Community Reinvestment (CR) Txoj Cai thiab Cov Lus Nug Nquag
Cov lus teb rau Cov Lus Nug Nquag Nug (FAQs) hauv qab no muab cov lus qhia ntxiv thiab kev piav qhia rau Medi-Cal cov phiaj xwm kev saib xyuas kev noj qab haus huv (MCPs) hais txog Tsab Ntawv Qhia Txog Kev Rov Nqis Peb Lub Zej Zog (APL) 25-004 uas tsim cov kev cai rau MCPs rov nqis peev ib feem ntawm lawv cov nyiaj tau los rau hauv lawv cov zej zog hauv zos los daws cov kev xav tau kev noj qab haus huv uas tsis tau txais kev pab thiab txhawb nqa kev noj qab haus huv hauv zej zog.
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Q: Puas yog qhov yuav tsum tau ua kom rov qab peev txheej hauv zej zog siv rau txhua tus neeg cog lus uas muaj daim ntawv tso cai Knox-Keene, suav nrog cov ntawv tso cai txwv/txwv? Thaum twg tus SubContractor yuav raug rau cov kev cai ntawm Community Reinvestment?
A: Tsis yog, qhov yuav tsum tau ua kom rov qab peev txheej hauv zej zog tsis siv rau txhua tus neeg cog lus uas muaj daim ntawv tso cai Knox-Keene. Qhov yuav tsum tau ua kom rov nqis peev hauv zej zog siv rau Knox-Keene Licensed Health Plans hauv Daim Ntawv Cog Lus Subcontractor nrog MCP, suav nrog ob qho tib si Knox-Keene cov chaw muaj ntawv tso cai tag nrho thiab cov chaw muaj kev txwv/txwv, uas yuav tsum xa daim ntawv qhia Medical Loss Ratio (MLR) raws li APL 24-018 thiab xav tias muaj kev pheej hmoo rau tsawg kawg 100,000 tus Tswv Cuab lossis tsawg kawg 50% ntawm MCP cov Tswv Cuab hauv ib lub nroog lossis thaj chaw ntsuas. Qhov yuav tsum tau ua kom rov qab peev txheej hauv zej zog tsis siv rau cov neeg cog lus uas tsis yog cov phiaj xwm tso cai los ntawm Knox-Keene.
Q: Puas yog MCP cov nyiaj pab rau Kev Noj Qab Haus Huv Hauv Zos (LHJs) rau CHA/CHIP los ntawm cov txheej txheem Kev Ntsuam Xyuas Kev Xav Tau ntawm Cov Neeg (PNA) suav nrog rau cov luag haujlwm Rov Nqis Peev Hauv Zej Zog, thiab cov kev cai PNA no puas yuav txuas ntxiv mus dhau xyoo 2027?
A: Tsis yog, MCP cov nyiaj pab rau LHJs los txhawb kev txhim kho CHA/CHIP, txawm tias los ntawm kev pab nyiaj txiag lossis kev ua haujlwm hauv cov khoom, tsis suav nrog rau hauv cov luag haujlwm Rov Nqis Peev Hauv Zej Zog. Cov haujlwm no yog ib feem ntawm cov kev cai ntawm PNA, uas yog sib cais thiab txawv ntawm qhov kev pab cuam Community Reinvestment. Cov MCPs siv tsis tau cov nyiaj rov qab nqis peev hauv zej zog rau cov haujlwm uas suav nrog hauv lawv daim ntawv cog lus MCP, suav nrog kev txhawb nqa rau kev txhim kho CHA/CHIP. Cov kev cai ntawm PNA los muab kev pabcuam (nyiaj txiag thiab/lossis cov neeg ua haujlwm hauv hom) rau kev txhim kho LHJ CHA/CHIP yuav txuas ntxiv mus tom qab xyoo 2027.
Q: MCPs muaj lub luag haujlwm los xyuas kom meej tias lawv Cov Neeg Cog Lus Ua Haujlwm ua raws li txhua txoj cai lij choj thiab kev cai lij choj ntawm lub xeev thiab tsoomfwv (APL nplooj ntawv 18) kom tsis txhob muaj Cov Phiaj Xwm Kho (CAP) thiab kev rau txim rau kev tswj hwm thiab/lossis kev nplua nyiaj rau kev ua tsis raws cai. Puas yog MCPs yuav tsum tau xyuas kom meej tias Qualifying Subcontractors ua raws li cov kev cai ntawm Community Reinvestment los ntawm kev thov cov ntaub ntawv ntxiv uas tsis suav nrog hauv APL? Piv txwv li, MCP puas yuav tsum tau tshuaj xyuas cov haujlwm uas tsis yog ib feem ntawm MCP Txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog?
A: Cov MCPs yuav tsum xyuas kom meej tias lawv cov SubContractors ua raws li APL. Cov MCPs tsis tas yuav thov lossis tshuaj xyuas cov ntaub ntawv ntxiv tshaj qhov tau teev tseg hauv APL tshwj tsis yog tias tsim nyog los lees paub qhov ua raws li cov kev cai ntawm daim ntawv cog lus lossis kev tshaj tawm.
Q: APL siv lub npe "Tus Thawj Coj Saib Xyuas Kev Noj Qab Haus Huv Pej Xeem" ua tus neeg uas yuav tsum muab daim ntawv pov thawj hauv Appendix B, Exhibit. Yog tias muaj ntau tus Thawj Coj Kev Noj Qab Haus Huv lossis Cov Tub Ceev Xwm Kev Noj Qab Haus Huv hauv ib lub nroog (piv txwv li, Los Angeles County, uas muaj peb Lub Chaw Haujlwm Kev Noj Qab Haus Huv Hauv Zos txhua tus muaj nws tus Tub Ceev Xwm Kev Noj Qab Haus Huv), puas yog lawv txhua tus yuav tsum xa daim ntawv pov thawj?
A: Lo lus Tus Thawj Coj Saib Xyuas Kev Noj Qab Haus Huv Pej Xeem yog hais txog tus neeg uas raug xaiv los ua tus thawj coj saib xyuas kev noj qab haus huv rau pej xeem rau thaj chaw. Hauv qee lub nroog, txoj haujlwm no yuav raug hu ua Tus Neeg Saib Xyuas Kev Noj Qab Haus Huv Pej Xeem es tsis yog Tus Thawj Coj Kev Noj Qab Haus Huv Pej Xeem. Hauv cov nroog uas muaj ntau lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv Hauv Zos xws li Los Angeles County, txhua tus Thawj Coj lossis Cov Tub Ceev Xwm Saib Xyuas Kev Noj Qab Haus Huv Hauv Pej Xeem yuav tsum xa daim ntawv pov thawj hauv Daim Ntawv Ntxiv B rau lawv cov chaw haujlwm.
