv tsev kho mob tuaj yeem suav nrog kev sib koom tes nrog cov kws kho mob siv tshuaj yeeb (SUD) los txhawb kev hloov pauv ntawm cov theem kev saib xyuas thiab cov peev txheej rov zoo, xa mus rau cov kws kho mob hlwb, thiab xa mus rau cov kws kho mob thawj zaug lossis cov kws kho mob tshwj xeeb. Rau cov kev pab cuam uas tau ntawv pov thawj xwb, cov phiaj xwm tso tawm thiab cov ntsiab lus luv luv yog qhov yuav tsum tau ua raws li Cov Txheej Txheem Kev Pov Thawj Cawv thiab/lossis Lwm Yam Tshuaj (AOD) 7120.​​ 

Ntxiv mus, cov kev pab cuam nyob hauv tsev uas tau txais daim ntawv tso cai yuav tsum hloov kho cov ntaub ntawv nyob hauv tsev raws li qhov tsim nyog kom ntseeg tau tias muaj tseeb tam sim no thiab suav nrog cov ntaub ntawv thiab vim li cas thiaj li tso tseg cov kev pabcuam, raws li CCR Title 9, Tshooj 5, Seem 10568. Tsis tas li ntawd xwb, BHIN 19-003 hloov kho H&S Code 11834.26(d) kom suav nrog kev tso tawm ntawm tus neeg nyob hauv tsev kho mob thiab kev txuas ntxiv kev saib xyuas ua ib feem ntawm txoj kev npaj sau ntawv uas yuav tsum tau ua los daws qhov teeb meem rov qab los ntawm tus neeg nyob hauv tsev kho mob.​​ 

Kev tsis muaj tsev nyob puas tuaj yeem yog qhov laj thawj rau kev siv tshuaj tua kab mob (SUD) lossis txawm tias nce qib kev saib xyuas (LOC)?​​ 

Reference: BHIN 24-001​​ 

Cov tswv cuab yuav tsum ua kom tau raws li cov txheej txheem nkag mus rau Drug Medi-Cal (DMC) lossis Drug Medi-Cal Organized Delivery System (DMC-ODS) kom nkag mus rau SUD cov kev pabcuam los ntawm DMC/DMC-ODS txoj haujlwm. American Society of Addiction Medicine (ASAM) Cov Txheej Txheem yog siv los txiav txim siab tso rau hauv LOC tsim nyog rau txhua tus tswv cuab tau txais kev pabcuam los ntawm DMC lossis DMC-ODS. Dimension 5 (Rov qab ib puag ncig kev sib cuam tshuam) ntawm ntau qhov kev ntsuam xyuas ASAM suav nrog cov xwm txheej uas tuaj yeem cuam tshuam txog kev rov qab los, xws li kev tsis muaj tsev nyob, los pab txiav txim siab qhov chaw tsim nyog. Kev tso cov tswv cuab thiab kev txiav txim LOC yuav tsum xyuas kom cov tswv cuab muaj peev xwm tau txais kev saib xyuas hauv LOC tsawg kawg nkaus uas tsim nyog kho lawv tus mob.​​ 

Puas yog qhov yuav tsum tau muab naloxone ntawm qhov Kev Pabcuam Kev Kho Mob Narcotic (NTP) / Opioid Treatment Program (OTP) tuaj yeem ua tau los ntawm kev muab ib daim ntawv ntawm buprenorphine (Suboxone ® ) uas muaj buprenorphine thiab naloxone?​​ 

Reference: BHIN 24-001, BHIN 23-064​​ 

Tsis yog. Thaum NTPs/OTPs tuaj yeem muab cov qauv ntawm buprenorphine uas muaj naloxone, qhov no tsis yog hloov rau naloxone. Naloxone (los ntawm nws tus kheej) yog siv los thim rov qab kev noj tshuaj ntau dhau ntawm opioid. Kev suav nrog naloxone hauv kev sib xyaw ua ke ntawm buprenorphine / naloxone cov khoom yog tsim los tiv thaiv kev sib txawv thiab kev siv cov tshuaj buprenorphine tsis raug; Nws tsis yog tsim los thim rov qab kev noj tshuaj ntau dhau ntawm opioid.​​ 

Tus kws kho mob yuav tsum sau nqi li cas rau qhov kev pab cuam kho mob yeeb tshuaj (NTP) thaum tus tswv cuab tau txais kev pab cuam ib ntus hauv lub nroog uas lawv tsis nyob hauv, thiab tus tswv cuab lub tsev NTP tsis muaj daim ntawv cog lus nrog lub nroog ntawd? – Cuaj 17 hlis ntuj hnub tim 0, 2024​​ 

Siv BHIN 24-001, Phau Ntawv Qhia Txog Kev Them Nqi DMC-ODS​​ 

Raws li tau hais tseg rau ntawm nplooj ntawv 31 ntawm BHIN 24-001, Lub Txoj Kev Npaj Tshuaj Kho Mob Cal-Organized Delivery System (DMC-ODS) muaj lub luag haujlwm los xyuas kom meej tias cov tswv cuab tau txais cov kev pabcuam NTP thiab ua haujlwm hauv lossis mus ncig rau lwm lub nroog (suav nrog lub nroog uas tsis xaiv rau hauv qhov kev pab cuam DMC-ODS) tsis ntsib kev cuam tshuam ntawm cov kev pabcuam NTP.​​ 

