Tsev Kev Sib Txuas Lus ntawm Medi-Cal Txog RSST​​ 

Hais txog RSST​​ 

Medi-Cal Connect​​ 

RSST yog dab tsi?​​ 

Qhov Risk Stratification, Segmentation, and Tiering (RSST) algorithm yog ib feem tseem ceeb ntawm Medi-Cal Connect. Nws muab txoj hauv kev zoo ib yam, thoob plaws xeev los txheeb xyuas qhov pheej hmoo ntawm Medi-Cal cov tswv cuab. RSST tau tsim los ua kom muaj kev pheej hmoo stratification ntau sib npaug thoob plaws California.​​ 

Tsis zoo li feem ntau cov qauv kwv yees kev pheej hmoo ib txwm muaj uas tsuas yog cim cov neeg uas kim heev lossis xav tau kev pab ntau xwb, RSST txheeb xyuas cov tswv cuab uas tsis siv cov kev pabcuam uas lawv xav tau - ib qho cim ntawm cov kev xav tau zais lossis tsis tau txais kev pab rau kev kho mob thiab kev pabcuam hauv zej zog. RSST qhov kev tsom mus rau qhov kev pheej hmoo thiab kev siv tsis txaus yog qhov tseem ceeb rau kev nrhiav pom qhov tsis txaus hauv kev saib xyuas uas tej zaum yuav tsis pom, txhawb nqa kev cuam tshuam ua ntej thiab ncaj ncees.​​ 

RSST groups members into low, medium-rising, or high-risk tiers based on their chances of facing future health, social, or behavioral challenges. This helps ensure care and support are focused where they’re needed most. The RSST method is open-source and ensures statewide consistency to help connect high-risk members to services.​​ 

RSST suav nrog cov qauv kwv yees rau peb pawg neeg: cov neeg laus (18+), menyuam yaus (4 lub hlis txog 17 xyoo); thiab cov tswv cuab yug menyuam. Cov neeg yug menyuam suav nrog cov poj niam uas yuav cev xeeb tub hnub nyoog 15-49 xyoo, suav nrog cov neeg uas muaj 12 lub hlis tom qab yug menyuam lossis tom qab cev xeeb tub poob, thiab cov menyuam mos txog 3 lub hlis.​​ 

Medi-Cal Connect's RSST yog tsim los txhawb—tsis yog hloov—cov cuab yeej npaj kev noj qab haus huv uas twb muaj lawm. Nws ntxiv ib txheej txheem ntawm cov ntaub ntawv txog kev pheej hmoo uas tuaj yeem txhim kho cov txheej txheem ua haujlwm tam sim no thiab kev txiav txim siab, pab kom ntseeg tau tias txhua tus neeg California muaj kev nkag mus rau cov kev pabcuam kev kho mob zoo dua.​​ 

Yuav siv RSST li cas?​​ 

MCPs will be required to use the DHCS RSST algorithm to identify and assess members who are in the high-risk tier. Plans can also use their own tools to identify and serve additional members, but at minimum they must assess all high-risk members flagged by DHCS’ RSST approach. This approach ensures consistency in Medi-Cal enrollee assessment and experience across all geographies in the state.​​ 

Daim Ntawv Qhia Txog Txoj Cai Tswjfwm Kev Noj Qab Haus Huv ntawm Cov Neeg (PHM) thaum Lub Xya Hli 2026 yuav muaj cov lus qhia ntxiv txog thaum twg qhov yuav tsum tau ua no yuav siv tau. Yuav muab cov phiaj xwm tsawg kawg yog rau lub hlis txij li Lub Xya Hli los ua haujlwm rau kev ntsuam xyuas RSST. DHCS yuav saib xyuas qhov cuam tshuam ntawm kev siv RSST rau cov tswv cuab Medi-Cal raws li cov lus qhia txoj cai RSST Lub Xya Hli 2026.​​ 

Cov MCPs raug txhawb kom nkag siab txog cov ntaub ntawv RSST thiab ntsib nrog cov neeg ua haujlwm DHCS Medi-Cal Connect thaum lub sijhawm siv, uas pib thaum Lub Xya Hli 2025. Kev siv lub sijhawm ua ntej no yuav pab ua kom muaj kev hloov pauv zoo thiab ua rau cov phiaj xwm tau txais kev nkag siab txog kev siv RSST thiab yuav ua li cas kom tau txiaj ntsig ntau tshaj plaws rau cov tswv cuab Medi-Cal.​​   

Kawm ntxiv​​ 

DHCS tau luam tawm ntau cov ntaub ntawv los muab kev piav qhia meej rau pej xeem txog txoj hauv kev RSST tau tsim thiab nws ua haujlwm li cas:​​