Q: Thaum twg DHCS mam li tso tawm cov lus qhia ntxiv (cov sijhawm thiab cov txheej txheem tshwj xeeb) ntsig txog qhov kev pab cuam Rov Nqis Peev Hauv Zej Zog thiab cov kev cai xa Daim Ntawv Ntxiv B?
A: DHCS yuav tshaj tawm cov lus qhia ntxiv thiab cov ntaub ntawv pov thawj txog qhov kev pab cuam Rov Nqis Peev Hauv Zej Zog thiab cov kev cai xa mus, txawm li cas los xij tseem tsis tau muaj hnub tso tawm tshwj xeeb. Cov kev hloov tshiab yuav raug xa mus rau MCPs thaum muaj.
Q: What are the immediate deliverables for MCPs under the Community Reinvestment requirement?
A: At this time, MCPs should have already updated their Policies and Procedures (P&P) to reflect Community Reinvestment requirements, as required within 90 days of the policy release. The next deliverable required will be the initial Community Reinvestment Plan based on Calendar Year (CY) 2024 net income. This deliverable will be due in early Q3 2026. DHCS will provide additional information on this submission process by Q2 2026.
Q: Regarding the initial Community Reinvestment plan, can you confirm whether MCPs should submit a two-year plan for 2025–2026 and align with the three-year cycles going forward, or if the first cycle will begin in 2027?
A: MCPs are not required to submit a Community Reinvestment Plan for the 2025-2026 period. The first deliverable will be the Initial Community Reinvestment Plan due in Q3 2026, based on 2024 net income. This initial Community Reinvestment Plan will cover a three-year investment period from 2027-2029, which will be the start of the first cycle. DHCS will issue preliminary funding obligations annually in early Q2; for CY 2024, this will occur in early Q2 2026. MCPs must submit updated Community Reinvestment Plans annually in Q3 to reflect how funds will be allocated to existing or new activities.
Q: How will DHCS provide technical assistance for Community Reinvestment, and when will MCPs be able to ask questions?
A: DHCS plans to provide guidance and support through an upcoming MCP-focused webinar, followed by an All-Comer webinar for all stakeholders. The FAQs will be periodically updated to answer additional questions. MCPs are encouraged to continue submitting specific questions to the MCP’s MCOD Contract Manager. DHCS will address these questions on a case-by-case basis.
Community Reinvestment Planning
Q: Cov kev cai rau MCPs hauv thawj xyoo ntawm kev ua haujlwm hauv ib lub nroog yog dab tsi? Yog tias thawj xyoo ntawm kev ua haujlwm yog xyoo 2024 thiab MCP muaj cov nyiaj tau los tsis zoo hauv CY 2025, cov kev cai yog dab tsi?
A: Ib lub MCP uas nyob hauv nws thawj xyoo ntawm kev ua haujlwm hauv ib lub nroog yuav raug rau Kev Rov Nqis Peev Hauv Zej Zog pib xyoo tom ntej hauv lub nroog ntawd. Piv txwv li, MCP hauv nws thawj xyoo ntawm kev ua haujlwm hauv ib lub nroog hauv CY 2024 yuav raug rau cov kev cai ntawm Kev Rov Nqis Peev Hauv Zej Zog raws li MCP cov nyiaj tau los tag nrho CY 2025 thiab CY 2025 MCAS ntsuas kev ua tau zoo. Yog tias MCP muaj cov nyiaj tau los tsis zoo hauv CY 2025 thiab tsis muaj Cov Neeg Cog Lus Tsim Nyog uas muaj cov nyiaj tau los zoo rau CY 2025, MCP tsis tas yuav xa Daim Ntawv Qhia Txog Kev Nqis Peev Hauv Zej Zog hauv Q3 CY 2027 raws li cov nyiaj tau los tsis zoo hauv CY 2025.
Q: Yog tias MCP tsis muaj nyiaj tau los hauv CY 2024 lossis tshiab ua haujlwm hauv ib lub nroog thiab yog li ntawd yuav raug rau Cov Kev Cai Rov Nqis Peev Hauv Zej Zog pib hauv CY 2025, nws puas yuav ua raws li lub voj voog peev peb xyoos tag nrho lossis lub voj voog luv dua (ob xyoos)?
A: Cov MCPs uas raug rau cov kev cai rov ua dua peev hauv zej zog uas pib hauv CY 2025 yuav muaj lub voj voog kev nqis peev luv dua thiab yuav xa daim phiaj xwm rov ua dua peev hauv zej zog ob xyoos lossis ib xyoos, raws li qhov siv tau, thaum cov nyiaj tau los zoo tau tshaj tawm hauv ib xyoos tom ntej hauv lub sijhawm nqis peev. Qhov no yog sib xws nrog lub sijhawm teem tseg hauv Tshooj VII ntawm APL. Piv txwv li, yog tias MCP lossis Tus Neeg Cog Lus Tsim Nyog muaj cov nyiaj tau los zoo rau CY 2026, lawv yuav tau txais lawv cov luag haujlwm rov nqis peev los ntawm DHCS hauv Q2 2028 thiab yuav tsum xa daim phiaj xwm rov nqis peev hauv zej zog ib xyoos hauv Q3 2028 rau cov peev txheej uas tau thov kom tas thaum kawg ntawm CY 2029.
Q: Cov MCPs yuav ua li cas thiaj nrhiav tau cov cib fim nyiaj txiag rau lawv Txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog uas sib haum nrog cov luag num nyiaj txiag lossis cov haujlwm cuam tshuam nrog CHIP?