Yog tias tus tswv cuab mus ncig teb chaws sab nraud lub nroog thiab xav tau cov tshuaj los ntawm NTP, txoj kev npaj DMC-ODS yuav them cov kev pabcuam no sab nraud ntawm lub network rau tus tswv cuab, tsuav yog lub network ntawm DMC-ODS txoj kev npaj tsis tuaj yeem muab tau. Hauv cov rooj plaub no, txoj kev npaj DMC-ODS yuav tsum sib koom tes thiab them rau cov kev pabcuam NTP sab nraud ntawm lub network rau tus tswv cuab. Ib nplooj ntawv 44 ntawm DMC-ODS Billing Manual, qhov kev siv NTP yuav tsum tau them nqi siv cov kev hloov kho UA thiab HG.​​ 

Yuav Ua Li Cas Tshuaj Medi-Cal Organized Delivery System (DMC-ODS) cov kws kho mob tuaj yeem siv Medi-Cal rau kev sau thiab xa naloxone rau cov neeg mob?​​ 

Reference: BHIN 24-001 , BHIN 23-064​​ 

Cov kws kho mob DMC-ODS muaj qhov yooj yim los muab lossis npaj rau naloxone kom raug thiab muab rau txhua tus tswv cuab DMC-ODS los ntawm kev siv Medi-Cal Rx. Medi-Cal Rx yog cov nyiaj pab kho mob sab nraud rau txhua tus tswv cuab Medi-Cal. Medi-Cal Rx suav nrog cov tshuaj kws kho mob thiab tom khw muag khoom, suav nrog naloxone.​​ 

DMC-ODS providers that are authorized to prescribe the medication can prescribe naloxone to each member who is under their care and arrange for staff to routinely fill these naloxone prescriptions at a pharmacy on behalf of the members, as a best practice overdose prevention measure. DMC-ODS providers can also coordinate delivery of the naloxone from a pharmacy to the member’s location or refer members to pharmacies that will dispense naloxone directly to the member. Furthermore, DMC-ODS counties may cover drug product costs for treatment when the medications are purchased and administered or dispensed in a nonclinical setting (e.g., criminal justice settings or street-based outreach). Finally, medical directors and prescribing clinicians of DMC-ODS providers are also able to establish a standardized protocol that authorizes designated staff working in a DMC-ODS provider agency to issue prescriptions on behalf of the medical directors or prescribing clinicians to a local pharmacy for naloxone.​​ 

Qhov Kev Pab Cuam Naloxone Faib Tawm (NDP) yog ib qhov project uas DHCS tau tsim tsa xyoo 2018 los txo cov neeg tuag uas muaj feem cuam tshuam nrog kev siv tshuaj opioid ntau dhau los ntawm kev muab naloxone pub dawb, xa ncaj qha mus rau cov chaw tsim nyog. Lub NDP txhawb nqa cov chaw tsim nyog, suav nrog, tab sis tsis txwv rau, tub ceev xwm, tsev kawm ntawv, cov koom haum hauv pab pawg neeg, cov chaw saib xyuas kev noj qab haus huv pej xeem thiab kev coj cwj pwm hauv nroog, thiab cov koom haum hauv zej zog. NDP tsis yog qhov chaw tseem ceeb rau naloxone hauv California thiab lwm cov peev txheej muaj los siv kom tau naloxone ua ntej siv NDP.​​ 

Cov tswvcuab Medi-Cal tuaj yeem nkag mus rau Cov Tshuaj Kho Mob rau Kev Tiv Thaiv Kab Mob (MAT) li cas?​​ 

Reference BHIN 24-001, BHIN 23-064, BHIN 23-054, BHIN 22-011, and the MCP Contracts.​​ 

Drug Medi-Cal Organized Delivery System (DMC-ODS)​​ 

Cov kws kho mob DMC-ODS tuaj yeem muab cov tshuaj rau Opioid Use Disorder (OUD) thiab Alcohol Use Disorder (AUD). Txhua yam tshuaj uas FDA pom zoo thiab cov khoom siv tshuaj lom neeg los kho cov kab mob no raug them, suav nrog buprenorphine thiab naltrexone. MAT raug them, them rov qab tau, thiab tuaj yeem muab rau feem ntau ntawm DMC-ODS qib kev saib xyuas, suav nrog kev kho mob sab nraud, kev kho mob hnyav sab nraud, kev pw hauv tsev kho mob ib nrab, kev kho mob nyob hauv tsev1, kev kho mob hauv tsev kho mob, thiab kev tswj kev rho tawm. MAT kuj tseem raug them, them rov qab tau, thiab tuaj yeem muab los ntawm cov kws kho mob DMC-ODS hauv cov chaw tsis yog kev kho mob (xws li cov chaw kho mob txawb thiab cov pab pawg kho mob hauv txoj kev) thiab thaum muab kev pabcuam ib leeg sab nraud ntawm cov theem kev kho mob no. Kev kho mob siv tshuaj methadone yuav tsum tau muab los ntawm Narcotic Treatment Program (NTP).​​ 

