California tuav cov phiaj xwm Medi-Cal lav kom cov tswv cuab tau txais kev saib xyuas zoo, sib npaug
TSHUAV TSHIAB
California tuav cov phiaj xwm Medi-Cal lav kom cov tswv cuab tau txais kev saib xyuas zoo, sib npaug
SACRAMENTO — The Department of Health Care Services (DHCS) today published quality ratings and imposed monetary sanctions on Medi-Cal managed care plans (MCP) that do not meet required performance levels. These actions are bolstered by the new MCP model contract that took effect on January 1, 2024, and significantly strengthens quality and health equity requirements for MCPs. Additionally, for the first time, DHCS is releasing quality ratings for county behavioral health plans, based upon performance.
California tseem yog ib lub xeev uas ua tus thawj coj hauv kev txhim kho txoj kev muab kev kho mob. Peb tab tom ua kom peb cov neeg koom tes hauv Medi-Cal lav ris lub luag haujlwm thaum tseem ua haujlwm nrog lawv kom txhim kho lawv cov qhab nia, " Tus Thawj Coj DHCS Michelle Baass hais. Los ntawm cov kev sib koom tes no, DHCS nrhiav kev los txhawb kom cov phiaj xwm thiab txhawb nqa cov neeg muab kev pabcuam kom ua tiav cov txiaj ntsig kev noj qab haus huv zoo dua rau txhua tus tswv cuab Medi-Cal.
VIM LI CAS QHOV NO TSEEM CEEB: DHCS tab tom tshaj tawm cov qhab nia ntsuas zoo rau Xyoo Ntsuas (MY) 2022 rau txhua tus MCPs thiab cov phiaj xwm kev noj qab haus huv ntawm lub nroog los pab txhawb kev txhim kho hauv kev txhawb nqa DHCS' Bold Goals 50 × 2025. Thaum DHCS txuas ntxiv ua haujlwm nrog Medi-Cal cov phiaj xwm rau kev txhim kho zoo, cov tswv cuab Medi-Cal tuaj yeem cia siab tias yuav pom ntau txoj kev koom tes thiab kev ncav tes los xyuas kom meej tias lawv cov kev xav tau kev kho mob raug muab tso ua ntej, tshwj xeeb tshaj yog kev kho mob tiv thaiv thiab kev kho mob thawj zaug uas txhawb kev noj qab haus huv thiab kev nyob zoo ntawm cov tswv cuab Medi-Cal.
DHCS cog lus tias yuav txhim kho qhov zoo, kev nkag tau yooj yim, thiab kev ncaj ncees ntawm kev noj qab haus huv hauv Medi-Cal thiab tab tom tuav cov phiaj xwm Medi-Cal kom muaj lub luag haujlwm los txhim kho cov txiaj ntsig kev noj qab haus huv rau ntau lab tus neeg California.
WHAT THIS MEANS FOR CALIFORNIANS: Medi-Cal members should expect better care coordination across all of their services, so the health care delivery system works for the member, rather than having to bear the burden of health care fragmentation. For example, the parents of child and adolescent members should expect their providers and plans to proactively reach out to them to schedule well-child visits and address barriers to accessing care, such as arranging transportation, supporting enrollment in programs like CalFresh, and screening for eligibility in Enhanced Care Management. Additionally, women of reproductive age should expect their providers and plans to contact them for services, such as breast and cervical cancer screening, in a manner convenient for them.
NEW SANCTIONS: Eighteen of the 25 MCPs will be fined due to performance rates below designated Minimum Performance Levels (MPLs), which is down from 22 plans in MY 2021. For MY 2022, MCP sanctions ranged from $25,000 to $890,000 based upon factors that include the eligible population impacted, the degree to which a plan fell below MPLs, the degree of improvement or decline from the previous MY, and the plan’s Healthy Places Index (HPI) score for assigned membership to that plan.
Txhua tus MCP uas ua tsis tau raws li MPLs yuav tsum tau ua raws li cov hauv qab no:
- Xa lub tswv yim kho kom zoo, suav nrog cov kev cuam tshuam tshiab tsim los ua kom tau raws li lossis tshaj li qhov yuav tsum tau ua hauv 2023 lub sijhawm tseem ceeb.
- Qhia meej tias txoj kev npaj npaj yuav muab cov peev txheej txaus thiab cov neeg ua haujlwm li cas rau kev txhim kho kom zoo.