A: Cov MCPs yuav tsum pib txoj kev npaj rov nqis peev hauv zej zog pib thaum ntxov CY 2025 los ntawm kev sau cov ntaub ntawv thiab thov cov tswv yim los ntawm cov neeg koom nrog txog cov kev xav tau ntawm zej zog. Qhov no suav nrog kev koom tes nrog Cov Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv Hauv Zos kom sau cov ntaub ntawv hais txog CHA thiab CHIP, thiab sab laj nrog MCP Pawg Neeg Saib Xyuas Zej Zog (CACs) kom thov cov lus pom zoo rau Kev Rov Nqis Peev Hauv Zej Zog. Txij li xyoo 2024 los, cov MCPs kuj tau koom nrog txoj kev CHA/CHIP, uas yuav tsum muab lub hauv paus rau kev sib haum xeeb. Cov MCPs yuav tsum tau txheeb xyuas cov cheeb tsam tseem ceeb thiab cov cib fim uas yuav muaj los ntawm kev npaj thiab kev koom tes thaum ntxov no, uas ua rau cov MCPs muaj peev xwm teeb tsa cov nyiaj txiag nrog cov kev xav tau uas zej zog pom zoo. Cov MCPs tuaj yeem txheeb xyuas cov koom haum tau txais nyiaj los ntawm cov txheej txheem no, thiab kuj tseem tuaj yeem nrhiav cov lus qhia los ntawm cov koom haum pab nyiaj txiag hauv zos. Cov MCPs yuav pom cov koom haum suav nrog tab sis tsis txwv rau cov koom haum pabcuam xws li Philanthropy California, ib lub koom haum ntawm SoCal Grantmakers, Northern California Grantmakers, thiab Catalyst of San Diego & Imperial Counites; cov koom haum hauv zej zog (Community Foundation Locator | Community Foundation National Standards); lossis cov chaw tshawb fawb thiab cov ntaub ntawv tsis muaj txiaj ntsig xws li Candid lossis Charity Navigator kom pab tau hauv kev txheeb xyuas cov neeg tau txais nyiaj pab, ib yam li kev paub hauv zos thiab cov tes hauj lwm. (Nco ntsoov, DHCS tsis tau soj ntsuam ib qho ntawm cov koom haum tau txais nyiaj no thiab kev xa mus rau cov peev txheej no yuav tsum tsis txhob txhais tau tias yog kev pom zoo ntawm cov koom haum no.)
Q: MCPs yuav tsum siv dab tsi los qhia txog cov haujlwm Rov Nqis Peev Hauv Zej Zog yog tias Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv Hauv Zos (LHJ) tsis muaj Kev Ntsuam Xyuas Kev Noj Qab Haus Huv Hauv Zej Zog (CHA) lossis Txoj Kev Npaj Txhim Kho Kev Noj Qab Haus Huv Hauv Zej Zog (CHIP) tam sim no?
A: MCPs thiab lawv cov Neeg Cog Lus Tsim Nyog yuav tsum xyuas kom meej tias cov haujlwm Rov Nqis Peev Hauv Zej Zog tau txais kev qhia ncaj qha los ntawm cov kev xav tau uas zej zog tau txheeb xyuas. Yog tias LHJ tsis muaj CHA lossis CHIP tam sim no, MCPs tuaj yeem siv lub nroog txoj Kev Npaj Tswv Yim lossis txoj kev npaj txhim kho kev noj qab haus huv sib npaug ntawm lub nroog los coj kev txheeb xyuas cov kev xav tau ntawm zej zog thiab qhia cov haujlwm Rov Ua Lag Luam Hauv Zej Zog uas tau npaj tseg. Txhua yam uas yuav tsum tau ua raws li tau teev tseg hauv APL rau kev npaj thiab kev sib koom ua ke ntawm Lub Zej Zog Rov Qab Ua Lag Luam tseem yuav tsum tau ua tiav.
Q: Yog tias kev nqis peev lossis kev ua ub no uas suav nrog hauv Txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog tsis tau siv lossis xav tau kev hloov pauv tseem ceeb vim muaj kev hloov pauv ntawm cov xwm txheej, cov txheej txheem rau kev ceeb toom lossis thov kev hloov kho Txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog yog dab tsi?
A: DHCS yuav tshaj tawm cov lus qhia ntxiv thiab cov ntaub ntawv pov thawj txog qhov kev pab cuam Rov Nqis Peev Hauv Zej Zog thiab cov kev cai xa mus, txawm li cas los xij tseem tsis tau muaj hnub tso tawm tshwj xeeb. Cov kev hloov tshiab yuav raug xa mus rau MCPs thaum muaj. Txog thaum muaj lus qhia ntxiv, MCPs raug txais tos los tawm tswv yim txog Kev Hloov Kho Txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog rau ntawm qhov kev hloov kho tshwj xeeb rau lawv tus kheej lossis lawv Tus Neeg Cog Lus Tsim Nyog.
Q: Yog tias ib qho kev pib ua hauv Txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog ntau dua lossis tsis ua tau raws li qib kev nqis peev uas xav tau, puas tuaj yeem hloov kho nyiaj txiag rau lwm yam kev nqis peev hauv Txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog? Cov txheej txheem rau qhov no yog dab tsi?
A: Cov MCPs xa ib daim phiaj xwm rov nqis peev hauv zej zog txhua xyoo hauv lub sijhawm peb xyoos ntawm kev nqis peev thiab tuaj yeem hloov kho cov nyiaj faib rau ntau yam haujlwm hauv Cov Phiaj Xwm Rov Nqis Peev Hauv Zej Zog tom ntej hauv tib lub sijhawm nqis peev raws li DHCS kev tshuaj xyuas thiab kev pom zoo. Ntxiv mus, nyob rau hauv cov xwm txheej tshwj xeeb thiab raws li DHCS kev pom zoo, MCPs kuj tseem yuav raug tso cai nqa cov nyiaj tsis tau siv mus rau lub sijhawm peb xyoos tom ntej yog tias muaj kev piav qhia txaus rau tsis siv cov nyiaj tag nrho hauv lub sijhawm siv tau. Txhua qhov kev hloov kho lossis kev thov nqa mus yuav tsum tau sau tseg thiab DHCS pom zoo.
Q: Cov MCPs yuav tsum qhia txog cov kev pab cuam ntawm Cov Neeg Cog Lus Tsim Nyog rau kev sib koom ua ke ntawm Cov Haujlwm Rov Nqis Peev Hauv Zej Zog li cas, tshwj xeeb tshaj yog rau cov neeg xa cov phiaj xwm rov nqis peev hauv zej zog ntau lub nroog?
A: Txhua lub MCP muaj lub luag haujlwm xa nws daim phiaj xwm rov nqis peev hauv zej zog thiab daim phiaj xwm rov nqis peev hauv zej zog ntawm lawv tus (cov) neeg cog lus tsim nyog. Yog tias Tus Neeg Cog Lus Tsim Nyog Hloov lawv lub luag haujlwm peev rau MCP, MCP yuav suav nrog qhov ntawd hauv lawv daim ntawv xa mus rau Txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog. DHCS tab tom ua haujlwm rau daim ntawv xa daim ntawv qhia txog Kev Npaj Rov Nqis Peev Hauv Zej Zog uas yuav tso cai rau MCPs tshaj tawm lawv tus kheej lub luag haujlwm ib yam li ntawm Tus Neeg Cog Lus Ua Haujlwm.
