Cov lus nug nquag
General
Medi-Cal Connect yog dab tsi?
Medi-Cal Connect yog ib qho kev daws teeb meem thiab cuab yeej siv los tshuaj xyuas cov ntaub ntawv thoob plaws lub xeev rau kev tswj hwm kev noj qab haus huv ntawm cov pej xeem (PHM) uas tsim los pab DHCS thiab nws cov neeg koom tes txhim kho kev saib xyuas rau cov tswv cuab Medi-Cal. Nws txhawb nqa CalAIM lub hom phiaj los hloov kho Medi-Cal kom niaj hnub los ntawm kev muab kev pab cuam kho mob thiab cov neeg muab kev pab kom nkag mus rau cov ntaub ntawv zoo dua rau kev sib koom tes kho mob, kaw qhov sib txawv ntawm kev pabcuam, thiab txhim kho cov txiaj ntsig kev noj qab haus huv. Medi-Cal Connect muab cov ntaub ntawv los ntawm cov chaw ntseeg siab los ua ke los qhia txog kev noj qab haus huv ntawm cov tswv cuab thiab cov pej xeem. Medi-Cal Connect yuav txuas ntxiv loj hlob thiab txhim kho zuj zus mus, thiab cov lus taw qhia los ntawm cov neeg koom tes yog qhov tseem ceeb los ua kom nws yog ib qho chaw pabcuam zoo rau txhua tus.
Lub hom phiaj ntawm Medi-Cal Connect yog dab tsi?
Kev saib xyuas tus kheej rau txhua tus neeg: Muab kev pab rau cov neeg muab kev pabcuam Medi-Cal kom muaj kev pom dav ntxiv txog txhua tus tswv cuab cov kev pheej hmoo thiab cov kev xav tau uas tsis tau txais kev pab kom muab kev saib xyuas zoo dua. DHCS yuav siv cov ntaub ntawv los ntawm ntau lub koom haum los pab txhawb kev faib cov kev pheej hmoo thoob plaws lub xeev thiab kev tshuaj xyuas cov txheej txheem, tsim cov ntaub ntawv qhia txog kev pheej hmoo rau txhua tus tswv cuab.
Txhim kho cov tswv cuab: Txhawb nqa Medi-Cal cov phiaj xwm tswj hwm kev saib xyuas (MCP) thiab cov phiaj xwm kev noj qab haus huv coj tus cwj pwm (BHP), cov thawj coj saib xyuas, cov kws kho mob, thiab cov koom haum hauv xeev thiab nroog kom sib koom tes sib koom ua ke, cia siab tias yuav xav tau kev pab, thiab muab kev pabcuam tus kheej, raws sijhawm, thiab ua haujlwm. Qhov no yuav txhawb kev sib raug zoo ntawm cov neeg muab kev pabcuam thiab cov tswvcuab uas txhawb nqa lub neej ntev dua, noj qab haus huv, thiab muaj kev zoo siab dua thiab muaj txiaj ntsig zoo dua qub.
Kev nkag siab ntawm cov pej xeem: Ua kom yooj yim rau DHCS los sib sau ua ke, txheeb xyuas, thiab saib cov ntaub ntawv kom nkag siab zoo dua thiab teb cov kev noj qab haus huv ntawm Medi-Cal cov tswv cuab.
Kev tsim cai thiab kev siv uas muaj kev paub zoo: Txhawb kom DHCS saib xyuas, saib xyuas, thiab txhim kho tas mus li ntawm qhov kev pab cuam Medi-Cal, thiab siv cov kev tshuaj xyuas thiab cov dashboards los tsav kev ncaj ncees hauv kev noj qab haus huv, kev nkag mus tau, thiab qhov zoo ntawm kev saib xyuas.
Leej twg yuav nkag tau rau Medi-Cal Connect?
Cov neeg siv Medi-Cal Connect suav nrog:
- DHCS pab neeg
- MCPs
- BHPs
- SP&As*
- Cov koom tes pab kev noj qab haus huv, suav nrog cov kws kho mob ib leeg, pab pawg kws kho mob, thiab tsoomfwv cov chaw kho mob tsim nyog
- Pawg Neeg Saib Xyuas Kev Noj Qab Haus Huv/Nroog Hauv Nroog (Cov Pabcuam Pabcuam Kev Noj Qab Haus Huv Hauv Nroog, Indian Health Care Programs).