Cov tswv cuab xav tau lossis siv MAT yuav tsum tau txais kev pabcuam. Cov tswvcuab tsis tuaj yeem tsis lees paub DMC-ODS cov kev pabcuam khomob, yuav tsum tau txo cov koob tshuaj, lossis raug txiav tawm cov tshuaj raws li qhov tau txais lossis txuas ntxiv cov kev pabcuam DMC-ODS. DMC-ODS cov chaw muab kev pabcuam MAT yuav tsum tsis txhob tsis lees paub kev nkag mus rau cov tshuaj lossis kev tswj xyuas tus tswvcuab uas tsis kam muab cov kev pabcuam sablaj.​​ 

Raws li tau piav qhia hauv BHIN 24-001, cov phiaj xwm DMC-ODS yuav tsum xyuas kom meej tias txhua tus neeg muab kev pab DMC-ODS, ntawm txhua qib kev saib xyuas, muab cov kev pabcuam MAT ncaj qha lossis muaj cov txheej txheem xa mus rau cov kev pabcuam MAT uas tsim nyog tshaj plaws, raws li cov kev cai teev tseg hauv BHIN 23-054. Ib txoj kev xa mus rau lwm tus kws kho mob uas zoo yuav tsum muaj kev sib raug zoo nrog tus kws kho mob MAT thiab kev thauj mus rau qhov chaw teem sijhawm rau MAT, txawm tias tus kws kho mob thov nyiaj rov qab los ntawm DMC-ODS los xij. Tsuas yog muab cov ntaub ntawv tiv tauj rau tus neeg muab kev pab MAT rau ib tus tswv cuab xwb tsis ua tau raws li qhov yuav tsum tau ua kom tau txais kev xa mus.​​ 

MAT kuj tseem tuaj yeem muab rau Medi-Cal cov tswv cuab hauv ntau qhov chaw sab nraum DMC-ODS, suav nrog:​​ 

  • Medi-Cal Managed Care Plans (MCPs). Medi-Cal cov tswv cuab tuaj yeem tau txais kev kho mob tsim nyog thiab them rau SUD cov kev pabcuam xa los ntawm MCP cov chaw muab kev pabcuam (xws li kev tshuaj xyuas cawv thiab tshuaj yeeb, kev tshuaj xyuas, kev cuam tshuam luv luv, thiab kev xa mus rau kev kho mob) los ntawm kev saib xyuas thawj zaug, chaw kho mob hauv zej zog, Federally Quality Health Centers (FQHCs), tsev kho mob hauv tsev kho mob, chaw kho mob xwm txheej ceev, thiab lwm yam kev cog lus kho mob, ib daim ntawv cog lus 2-CP1 thiab BHIN . kuj tseem npaj rau kev muab MAT muab rau hauv kev saib xyuas thawj, tsev kho mob hauv tsev kho mob, chaw kho mob xwm txheej ceev, thiab lwm qhov chaw kho mob tau cog lus.​​ 
  • Cov chav kho mob thaum muaj xwm ceev (EDs) thiab cov tsev kho mob. EDs tuaj yeem yog qhov chaw ruaj khov rau cov tswv cuab uas muaj OUD. Txhua lub tsev kho mob lossis tus kws kho mob ED tuaj yeem muab cov tshuaj buprenorphine raws li CA Bridge Treatment Protocols los txo cov tsos mob ntawm kev rho tawm sai sai thiab pab txhawb kev xa tus neeg mob mus rau kev kho mob. Muaj ntau tshaj 240 lub chaw kho mob hauv California muab kev pab cuam MAT los ntawm kev qhia txog MAT hauv chaw kho mob thiab kev muab tshuaj buprenorphine luv luv los txuas tus tswv cuab kom txog thaum lawv mus ntsib kws kho mob thawj zaug. Thov mus saib lub vev xaib California Bridge Program kom nrhiav tau cov peev txheej, cov cuab yeej, thiab EDs uas muaj MAT thoob plaws California.​​ 
  • Cov khw muag tshuaj. Cov tswv cuab ntawm Medi-Cal tuaj yeem tau txais cov tshuaj rau kev kho mob ntawm kev siv tshuaj yeeb dej cawv zoo ib yam li lwm cov tshuaj kho mob los ntawm lub tsev muag tshuaj uas tau sau npe rau Medi-Cal. Txhua yam tshuaj thiab cov khoom siv tshuaj lom neeg siv los kho SUDs, suav nrog cov tshuaj txhaj uas ua haujlwm ntev, muaj los ntawm Medi-Cal Rx yam tsis tau kev tso cai ua ntej. Cov tshuaj kuj tseem tuaj yeem xa ncaj qha mus rau cov chaw ua haujlwm ntawm cov kws kho mob rau kev tswj hwm ntawm qhov chaw. Koj tuaj yeem nrhiav tau cov chaw muag tshuaj Medi-Cal Rx los ntawm kev mus saib lub vev xaib Medi-Cal Rx, thiab cov peev txheej kev cob qhia rau cov kws kho mob tuaj yeem nrhiav tau ntawm lub vev xaib Medi-Cal Rx Education & Outreach. Daim ntawv teev tag nrho cov tshuaj uas tau pom zoo rau qhov kev pab cuam Medi-Cal Rx tuaj yeem pom ntawm lub vev xaib Medi-Cal Rx Contract Drugs List.​​ 