Thaum kawg ntawm txhua lub sijhawm peb xyoos ntawm kev nqis peev, MCPs yuav tsum tsim thiab tshaj tawm Daim Ntawv Qhia Txog Kev Rov Nqis Peev Hauv Zej Zog rau ntawm lawv lub vev xaib thiab muab qhov txuas mus rau DHCS. Cov MCPs yuav piav qhia hauv daim ntawv tshaj tawm txog kev nqis peev ua ke lossis kev sib koom tes ua ke uas tau ua nrog lwm cov phiaj xwm hauv lub nroog los qhia txog kev siv zog ua lag luam ua ke.
Q: Thaum muaj ntau lub MCP ua haujlwm hauv tib lub nroog, kev cia siab lossis kev nyiam li cas txog kev sib phim lossis kev sib koom ua ke cov nyiaj pab rau Kev Nqis Peev Hauv Zej Zog?
A: DHCS txhawb kom MCPs thiab Cov Neeg Cog Lus Tsim Nyog uas ua haujlwm hauv tib lub nroog koom tes ua haujlwm Rov Nqis Peev Hauv Zej Zog kom ua kom muaj txiaj ntsig zoo tshaj plaws ntawm cov nyiaj txiag. Lub hom phiaj yog los txhawb kom muaj kev sib haum xeeb nrog cov zej zog uas tau txheeb xyuas qhov tseem ceeb thiab kom nce qhov cuam tshuam tag nrho ntawm kev nqis peev thaum cov phiaj xwm ua haujlwm ua ke. Cov MCPs yuav tsum xav txog cov cib fim los sib phim cov peev txheej. Cov MCP xaiv koom tes li cas, txawm tias ntawm txhua txoj kev npaj hauv ib lub nroog ua ke lossis ib pawg me, yog nyob ntawm lawv qhov kev txiav txim siab. Cov MCPs uas muab nyiaj pab rov qab los ua lag luam hauv zej zog tsuas yog yuav tsum tau tshaj tawm txog lawv cov haujlwm thiab kev nqis peev xwb.
Q: Cov rooj sib tham xws li Tribal Health lossis Justice-Involved rooj sib tham puas suav tias yog ib feem ntawm qhov kev pab cuam Community Reinvestment, lossis lawv puas yog ib feem ntawm cov txheej txheem npaj kev koom tes hauv zej zog?
A: Cov kev sib ntsib no yog ib feem ntawm cov txheej txheem npaj kev koom tes hauv zej zog. Cov luag num rov ua lag luam hauv zej zog yuav tsis raug ua tiav los ntawm kev siv nyiaj rau cov txheej txheem lossis cov haujlwm kev tswj hwm ntsig txog kev npaj lossis kev siv rov ua lag luam hauv zej zog, suav nrog cov haujlwm hauv zej zog lossis cov neeg koom nrog.
Q: Hais txog Kev Rov Nqis Peev Hauv Zej Zog, yuav ua li cas yog tias MCP thiab LHJ/BH Cov Thawj Coj tsis pom zoo txog kev faib nyiaj txiag? Thaum kawg leej twg muaj cai txiav txim siab?
A: Cov MCPs yuav tsum suav nrog LHJs thiab Lub Nroog Kev Noj Qab Haus Huv Kev coj cwj pwm hauv lawv txoj kev npaj thiab kev txiav txim siab. Lub hom phiaj yog rau MCPs ua haujlwm sib koom tes nrog LHJs thiab Lub Nroog BH kom ntseeg tau tias muaj kev sib haum xeeb hauv cov yam tseem ceeb thiab tias txoj kev npaj peev txheej "feem ntau pom zoo" rau LHJs thiab Lub Nroog BH. Hauv cov xwm txheej uas MCP thiab LHJ/BH tsis pom zoo rau Txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog, MCP lub luag haujlwm tseem ceeb yog xyuas kom meej tias txoj kev npaj nqis peev sib haum nrog cov kev xav tau ntawm zej zog uas tau teev tseg hauv CHA/CHIP. Yuav tsum muaj daim ntawv pov thawj lees paub qhov kev sib haum xeeb ntawm CHA/CHIP los ntawm LHJs thiab Cov Thawj Coj Saib Xyuas Kev Noj Qab Haus Huv Hauv Lub Nroog, thiab cov Thawj Coj yuav suav nrog cov ntsiab lus tshwj xeeb txog qhov twg yuav muaj kev tsis pom zoo hauv daim ntawv pov thawj no, tab sis MCP muaj cai txiav txim siab zaum kawg rau kev faib nyiaj tshwj xeeb thiab lwm cov ntsiab lus ntawm Txoj Kev Npaj.
Q: Rau ntau lub nroog uas muaj ntau txoj kev npaj, DHCS xav li cas rau kev koom tes ntawm ntau txoj kev npaj thiab txoj kev npaj/LHJ, kev sib koom ua ke ntawm cov nyiaj txiag tseem ceeb thoob plaws cov phiaj xwm thiab LHJs, thiab kev koom tes ntawm CHEO thoob plaws cov phiaj xwm?
A: Hauv cov nroog uas muaj ntau lub MCP ua haujlwm, cov MCP thiab Cov Neeg Cog Lus Tsim Nyog yuav tsum sib koom tes nrog lwm cov MCP uas ua haujlwm hauv tib lub nroog kom koom nrog LHJs thaum lub sijhawm npaj kev nqis peev hauv zej zog, raws li MCP cov kev cai rau cov txheej txheem CHA/CHIP. DHCS txhawb kom txhua tus MCPs thiab Cov Neeg Cog Lus Tsim Nyog uas ua haujlwm hauv tib lub nroog los sib koom ua ke cov haujlwm Rov Nqis Peev Hauv Zej Zog uas tau txheeb xyuas los ntawm lub zej zog kom ua kom muaj txiaj ntsig zoo tshaj plaws ntawm cov nyiaj txiag. Cov MCPs yuav tsum tau ua pov thawj tias lawv tau koom tes nrog lwm cov MCPs thaum xa lawv txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog. Txawm li cas los xij, MCPs xaiv koom tes li cas yog nyob ntawm txhua txoj kev npaj lub siab nyiam. Ib yam li ntawd, txhua lub MCP (thiab nws cov Neeg Cog Lus Tsim Nyog raws li siv tau) yuav tsum koom nrog nws tus Thawj Coj Saib Xyuas Kev Ncaj Ncees Kev Noj Qab Haus Huv (CHEO) hauv cov txheej txheem npaj kev nqis peev hauv zej zog, kom ntseeg tau tias txhua Txoj Kev Npaj Kev Nqis Peev Hauv Zej Zog sib haum nrog cov kev xav tau thiab qhov tseem ceeb ntawm kev ncaj ncees kev noj qab haus huv. Cov CHEOs koom tes li cas, thiab lub luag haujlwm tshwj xeeb ntawm txhua tus CHEO hauv cov txheej txheem npaj, kuj yog nyob ntawm MCP qhov kev txiav txim siab.