* SP&As yuav nyob rau hauv cov ntaub ntawv tsis tu ncua kev pom zoo hloov tshiab.
Thaum twg cov neeg siv cov pab pawg no tuaj yeem nkag mus rau Medi-Cal Connect?
Hauv qab no yog lub sijhawm xav tau rau kev tshaj tawm Medi-Cal Txuas:
Release 1*: July 24, 2024: DHCS (limited user group)
Release 2*: March 3, 2025: DHCS (full user group)
Release 3: Quarter 3 2025: MCPs
Phase 1*: Data sharing
Phase 2*: All functions go live, including portals and dashboards
Release 4: Quarter 4 2025: BHPs
Release 5: Quarter 2 2026: Enhancements to support behavioral health measures, no new user groups
Release 6: Quarter 4 2026: Local county providers, PHM program services and supports, health care delivery partners, and Tribal partners
* Mus-Live Ua tiav
Puas muaj lwm lub xeev tau tsim cov cuab yeej zoo sib xws?
Tsis yog, Medi-Cal Connect yog thawj lub cuab yeej PHM thoob plaws lub xeev. Los ntawm Medi-Cal Connect, California yog tus thawj coj hauv kev txhim kho PHM thiab kev npaj kho mob uas muaj cov ntaub ntawv qhia rau cov tswv cuab Medicaid.
Cov tswvcuab Medi-Cal puas yuav nkag tau?
Tsis tau. DHCS tau xaiv los ncua qhov kev nthuav tawm ntawm cov tswv cuab-ntsib cov cuab yeej kom tsis txhob muaj kev ntxhov siab ntxiv vim cov tswv cuab twb siv ntau lub portals. DHCS tab tom tshawb nrhiav qhov zoo tshaj plaws los muab kev koom tes nrog cov tswv cuab yam tsis tau ntxiv ib lub portal uas nyob ib leeg.
Kuv tuaj yeem kawm ntxiv txog Medi-Cal Connect qhov twg?
Thov saib cov peev txheej hauv qab no:
- Listen to this podcast on CalAIM with Dr. Palav Babaria, DHCS’ Chief Quality Officer, Chief Medical Officer, and Deputy Director of Quality and Population Health Management.
- Mus saib nplooj ntawv Medi-Cal Connect .
- Sau npe rau txhua lub limtiam cov neeg koom nrog hloov tshiab ntawm DHCS ListServ.
Kev sib pauv ntaub ntawv thiab kev sib faib tiag tiag
Medi-Cal Connect txawv li cas los ntawm Kev Sib Pauv Cov Ntaub Ntawv Txog Kev Noj Qab Haus Huv (HIE)?
Medi-Cal Connect tsis rub cov ntaub ntawv ncaj qha los ntawm Electronic Health Records (EHR) lossis muab kev ceeb toom rau lub sijhawm zoo li HIE. Nws siv cov ntaub ntawv thov, uas ncua sijhawm tsawg kawg yog ob mus rau peb lub hlis. Medi-Cal Connect tsis yog tsim los pab txhawb kev txiav txim siab kho mob tam sim lossis ua lub luag haujlwm tswj hwm kev saib xyuas, tab sis muab cov neeg saib xyuas cov ntaub ntawv keeb kwm muaj txiaj ntsig zoo rau cov tswv cuab thiab pab muab cov duab ntawm tag nrho cov neeg uas mus dhau kev kho mob, suav nrog cov ntaub ntawv kev noj qab haus huv thiab kev pabcuam pej xeem. Thaum nws tuaj yeem tau txais HIE cov ntaub ntawv, tam sim no tsis yog qhov teeb meem.
Medi-Cal Connect txawv li cas ntawm Data Exchange Framework (DxF)?
Lub DxF, tswj hwm los ntawm CalHHS thiab tsim raws li AB 133, yog txoj cai thoob plaws lub xeev uas qhia txog kev qhia txog kev noj qab haus huv li cas. Nws teeb tsa cov qauv rau kev sib pauv ntaub ntawv hauv lub sijhawm thoob plaws txhua tus neeg muab kev pabcuam thiab cov neeg them nyiaj. Medi-Cal Connect txhawb nqa lub hom phiaj ntawm DxF, tab sis nws yog lub cuab yeej PHM. Medi-Cal Connect pab cov neeg siv kev sib koom tes saib xyuas thiab nkag siab txog cov qauv kev noj qab haus huv, tsis suav nrog kev sib pauv chaw kho mob hauv lub sijhawm.
