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 — The Department of Health Care Services (DHCS) today published quality ratings for Medi-Cal managed care plans (MCP) and county behavioral health plans (BHP). DHCS oversees all MCPs to ensure the plans provide members with the best possible care and to increase transparency.
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.
WHY THIS IS IMPORTANT: The quality ratings are part of DHCS’ Bold Goals 50×2025 initiative, which targets improvements in children’s health, reproductive care, cancer prevention, maternal health, and behavioral health integration. By releasing these ratings, DHCS encourages MCPs and BHPs to provide improved care, particularly in areas like preventive and primary care services as well as behavioral health services.
WHAT THIS MEANS FOR CALIFORNIANS: Based on the quality ratings, MCPs will take corrective actions, including providing more proactive care to members, such as supporting them in finding a primary care provider and scheduling well-child visits, helping with transportation needs to appointments and picking up prescriptions, assisting them with accessing programs like CalFresh, and screening for eligibility for Enhanced Care Management and Community Supports. MCPs will also ensure their network providers increase evening and weekend appointments and reduce wait times to improve access to care. Additionally, BHPs will focus on improving access to timely and culturally responsive behavioral health services. This includes reaching out to members to connect them with therapy and counseling and supporting them in managing serious mental health conditions and substance use disorders (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.
Additionally, DHCS has engaged with BHPs on quality improvement through regular Behavioral Health Regional Collaborative meetings to share best practices and quality improvement strategies. Further, DHCS has partnered with the Institute for Healthcare Improvement (IHI) on a Behavioral Health Demonstration Collaborative designed to enable whole-person care that seamlessly addresses the behavioral, physical, and health-related social needs of Medi-Cal members. Read the Quality Fact Sheet to learn more about how DHCS is working to improve quality of care for members.
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.
Additionally, in the behavioral health field, the Drug Medi-Cal Organized Delivery System Interagency Agreements and mental health plan contracts require BHPs to establish Quality Improvement Systems and to collect and submit performance measurement data required by DHCS, according to the Comprehensive Quality Strategy. DHCS also released Behavioral Health Information Notice 24-004 in December 2023 to clarify DHCS requirements for the BHPs’ Quality Improvement Systems. DHCS will launch the Behavioral Health Quality Improvement and Health Equity Framework in 2025, which will focus on improving BHAS measure performances.
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