Q: Do MCPs need to complete a stakeholder attestation for the portions of the investment allocated to 2025 and beyond?
A: Starting with Community Reinvestment based on CY 2025 net income (and annually thereafter), MCPs must provide Attestations of Support from local Public Health and Behavioral Health Directors indicating the proposed investments included in the annual Community Reinvestment Plan generally align with community needs identified in the Community Health Assessment (CHA)/Community Health Improvement Plan (CHIP) and Behavioral Health Transformation (BHT) processes and comply with all other APL requirements. All APL requirements apply whether a proposed activity was previously committed to or is newly identified.
Q: Yog tias MCP thiab/lossis Tus Neeg Cog Lus Tsim Nyog xaiv los thov kev nqis peev dawb rau xyoo 2024 Kev Nqis Peev Hauv Zej Zog, MCP thiab/lossis Tus Neeg Cog Lus Tsim Nyog yuav tsum xa dab tsi? Puas yog tag nrho cov peev txheej rov ua lag luam hauv zej zog yuav tsum tau ua tiav los ntawm kev nqis peev dawb, lossis puas tuaj yeem xa ib feem ntawm cov nyiaj ua "credit" rau tag nrho cov luag num nrog rau kev pab cuam ntxiv hauv Txoj Kev Npaj Rov Ua Lag Luam hauv Zej Zog?
A: Yog tias MCP thiab/lossis Cov Neeg Cog Lus Tsim Nyog xaiv los thov kev nqis peev dawb rau Txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog thawj zaug, raws li cov nyiaj tau los ntawm CY 2024 MCP, cov ntaub ntawv xa tuaj hauv qab no yuav tsum muaj:
- -Ib daim ntawv pov thawj tias muaj kev cog lus ua lag luam hauv zej zog ua ntej lub Peb Hlis 7, 2025, nrog rau lub sijhawm pab nyiaj txiag txuas mus rau lub sijhawm peev txheej thawj zaug ntawm Txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog. Cov ntaub ntawv pov thawj ntawm qhov kev cog lus no yuav suav nrog daim ntawv cog lus nkag siab (MOU) uas tau kos npe ntawm MCP lossis Tus Neeg Cog Lus Tsim Nyog thiab nws tus neeg tau txais nyiaj, daim ntawv cog lus pub nyiaj uas tau kos npe, lossis lwm daim ntawv cog lus sau ua ke.
- -Ib Txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog uas ua tau raws li txhua yam uas tau teev tseg hauv APL, nrog rau kev hloov pauv ib zaug hauv hom kev pov thawj. Cov Thawj Coj Saib Xyuas Kev Noj Qab Haus Huv Pej Xeem thiab Lub Nroog yuav tsum ua pov thawj tias tau txais kev qhia txog cov haujlwm Rov Nqis Peev Hauv Zej Zog uas tau npaj tseg es tsis yog ua pov thawj tias txoj kev npaj no "feem ntau pom zoo."
Ntxiv rau qhov ntawd, tus Neeg Cog Lus Tsim Nyog yuav ua tau ib qho:
- -Tsim ib Txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog thiab txhua yam khoom xa tuaj uas MCP xa rau lawv, lossis
- Hloov nws lub luag haujlwm Rov Nqis Peev Hauv Zej Zog rau MCP los tswj hwm cov nyiaj rau nws, raws li tau pom zoo ntawm MCP thiab Tus Neeg Cog Lus. Kev hloov pauv ntawm Tus Neeg Cog Lus Tsim Nyog Lub Luag Haujlwm Rov Nqis Peev Hauv Zej Zog rau MCP yuav tsum tau sau ua ntawv sau thiab kos npe los ntawm MCP thiab Tus Neeg Cog Lus.
-Kev thov kev nqis peev dawb rau kev rov ua lag luam hauv zej zog yog xaiv tau. Cov MCPs thiab/lossis Cov Neeg Cog Lus Tsim Nyog tuaj yeem thov cov peev txheej dawb ua credit rau ib feem ntawm Lub Luag Haujlwm Rov Nqis Peev Hauv Zej Zog, yog tias cov peev txheej ntawd tau txais kev pom zoo los ntawm DHCS ua ib feem ntawm MCP's 2026 Community Reinvestment Plan, nrog rau qhov seem ntawm lub luag haujlwm tau ua tiav los ntawm cov haujlwm tshiab thiab kev pab nyiaj txiag raws li tau teev tseg hauv Lub Luag Haujlwm Rov Nqis Peev Hauv Zej Zog.
Q: Lub ntsiab lus ntawm "kev nqis peev ua haujlwm pub dawb tam sim no" yog dab tsi? Puas yog cov peev txheej uas pib xyoo 2024 lossis ua ntej ntawd thiab txuas mus txog xyoo 2025 thiab tom qab ntawd suav tau rau hauv Kev Rov Nqis Peev Hauv Zej Zog?
A: Kev nqis peev ua haujlwm pub dawb yog txhais tias yog cov lus cog tseg kev nqis peev uas tau sau tseg los ntawm MCPs thiab Cov Neeg Cog Lus Tsim Nyog ua ntej lossis hauv ib hlis ntawm kev tshaj tawm APL 25-004 thiab tej zaum yuav suav nrog rau thawj qhov kev lav phib xaub rau Kev Nqis Peev Hauv Zej Zog raws li cov nyiaj tau los ntawm CY 2024. Yuav suav tias yog kev nqis peev dawb:
- -Cov peev txheej yuav tsum tau cog lus rau, los ntawm Daim Ntawv Cog Lus Nkag Siab, daim ntawv cog lus pub nyiaj, lossis lwm daim ntawv cog lus sau ua ke, ua ntej Lub Peb Hlis 7, 2025.
- -MCPs yuav tsum ua pov thawj ua ib feem ntawm lawv daim ntawv xa mus rau Txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog thawj zaug tias qhov kev cog lus tau ua ua ntej lub Peb Hlis 7, 2025.