Ntxiv cov peev txheej rau Access MAT​​ 

  • Lub hom phiaj ntawm DHCS Opioid Response yog kom muaj kev nkag mus rau MAT ntau ntxiv, txo cov kev xav tau kev kho mob uas tsis tau txais kev pab, thiab txo cov neeg tuag uas muaj feem cuam tshuam nrog kev siv tshuaj opioid ntau dhau los ntawm cov kev pab cuam uas tsom mus rau kev tiv thaiv, kev kho mob, thiab kev rov zoo. Ntau tus kws kho mob thawj zaug, FQHCs, cov kws kho mob tshwj xeeb SUD thiab lwm lub koom haum tau txais nyiaj los ntawm qhov project no, uas tuaj yeem pab them nqi tshuaj thiab kev pab rau cov neeg uas tsis muaj kev pov hwm lossis tsis muaj kev pov hwm txaus.​​ 
  • Qhov Tribal MAT Project yog ib qho kev teb sib koom ua ke uas tsim los ua kom tau raws li kev tiv thaiv, kev kho mob, thiab kev rov zoo ntawm cov zej zog Tribal thiab Urban Indian hauv California. Qhov Tribal MAT Project txhawb kev nyab xeeb ntawm opioid, txhim kho kev muaj thiab kev muab MAT, thiab pab txhawb kev nkag mus rau naloxone dav dua nrog kev xav tshwj xeeb rau Tribal thiab Urban Indian tus nqi, kab lis kev cai, thiab kev kho mob.​​ 
  • Cov Chaw Kho Mob: Thov mus saib http://choosemat.org/ rau daim ntawv teev cov chaw muab kev pab thiab cov chaw muab MAT hauv koj cheeb tsam. Lub koom haum Shatterproof kuj tau tsim ib qho chaw nrhiav kev kho mob nrog cov lus nug los pab cov tib neeg thiab tsev neeg nrhiav kev kho mob uas haum rau lawv cov kev xav tau, los ntawm lub platform ATLAS.​​ 

1 Cov kev pab cuam kho mob nyob hauv tsev uas tau tso cai los muab cov kev pab kho mob xwm txheej ceev (IMS) kuj tseem yuav muab MAT.​​ 

Cov kev pab cuam nyiaj txiag puas muaj nyob hauv Drug Medi-Cal Organized Delivery System (DMC-ODS) li cas?​​ 

Siv: BHIN 24-001, Phau Ntawv Qhia Txog Kev Them Nqi DMC-ODS, Rooj Kev Pabcuam DMC-ODS​​ 

Tus neeg lav ris yog ib tug tswv cuab hauv tsev neeg lossis lwm tus neeg uas txhawb nqa tus tswv cuab DMC-ODS. "Cov kev pabcuam sib koom ua ke" tsis yog txhais tias yog ib feem ntawm cov kev pabcuam tshwj xeeb ntawm DMC-ODS cov qauv kev pabcuam lawm. Raws li tau piav qhia hauv BHIN 24-001, lub tswv yim ntawm kev suav nrog cov khoom siv hauv kev kho mob ntawm tus tswv cuab kev siv tshuaj yeeb tau raug suav nrog rau hauv cov kev pabcuam ntsuam xyuas, kev sab laj tus kheej, Medi-Cal Peer Support Services, thiab kev kho mob tsev neeg. Yuav muaj tej lub sij hawm, raws li kev txiav txim siab ntawm tus kws kho mob, tus tswv cuab tsis nyob ntawd thaum lub sij hawm muab kev pab no, tab sis qhov kev pab no yog rau qhov txiaj ntsig ncaj qha rau tus tswv cuab.​​ 

Cov kev pab cuam ntsuam xyuas yuav suav nrog kev sib cuag nrog cov tswv cuab hauv tsev neeg lossis lwm yam khoom siv yog tias lub hom phiaj ntawm kev koom tes ntawm cov khoom siv yog los tsom mus rau qhov xav tau kev kho mob ntawm tus tswv cuab. Cov kev pab tswv yim rau tus kheej thiab Medi-Cal Peer Support Services kuj tseem tuaj yeem suav nrog kev sib cuag nrog cov tswv cuab hauv tsev neeg lossis lwm yam khoom siv yog tias lub hom phiaj ntawm kev koom tes ntawm cov khoom siv yog los tsom mus rau qhov xav tau kev kho mob ntawm tus tswv cuab los ntawm kev txhawb nqa kev ua tiav ntawm tus tswv cuab lub hom phiaj kho mob.​​ 

Family therapy is a rehabilitative service that includes family members in the treatment process, providing education about factors that are important to the member’s recovery as well as the holistic recovery of the family system. Family members can provide social support to the member and help motivate their loved one to remain in treatment.​​ 

BHIN 24-001 thiab DMC-ODS Medi-Cal Billing Manual qhia meej txog cov kev pabcuam DMC-ODS suav nrog kev ntsuam xyuas kev pabcuam, kev pab tswv yim rau tus kheej, Medi-Cal Peer Support Services thiab kev kho mob hauv tsev neeg ua cov khoom pabcuam uas them tau.​​ 

