Tsev Cov Ntawv Cog Lus Nkag Siab Ntawm Cov Phiaj Xwm Kev Kho Mob Medi-Cal Managed Care thiab Cov Chaw Sab Nraud ​​ 

Memoranda ntawm kev nkag siab ntawm Medi-Cal Cov Kev Npaj Kho Mob thiab Cov Neeg Thib Peb​​  

Rov qab mus rau Managed Care All Plan Letters Homepage​​ 

Medi-Cal Managed Care Plans (MCPs) contract with the Department of Health Care Services (DHCS) to provide high-quality, accessible, and cost-effective health care through managed care delivery systems. The MCP Contract requires MCPs to build partnerships with the following Third-Party Entities to ensure Member care is coordinated and Members have access to community-based resources in order to support whole-person care:​​  

Local Health Departments;​​  

Local educational and governmental agencies, such as county behavioral health departments for Specialty Mental Health Care and Substance Use Disorder (SUD) Treatment Services; and​​ 

Lwm cov kev pabcuam hauv zos thiab cov kev pabcuam, suav nrog​​  

  • Lub Chaw Saib Xyuas Kev Noj Qab Haus Huv Hauv Zos​​ 
  • Cov koom haum kev kawm hauv zos thiab tsoomfwv, xws li cov chaw haujlwm kev noj qab haus huv ntawm lub nroog rau Kev Kho Mob Hlwb Tshwj Xeeb thiab Kev Kho Mob Siv Tshuaj Yeeb (SUD); thiab​​ 
  • Lwm cov kev pabcuam hauv zos thiab cov kev pabcuam, suav nrog​​ 
    • Kev Pabcuam Zej Zog;​​ 
    • Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv Me Me;​​ 
    • Thawj 5 County Commissions​​ 
    • Cov chaw hauv cheeb tsam;​​ 
    • Cov Kev Pab Cuam Ntxiv rau Kev Noj Qab Haus Huv rau Cov Poj Niam, Cov Menyuam Mos, thiab Cov Menyuam; thiab​​ 
    • California Department of Corrections and Rehabilitation, county jail, thiab cov chaw kho cov hluas​​ 

Cov kev cai ntawm Daim Ntawv Cog Lus Nkag Siab (MOUs) tuaj yeem pom muaj nyob rau hauv Daim Ntawv Cog Lus MCP, Daim Ntawv Qhia A, Daim Ntawv Txuas III, Tshooj 5.6 (MOUs nrog Cov Neeg Thib Peb). Cov MOUs no yog tsim los ua cov cuab yeej zoo los qhia meej txog lub luag haujlwm thiab lub luag haujlwm ntawm MCPs thiab Cov Neeg Thib Peb, txhawb kev koom tes hauv zos, thiab pab txhawb kev sib koom tes saib xyuas thiab kev sib pauv cov ntaub ntawv tsim nyog los pab txhawb kev sib koom tes saib xyuas thiab txhim kho cov txheej txheem xa mus ntawm MCPs thiab Cov Chaw Thib Peb. Cov MOUs kuj tseem yog los txhim kho kev pom tseeb thiab kev lav ris los ntawm kev teeb tsa qee yam uas twb muaj lawm rau txhua tog raws li lawv cuam tshuam nrog kev pabcuam lossis kev saib xyuas thiab kev sib koom tes kom cov tog neeg hauv MOU paub txog txhua tus lub luag haujlwm.​​ 

