Tsev Kev Tshaj Tawm Txog Qhov Zoo thiab Cov Ntaub Ntawv ntawm D-SNP​​ 

D-SNP Kev Qhia Zoo thiab Cov Ntaub Ntawv​​ 

Mus rau D-SNP Dashboard
Rov qab mus rau Kev Saib Xyuas Kev Sib Txuas rau Cov Neeg Tau Txais Kev Pabcuam Dual
Rov qab mus rau D-SNP Daim Ntawv Cog Lus thiab Txoj Cai Qhia {cph0
Rov qab mus rau D-SNP Cov Ntaub Ntawv thiab Daim Ntawv Qhia Dua
​​ 

Dual-Eligible Special Needs Plans (D-SNPs) yog ib hom Medicare Advantage Plan uas tsuas yog muaj rau cov tib neeg uas tsim nyog tau txais Medicare thiab Medi-Cal. Txhua D-SNP yuav tsum muaj daim ntawv cog lus nrog Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) uas qhia txog kev sib koom tes saib xyuas tshwj xeeb hauv lub xeev thiab kev tshaj tawm cov cai, nrog rau lwm cov kev cai.​​ 

California’s state-specific reporting requirements for Exclusively Aligned Enrollment (EAE) D-SNPs, non-EAE D-SNPs, and SCAN’s Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP) are part of a larger quality strategy within DHCS. This includes the Comprehensive Quality Strategy, the Long-Term Services and Supports (LTSS) dashboard, and the Master Plan for Aging.​​ 

D-SNPs muaj qhov yuav tsum tau muaj kev ceeb toom zoo rau Medicare thiab Medi-Cal. CMS xav tau ntau hom kev tshaj tawm zoo rau Medicare Advantage Plans suav nrog D-SNPs. DHCS tseem saib xyuas qhov zoo ntawm kev saib xyuas thiab kev noj qab haus huv muaj vaj huam sib luag rau cov tswv cuab hauv Medi-Cal los ntawm ntau yam kev qhia yuav tsum tau ua, raws li tau piav qhia hauv 2022 DHCS Comprehensive Quality Strategy thiab Medi-Cal cov ntawv cog lus.​​ 

DHCS state-specific quality and reporting requirements for EAE D-SNPs, non-EAE D-SNPs, and SCAN’s FIDE SNP are described in the 2025 D-SNP Policy Guide and 2025 D-SNP Reporting Requirements Technical Specifications.​​ 

Cov peev txheej tseem ceeb rau D-SNPs​​ 

Xyoo Daim Ntawv Cog Lus 2026 Cov Khoom Siv​​ 

Daim ntawv cog lus xyoo 2025 Cov ntaub ntawv​​ 

Daim ntawv cog lus xyoo 2024 Cov ntaub ntawv​​ 

Daim ntawv cog lus xyoo 2023 Cov ntaub ntawv​​ 

Cov peev txheej ntxiv​​  

2025 Lub Xeev Cov Lus Qhia Tshwj Xeeb Zoo thiab Kev Qhia Txog Kev Xav Tau​​ 

Hauv qab no yog cov npe ntawm cov kev cai zoo thiab kev tshaj tawm tshwj xeeb rau D-SNPs hauv xyoo 2025.​​ 

Chav Kho Mob Thaum Muaj Xwm Ceev (ED) Kev Siv Cov Kev Pabcuam Kev Noj Qab Haus Huv (ED BH)

