Daim ntawv tshaj tawm sib koom ntawm daim ntawv cog lus 2024 Medi-Cal Managed Care Plan
Cov ntawv cog lus tshiab yuav ua rau muaj kev ncaj ncees, kev noj qab haus huv, kev nkag mus tau, kev lav phib xaub, thiab kev pom tseeb los txhim kho Medi-Cal kev saib xyuas kev noj qab haus huv.
SACRAMENTO – The Department of Health Care Services (DHCS) is joined today with five commercial managed care plans (MCPs)–Blue Cross of California Partnership Plan (“Anthem”), Blue Shield of California Promise Health Plan, CHG Foundation d.b.a. Community Health Group Partnership Plan, Health Net Community Solutions, Inc. and Molina Healthcare of California–to announce an agreement to deliver Medi-Cal services to Medi-Cal managed care members in 21 counties across the state starting in January 2024:
"Peb tau cog lus tias yuav txhim kho kev kho mob thiab kev paub dhau los rau Medi-Cal cov tswv cuab los ntawm kev teeb tsa tus qauv tshiab rau qhov kev saib xyuas neeg nyob hauv nruab nrab thiab kev ncaj ncees zoo li hauv Golden State. Daim ntawv cog lus no yuav muab kev paub tseeb rau peb cov tswv cuab, cov neeg muab kev pabcuam, thiab cov neeg muaj feem cuam tshuam thaum peb ua haujlwm ua ke los pib qhov kev hloov pauv tseem ceeb ntawm Medi-Cal program hauv 2024.
"Peb tau cog lus los teeb tsa theem rau kev hloov pauv Medicaid thoob plaws lub tebchaws nrog rau kev txhim kho kev noj qab haus huv thoob plaws hauv California."
Lub Xeev qhov tseem ceeb tshaj plaws yog los xyuas kom meej tias Medi-Cal cov tswv cuab tau nkag mus rau cov phiaj xwm kev pov hwm kev noj qab haus huv uas muab kev saib xyuas zoo thiab raug raws sijhawm thiab tsom mus rau kev xa tawm ntawm Lub Xeev cov kev hloov pauv uas tau tsim los hloov kho cov kab ke kev noj qab haus huv los ua tib neeg, kev ncaj ncees. -focused, thiab cov ntaub ntawv-tsav.
Txhawm rau ua kom muaj kev ntseeg siab rau cov tswv cuab, cov chaw muab kev pabcuam thiab cov phiaj xwm, Lub Xeev tau siv nws txoj cai los ua haujlwm ncaj qha nrog cov phiaj xwm los rov qhia peb txoj kev koom tes thiab txav mus nrog kev ntseeg siab thiab nrawm mus rau kev ua raws li cov kev hloov pauv uas peb xav pom. Kev pom zoo tau ua tiav kom ua ke peb tuaj yeem pib peb txoj haujlwm sib koom ua ke ntawm kev xa ib tus neeg nyob nruab nrab, tsom mus rau kev ncaj ncees, thiab cov ntaub ntawv uas tau tsav los ntawm Medi-Cal program. Raws li ib feem ntawm daim ntawv cog lus no, Medi-Cal cov phiaj xwm kev noj qab haus huv yuav raug coj mus rau cov qauv tshiab ntawm kev saib xyuas thiab kev lav phib xaub ntau dua, pab kom cov tswv cuab Medi-Cal muaj kev saib xyuas thiab kev txhawb nqa lawv xav tau kom muaj kev noj qab haus huv, ua tiav lub neej ntau dua.
Cov phiaj xwm no, thiab tag nrho lwm cov koom tes nrog Medi-Cal tswj hwm txoj kev npaj kho mob, yuav ua haujlwm raws li daim ntawv cog lus tshiab, nruj MCP, los muab kev pab zoo, sib npaug thiab muaj nuj nqis rau Medi-Cal cov tswv cuab tswj hwm. Txhawm rau pab daws cov neeg tsav tsheb kev noj qab haus huv, cov ntawv cog lus tshiab yuav tsum muaj kev koom tes nrog cov chaw saib xyuas kev noj qab haus huv hauv nroog, cov chaw qhia ntawv hauv nroog thiab tsoomfwv, thiab lwm yam kev pabcuam hauv zos, suav nrog kev pabcuam pejxeem, chaw saib xyuas menyuam yaus, thiab chaw saib xyuas kev ncaj ncees, kom ntseeg tau tias kev saib xyuas cov tswvcuab raug sib koom ua ke. thiab cov tswvcuab tau nkag mus rau cov kev pabcuam hauv zej zog, suav nrog Kev Pabcuam Zej Zog.
MCPs are an important part of the work of CalAIM, transforming Medi-Cal toward a population health approach that prioritizes prevention and whole-person care by offering services that address long-term care needs, throughout a member’s life, from birth to a dignified end of life.