Thov saib phau ntawv qhia txog kev them nqi ntawm DMC-ODS thiab daim ntawv qhia kev pabcuam DMC-ODS sib cais kom paub cov lus qhia txog kev them nqi uas cuam tshuam nrog cov khoom siv ntawm tus tswv cuab.​​ 

Txhawm rau muab cov kev pabcuam hauv tsev kho mob ib nrab los ntawm Kev Pabcuam Kev Muag Khoom Medi-Cal Organized Delivery System (DMC-ODS), yuav tsum muaj ntawv pov thawj dab tsi los ntawm DMC-ODS txoj kev npaj?​​ 

Reference: BHIN 24-001​​ 

Kev Pabcuam Tsev Kho Mob Ib Feem yog xaiv tau rau DMC-ODS cov kev npaj. Tsis muaj DMC daim ntawv pov thawj qeb tshwj xeeb rau kev mus pw hauv tsev kho mob ib nrab. Txhawm rau muab Kev Pabcuam Hauv Tsev Khomob Ib Ntu los ntawm DMC-ODS, DMC-ODS txoj kev npaj, lossis DMC-ODS cov chaw muab kev cog lus yuav tsum:​​ 

  • Tau ntawv pov thawj raws li DMC Intensive Outpatient Treatment (IOT) cov kws kho mob;​​ 
  • Muaj peev xwm muab 20 lossis ntau teev ntawm kev kho mob hnyav hauv ib lub lis piam; thiab​​ 
  • Ua kom pom lub peev xwm los pab txhawb kev nkag mus rau kev puas siab puas ntsws, kev kho mob, thiab kev kuaj mob, raws li xav tau.​​ 

Dab tsi yog Qhov Kev Npaj Qhia Tshuaj Medi-Cal Organized Delivery System (DMC-ODS) cov ntaub ntawv xav tau ntsig txog kev tsis txaus siab?​​ 

Siv: BHIN 24-001, Lub Xya Hli 1, 2022 – Lub Xya Hli 1, 2027 Daim Ntawv Cog LusDMC-ODS​​ 

Raws li tau teev tseg hauv Daim Ntawv Pom Zoo Sib Tham (DMC-ODS daim ntawv cog lus), txhua qhov DMC-ODS txoj kev npaj yuav tsum khaws cov ntaub ntawv tsis txaus siab thiab kev thov rov hais dua thiab yuav tsum tshuaj xyuas cov ntaub ntawv raws li ib feem ntawm nws cov txheej txheem kev saib xyuas tsis tu ncua, nrog rau kev hloov kho thiab hloov kho rau Lub Tsev Haujlwm Saib Xyuas Kev Ua Haujlwm zoo.​​ 

Cov ntaub ntawv ntawm txhua qhov kev tsis txaus siab lossis kev thov rov hais dua yuav tsum muaj, yam tsawg kawg, tag nrho cov ntaub ntawv hauv qab no:​​ 

  • Cov lus piav qhia dav dav ntawm qhov laj thawj rau kev thov rov hais dua lossis tsis txaus siab.​​ 
  • Hnub tau txais.​​ 
  • Hnub tim ntawm txhua qhov kev tshuaj xyuas lossis, yog tias tsim nyog, lub rooj sib tham tshuaj xyuas.​​ 
  • Kev daws teeb meem ntawm txhua theem ntawm kev thov rov hais dua lossis kev tsis txaus siab, yog tias muaj.​​ 
  • Hnub ntawm kev daws teeb meem ntawm txhua qib, yog tias tsim nyog.​​ 
  • Lub npe ntawm tus neeg tau txais kev pab uas tau thov kom rov hais dua lossis tsis txaus siab.​​ 

Txhua cov ntaub ntawv yuav tsum tau khaws cia kom raug raws li txoj kev uas Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) nkag tau thiab muaj rau Lub Chaw rau Medicare thiab Medicaid Services (CMS) thaum thov. Cov ntaub ntawv sau txog kev tsis txaus siab thiab kev thov rov hais dua yuav tsum xa mus rau pawg neeg txhim kho zoo ntawm txoj kev npaj tsawg kawg yog peb lub hlis ib zaug rau pawg neeg saib xyuas kev txhim kho zoo kom muaj kev sib sau ua ke thiab kev tshuaj xyuas kom zoo dua qub. Cov kev tsis txaus siab thiab kev thov rov hais dua uas tau tshuaj xyuas yuav suav nrog, tab sis tsis txwv rau, cov uas cuam tshuam nrog kev nkag mus rau kev kho mob, qhov zoo ntawm kev kho mob, thiab kev tsis lees paub cov kev pabcuam. Yuav tsum ua cov kauj ruam tsim nyog los kho txhua yam teeb meem uas pom tau.​​ 

Dab tsi yog Qhov Kev Pabcuam Kev Xa Khoom Siv Tshuaj Medi-Cal (DMC-ODS) cov kev cai rau kev thov rov hais dua?​​ 

Siv: BHIN 24-001, Lub Xya Hli 1, 2022 – Lub Xya Hli 1, 2027 Daim Ntawv Cog LusDMC-ODS​​ 