Lub hom phiaj ntawm MOU yog:​​ 

  • Sau cov MOU yam tsawg kawg nkaus uas yuav tsum tau ua los ntawm MCP Daim Ntawv Cog Lus;​​ 
  • Qhia meej txog lub luag haujlwm thiab kev lav phib xaub rau kev sib koom tes ntawm kev xa kev saib xyuas thiab kev pabcuam ntawm txhua tus tswvcuab, tshwj xeeb tshaj yog thoob plaws MCP cov kev pabcuam carved-out, uas tej zaum yuav muab los ntawm Pawg Thib Peb;​​  
  • Tsim kom muaj kev sib tham thiab pom zoo raws li cov txheej txheem rau yuav ua li cas MCPs thiab Thib Peb Cov Neeg Koom Tes yuav koom tes thiab sib koom tes ntawm pej xeem kev noj qab haus huv thiab / lossis lwm yam kev pab cuam thiab kev pib;​​ 
  • Memorialize seb cov ntaub ntawv twg yuav raug muab faib ntawm MCPs thiab Third-Party Entities thiab yuav muab cov ntaub ntawv li cas los pab txhawb kev saib xyuas thiab pab saib xyuas;​​ 
  • Muab kev pom tseeb rau pej xeem rau hauv kev sib raug zoo thiab lub luag haujlwm / kev lav phib xaub ntawm MCPs thiab Cov Koom Haum Thib Peb; thiab​​ 
  • Muab cov txheej txheem rau ob tog los daws qhov kev tsis sib haum xeeb thiab ua kom muaj kev saib xyuas tag nrho thiab kev lav phib xaub raws li MOU.​​ 

MCP Contracts require MCPs to execute an MOU with each of the Third-Party Entities outlined below. DHCS has developed MOU Templates for MCPs and Third-Party Entities to utilize in this process to ensure that all MCP Contract provisions for MOUs are captured and provide standardization in reporting. Each MOU is a binding, contractual agreement between the MCP and a Third-Party Entity which outlines the responsibilities and obligations of the MCP and a Third-Party Entity to coordinate and facilitate whole-system, person-centered care for Members.​​ 

The Base MOU Template is meant to provide context for the Bespoke MOUs. It includes each of the elements required to be included in all MOUs as set forth in the 2024 MCP Model Contract. The Base MOU Template includes the minimum requirements; MCPs and Third-Party Entities may include additional provisions so long as they do not conflict with the minimum required provisions.​​  

MOUs Pib Lub Ib Hlis Ntuj 1, 2024​​ 

Hom Lub Chaw Haujlwm / Chaw Haujlwm​​ 

Program(s)​​ 

Local Government Agency (LGA)​​ In-Home Supportive Services (IHSS)​​ 
LGA/Lub Nroog Tus Cwj Pwm Saib Xyuas Kev Noj Qab Haus Huv​​ Kev Pabcuam Kev Puas Siab Puas Ntsws Tshwj Xeeb hauv Medi-Cal Cov Kev Pabcuam Kev Puas Siab Puas Ntsws​​ 
LGA/Lub Nroog Tus Cwj Pwm Saib Xyuas Kev Noj Qab Haus Huv​​ SUD Treatment Services hauv Drug Medi-Cal Organized Delivery System (ODS) Lub Nroog​​ 
Regional Centers​​ Intermediate Care Facility for Developmentally Disabled​​ 
Lub Chaw Saib Xyuas Kev Noj Qab Haus Huv Hauv Zos​​ Including, without limitation, California Children’s Services*, Maternal and Child and Adolescent Health, Tuberculosis Direct Observed Therapy​​ 
LGA/County Social Services Department​​ County Social Services Programs thiab Child Welfare​​ 
Lub Chaw Saib Xyuas Kev Noj Qab Haus Huv Hauv Zos​​ Poj Niam, Me Nyuam, & Me Nyuam (WIC)​​ 

MOUs Pib Lub Xya Hli 1, 2024​​ 

Hom Lub Chaw Haujlwm / Chaw Haujlwm​​ 

Program(s)​​ 

LGA​​ County-Based Targeted Case Management (TCM)​​ 
LGA/Lub Nroog Tus Cwj Pwm Saib Xyuas Kev Noj Qab Haus Huv​​ SUD Kev Pabcuam Kev Khomob hauv Cov Tshuaj Khomob Medi-Cal Xeev Lub Nroog (DMC-SP)​​ 

