California tuav cov phiaj xwm Medi-Cal lav kom cov tswv cuab tau txais kev saib xyuas zoo, sib npaug
XOV XWM TSHIAB
California tuav cov phiaj xwm Medi-Cal lav kom cov tswv cuab tau txais kev saib xyuas zoo, sib npaug
SACRAMENTO — Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) hnub no tau tshaj tawm cov qhab nia zoo rau Medi-Cal cov phiaj xwm kev saib xyuas kev noj qab haus huv (MCP) thiab cov phiaj xwm kev noj qab haus huv ntawm lub nroog (BHP). DHCS saib xyuas txhua lub MCPs kom ntseeg tau tias cov phiaj xwm muab kev saib xyuas zoo tshaj plaws rau cov tswv cuab thiab kom muaj kev pom tseeb ntxiv.
Monetary sanctions are being imposed on MCPs that did not meet or exceed the established minimum performance levels (MPL), meaning the plans failed to provide members with a level of care that reached the quality standards established by DHCS. Today’s actions are the result of the MCP contract, effective January 1, 2024, which significantly strengthened quality and health equity requirements for MCPs.
"California cog lus tias yuav txhim kho qhov zoo ntawm kev kho mob los ntawm kev tuav cov neeg koom tes hauv txoj kev npaj kom lav ris rau cov qauv ntsuas uas tau teeb tsa thiab tsav kev txhim kho uas ntsuas tau," Tus Thawj Coj DHCS Michelle Baass hais. Los ntawm kev txhawb nqa kev lav ris, txhawb kev ncaj ncees ntawm kev noj qab haus huv, txhawb kev koom tes, thiab koom tes nrog cov phiaj xwm, peb tab tom txhim kho kev saib xyuas thiab txhim kho cov txiaj ntsig kev noj qab haus huv rau txhua tus tswv cuab Medi-Cal. Los ntawm cov kev sib koom tes no, DHCS lub hom phiaj yog txhawb nqa Medi-Cal cov phiaj xwm kev saib xyuas kev noj qab haus huv, cov phiaj xwm kev noj qab haus huv ntawm lub nroog, thiab cov chaw muab kev pabcuam kom muab cov txiaj ntsig zoo dua rau txhua tus tswv cuab Medi-Cal.
VIM LI CAS QHOV NO TSEEM CEEB: Cov kev ntsuas zoo yog ib feem ntawm DHCS' Bold Goals 50 × 2025 qhov kev pib, uas tsom mus rau kev txhim kho hauv kev noj qab haus huv ntawm menyuam yaus, kev saib xyuas kev yug me nyuam, kev tiv thaiv kab mob qog noj ntshav, kev noj qab haus huv ntawm niam, thiab kev koom ua ke ntawm kev noj qab haus huv. Los ntawm kev tso tawm cov kev ntsuas no, DHCS txhawb kom MCPs thiab BHPs muab kev saib xyuas zoo dua, tshwj xeeb tshaj yog nyob rau hauv cov cheeb tsam xws li kev tiv thaiv thiab kev saib xyuas thawj zaug nrog rau kev pabcuam kev noj qab haus huv tus cwj pwm.
QHO NO TXHAIS LI CAS RAU COV NEEG CALIFORNIANS: Raws li qhov ntsuas zoo, MCPs yuav ua cov kauj ruam kho kom raug, suav nrog kev muab kev saib xyuas ua ntej rau cov tswv cuab, xws li kev txhawb nqa lawv nrhiav tus kws kho mob thawj zaug thiab teem sijhawm mus ntsib kws kho mob, pab nrog kev xav tau kev thauj mus rau qhov chaw teem sijhawm thiab tuaj tos cov tshuaj, pab lawv nkag mus rau cov kev pab cuam xws li CalFresh, thiab kev tshuaj xyuas seb puas tsim nyog rau Kev Tswj Xyuas Kev Saib Xyuas Zoo dua thiab Kev Txhawb Nqa Hauv Zej Zog. MCPs kuj tseem yuav xyuas kom meej tias lawv cov neeg muab kev pabcuam hauv network nce cov sijhawm teem sijhawm yav tsaus ntuj thiab hnub so thiab txo lub sijhawm tos kom txhim kho kev nkag mus rau kev kho mob. Tsis tas li ntawd xwb, BHPs yuav tsom mus rau kev txhim kho kev nkag mus rau cov kev pabcuam kev noj qab haus huv raws sijhawm thiab teb rau kab lis kev cai. Qhov no suav nrog kev ncav tes rau cov tswv cuab kom txuas lawv nrog kev kho mob thiab kev sab laj thiab txhawb nqa lawv hauv kev tswj hwm cov mob hlwb loj heev thiab kev siv tshuaj yeeb dej cawv (SUD).