Hauv qab no yog cov phiaj xwm thiab cov nroog uas lawv yuav ua haujlwm:
| Managed Care Plans |
Lub nroog |
| Blue Cross of California Partnership Plan (“Anthem”) |
Alpine, Amador, Calaveras, El Dorado, Fresno, Inyo, Kern, Vaj, Madera, Mono, Sacramento, San Francisco, Santa Clara, Tuolumne |
| Blue Shield of California Promise Health Plan |
San Diego |
| CHG Foundation dba Community Health Group Partnership Plan |
San Diego |
| Health Net Community Solutions, Inc. |
Amador, Calaveras, Inyo, Los Angeles (nrog rau daim ntawv cog lus rau Molina rau 50% ntawm kev ua tswv cuab), Mono, Sacramento, San Joaquin, Stanislaus, Tulare, Tuolumne |
| Molina Healthcare ntawm California |
Riverside, Sacramento, San Bernardino, San Diego, (thiab hauv Los Angeles subcontractor rau Health Net rau 50% ntawm cov tswv cuab) |
Raws li cov ntawv cog lus tshiab no, Medi-Cal cov tswv cuab tuaj yeem cia siab tias:
Coordinated access to care: Members who need extra help will have access to care management based on their health care needs. This means having a designated point person, a care manager, who can assist them and their families with navigating the health care system, handling referrals, and supporting communication with providers.
Kev saib xyuas kev coj noj coj ua ntau dua: Cov tswv cuab yuav tau txais txiaj ntsig los ntawm kev saib xyuas thiab kev pabcuam uas suav nrog lawv cov kab lis kev cai, kev nyiam kev sib deev, poj niam txiv neej thiab poj niam txiv neej, thiab hom lus nyiam.
Better behavioral and physical health integration: Members’ physical health care will be better integrated with their behavioral health care, narrowing the divide between the two and improving access to mental health support and substance use disorder treatment.
Focus on primary care use and investment: MCPs will be required to review utilization reports to identify members not accessing primary care. For example, if members are underutilizing primary care, they may not be obtaining appropriate screenings, preventive care, or managing their conditions to prevent exacerbation. The contract also includes steps to ensure MCPs are investing in primary care. Plans will be required report on primary care spending (as a percentage of total expenditures) to help ensure sufficient investment in upstream and preventive care.
Kev nqis peev rov qab rau hauv zej zog: Thawj zaug, MCPs thiab lawv cov neeg ua haujlwm ua haujlwm tiav nrog cov nyiaj tau los zoo yuav tsum tau faib 5 mus rau 7.5 feem pua ntawm cov nyiaj tau los no (nyob ntawm theem ntawm lawv cov nyiaj tau los) rau cov haujlwm hauv zej zog uas tsim kho hauv zej zog los txhawb cov tswv cuab Medi-Cal. Cov neeg koom tes npaj yuav tsum tau xa ib xyoos ib zaug rau Lub Zej Zog Reinvestment Plan thiab Tshaj Qhia uas qhia meej tias lub zej zog yuav tau txais txiaj ntsig li cas los ntawm kev nqis peev rov qab thiab cov txiaj ntsig ntawm cov kev nqis peev no.
Kev koom tes zoo nrog cov pab pawg neeg tawm tswv yim hauv zej zog: Keeb kwm, Medi-Cal MCPs yuav tsum tau tswj hwm Pawg Neeg Tawm Tswv Yim Hauv Zej Zog (CAC) uas ua haujlwm los qhia txog cov phiaj xwm kev pab cuam kab lis kev cai thiab lus. DHCS nrhiav kev txhawb nqa CAC los ntawm kev qhia meej txog nws lub luag haujlwm thiab cov tswvcuab muaj pes tsawg leeg thiab sau cov phiaj xwm lub luag haujlwm hauv kev muab kev txhawb nqa rau CAC cov tswv cuab txhawm rau kom muaj kev koom tes thiab kev koom tes ntau tshaj. Tsis tas li ntawd, CAC cov tswv cuab yuav muaj lub cib fim los ua haujlwm ntawm DHCS Pawg Neeg Koom Tes Koom Tes. MCPs yuav tsum tau ua kom ntseeg tau tias lawv cov tswvcuab CAC cuam tshuam txog cov phiaj xwm kev noj qab haus huv thiab lub nroog tau txais kev pabcuam.
Ua kom pom tseeb: Cov tswv cuab yuav nkag tau yooj yim rau cov ntaub ntawv uas tuaj yeem coj lawv hauv kev xaiv txoj kev npaj zoo tshaj plaws rau lawv tsev neeg thiab / lossis tus kheej xav tau. Cov phiaj xwm tseem yuav tsum tau ua ntu zus thiab tshaj tawm rau pej xeem txog kev nkag mus tau, kev txhim kho kom zoo, thiab kev noj qab haus huv kev ncaj ncees, suav nrog lawv cov neeg ua haujlwm ua haujlwm tau txais txiaj ntsig zoo thiab txaus siab rau cov neeg siv khoom.
Saib Medi-Cal Cov Kev Npaj Kho Mob los ntawm Lub Nroog (raws li xyoo 2023 thiab 2024)
DHCS tshaj tawm Medi-Cal Managed Care Plans