MOUs siv tau rau lub Ib Hlis 1, 2025​​ 

Thawj 5 County Commissions​​ 

MOU siv tau rau lub Ib Hlis 1, 2026​​ 

Cov Tsev Kaw Neeg Hauv Lub Nroog thiab Cov Chaw Kho Cov Hluas (Kev Ncaj Ncees Koom Tes)​​  

California Lub Chaw Haujlwm Saib Xyuas Kev Kho thiab Kev Kho Dua Tshiab (Kev Ncaj Ncees Koom Tes) (Qauv yuav los tom ntej)​​ 

MOU siv tau rau lub Ib Hlis 1, 2027​​ 

Local Educational Agencies (Template forthcoming)​​ 

Hloov tshiab tseem ceeb​​  

DHCS yuav tshaj tawm cov kev hloov tshiab tseem ceeb thaum lawv muaj.​​ 

  • DHCS tau tshaj tawm cov lus nug nquag nug (FAQS) ntawm MOU uas tau hloov kho tshiab uas tuaj yeem pom hauv ntu "Cov Ntaub Ntawv Tseem Ceeb" hauv qab no.​​ 
  • Thaum Lub Ib Hlis 16, DHCS tau koom nrog hauv kev sib tham hauv online uas tau tuav los ntawm pab pawg pabcuam kev pabcuam ntawm UC Davis California Children and Youth System of Care, uas tau hais txog qhov tseem ceeb thiab cov txiaj ntsig ntawm Child Welfare MOUs thiab MCP Child Welfare Liaisons. Cov ntaub ntawv hais txog lub rooj sib tham hauv online no tuaj yeem pom ntawm: Silos to Synergy: Transforming Child Welfare Health Through Partnerships With Managed-Care Plans​​ 
  • Thaum Lub Kaum Ob Hlis 12, DHCS tau tso tawm daim ntawv qauv MOU rau cov tsev loj cuj hauv nroog thiab cov chaw kaw cov tub ntxhais hluas thiab tau tuav lub rooj sib tham hauv online tom qab tso tawm, thaum 10:00 teev sawv ntxov.  Thov saib ntu "Cov Ntaub Ntawv Webinars Yav Dhau Los" hauv qab no rau cov ntaub ntawv webinar. 
    Yuav muaj daim ntawv MOU sib cais rau kev siv ntawm MCPs thiab California Department of Corrections and Rehabilitations.​​  
  • Thaum Lub Yim Hli 12, DHCS tau tuav lub rooj sib tham hauv California Department of Corrections and Rehabilsities, cov tsev loj cuj hauv nroog, thiab cov chaw kaw neeg hluas kom tau txais cov lus taw qhia tseem ceeb txog Daim Ntawv Qhia Txog Kev Pom Zoo ntawm Chaw Kaw Neeg. Thov saib ntu "Informational Webinar" hauv qab no rau cov ntaub ntawv sib tham. 
    DHCS tau hloov kho hnub siv rau Daim Ntawv Cog Lus Qhia Txog Kev Kawm Hauv Zos txij lub Ib Hlis 1, 2026, mus txog lub Ib Hlis 1, 2027.​​ 
  • DHCS tau tshaj tawm Lub Tsev Haujlwm Saib Xyuas Kev Khomob thiab Kev Khomob hauv California, lub tsev kaw neeg hauv nroog, thiab cov chaw kho cov hluas MOU qauv. Cov tswv yim tawm tswv yim yuav dhau los thaum Lub Yim Hli 22, 2025.​​  
  • California Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv tau tsim cov yeeb yaj kiab qhia IHSS hauv qab no los txhawb cov kev cob qhia uas tau teev tseg hauv IHSS MOU.​​ 
  • Kaw- Loop Referral (CLR) Hloov tshiab​​ 