TXOJ CAI TSHIAB: Ntawm 24 lub MCP uas tau cog lus nrog DHCS, 20 (83.3 feem pua) yuav raug rau txim rau qhov tsis ua raws li cov cai MPL uas tau cog lus tseg ntawm Managed Care Accountability Set (MCAS) cov kev ntsuas zoo, ntau dua li xyoo ntsuas (MY) 2022. Cov kev rau txim yog txij li $25,000 txog $819,000, tag nrho yog $3,069,000, uas tsawg dua MY22.
Cov kev rau txim rau MCAS tau txiav txim siab raws li cov yam xws li tus naj npawb ntawm cov neeg raug kev cuam tshuam, kev hloov pauv ntawm MCP qhov kev ua tau zoo, thiab MCP qhov qhab nia Healthy Places Index. Cov laj thawj tseem ceeb rau kev rau txim rau xyoo no yog cuam tshuam nrog Topical Fluoride for Children (TFL-CH), Kev Mus Saib Xyuas Kev Noj Qab Haus Huv rau Menyuam Yaus thiab Cov Hluas, thiab Kev Tshuaj Xyuas Kab Mob Cancer Cervical, uas ua ke suav txog li 82 feem pua ntawm tag nrho cov kev rau txim vim lawv cuam tshuam rau cov pej xeem coob. Muaj ntau tshaj 1.5 lab tus tswv cuab tsis tau txais cov kev pabcuam TFL-CH, ua rau muaj li ntawm $ 1.1 lab ntawm tag nrho cov kev rau txim. Cov MCPs yuav tsum koom nrog kev txhim kho, xws li kev koom tes ntawm cov tswv cuab thiab cov zej zog, thiab txhim kho kev sib qhia cov ntaub ntawv kev noj qab haus huv thoob plaws cov txheej txheem xa khoom (piv txwv li, kev kho mob, kev kho hniav, thiab kev noj qab haus huv tus cwj pwm) los txhim kho kev nkag mus rau cov tswv cuab thiab kev xa khoom ntawm txhua yam kev pabcuam kev noj qab haus huv uas xav tau.
Ntxiv rau qhov kev ntsuas qhov zoo rau MCPs, DHCS tau tso tawm cov qhab nia zoo ntawm Behavioral Health Accountability Set (BHAS) rau BHPs rau xyoo thib ob. Rau cov BHPs hauv nroog, 71 feem pua ntawm cov nroog tau ua tiav lossis ua tau ntau tshaj qhov ntsuas rau tsawg kawg ib nrab ntawm cov kev ntsuas kev noj qab haus huv ntawm lub hlwb. Kev ua tau zoo ntawm lub nroog zoo sib xws rau cov kev ntsuas SUD, nrog rau 80 feem pua ntawm cov nroog ua tau raws li lossis tshaj qhov ntsuas rau tsawg kawg ib nrab ntawm cov kev ntsuas SUD. Txawm hais tias tsis muaj kev rau txim nyiaj txiag rau BHPs xyoo no, kev siv zog yuav pib rau xyoo tom ntej. DHCS cog lus tias yuav tsim kom muaj ib lub kaw lus pob tshab nrog cov ntaub ntawv txhim khu kev qha thiab tsim kom muaj kev lav ris mus sij hawm ntev rau kev kho mob zoo dua.