Medi-Cal Connect txawv li cas los ntawm Lub Koom Haum Saib Xyuas Kev Noj Qab Haus Huv (QHIO)?
QHIOs play a key role in California’s DxF by facilitating real-time exchange of clinical data, such as EHR information, notifications, and referrals, across all health care and social service entities, regardless of payer or provider type. Medi-Cal Connect, on the other hand, focuses exclusively on the Medi-Cal population and provides a statewide data analytics solution and tool for PHM; it is not a real-time clinical data exchange.
Puas yuav Medi-Cal Connect pauv cov ntaub ntawv nrog QHIOs?
Tsis yog lub sijhawm no. DHCS tab tom tshawb nrhiav kev sib pauv ntaub ntawv yav tom ntej ntawm Medi-Cal Connect thiab QHIOs los txhawb kev sib koom tes saib xyuas.
Cov ntaub ntawv thiab muaj peev xwm
Cov ntaub ntawv dab tsi uas Medi-Cal Connect muab uas feem ntau tsis muaj los ntawm kev npaj cov ntaub ntawv pub?
Medi-Cal Connect yuav muaj cov ntaub ntawv uas feem ntau tsis muaj rau MCPs thiab BHPs los ntawm Txoj Kev Npaj Cov Ntaub Ntawv Pub Noj los ntawm DHCS, xws li Kev Tswj Xyuas Kev Kho Mob (ECM) thiab Cov Ntaub Ntawv Txhawb Hauv Zej Zog (ntau qhia hauv cov lus hauv qab no).
Medi-Cal Connect cov ntaub ntawv:
| Cov ntaub ntawv | piav qhia | Npaj Cov Ntaub Ntawv Pub | Risk API | LMR API | Portal |
|---|---|---|---|---|---|
| All-Payer Claims Database Common Data Layout (APCD-CDL)* | Cov ntaub ntawv thov dav dav, suav nrog kev kho mob, kev coj tus cwj pwm, kev kho hniav, thiab tsev muag tshuaj, thiab cov ntaub ntawv qhia txog pej xeem cov tswv cuab | X | X | X | X |
| Kev Tsim Nyog Ntxiv (SUME)** | Txhim kho cov ntaub ntawv tseem ceeb ntawm kev tsim nyog los ntawm kev ntxiv cov tswv cuab kom ntxaws txog pej xeem thiab cov ntaub ntawv tiv tauj | X | X | X | |
| ECM/Community Supports (CS) Kev Ua Haujlwm Zoo thiab Saib Xyuas Daim Ntawv Qhia (QIMR) thiab JavaScript Object Notation (JSON) | Comprehensive ECM thiab Zej Zog Txhawb cov ntaub ntawv, suav nrog kev ntsib thiab cov kws kho mob lossis cov koom haum koom nrog hauv kev saib xyuas | X | X | ||
| 274 Ib File | Muaj cov ntaub ntawv qhia txog tus kws kho mob rau kev kho mob, kho hniav thiab kev noj qab haus huv | X | X | ||
| Kev Pabcuam Kev Pabcuam Thawj Pwm Tsav (PCPA) | Muaj PCPA thiab cov ntaub ntawv tiv tauj los ntawm tus tswv cuab | X | X | ||
| Poj Niam, Me Nyuam, thiab Me Nyuam (WIC) | Pab txheeb xyuas cov tswv cuab uas tsim nyog tau txais, tab sis tsis tau rau npe hauv WIC | X | X | ||
| Risk Tiering | Muaj cov ntaub ntawv Risk Tiering los ntawm cov ntaub ntawv hauv APCD-CDL* thiab SUME** cov ntaub ntawv | X | X | X | |
| Kev ntsuas zoo | Muaj Cov Kev Ntsuas Zoo, muab los ntawm cov ntaub ntawv thov dav dav hauv APCD-CDL thiab SUME cov ntaub ntawv | X | X | ||
| Cov Kev Pabcuam thiab Kev Pabcuam Chij | Muaj cov kev pab cuam thiab kev tsim nyog tau txais kev pab thiab cov ntaub ntawv teev npe nkag los ntawm APCD-CDL, SUME, ECM/Community Supports QIMR & JSON | X | X |
*APCD-CDL - Cov Ntaub Ntawv Thov Nyiaj Them Tag Nrho Cov Ntaub Ntawv Dav Dav yog hom ntawv txheem uas siv rau kev sau cov ntaub ntawv thov kev kho mob
**SUME - Cov Ntaub Ntawv Tsim Nyog Ntxiv yog cov ntaub ntawv digital uas muaj cov ntaub ntawv tshaj li cov ntaub ntawv sau npe yooj yim uas siv los txiav txim siab tus neeg tsim nyog tau txais cov nyiaj pab.