- -Cov peev txheej yuav tsum tau siv tom qab kev pom zoo ntawm Txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog xa tuaj rau lub Cuaj Hli 1, 2026, thiab siv tag ua ntej kaw lub sijhawm rov nqis peev hauv zej zog peb xyoos thaum kawg ntawm xyoo 2029.
- Cov kev nqis peev yuav tsum poob rau hauv ib lossis ntau pawg kev siv uas yuav tsum tau ua rau cov haujlwm rov ua lag luam hauv zej zog thiab yuav tsum tsis txhob poob rau hauv ib pawg twg uas tsis suav nrog (piv txwv li, cov haujlwm suav nrog hauv Daim Ntawv Cog Lus MCP). Cov kev nqis peev yuav tsis raug suav nrog cov luag haujlwm rov ua lag luam hauv zej zog raws li CY 2025 lossis CY 2026 cov nyiaj tau los tag nrho.
- Qhov kev ywj pheej no yog tsim los pub rau MCPs thiab Cov Neeg Cog Lus Tsim Nyog kom ua raws li cov kev pib nqis peev ntau xyoo uas twb tau cog lus ua ntej DHCS' APL tshaj tawm, uas tau teem sijhawm kom muaj kev siv nyiaj thaum lub sijhawm pib nqis peev ntawm Txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog. Cov nyiaj siv ua ntej MCPs txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog tau txais kev pom zoo yuav tsis suav nrog rau hauv lub luag haujlwm Rov Nqis Peev Hauv Zej Zog.
Q: Cov MCP twg uas tsis muaj lub luag haujlwm Rov Nqis Peev Hauv Zej Zog raws li cov nyiaj tau los tiag tiag uas yuav tsum tau tshaj tawm rau lawv lub vev xaib? Puas yog lawv yuav tsum tshaj tawm ib yam dab tsi hloov chaw ntawm Txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog?
A: Cov MCPs thiab Cov Neeg Cog Lus Tsim Nyog uas muaj cov nyiaj tau los tsis zoo, tsis tas yuav xa Daim Ntawv Qhia Txog Kev Nqis Peev Hauv Zej Zog rau CY uas siv tau. Txawm li cas los xij, MCP yuav tsum tshaj tawm cov lus luv luv rau ntawm nws lub vev xaib thaum Lub Cuaj Hlis 1, lossis Hnub Ua Haujlwm thawj zaug ntawm Lub Cuaj Hlis, qhia tias nws tsis raug rau cov kev cai ntawm Kev Rov Nqis Peev Hauv Zej Zog rau CY ntawd. Yog tias tsis muaj lub luag haujlwm Rov Ua Lag Luam Hauv Zej Zog rau tag nrho peb xyoos ntawm kev nqis peev, MCP kuj tseem yuav tsum tshaj tawm cov lus luv luv ntawm nws lub vev xaib qhia tias nws tsis raug rau cov kev cai Rov Ua Lag Luam Hauv Zej Zog rau lub sijhawm ntawd thiab tsis muaj lub luag haujlwm tshaj tawm.
Q: Lub sijhawm siv nyiaj rau Kev Rov Nqis Peev Hauv Zej Zog yog dab tsi thiab lub sijhawm siv nyiaj pib thaum twg?
A: Lub sijhawm siv nyiaj yog hais txog lub sijhawm uas MCPs thiab lawv cov Neeg Cog Lus Tsim Nyog yuav tsum faib thiab siv cov nyiaj rov qab nqis peev hauv zej zog raws li Txoj Kev Npaj Rov Qab Nqis Peev Hauv Zej Zog uas tau pom zoo. Rau lub sijhawm peb xyoos thawj zaug ntawm kev nqis peev, MCPs yuav tsum pib kev nqis peev tom qab lawv Txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog uas yuav tsum tau ua tiav rau lub Cuaj Hlis 1, 2026 tau txais kev pom zoo los ntawm DHCS. Cov MCPs yuav tsum siv tag nrho cov nyiaj uas cuam tshuam nrog Txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog uas tau pom zoo rau lub sijhawm nqis peev thawj zaug thaum kaw xyoo 2029.
Q: Cov txheej txheem rau kev xa cov ntawv pov thawj uas yuav tsum tau ua yog dab tsi? Leej twg yuav tsum tau kos npe rau cov ntaub ntawv no?
A: Cov ntawv pov thawj yuav tsum tau kos npe los ntawm Tus Thawj Coj Kev Noj Qab Haus Huv Hauv Zos (lossis tus sib npaug) thiab Tus Thawj Coj Kev Noj Qab Haus Huv Kev Coj Tus Cwj Pwm ntawm Lub Nroog (lossis tus sib npaug). Cov MCPs yuav tsum ua kom tiav lawv daim ntawv pov thawj, suav nrog lub npe MCP thiab xyoo peev txheej siv tau, thiab tom qab ntawd muab daim ntawv rau Tus Thawj Coj Kev Noj Qab Haus Huv Pej Xeem thiab Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv ntawm Lub Nroog kom ua tiav thiab kos npe rau lawv cov ntu thiab xa rov qab mus rau MCP. Cov MCPs muaj lub luag haujlwm xa cov ntawv pov thawj uas tau ua tiav tag nrho rau DHCS ua ib feem ntawm lawv daim ntawv xa mus rau Txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog. Yuav tsum muaj ib daim ntawv pov thawj rau ib tus Thawj Coj Kev Noj Qab Haus Huv Pej Xeem thiab ib tus Thawj Coj Kev Noj Qab Haus Huv ntawm Lub Nroog, txawm tias MCP thov kev nqis peev dawb rau tsis muaj, tag nrho, lossis ib feem ntawm lawv qhov kev lav phib xaub rov qab peev hauv zej zog thawj zaug. Cov lus pov thawj muaj cov lus txhawb nqa thiab kev lees paub, thiab Cov Thawj Coj Kev Noj Qab Haus Huv Pej Xeem thiab Cov Thawj Coj Kev Noj Qab Haus Huv ntawm Lub Nroog yuav tsum ua pov thawj rau cov lus hais uas siv tau.
Kev Siv Nyiaj Rov Qab Los Ua Lag Luam Hauv Zej Zog Uas Tau Tso Cai
Q: Rau cov haujlwm uas yuav tsum tau siv xws li Kev Tsim Kom Muaj Cov Neeg Ua Haujlwm Saib Xyuas Kev Noj Qab Haus Huv, DHCS puas yuav xav txog kev nqis peev rau cov neeg ua haujlwm uas tsis yog ib txwm muaj thiab tsis yog cov neeg ua haujlwm uas tau cog lus nrog txoj kev npaj kho mob xws li thev naus laus zis lossis kev tshawb fawb txog kev kho mob - uas txhawb nqa lossis txhim kho kev xa khoom kho mob raws li tsim nyog rau Kev Rov Nqis Peev Hauv Zej Zog?