Raws li tau teev tseg hauv Daim Ntawv Pom Zoo Sib Tham (DMC-ODS daim ntawv cog lus), tus tswv cuab lossis tus neeg muab kev pabcuam thiab / lossis tus neeg sawv cev tau txais kev tso cai tuaj yeem foob tus kheej, hais lus, lossis sau ntawv. Yog tias lawv thov kom daws teeb meem sai sai, tus tswv cuab lossis tus neeg sawv cev yuav tsum ua raws li tus kheej los yog qhov ncauj ua ntaub ntawv nrog sau ntawv, kos npe thov rov hais dua. Qhov kev thov rov hais dua yuav tsum tsis suav nrog tus tswvcuab lossis tus neeg sawv cev tau tso cai nyob rau hauv ib txoj kev. Cov tib neeg txiav txim siab txog qhov kev txiav txim plaub ntug yuav tsum tsim nyog ua li ntawd thiab tsis koom nrog rau qib dhau los ntawm kev tshuaj xyuas lossis kev txiav txim siab.​​ 

Cov tswv cuab thiab/los yog lawv tus neeg sawv cev tso cai yuav tsum:​​ 

  • Muaj txoj cai los tshuaj xyuas lawv cov ntaub ntawv, suav nrog lawv cov ntaub ntawv kho mob thiab lwm yam ntaub ntawv lossis cov ntaub ntawv khaws tseg uas tau txiav txim siab thaum lub sijhawm thov rov hais dua, ua ntej thiab thaum lub sijhawm rov hais dua.​​ 
  • Muaj lub sijhawm tsim nyog los nthuav tawm cov pov thawj thiab cov lus iab liam ntawm qhov tseeb lossis kev cai lij choj, ntawm tus kheej lossis sau ntawv.​​ 
  • Tau tso cai rau tus neeg sawv cev raws li txoj cai thiab/lossis tus neeg sawv cev raws li txoj cai ntawm tus tswv cuab uas tuag lawm suav nrog ua cov tog neeg hauv qhov kev thov rov hais dua.​​ 
  • Nco ntsoov tias lawv qhov kev thov rov hais dua tau raug tshuaj xyuas los ntawm kev sau ntawv lees paub.​​ 
  • Tau txais kev ceeb toom txog lawv txoj cai thov lub Xeev Lub Rooj Sib Hais, tom qab ua tiav cov txheej txheem thov rov hais dua.​​ 

Cov kev cai thiab lub sijhawm rau Txoj Kev Npaj Tshuaj Medi-Cal Organized Delivery System (DMC-ODS) rau Kev Mloog Lus hauv Xeev yog dab tsi?​​ 

Siv: BHIN 24-001, Lub Xya Hli 1, 2022 – Lub Xya Hli 1, 2027 Daim Ntawv Cog LusDMC-ODS​​ 

Raws li tau teev tseg hauv Daim Ntawv Pom Zoo Sib Tham (DMC-ODS daim ntawv cog lus), cov tswv cuab tuaj yeem thov Lub Xeev Lub Rooj Hais Plaub tsuas yog tom qab tau txais ntawv ceeb toom tias txoj kev npaj txhawb nqa qhov kev txiav txim siab tsis zoo.​​ 

Cov tswvcuab muaj 120 hnub los thov Lub Xeev Lub Rooj Sib Hais, pib txij hnub uas txoj kev npaj tau muab qhov kev txiav txim rau tus tswvcuab ntawm tus kheej, lossis hnub tomqab qhov kev txiav txim plaub ntug raug kaw lawm. Yog tias tus tswv cuab tsis tau txais Daim Ntawv Ceeb Toom Txog Kev Txiav Txim Siab Tsis Zoo (NOABD), lawv tuaj yeem xa mus rau Lub Xeev Lub Rooj Sib Hais Thaum twg los tau.​​ 

Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv California yuav ua qhov kev tshuaj xyuas ywj pheej tsis pub dhau 90 hnub tom qab tau txais daim ntawv thov. Cov tswvcuab tuaj yeem thov kom muaj Lub Xeev Lub Rooj Sib Hais Ncaj Ncees. Yog tias daim ntawv thov tsim nyog rau lub Xeev Lub Rooj Sib Hais Ncaj Ncees, qhov kev txiav txim yuav raug muab tso rau hauv peb hnub ua haujlwm txij li hnub uas Lub Xeev Lub Rooj Sib Hais Plaub tau txais.​​ 

Qhov twg tuaj yeem Siv Tshuaj Kho Mob Medi-Cal Organized Delivery System (DMC-ODS) cov phiaj xwm thiab cov chaw muab kev pab nrhiav kev taw qhia ntawm Daim Ntawv Ceeb Toom Txog Kev Txiav Txim Tsis Zoo (NOABD) kev tsis txaus siab thiab kev thov rov hais dua?​​ 

Siv: MHSUDS IN 18-010E​​ 

Thov saib MHSUDS IN 18-010E: Cov Kev Cai ntawm Lub Txheej Txheem Kev Tsis Txaus Siab thiab Kev Thov Rov Hais Dua ntawm Tsoom Fwv Teb Chaws nrog Cov Qauv Ceeb Toom Txog Cov Neeg Tau Txais Txiaj Ntsig uas Tau Hloov Kho Dua kom paub meej thiab qhia txog kev siv cov cai lij choj ntawm tsoom fwv teb chaws uas tau hloov kho dua tshiab rau kev ua cov kev tsis txaus siab thiab kev thov rov hais dua.​​ 