- Ua haujlwm nrog DHCS pab neeg zoo ntawm kev siv cov ntaub ntawv los txhim kho kom zoo dua qub uas yuav daws tau qhov tsis sib xws uas muaj thoob plaws lub xeev tas mus li.
Nov yog thawj xyoo uas DHCS tso tawm cov qhab nia zoo rau cov phiaj xwm kev noj qab haus huv ntawm lub nroog, tab sis tsis muaj kev rau txim rau cov phiaj xwm no. Cov kev nqis tes ua raws li txoj cai yuav pib rau cov nroog hauv xyoo tom ntej.
SUPPORTING QUALITY: DHCS is committed to working closely with MCPs to improve performance ratings by taking the following actions to support plans and statewide quality efforts:
- Setting improvement goals for all MCPs on children’s and reproductive health/cancer preventive services to be achieved annually and working toward providing real-time data to assess the effectiveness of quality improvement efforts.
- Partnering with communities to improve well-infant visits by sharing best practices to assist improvement efforts, in collaboration with plan partners and the Centers for Medicare & Medicaid Services (CMS), as a part of the broader Bold Goals 50×2025 initiative.
- Muab kev pab cuam tsis tu ncua thiab kev qhia rau cov cuab yeej txhim kho kom zoo los ntawm kev koom tes hauv cheeb tsam kev kawm thiab kev koom tes hauv CMS Infant Well-Child Visit Learning Collaborative.
- Tsim kev sib koom tes hauv cheeb tsam tshiab rau txhua tus MCPs los tham txog cov teeb meem hauv cheeb tsam, qhov tsis sib xws, thiab cov neeg koom tes hauv zej zog muaj peev xwm (cov txheej txheem hauv cheeb tsam no yog tshiab hauv 2023).
- Kev tuav lub rooj sab laj DHCS Zoo & Kev Noj Qab Haus Huv Equity Conference hauv 2023 ua lub rooj sab laj rau cov phiaj xwm sib qhia thiab sib koom tes cov tswv yim ua tiav hauv kev txhim kho kom muaj txiaj ntsig zoo thiab kev ncaj ncees.
- Launching two new statewide learning collaboratives in 2024, one focused on improving and scaling children’s preventive services and the other focused on behavioral health integration and improved collaboration between MCPs and county behavioral health plans.
KEV UA HAUJ LWM NTAWM LUB NEEJ: Raws li lawv daim ntawv cog lus nrog DHCS, txhua lub phiaj xwm (ob qho tib si MCPs thiab lub nroog cov phiaj xwm kev noj qab haus huv) yuav tsum ua kom tau raws li DHCS tau tsim MPLs rau txhua qhov kev ntsuas kev ua tau zoo ntawm Medi-Cal Managed Care Accountability Set (MCAS). Rau MCPs, thaum feem pua ntawm cov chav tshaj tawm uas ua tau raws li MPLs tau nce rau feem ntau cov kev ntsuas thaum piv rau MY 2021, qee qhov kev ntsuas tau txo qis ntawm tus naj npawb ntawm cov chav tshaj tawm uas ua tau raws li MPLs.
Reporting units are defined as the smallest geographic boundary from which network adequacy ratios are determined and MCP quality performance measure rates and incentive programs are based. A reporting unit may be a single county or an aggregate of counties with less populated areas. For MY 2022, there are a total of 56 MCP reporting units across 25 MCPs.
Additionally, DHCS held MCPs accountable to more measures in 2022 than in 2021. As a result, the total sanction amount across all plans increased significantly, which was driven by large population-impacted numbers for two measures (well-child visits and cervical cancer screening). These two measures account for more than 70 percent of the total sanction amount.
Hauv kev noj qab haus huv ntawm cov menyuam yaus, thaum feem ntau ntawm cov kev ntsuas tau qhia txog kev txhim kho tag nrho nrog kev nce ntxiv ntawm feem pua ntawm cov chav tshaj tawm uas ua tau raws li MPLs, feem ntau MCPs tseem muaj teeb meem kom ua tau raws li MPLs ntawm ib nrab ntawm cov kev ntsuas kev noj qab haus huv ntawm cov menyuam yaus. Ntxiv rau qhov ntawd, MPL rau kev ntsuas kev mus ntsib saib xyuas kev noj qab haus huv rau menyuam yaus thiab cov hluas tau nce rau MY 2022 piv rau MY 2021 los ntawm 3.62 feem pua. Yog tias MPL tseem zoo li qub hauv MY 2021, ntxiv 27 feem pua ntawm cov chaw tshaj tawm yuav tau ua tau raws li cov qauv MPL. Qhov no tseem ceeb heev vim tias qhov kev ntsuas kev mus ntsib saib xyuas kev noj qab haus huv rau menyuam yaus thiab cov hluas suav nrog qee tus neeg coob tshaj plaws. Thaum piv rau lawv cov nqi MY 2021, 52 feem pua ntawm cov chav tshaj tawm tau zoo dua ntawm qhov kev ntsuas no.