A: Yog, DHCS yuav xav txog kev nqis peev rau cov neeg ua haujlwm uas tsis yog ib txwm muaj thiab tsis yog cov neeg ua haujlwm cog lus nrog txoj kev npaj kho mob uas txhawb nqa lossis txhim kho kev muab kev pabcuam kho mob, tsuav yog lawv poob rau hauv cov kev cai ntawm cov pawg siv yuav tsum tau ua thiab ua tau raws li txhua yam uas tau teev tseg hauv APL.
Xam & Kev Sib Txuas Lus Nyiaj Txiag
Q: DHCS yuav txiav txim siab li cas txog cov nyiaj tau los tag nrho uas siv los xam qhov kev lav phib xaub rau Kev Rov Nqis Peev Hauv Zej Zog?
A: DHCS yuav siv cov nyiaj tau los tag nrho uas tau tshaj tawm hauv daim ntawv xa MLR, kho raws li qhov tsim nyog, rau CY siv tau los txiav txim siab tus nqi ntawm Lub Zej Zog Rov Ua Lag Luam.
Q: Puas muaj lub sijhawm tshwj xeeb dua thaum MCP yuav tau txais cov nyiaj pab los ntawm DHCS hauv Q2 ntawm CY 2026?
A: Cov MCPs yuav tau txais cov nyiaj pab los ntawm DHCS thaum lub Plaub Hlis Ntuj xyoo 2026.
Q: Cov MCPs yuav tsum tswj hwm cov nyiaj pab rov qab peev hauv zej zog li cas? Puas yuav tsum muab nyiaj ncaj qha rau Lub Nroog BH thiab Cov Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv Pej Xeem lossis rau cov koom haum uas ua cov haujlwm raws li cov pawg siv uas raug tso cai?
A: Thaum DHCS pom zoo rau Txoj Kev Npaj Rov Nqis Peev Hauv Zej Zog, txhua lub MCP muaj lub hwj chim txiav txim siab seb yuav siv nws cov nyiaj li cas, raws li txoj kev npaj uas tau pom zoo. Cov MCPs yuav koom tes nrog lub nroog Behavioral Health lossis Public Health departments, cov koom haum hauv zej zog, lossis lwm lub koom haum los ua cov haujlwm tau pom zoo, raws li tsim nyog. Cov nyiaj txiag yuav tsum tau muab xa mus rau cov koom haum uas muaj peev xwm ua tiav cov haujlwm Rov Nqis Peev Hauv Zej Zog thiab ua tiav cov txiaj ntsig zoo rau zej zog.
Q: Yog tias MCP tsis muaj cov nyiaj tau los tag nrho thiab tsis ua tau raws li qhov ntsuas kev ua tau zoo tsawg kawg nkaus rau CY uas siv tau, puas yog MCP tseem yuav tsum tau ua qhov Kev Nqis Peev Zoo rau Zej Zog?
A: Tsis yog, yog tias MCP tsis muaj cov nyiaj tau los tag nrho rau xyoo ntawd, nws tsis muaj lub luag haujlwm Rov Nqis Peev Hauv Zej Zog. Tsuas yog MCPs uas muaj cov nyiaj tau los zoo rau txhua xyoo uas siv tau thiaj li raug rau cov luag num rov qab nqis peev ntawm Lub Hauv Paus thiab/lossis Kev Ua tiav Zoo ntawm Lub Zej Zog.
Q: Yog tias MCP tsis muaj cov nyiaj tau los tag nrho, tab sis Tus Neeg Cog Lus Tsim Nyog Muaj, lub koom haum twg yog tus saib xyuas kev pab nyiaj rau Kev Rov Nqis Peev Hauv Zej Zog, Tus Neeg Cog Lus Tsim Nyog lossis MCP?
A: Yog tias MCP tsis muaj cov nyiaj tau los tag nrho tab sis Tus Neeg Cog Lus Tsim Nyog Muaj, Tus Neeg Cog Lus Tsim Nyog yuav yog tus lav ris rau lub luag haujlwm Rov Nqis Peev Hauv Zej Zog. Cov Neeg Cog Lus Uas Tsim Nyog Tau Tso Cai, tab sis tsis tas yuav tsum tau, hloov lawv lub luag haujlwm Rov Ua Lag Luam Hauv Zej Zog rau MCPs los tswj hwm cov nyiaj rau lawv, yog tias MCP qhov kev nqis peev ntawm cov nyiaj no ua tau raws li txhua qhov yuav tsum tau ua raws li APL. Vim lawv lub luag haujlwm tseem ceeb hauv kev muab cov kev pabcuam rau cov Tswv Cuab, DHCS txhawb kom cov Neeg Cog Lus Tsim Nyog koom nrog hauv qhov kev pab cuam Rov Qiv Nyiaj Hauv Zej Zog. Txawm li cas los xij, MCP yog tus saib xyuas kev xa Daim Ntawv Qhia Txog Kev Nqis Peev Hauv Zej Zog thiab xyuas kom meej tias txhua yam khoom xa tuaj raug xa tuaj rau tus Neeg Cog Lus Tsim Nyog.
Q: Yog tias MCP thiab Tus Neeg Cog Lus Tsim Nyog tsis muaj cov nyiaj tau los zoo, yuav muaj kev cia siab li cas rau kev npaj rov nqis peev hauv zej zog?
A: Pib thaum ntxov CY 2025, txhua lub MCPs yuav tsum koom nrog kev npaj rov nqis peev hauv zej zog, suav nrog kev sau cov ntaub ntawv thiab thov cov neeg koom nrog cov tswv yim txog cov kev xav tau ntawm zej zog. Yog tias MCP lossis Tus Neeg Cog Lus Tsim Nyog tau tshaj tawm cov nyiaj tau los tsis zoo hauv xyoo thawj zaug ntawm lub sijhawm peb xyoos ntawm kev nqis peev tab sis tom qab ntawd tshaj tawm cov nyiaj tau los zoo, lawv yuav tsum xa Daim Ntawv Qhia Txog Kev Nqis Peev Hauv Zej Zog rau xyoo (cov) uas lawv muaj cov nyiaj tau los zoo thaum lub sijhawm nqis peev. Vim li no, cov MCPs yuav tsum koom tes nrog kev npaj rov ua lag luam hauv zej zog txawm tias nyob rau xyoo uas lawv tsis muaj qhov yuav tsum tau xa daim ntawv thov, kom paub tseeb tias npaj txhij yog tias xav tau kev npaj rau xyoo tom ntej.