Cov ntaub ntawv tsis txaus siab thiab kev thov rov hais dua dab tsi yuav tsum muaj nyob rau hauv Txoj Kev Npaj Kho Mob Medi-Cal Organized Delivery System (DMC-ODS) Plan's Quality Improvement (QI) Plan?​​ 

Reference: BHIN 24-001​​ 

QI Plan yuav tsum muaj cov ntaub ntawv hais txog yuav ua li cas cov tswv cuab cov ntaub ntawv tsis txaus siab yuav raug sau, cais, thiab tshuaj xyuas rau kev saib xyuas. Yam tsawg kawg nkaus, QI Plan yuav tsum muaj cov ntaub ntawv hais txog:​​ 

  • Yuav ua li cas xa daim ntawv tsis txaus siab, thov rov hais dua, thiab thov kom muaj lub rooj sib hais hauv lub xeev​​ 
  • Lub sijhawm rau kev daws teeb meem ntawm kev hais plaub ntug;​​ 
  • Cov ntsiab lus ntawm qhov kev daws teeb meem tsis txaus siab;​​ 
  • Kev khaws cia;​​ 
  • Kev txuas ntxiv ntawm cov txiaj ntsig; thiab​​ 
  • Qhov yuav tsum tau muaj ntawm Xeev Lub Rooj Sib Hais.​​ 

Yog tias Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (Drug Medi-Cal Organized Delivery System) (DMC-ODS) muaj lub chaw saib xyuas kev noj qab haus huv sib koom ua ke, nws puas tuaj yeem siv tib Pawg Kev Txhim Kho Zoo (QI) uas xav tau los ntawm daim ntawv cog lus Mental Health Plan kom ua tiav DMC-ODS QI Pawg Neeg Saib Xyuas?​​ 

Reference: BHIN 24-001​​ 

Yog lawm. DMC-ODS txoj kev npaj yuav siv tib pawg neeg ua haujlwm, nrog rau kev koom nrog kev siv yeeb tshuaj, rau cov nroog uas muaj chaw saib xyuas kev noj qab haus huv.​​ 

Puas yog cov tub ntxhais kawm xyaum ua haujlwm lossis cov neeg cob qhia suav tias yog Cov Kws Kho Mob Kho Mob (LPHAs)?​​ 

Siv: BHIN 24-001, SPA 23-0026​​ 

Tsis yog. Tus Kws Kho Mob Uas Muaj Daim Ntawv Tso Cai (LPHA) suav nrog ib qho ntawm cov hauv qab no: Kws Kho Mob, Kws Saib Xyuas Neeg Mob (NP), Tus Pab Kws Kho Mob (PA), Kws Saib Xyuas Neeg Mob uas Muaj Daim Ntawv Sau Npe, Kws Muag Tshuaj uas Muaj Daim Ntawv Sau Npe, Kws Kho Mob Hlwb Uas Muaj Daim Ntawv Tso Cai (LCP), Kws Ua Haujlwm Pabcuam Zej Zog uas Muaj Daim Ntawv Tso Cai (LCSW), CSW uas Muaj Daim Ntawv Sau Npe, Kws Pab Tswv Yim Kho Mob uas Muaj Daim Ntawv Tso Cai (LPCC), PCC uas Muaj Daim Ntawv Sau Npe, Kws Kho Mob Sib Yuav thiab Tsev Neeg uas Muaj Daim Ntawv Tso Cai (LMFT), MFT uas Muaj Daim Ntawv Sau Npe, Kws Saib Xyuas Neeg Mob uas Muaj Daim Ntawv Tso Cai (LVN), Kws Kho Mob Ua Haujlwm uas Muaj Daim Ntawv Tso Cai (LOT), thiab Kws Kho Mob Hlwb uas Muaj Daim Ntawv Tso Cai (LPT).​​ 

Ib tug neeg kawm tiav hauv kev kho mob yog ib tug neeg tsis muaj daim ntawv tso cai uas tau kawm hauv ib qho kev kawm tiav qib siab hauv Xeev California uas yuav tsum tau rau tus neeg kom tau txais daim ntawv tso cai ua LPHA; tab tom koom nrog kev xyaum ua haujlwm, kev ua haujlwm sau ntawv, lossis kev xyaum ua haujlwm uas tus neeg tau pom zoo los ntawm qhov kev pab cuam ntawm tus neeg; thiab ua tau raws li txhua yam kev cai ntawm qhov kev pab cuam thiab/lossis pawg thawj coj saib xyuas kev tso cai kom koom nrog kev xyaum ua haujlwm, kev ua haujlwm sau ntawv, lossis kev xyaum ua haujlwm thiab muab cov kev pabcuam kho mob siv tshuaj yeeb, suav nrog, tab sis tsis txwv rau, txhua yam kev kawm thiab kev saib xyuas kev xyaum ua haujlwm.​​ 

SPA 23-0026 tso cai rau CSW, MFT, thiab PCC cov neeg sib tw muab cov kev pabcuam DMC-ODS yog tias tus neeg sib tw:​​ 