Yog xav paub ntxiv txog kev ntsuas kev ua tau zoo, thov saib cov hauv qab no:
KEV TXHIM KHO ZOO: DHCS mob siab rau kev txhawb nqa MCPs hauv kev txhim kho lawv txoj kev ua tau zoo los ntawm kev teeb tsa cov hom phiaj meej, muab cov ntaub ntawv raws sijhawm, thiab koom tes nrog cov zej zog los txhim kho kev nkag mus rau cov kev pabcuam tiv thaiv. DHCS sib qhia cov kev coj ua zoo tshaj plaws, muab kev pab txog kev siv tshuab, thiab tsim kev koom tes hauv cheeb tsam uas MCPs tuaj yeem sib tham txog cov teeb meem thiab cov kev daws teeb meem uas yuav muaj tau. Xyoo 2024, DHCS tau tsim ob txoj kev koom tes tshiab thoob plaws lub xeev uas tsom mus rau cov kev pabcuam tiv thaiv menyuam yaus thiab kev koom ua ke ntawm kev noj qab haus huv tus cwj pwm.
Tsis tas li ntawd xwb, DHCS tau koom tes nrog BHPs txog kev txhim kho zoo los ntawm kev sib tham tsis tu ncua txog Kev Noj Qab Haus Huv Hauv Cheeb Tsam los sib qhia cov kev coj ua zoo tshaj plaws thiab cov tswv yim txhim kho zoo. Ntxiv mus, DHCS tau koom tes nrog Lub Koom Haum rau Kev Txhim Kho Kev Kho Mob (IHI) ntawm Kev Koom Tes Qhia Txog Kev Noj Qab Haus Huv Tus cwj pwm uas tsim los pab txhawb kev saib xyuas tus kheej tag nrho uas daws tau cov kev xav tau ntawm tus cwj pwm, lub cev, thiab kev noj qab haus huv ntawm cov tswv cuab Medi-Cal. Nyeem Daim Ntawv Qhia Txog Qhov Zoo kom paub ntau ntxiv txog seb DHCS ua haujlwm li cas los txhim kho qhov zoo ntawm kev saib xyuas rau cov tswv cuab.
ADDITIONAL INFORMATION: DHCS’ Comprehensive Quality Strategy focuses on improving health outcomes through the Bold Goals 50X2025 initiative. Since 2022, DHCS has been publicly releasing annual quality measure ratings for all MCPs and requiring quality improvement actions. Since 2023, DHCS has publicly released annual quality measure ratings for all BHPs and will begin requiring quality improvement actions. These efforts, as well as targeted audits of MCPs and BHPs and enhanced quality improvement and oversight, are aimed at improving health outcomes for millions of Californians. Assembly Bill 1642 (Chapter 465, Statutes of 2019) authorized DHCS to increase sanctions for MCPs that do not meet or exceed required MPLs. The MCP contracts, which became effective on January 1, 2024, promotes a more person-centered, equity-focused, and data-driven Medi-Cal program.
Tsis tas li ntawd xwb, hauv kev kho mob tus cwj pwm, Daim Ntawv Cog Lus Sib Koom Tes ntawm Lub Chaw Muab Tshuaj Medi-Cal thiab cov ntawv cog lus txog kev npaj kho mob hlwb yuav tsum tau kom BHP tsim cov Txheej Txheem Txhim Kho Zoo thiab sau thiab xa cov ntaub ntawv ntsuas kev ua tau zoo uas DHCS xav tau, raws li Txoj Cai Zoo Tag Nrho. DHCS kuj tau tshaj tawm Daim Ntawv Ceeb Toom Txog Kev Noj Qab Haus Huv Tus Cwj Pwm 24-004 thaum Lub Kaum Ob Hlis 2023 los qhia meej txog cov kev cai ntawm DHCS rau BHPs' Quality Improvement Systems. DHCS yuav tshaj tawm Txoj Cai Txhim Kho Kev Noj Qab Haus Huv Zoo thiab Kev Ncaj Ncees Kev Noj Qab Haus Huv hauv xyoo 2025, uas yuav tsom mus rau kev txhim kho kev ua tau zoo ntawm BHAS.
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