Q: Rau Cov Lus Qhia Ntxiv Txog Kev Siv Nyiaj Uas Tso Cai & Txwv Tsis Pub Siv, puas muaj kev sib tham hauv online lossis tus kheej los tham txog cov xwm txheej uas tau nthuav tawm hauv ntu no kom paub qhov txawv ntawm cov piv txwv ntawm kev cuam tshuam los ntawm sab saud, sab hauv qab thiab kev cuam tshuam sib xyaw?
A: DHCS tsis npaj yuav tuav ib lub rooj sib tham sib cais los qhia txog txhua qhov xwm txheej hauv Cov Lus Qhia Ntxiv. Cov MCPs yuav tsum siv cov piv txwv uas tau muab rau hauv cov lus qhia ua cov ntsiab lus siv thiab siv cov lus hauv qab hauv APL 25-004 Appendix A ua cov piv txwv tshwj xeeb los pab txiav txim siab txog kev sib phim nrog cov pawg siv uas raug tso cai. Yog tias muaj lus nug txog cov xwm txheej tshwj xeeb, MCPs yuav tsum tiv tauj lawv tus Thawj Saib Xyuas Daim Ntawv Cog Lus DHCS kom paub meej ntxiv.
Q: Will HEDIS reporting for the Community Reinvestment program be assessed at the state or county level?
A: Raws li APL 25-007 Daim Ntawv Txuas C, (uas hloov APL 23-012) DHCS xav kom MCPs tshaj tawm cov ntaub ntawv Medi-Cal Managed Care Accountability Sets (MCAS) ob qho tib si ntawm qib phiaj xwm thiab qib nroog. Cov nqi MCAS uas MCP tshaj tawm yuav raug tshuaj xyuas ntawm theem phiaj xwm thaum cov ntaub ntawv theem nroog yuav raug siv los ntawm DHCS rau kev siv zoo thiab kev siv zog xwb. Raws li APL 25-007 Daim Ntawv Txuas C, thiab pib xyoo ntsuas 2024 (MY24), DHCS yuav siv cov txheej txheem kev tswj hwm ntawm theem nroog, raws li kev tshaj tawm theem nroog ntawm cov nqi MCAS suav nrog kev ntsuas HEDIS hauv MCAS.
Rau lub hom phiaj ntawm kev nqis peev hauv zej zog, DHCS yuav siv cov txheej txheem tswj hwm thiab cov txheej txheem yav dhau los tau piav qhia hauv APL 25-007 Daim Ntawv Cuam Tshuam C, cuam tshuam nrog county-theem qhia rau MCAS ntsuas. DHCS yuav siv tib lub luag haujlwm rau kev tswj hwm theem ntawm lub nroog-theem rau kev txiav txim siab txog Kev Ua Tau Zoo Tshaj Plaws Hauv Zej Zog Kev Ua Lag Luam.
Piv txwv li, yog tias Plan A npog 10 lub nroog, thiab hauv Lub Nroog 1-8 lawv tau ntsib MPLs rau txhua qhov kev ntsuas, tab sis nyob rau hauv Lub Nroog 9 thiab 10 lawv poob rau Txoj Cai Theem 2 lossis 3 (raws li tau hais tseg hauv APL 25-007 Daim Ntawv Cuam Tshuam C), ces Plan A yuav raug ntxiv rau Kev Ua Tau Zoo Tshaj Plaws Hauv Zej Zog 10.
Q: How is an MCP’s annual net income determined for Community Reinvestment? Is it calculated across all counties or for each county separately?
A: DHCS will calculate MCPs’ annual net income as a statewide aggregate based on annual Medical Loss Ratio (MLR) submissions submitted no later than 12 months after the close of each calendar year. The allocation of Community Reinvestment funds at the county-level will generally be proportional to the MCP’s Medi-Cal membership by county. See Section V of APL 25-004 for the detailed allocation methodology.
Qhov kev lav phib xaub tau txais txiaj ntsig zoo (piv txwv li, 7.5% ntawm cov nyiaj tau los) tsuas yog xam raws li kwv yees cov nyiaj tau los ntawm cov nroog uas MCP tau txais Txoj Cai Lij Choj 2 lossis 3 txoj haujlwm (raws li kev faib nyiaj txheeb ze rau cov tswv cuab lub hlis) es tsis yog MCP cov nyiaj tau los ntawm lub xeev tag nrho.
Q: Will the funding obligations for Community Reinvestment be shared publicly?
A: Once the Community Reinvestment funding obligations are calculated, they will be public record and subjected to the Public Record Act (PRA). In addition, under Section IV of APL 25-004, MCPs are required to post Community Reinvestment Plans on their websites annually (subsequent to DHCS approval). The Community Reinvestment Plans will include the projected allocation of funds across each Community Reinvestment activity for each county in which the MCP operates.
Q: If an MCP or Qualifying Subcontractor does not have net income, what are the expectations for Community Reinvestment planning?
A: If neither the MCP nor the Qualifying Subcontractor has net income, no CR funding obligation applies for the applicable year, and no Community Reinvestment plan is due to DHCS for the applicable year. For example, if neither the MCP nor the Qualifying Subcontractor has positive net income for CY 2024, no Community Reinvestment Plan is due in Q3 2026 for obligations based on CY 2024 net income. However, MCPs must participate in Community Reinvestment engagement and planning activities as described in Section VII of the APL (pg. 16), such as collecting data and soliciting stakeholder input on community needs. If the MCP or its Qualifying Subcontractors has positive net income in a subsequent CY tied to the investment period, the MCP must submit a two-year or one-year Community Reinvestment Plan (as applicable).
Q: If the MCP does not have net revenue, but the Qualifying Subcontractor does have net revenue for the applicable CY, do the dollars for that Community Reinvestment plan come from the Qualifying Subcontractor or the MCP?
A: If an MCP has no net income, but the Qualifying Subcontractor has net income, the Qualifying Subcontractor is responsible for fulfilling the CR obligations and is subject to all APL requirements. Any transfer of that obligation to the MCP to administer funds on their behalf is optional.
Q: What is the definition of “Member Grants” in the context of Community Reinvestment?
A: Member Grants refers to any payments or funds provided directly to members as part of the Community Reinvestment activities. These types of expenditures cannot be used to meet Community Reinvestment obligations as outlined in APL 25-004.