  • Tau xa lawv daim ntawv thov rau kev sau npe ua tus khub rau Pawg Neeg Saib Xyuas Kev coj cwj pwm (BSS) hauv 90 hnub ntawm lawv hnub tau txais daim ntawv kawm tiav qib master,​​ 
  • Ua kom tiav cov sij hawm saib xyuas ntawm lawv daim ntawv tso cai, thiab​​ 
  • Ua raws li lawv qhov kev coj ua raws li California txoj cai lij choj.​​ 

Txoj Cai "90 Hnub" ntawm BSS tso cai rau cov neeg sib tw CSW, MFT, thiab PCC uas tau xa lawv daim ntawv thov rau kev sau npe ua tus khub hauv 90 hnub ntawm hnub muab daim ntawv kawm tiav los suav cov kev paub dhau los uas tau txais thaum lub sijhawm ntawm hnub muab daim ntawv kawm tiav thiab hnub muab tus lej sau npe ua tus khub rau hauv lawv daim ntawv tso cai.​​ 

Puas yog tus kws kho mob tsis tuaj yeem ua haujlwm rau tus menyuam cev xeeb tub Cov Tshuaj Medi-Cal Organized Delivery System (DMC-ODS) tus tswv cuab? Tus txheej txheem los thov rau cov kev pabcuam no yog dab tsi?​​ 

Siv: Cov Lus Qhia Txog Kev Xyaum Thaum Yug Me Nyuam​​ 

Yog. Ib tug tswv cuab cev xeeb tub tuaj yeem xaiv tau txais cov kev pabcuam los ntawm tus kws kho mob uas tsis yog tus menyuam yug tshiab. Yog tias tus tswv cuab DMC-ODS tau txais kev tsim nyog los ntawm tus lej pab cev xeeb tub, daim ntawv thov yuav tsum muaj cov ntaub ntawv ntawm tus neeg mob, tseem hu ua PAT, 9 qhov qhia txog cev xeeb tub kom siv tau. Thov saib cov Lus Qhia Txog Kev Xyaum Thaum Yug Me Nyuam rau cov kws kho mob ua haujlwm nrog cov poj niam cev xeeb tub thiab cov niam txiv uas tab tom nrhiav lossis xa mus rau kev kho mob siv tshuaj yeeb dej caw.​​ 

Yuav ua li cas them nqi rau Drug Medi-Cal Organized Delivery System (DMC-ODS) pab pawg kws pab tswv yim suav?​​ 

Siv: BHIN 24-001, Phau Ntawv Qhia Txog Kev Them Nqi DMC-ODS, Rooj Kev Pabcuam DMC-ODS​​ 

Cov chav nyob rau DMC-ODS cov kev pabcuam pab pawg sab laj yuav tsum suav nrog cov qauv hauv qab no: (Ntau feeb rau pawg pab pawg sab laj/15-feeb increments = tag nrho cov units xa mus siv tus txheej txheem H0005. DMC-ODS Cov Kev Npaj yuav tsum xa cov ntaub ntawv sib cais rau txhua tus tswvcuab tau txais kev sab laj pab pawg.​​ 

Thov saib phau ntawv qhia txog kev them nqi ntawm DMC-ODS thiab daim ntawv qhia kev pabcuam DMC-ODS sib cais kom paub cov lus qhia txog kev them nqi rau cov kev pabcuam sab laj pab pawg.​​ 

Koj puas tuaj yeem xa daim ntawv thov rau tus tswv cuab "chav pw thiab khoom noj" thaum lub sijhawm kho mob hauv tsev kho mob yog tias tus tswv cuab tsis tau txais kev pabcuam kho mob hauv tsev kho mob thaum hnub ua haujlwm rau daim ntawv thov?​​ 

Siv: BHIN 24-001, Phau Ntawv Qhia Txog Kev Them Nqi DMC-ODS, Rooj Kev Pabcuam DMC-ODS​​ 

Tsis tau. "Chav pw thiab khoom noj" tsis tuaj yeem thov cais. Yuav kom thov tau kev kho mob hauv tsev kho mob, ib tug tswv cuab yuav tsum tau txais tsawg kawg ib qho kev pab kho mob hauv tsev kho mob uas them (piv txwv li. kev ua ub ua no uas yuav tsum tau ua) rau hnub uas tau txais kev pabcuam rau qhov kev thov. BHIN 24-001 piav qhia txog cov kev pabcuam uas them rau hauv Kev Kho Mob Hauv Tsev.​​ 

Thov saib phau ntawv qhia txog kev them nqi rau DMC-ODS thiab daim ntawv teev kev pabcuam DMC-ODS sib cais kom paub cov lus qhia txog kev them nqi rau Cov Kev Pabcuam Nyob Hauv Tsev.​​ 

Puas yog cov nyiaj tau los uas tsis yog 2011 cov nyiaj rov qab los tsim nyog rau tsoomfwv qhov kev sib tw?​​ 

Siv rau: SSA § 1903(w)(6); 42 CFR § 433.51.​​ 

Yog lawm. Lwm cov nyiaj hauv zos tsim nyog siv los ua qhov tsis yog tsoomfwv qhov kev sib tw yog tias lawv tsis yog tsoomfwv cov peev nyiaj thiab lwm yam tsim nyog siv raws li kev sib tw raws li cov kev xav tau teev tseg hauv SSA §1903(w)(6) thiab 42 CFR §433.51.​​