Tsev CalAIM: Hloov Medi-Cal California Hloov Kev Noj Qab Haus Huv ntawm Niam​​ 

California Transforming Maternal Health​​ 

In January 2025, the Centers for Medicare and Medicaid (CMS) Innovation Center announced that California was among the 15 states selected to participate in the Transforming Maternal Health (TMaH) Model, a Medicaid and Children’s Health Insurance Program (CHIP) delivery and payment model designed to test whether effective implementation of evidence-informed interventions, sustained by a value-based payment (VBP) model, can improve maternal health outcomes and reduce Medicaid and CHIP program costs. CMS awarded DHCS $17 million in federal funding to plan and implement the TMaH Model over ten years in a 5-county region in the Central Valley including Fresno, Kern, Kings, Madera and Tulare Counties.​​  

Nyob rau thawj peb lub xyoos (Lub Sijhawm Ua Ntej Ua Ntej), DHCS yuav tau txais kev pabcuam kev pabcuam los txhawb txhua tus qauv thiab ua tiav CMS-yuav tsum tau ua ua ntej ua tiav. Tom qab ntawd, yuav muaj Lub Sijhawm Ua Haujlwm 7 xyoo thaum VBP qauv yuav raug siv.​​   

Context​​  

Zoo li lwm lub tebchaws, California tab tom ntsib teebmeem kev noj qab haus huv ntawm niam txiv. Txawm hais tias California qhov piv txwv ntawm cev xeeb tub-muaj feem cuamtshuam txog kev tuag ntawm cev xeeb tub rau 100,000 tus menyuam yug los-yog qis dua li lub tebchaws piv, nws tau nce siab nyob rau xyoo tas los no, thiab feem ntau ntawm cov kev tuag ntsig txog kev xeeb tub yog tiv thaiv tau. California tus mob hnyav niam txiv (SMM) tus nqi kuj tau nce thiab siab dua li lub tebchaws. Medi-Cal them 40% ntawm tag nrho cov kev yug me nyuam hauv California, thiab ntau dua 70% ntawm cev xeeb tub thiab tom qab yug me nyuam Medi-Cal cov tswv cuab tau cuv npe hauv Managed Care Plan (MCP).​​  

Tus qauv TMaH tau ua raws li thiab ua tiav rau DHCS' Txoj Kev Kho Mob Yug Me Nyuam . Cov kev kawm tau kawm thiab ua pov thawj los ntawm TMaH tej zaum yuav raug ntsuas los ntawm 5-county cheeb tsam mus rau lwm qhov hauv lub xeev.​​   

Qauv Paub meej​​ 

Maternal Health Experience Transformation​​ 

TMaH Model yuav muab nyiaj los hloov pauv kev saib xyuas kev noj qab haus huv niam txiv hauv peb qhov tseem ceeb:​​ 

Nkag mus rau Kev Saib Xyuas, Infrastructure, thiab Kev Ua Haujlwm​​   Kev Txhim Kho Zoo thiab Kev Nyab Xeeb​​  Kev Pabcuam Tib Neeg Txhua Tus​​ 
Cov ntaub ntawv qhia txog kev noj qab haus huv niam txiv thiab kev koom tes hauv zej zog los txhawb kev nkag mus rau cov peev txheej muaj txiaj ntsig, xws li cov poj niam yug menyuam, doulas, thiab cov chaw yug me nyuam, nrog rau kev txhim kho kev sau cov ntaub ntawv thiab kev sib txuas los txhim kho kev sib qhia cov ntaub ntawv​​  Cov thawj coj zoo thiab cov txheej txheem nrog lub hom phiaj ntawm kev yug menyuam kom nyab xeeb thiab txhim kho kev paub tag nrho rau leej niam thiab tus menyuam​​  Kev tshuaj ntsuam xyuas thiab kev pheej hmoo tsim nyog thiab kev xa mus rau cov txheej txheem thiab nce kev pab them nqi kho mob kom ntseeg tau tias txhua leej niam tau txais kev saib xyuas uas raug kho raws li lawv cov kev xav tau tshwj xeeb​​ 

Transforming Maternal Health (TMaH) Model Maternal Health Care Team Factsheet​​ 

Cov ncej​​ 

TMaH Model yog tsim los ntawm peb tus ncej:​​ 

Access, Infrastructure thiab Workforce: TMaH Model txhawb kev tsim kev sib raug zoo thiab kev kawm los pab cov koom nrog daws cov teeb meem uas txwv tsis pub nkag mus rau cov peev txheej muaj txiaj ntsig, xws li midwives, doulas, thiab cov neeg ua haujlwm noj qab haus huv hauv zej zog (CHWs).​​  