    • CLR yog kev xa mus rau ib tus tswv cuab ntawm Medi-Cal Managed Care mus rau ib qho kev pabcuam lossis kev txhawb nqa uas tau txais kev txhawb nqa, taug qab thiab saib xyuas thiab ua rau muaj Kev Kaw Paub. Txij li Lub Xya Hli 1, 2025, CLR Cov Kev Cai rau Managed Care Plans (MCP) yuav siv rau cov kev xa mus rau Enhanced Care Management (ECM) thiab Community Supports xwb. Cov MCPs yuav tsum ua raws li Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) CLR Cov Lus Qhia Txog Kev Siv. Xav paub ntxiv txog cov kev cai ntawm CLR tuaj yeem pom ntawm no hauv Phau Ntawv Qhia Txog Txoj Cai Tswjfwm Kev Noj Qab Haus Huv ntawm Cov Neeg.​​ 
    • DHCS tsis tau hloov kho cov Qauv MOU raws li txoj cai CLR tshiab no thiab tsis npaj yuav rov tsim cov Qauv MOU tshiab. Cov lus qhia ntawm MOU hauv qab no yog los pab cov neeg thib peb nkag siab txog cov kev cai ntawm MCP los siv CLR thiab txhawb kom cov neeg thib peb koom tes nrog MCPs los koom ua ke cov kev cai ceeb toom CLR rau hauv cov kev xa mus uas twb muaj lawm. DHCS kuj txhawb kom MCPs muab cov kev cai CLR tshiab tso rau hauv lawv cov MOUs nrog cov neeg thib peb uas tseem tsis tau ua tiav.​​ 
    • Kev Hloov Kho Tshiab ntawm CLR MOU: Siv Tau Txij Lub Xya Hli 1, 2025, MCP yuav tsum ua raws li DHCS CLR Implementation Guidance Guidance. Rau txhua qhov kev xa mus rau ECM, Kev Txhawb Nqa Hauv Zej Zog, thiab cov kev pabcuam CLR yav tom ntej, MCP yuav tsum siv cov txheej txheem los taug qab, txhawb nqa, thiab saib xyuas cov kev xa mus los ntawm [Lwm Tus Neeg] los ntawm kev kaw kev xa mus. MCP yuav tsum ua raws li cov kev cai rau kev ceeb toom rau [Lwm Tus Neeg] txog qhov xwm txheej kev tso cai, qhov laj thawj kaw lub voj voog xa mus thiab hnub kaw hauv lub sijhawm teev tseg hauv cov lus qhia los txhawb [Lwm Tus Neeg] hauv lawv txoj kev paub txog qhov xwm txheej xa mus thiab cov txiaj ntsig rau Cov Tswv Cuab xa mus rau CLR cov kev pabcuam. Cov Tog yuav ua haujlwm ua ke los tsim kom muaj cov hau kev thiab cov txheej txheem rau MCP cov ntawv ceeb toom rau CLRs. DHCS xav kom MCPs siv cov txheej txheem hluav taws xob los ceeb toom rau cov neeg xa mus txog qhov xwm txheej ntawm tus neeg xa mus, tsis yog cov txheej txheem ua raws li ntawv.​​ 

Cov ntaub ntawv tseem ceeb​​ 

DHCS yuav tshaj tawm cov ntaub ntawv tseem ceeb thaum lawv muaj, suav nrog:​​ 

Cov ntaub ntawv Webinars​​ 

DHCS yuav tshaj tawm cov ntaub ntawv hais txog webinars tom ntej no thaum cov ntaub ntawv muaj.​​ 

Previous Cov Ntaub Ntawv Webinar​​ 

Cov peev txheej ntxiv​​ 

Cov npe hauv qab no yog cov peev txheej ntxiv:​​ 

Lus nug thiab lus pom​​ 

Tiv tauj DHCS yog tias muaj lus nug lossis lus tawm tswv yim txog MOUs ntawm MCPMOUS@dhcs.ca.gov.​​