Neeg Saib Xyuas Kev Kho Mob rau Tus Tswv Cuab (CCMR)
Kev Ntsuam Xyuas Kev Noj Qab Haus Huv (CHA)
Cov Tswv Cuab Uas Muaj Txoj Kev Npaj Kho Mob Ua Tiav Hauv 90 Hnub Ntawm Kev Sau Npe (ICP)
Cov Kev Pabcuam Zoo Li ECM (ECM)
Kev Kho Mob Palliative (PAL)
Kev Kho Mob Mus Ntev (LTC) {cph0}LusCim: Cov Non-EAE D-SNPs tsis tas yuav tshaj tawm txog kev ntsuas LTSS.
Cov Ntaub Ntawv thiab Cov Ntaub Ntawv Txog Kev Ua Haujlwm Zoo ntawm Kev Kho Mob (HEDIS) Cov Neeg Laus Tau Txais Kev Pabcuam Kev Noj Qab Haus Huv Tiv Thaiv/Mbulatory (AAP)
HEDIS Tswj Kev Ntshav Siab (CBP)
HEDIS Kev Ntsuam Xyuas Qib Glycemic rau Cov Neeg Mob Uas Muaj Mob Ntshav Qab Zib (>9.0%) (GSD)
HEDIS Kev Soj Ntsuam Tom Qab Mus Xyuas Chav Kho Mob Thaum Muaj Xwm Ceev Rau Kev Mob Hlwb (FUM)
HEDIS Txoj Kev Npaj Rov Qab Mus Kho Mob Txhua Yam Ua Rau (PCR)
Lus Cim: 2025 daim ntawv qhia txog D-SNP rau HEDIS AAP, CBP, GSD, FUM, thiab PCR tsuas yog xav tau rau D-SNPs yam tsis muaj Daim Ntawv Cog Lus H rau lub xeev xwb.​​ 

2024 Lub Xeev Cov Lus Qhia Tshwj Xeeb Zoo thiab Kev Tshaj Tawm Txog Kev Xav Tau​​ 

Hauv qab no yog cov npe ntawm lub xeev cov kev ua tau zoo thiab tshaj tawm cov cai rau D-SNPs hauv 2024.​​ 

Nkag mus tau / Muaj Kev Kho Mob​​ 

1. Healthcare Effectiveness Data and Information Set (HEDIS) Adults’ Access to Preventative/Ambulatory Health Services (AAP)​​ 

Kev saib xyuas zoo​​ 

  • HEDIS Tswj Cov Ntshav Siab (CBP)​​ 
  • HEDIS Glycemic Status Assessment rau Cov Neeg Mob Ntshav Qab Zib (> 9.0%) (GSD, yav tas los HBD-H9)​​ 
  • HEDIS Kev Rov Qab Los Tom Qab Lub Tuam Tsev Saib Xyuas Kev Kub Ntxhov Mus Saib Xyuas Kev Mob Puas Siab (FUM)​​ 

Kev siv thiab Risk Adjusted Siv​​ 

  • HEDIS Plan All-Cause Readmissions (PCR)​​ 
  • Emergency Department (ED) Behavioral Health Services Utilization (ED BH)​​ 

Kev Sib Koom Tes​​ 

  • Cov tswv cuab nrog Kev Ntsuam Xyuas Kev Nyab Xeeb Kev Nyab Xeeb (HRA) ua tiav hauv 90 hnub ntawm kev tso npe (HRA1)​​ 
  • Cov tswv cuab nrog Kev Ntsuam Xyuas Txhua Xyoo (HRA2)​​ 
  • Cov tswvcuab nrog Txoj Kev Npaj Kho Mob Ua tiav hauv 90 Hnub ntawm Kev Sau Npe (ICP1)​​ 
  • Cov tswvcuab nrog Txoj Kev Npaj Khomob tam sim no (tsim lossis hloov kho tshiab xyoo tas los) (ICP2)​​ 
  • Cov tswvcuab nrog Cov Ntaub Ntawv Sib Tham Txog Cov Hom Phiaj Kho Mob (GOC)​​ 

Lub Koom Haum Kev Ua Haujlwm thiab Kev Ua Haujlwm​​ 

  • Care Coordinator to Member Ratio (CCMR)​​ 

Medi-Cal Long-Term Services and Supports (LTSS)​​ 

  • Community-Based Adult Services (CBAS).​​ 
  • In-Home Supportive Services (IHSS)​​ 
  • Multipurpose Senior Services Program (MSSP)​​ 
  • Long-Term Care (LTC)​​ 

Nco tseg: Tsis yog-EAE D-SNPs tsis tas yuav tsum tau tshaj tawm txog LTSS ntsuas.​​ 

Alzheimer’s/Dementia Quality of Care​​ 

  • Kev soj ntsuam kev paub txog kev noj qab haus huv (CHA)​​ 

Txhim Kho Kev Tswj Xyuas Zoo Zoo (ECM-zoo li) Kev Pabcuam​​ 

18. ECM-like Services (ECM)​​ 

Palliative Care​​ 

19. Palliative Care (PAL)​​