Puas yuav RSST txoj kev sib koom nrog MCPs?
Yes. For more information about the RSST algorithm, read the RSST Transparency Guide Document
Puas yuav Medi-Cal Connect hloov lwm cov ntaub ntawv DHCS muab rau MCPs?
Tsis yog lub sijhawm no, tab sis DHCS tab tom tshawb nrhiav qhov ua tau no.
Medi-Cal Connect pab txhawb BH-CONNECT thiab Behavioral Health Transformation (BHT) li cas?
Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) Access, Reform, and Outcomes Incentive Program measures will be calculated and shared through Medi-Cal Connect starting in Release 5 (Quarter 2 2026). BHT will have 5 Healthcare Effectiveness Data and Information Set (HEDIS) measures calculated and shared through Medi-Cal Connect starting in Release 4 (Quarter 4 2025). Visit the BH-CONNECT webpage and BHT webpage for more information.
Cov ntaub ntawv kho mob ntau npaum li cas yuav raug ntes hauv Medi-Cal Connect? Piv txwv li, yog tias ib tug neeg muaj ntshav qab zib, peb puas yuav pom cov keeb kwm ntawm lawv qhov kev kuaj mob?
Medi-Cal Connect suav nrog cov ntaub ntawv thov kev kho mob uas pib txij li xyoo 2021. Nws tsis yog tsim los rau kev txiav txim siab hauv kev kho mob tiag tiag thiab tsis hloov txoj kev npaj kho mob lossis cov txheej txheem tswj kev saib xyuas tus neeg muab kev pab. Medi-Cal Connect tsis muaj cov ntaub ntawv qhia txog kev kho mob los ntawm EHRs, xws li cov txiaj ntsig ntawm kev kuaj mob (piv txwv li, cov nqi A1C) lossis cov ntawv sau ntawm cov kws kho mob. Yog tias tus mob tau pom nyob rau hauv cov ntaub ntawv thov, nws yuav tshwm sim hauv Medi-Cal Connect. Cov neeg siv kuj tseem yuav pom tau tus kws kho mob thiab/lossis chaw kho mob uas tus tswv cuab tau xaiv, nrog rau cov kws kho mob tshwj xeeb uas feem ntau pom, cov kws kho mob kev noj qab haus huv, thiab cov tswv cuab ntawm pab pawg saib xyuas (xws li cov thawj coj saib xyuas).
Puas yuav Medi-Cal Connect muaj qhov kaw-loop xa mus taug qab cov khoom?
No. DHCS has separately developed a closed-loop referral tracking policy for ECM and Community Supports. See page 35 of the PHM Policy Guide July 2025 for more information.
Will a member’s data carry over to new MCP assignments or other changes?
Yes. One of Medi-Cal Connect’s goals is to create a LMR that holds member information even when they change MCP and providers. For example, if a member moves between MCPs, the new MCP will have the member’s contact and demographic information, LMR (including diagnoses), risk score, and care plan, if applicable.
Rau Cov Kev Pabcuam thiab Kev Npaj
Cov neeg siv Medi-Cal Connect xav tau dab tsi?