TMaH Model yog npaj los txhawb kev saib xyuas tus neeg tshwj xeeb thiab hauv paus rau kev mloog zoo thiab txhim kho kev ntseeg siab, nrog rau lub hom phiaj ntawm kev ua niam txiv muaj peev xwm tswj hwm lawv txoj kev yug me nyuam.​​ 

Quality Improvement and Safety: The TMaH Model will facilitate implementation of quality initiatives and protocols with a goal of making childbirth safer and improving both the mother and baby’s overall experience. DHCS has partnerships with California Maternal Quality Care Collaborative (CMQCC) and the California Perinatal Quality Care Collaborative (CPQCC) to support implementation of “patient safety bundles.” When implemented together and consistently, these protocols are shown to improve health outcomes across several clinical areas, including hypertension during pregnancy, cardiac conditions, and care for pregnant and postpartum women living with substance use disorders.​​ 

Whole-Person care delivery: In the TMaH Model, every mother should receive customized care to meet their specific needs by supporting the development of a unique birth plan. Important tools that will be used include risk assessments and screening tools for perinatal mood and anxiety disorders, substance use, tobacco use, and health related social needs.​​  

Yog tias tsim nyog, kev saib xyuas tej thaj chaw deb, xws li ntshav siab thiab ntshav qab zib mellitus, yuav raug muab los txo lub nra ntawm kev mus thiab los ntawm kws kho mob lub chaw ua haujlwm. Cov neeg mob kuj tseem tuaj yeem txuas nrog cov koom haum hauv zej zog lossis cov neeg ua haujlwm saib xyuas kev noj qab haus huv hauv zej zog nyob ntawm qhov kev xav tau ntawm kev noj qab haus huv uas lawv muaj.​​ 

The TMaH Payment Model​​ 

Tus qauv VBP yuav tsim los ntawm CMS thiab yuav zoo ib yam thoob plaws 15 TMaH-lub xeev uas koom nrog. Nws yuav raug siv nyob rau hauv peb theem.​​  

Pib xyoo 2027, DHCS yuav faib ib feem ntawm TMaH cov nyiaj los them cov neeg muab kev koom tes rau kev hloov pauv kev saib xyuas thiab kev txhim kho cov ntaub ntawv hauv vaj tse kom ua tau raws li VBP qauv.  Kev taw qhia yuav los tom ntej los ntawm CMS ntawm Cov Kev Pab Them Nqi Them Nqi Them Nqi.​​ 

Pib xyoo 2028, cov koom haum muab kev koom tes yuav tsim nyog tau txais kev txhawb nqa kev ua tau zoo xwb. Cov kev them nyiaj no yuav muab nqi zog rau tus neeg muab kev pabcuam zoo tshaj plaws ntawm cov kev ntsuas zoo uas ua raws li cov qauv hom phiaj nrog rau kev ua tiav ntawm tus nqi ntsuas.​​ 

Pib xyoo 2029, DHCS yuav ua hauj lwm nrog Medi-Cal cov kev npaj saib xyuas kev tswj hwm kom hloov mus rau VBP qauv tsim los txhawb kev xa cov kev saib xyuas tag nrho uas txhim kho cov txiaj ntsig kev noj qab haus huv ntawm niam txiv thaum tswj lossis txo cov kev siv nyiaj Medicaid & CHIP.​​ 

Txoj Kev Mus Koom​​ 

Koom nrog peb cov npe muaj feem cuam tshuam​​ 

Peb yuav siv daim ntawv teev npe no los nthuav tawm cov ntaub ntawv thiab hloov tshiab txhua lub sijhawm txog TMaH kev nce qib lossis cov hauv kev rau kev koom tes, Tus Muab Kev Pabcuam Kev Them Nyiaj thiab VBP tus qauv, thiab yuav ua li cas los ua tus muab kev koom tes.​​  

Provide feedback on the DRAFT Provider Participation Standards.​​  

This document is an initial draft of requirements for providers to participate in the CA TMaH Model. We invite provider, managed care plan, and other stakeholder feedback on these draft standards via this email address: tmah@dhcs.ca.gov.​​  

Hu rau peb ntawm tmah@dhcs.ca.gov ​​ 

Khoom siv​​ 

Cov nplooj ntawv txheeb ze​​ 

Kev lees paub txog kev txhawb nqa​​ 

Txoj haujlwm no tau txais kev txhawb nqa los ntawm Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv & Medicaid (CMS) ntawm Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv thiab Tib Neeg (HHS) uas yog ib feem ntawm kev pabcuam nyiaj txiag suav nrog $ 17M nrog 100 feem pua ntawm CMS / HHS. Cov ntsiab lus yog cov neeg sau ntawv thiab tsis tas yuav sawv cev rau cov kev pom zoo ntawm, lossis kev pom zoo, los ntawm CMS/HHS, lossis Tsoomfwv Meskas.​​