Qhov kev saib xyuas tom qab mus ntsib chav kho mob ceev rau kev ntsuas kev mob hlwb yog lwm qhov uas yuav tsum tau ua tib zoo saib xyuas, nrog rau kwv yees li 70 feem pua ntawm cov chav qhia poob qis dua MPL, txawm hais tias tag nrho, tus naj npawb ntawm cov chav qhia uas ua tau raws li MPL tau zoo dua li 20 feem pua piv rau MY 2021. Cov MCPs tau ua pov thawj tias lawv ua tau zoo heev hauv kev soj ntsuam tom qab mus xyuas chav kho mob ceev rau kev ntsuas kev siv tshuaj yeeb dej cawv, yuav luag 90 feem pua ntawm cov chav tshaj tawm tau ua raws li MPL.
Rau cov phiaj xwm kev noj qab haus huv ntawm lub nroog, cov nroog feem ntau ua tau zoo ntawm kev ntsuas kev noj qab haus huv ntawm lub hlwb, nrog rau 71 feem pua ntawm cov nroog tau ntsib MPLs tsawg kawg yog ib nrab ntawm cov kev ntsuas kev noj qab haus huv ntawm lub hlwb ntsig txog kev ua raws li tom qab mus ntsib chav kho mob ceev thiab kev pw hauv tsev kho mob ntsig txog kev mob hlwb, thiab kev tswj hwm cov tshuaj antidepressants (thiab 16 feem pua ntawm cov nroog tau ntsib MPLs tsawg kawg yog peb feem plaub ntawm cov kev ntsuas kev noj qab haus huv ntawm lub hlwb no). Kev ua tau zoo ntawm lub nroog zoo ib yam li cov kev ntsuas kev siv tshuaj yeeb dej cawv (SUD), nrog rau 80 feem pua ntawm cov nroog tau ntsib MPLs tsawg kawg yog ib nrab ntawm cov kev ntsuas ntsig txog kev ua raws li tom qab mus ntsib chav kho mob ceev rau SUD, kev siv tshuaj kho mob rau kev siv tshuaj opioid, thiab kev pib thiab kev koom tes nrog kev kho SUD, tab sis tsis muaj lub nroog tau ntsib MPLs tsawg kawg yog peb feem plaub ntawm cov kev ntsuas SUD no.
ADDITIONAL INFORMATION: DHCS’ Comprehensive Quality Strategy outlines the pathway for achieving improvement through the Bold Goals 50X2025 initiative, which will enhance quality measures across children’s and women’s preventive services, maternal health care outcomes, and behavioral health integration, as well as maintaining strong performance in adult chronic disease outcomes. DHCS evaluates quality scores annually and imposes financial sanctions on MCPs that do not meet required performance targets.
Ua ib feem ntawm kev cog lus los ua kom MCPs pom tseeb thiab muaj kev lav ris ntau dua, DHCS tau tshaj tawm cov qhab nia zoo rau txhua tus MCPs thawj zaug thiab xav tau kev nqis tes ua tam sim ntawd thiab meej los ntawm MCPs los txhim kho lawv cov qhab nia zoo. Cov kev siv zog no, nrog rau kev tshuaj xyuas MCPs thiab cov kev ntsuas zoo dua, yog lub hom phiaj los txhim kho cov txiaj ntsig kev noj qab haus huv rau ntau lab tus neeg California. Tus Thawj Kav Xeev Newsom tau tsim tsa Txoj Cai Lij Choj Sib Tham 1642 (Tshooj 465, Cov Cai ntawm Xyoo 2019) los muab lub hwj chim rau DHCS los nce kev rau txim rau MCPs txoj kev ua tsis tau raws li qee qib kev ua tau zoo. Thaum Lub Ib Hlis 1, 2024, daim ntawv cog lus MCP tshiab tau pib siv los muab kev pab cuam Medi-Cal uas tsom mus rau tib neeg, tsom mus rau kev ncaj ncees, thiab tsav los ntawm cov ntaub ntawv.
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