DHCS will require all MCPs to use its RSST algorithm in 2026. Currently, MCPs are strongly encouraged to use Medi-Cal Connect’s RSST risk tiers, but not required. DHCS defines two distinct time periods:
Lub Sijhawm Pib Siv: Lub sijhawm no pib nrog kev tso tawm cov haujlwm RSST rau MCPs thiab yuav xaus tsis pub dhau Lub Xya Hli 2026. Cov MCPs yuav muaj kev nkag mus rau, tab sis tsis tas yuav siv, DHCS cov theem kev pheej hmoo RSST uas tau teev tseg thaum lub sijhawm no.
Yuav Tsum Tau Siv Lub Sijhawm Ua Haujlwm Lub sijhawm no pib tsis pub dhau Lub Xya Hli 2026. MCPs yuav tsum tau siv DHCS' standardized RSST tiering.
RSST algorithm yuav kwv yees qhov kev pheej hmoo thoob plaws peb lub subdomains (Adverse Events, Underutilization, and Social Risk), standardizing yuav ua li cas cov tswv cuab muaj kev pheej hmoo siab raug txheeb xyuas thoob plaws lub xeev los txhawb kev sib raug zoo thiab kev txhawb nqa thiab kev saib xyuas. MCPs kuj tseem yuav tsum tau ntsuas txhua tus tswvcuab pom tias muaj kev pheej hmoo siab los ntawm RSST kom nkag siab zoo dua lawv cov kev xav tau thiab txuas lawv mus rau cov kev pabcuam tsim nyog. MCPs tuaj yeem txuas ntxiv siv lawv tus kheej cov cuab yeej kev pheej hmoo stratification los txheeb xyuas thiab tshuaj xyuas cov tswv cuab muaj kev pheej hmoo siab ntxiv, tab sis cov pej xeem RSST-tus chij yuav tsum tau hais txog qhov tsawg kawg nkaus.
For more information about RSST requirements, please see pages 25-31 of the PHM Policy Guide July 2025.
Cov koom haum muab kev pabcuam thiab cov chaw muab kev pabcuam puas tuaj yeem nkag mus rau Medi-Cal Connect?
DHCS tab tom tsom mus txuas ntxiv mus rau Medi-Cal cov kws kho mob hauv Kev Tshaj Tawm 6 (Q4 2026).
Tsis pub twg paub thiab kev ruaj ntseg
Leej twg tuaj yeem pom Medi-Cal Connect cov ntaub ntawv, thiab DHCS tiv thaiv cov ntaub ntawv kev noj qab haus huv ntawm tus kheej (PHI) li cas?
Medi-Cal Connect (Portal, Dashboards, API, Flat File) muaj cov ntaub ntawv tseem ceeb thiab tus kheej tus kheej, suav nrog PHI. Kev tswj hwm kev tso cai nruj nyob rau hauv qhov chaw kom ntseeg tau tias tsuas yog cov chaw tso cai tuaj yeem nkag mus rau cov ntaub ntawv tseem ceeb thiab muaj cov tswv cuab, ua kom cov ntaub ntawv ntiag tug thiab kev nyab xeeb txhua lub sijhawm.
Kev siv thiab kev tshaj tawm cov ntaub ntawv Medi-Cal Connect yuav tsum ua raws li txhua txoj cai lij choj txog kev ceev ntiag tug, kev ceev ntiag tug, thiab kev ruaj ntseg ntawm tsoomfwv thiab xeev, koj lub koom haum cov ntaub ntawv sib koom thiab kev pom zoo txog kev ceev ntiag tug nrog DHCS, thiab DHCS cov Lus Qhia Txog Kev Tshem Tawm Tus Kheej Cov Ntaub Ntawv. Kev siv lossis kev tshaj tawm tsis raug cai yuav ua txhaum txoj cai lij choj hauv xeev thiab tsoomfwv tebchaws, suav nrog, tab sis tsis txwv rau, Txoj Cai Kev Thauj Mus Los thiab Kev Lav Ris Haujlwm ntawm Tsoomfwv Tebchaws (HIPAA), Kev Khaws Cia Cov Ntaub Ntawv ntawm Cov Neeg Mob Uas Muaj Kev Tsis Txaus Siab Txog Kev Siv Tshuaj Yeeb (42 CFR Ntu 2), Txoj Cai Kev Ua Haujlwm Txog Cov Ntaub Ntawv Hauv California (IPA), thiab Txoj Cai Kev Khaws Cia Cov Ntaub Ntawv Kho Mob (CMIA).