Kaum Ob Hlis Ntuj 23 , 2024
Xov xwm tshaj plaws
CMS pom zoo MCO Kev zam se hloov kho
On December 20, the federal Centers for Medicare & Medicaid Services (CMS) approved California’s Managed Care Organization (MCO) Tax waiver amendment, the final step in allowing DHCS to proceed with implementation. This approval secured an estimated net $7.2 billion through December 2026 in additional funding to support Medi-Cal, as authorized by Senate Bill 160 (Chapter 39, Statutes of 2024). The MCO Tax has provided critical support for Medi-Cal since 2005, evolving through legislative updates to align with California’s health care funding needs.
Raws li lub xeev txoj cai lij choj, DHCS yuav sau ntawv pov thawj tias tsoomfwv tau txais kev pom zoo thiab tshaj tawm cov ntawv ceeb toom rau txhua tus MCO uas raug them se, qhia txog tus nqi them rau txhua lub sijhawm se thiab cov hnub uas cov nyiaj them poob haujlwm. Tsis tas li ntawd, DHCS yuav tshaj tawm rau hauv nws lub vev xaib cov ntaub ntawv ntsig txog MCO Tax, suav nrog tsab ntawv pom zoo, cov nyiaj se uas tau them rau txhua lub sijhawm se, thiab lwm yam ntaub ntawv tseem ceeb.
California Tshaj Tawm Medi-Cal Managed Care Plan thiab County Behavioral Health Plan Rating
Ua raws li DHCS txoj kev cog lus los txhim kho qhov zoo thiab kev sib luag hauv Medi-Cal thiab cov kev pab cuam kev noj qab haus huv tus cwj pwm, DHCS tau tshaj tawm rau lub Kaum Ob Hlis 20 qhov kev ntsuas qhov zoo ntawm txoj kev npaj kho mob xyoo 2023 thiab txoj kev npaj kho mob tus cwj pwm hauv nroog thiab, qee zaum, kev rau txim rau cov phiaj xwm kev kho mob uas ua tsis tau raws li lossis tshaj qhov kev ua tau zoo uas xav tau. DHCS mob siab rau kev ua kom cov tswv cuab Medi-Cal muaj kev nkag mus rau kev kho mob zoo thiab ncaj ncees. Txhawm rau txhawb kev txhim kho, DHCS tab tom koom tes nrog cov phiaj xwm kev saib xyuas thiab cov phiaj xwm kev noj qab haus huv ntawm tus cwj pwm ntawm cov hom phiaj kev ua tau zoo thiab muab kev pab txhawb nqa los ntsuam xyuas qhov ua tau zoo ntawm cov kev pib txhim kho zoo.
DHCS tau tshaj tawm Txoj Cai Tswjfwm Saib Xyuas Kev Ruaj Ntseg Teeb tsa cov ntawv txiav txim, raws li CMS xav tau. Cov ntaub ntawv no qhia txog kev tswj hwm txoj kev npaj khomob, kev rau txim, thiab kev txhim kho kom zoo. Yog xav paub ntxiv, hu rau QualityMonitoring@dhcs.ca.gov. Kawm paub ntau ntxiv nyob rau hauv Daim Ntawv Pom Zoo Zoo.
Kev hloov kho tshiab
Tseeb Txhim Kho Kev Tswj Xyuas Kev Kho Mob thiab Zej Zog Txhawb Kev Pabcuam Peb Lub Hlis Cov ntaub ntawv tso tawm
Thaum Lub Kaum Ob Hlis 20, DHCS tau tshaj tawm tsab ntawv tshaj tawm tshiab tshaj plaws Kev Tswj Xyuas Kev Kho Mob (ECM) thiab Zej Zog Txhawb Kev Pabcuam rau peb lub hlis twg, suav nrog cov ntaub ntawv txij lub Ib Hlis 2022 txog Lub Rau Hli 2024. ECM muab kev pabcuam siab, pab pawg tswj xyuas kev saib xyuas rau cov tswvcuab Medi-Cal nrog cov kev xav tau nyuaj, thaum Cov Kev Pabcuam Zej Zog muab cov nqi-zoo, kev kho mob uas tsim nyog rau cov kev pabcuam ib txwm muaj, hais rau cov neeg tsav tsheb kev noj qab haus huv, xws li vaj tse thiab khoom noj khoom haus. Ua ke, cov phiaj xwm no yog qhov tseem ceeb rau kev ua kom muaj kev saib xyuas tib neeg lub cev uas txhim kho cov txiaj ntsig kev noj qab haus huv thiab lub neej zoo rau Medi-Cal cov tswv cuab. Daim ntawv tshaj tawm qhia tau hais tias muaj kev vam meej, peb lub hlis twg ntawm kev loj hlob nyob rau hauv ob qho tib si ECM thiab Community Supports siv, raws li cov neeg ntxiv ntawm Focus (POF) tau txais kev pab rau ECM thiab muaj ntau cov kev pab cuam thoob plaws lub xeev. Daim ntawv tshaj tawm kuj tseem muab thawj cov ntaub ntawv ntawm ECM cov tswv cuab hauv kev qhia tshiab Kev Ncaj Ncees POF thiab Cov Neeg Hloov Pauv ntawm Kev Raug Ncua POF, ob qho tib si tau tshaj tawm lossis nthuav tawm thaum Lub Ib Hlis 2024.
Cov kev tshawb pom tseem ceeb suav nrog 244,750 Medi-Cal cov tswv cuab tau txais cov txiaj ntsig ECM, nrog rau 127,024 tus tswv cuab tau txais kev pab txij lub Plaub Hlis mus txog rau Lub Rau Hli 2024. Qhov no sawv cev ntau dua 50 feem pua nce hauv peb lub hlis twg ECM cov tswv cuab txij li lub Plaub Hlis mus txog rau Lub Rau Hli 2023. Kwv yees li 239,500 tus tswvcuab tau siv cov kev pabcuam Community Supports, thiab 89 feem pua ntawm Medi-Cal cov tswvcuab tau nkag mus rau yam tsawg kawg kaum qhov kev pabcuam. Qhov no sawv cev rau ntau dua 120 feem pua nce hauv peb lub hlis twg Cov Neeg Txhawb Zej Zog txij li lub Plaub Hlis txog Lub Rau Hli 2023. Nyob rau lub Plaub Hlis mus txog rau Lub Rau Hli 2024, ntau dua 59 feem pua ntawm cov tswv cuab siv Cov Kev Pab Txhawb Hauv Zej Zog tau nkag mus rau Cov Khoom Noj Kho Mob / Cov Khoom Noj Kho Mob, thiab kwv yees li 35 feem pua tau siv ib lossis ntau qhov kev pabcuam los ntawm Housing Trio (Housing Transition Navigation Services, Housing Tenancy and Sustaining Services, and Housing Deposits).
Streamlining Access rau ECM
Effective January 1, 2025, managed care plans will be required to implement new ECM Referral Standards and ECM presumptive authorization requirements. DHCS released materials from an October 9 webinar to share details on these two new policies that are intended to make it easier for Medi-Cal members to be referred to and engage in ECM services. In this webinar, DHCS leaders provided:
- Ib qho kev piav qhia txog vim li cas DHCS hloov kho uas ua kom yooj yim rau kev xa mus thiab kev tso cai rau ECM yog qhov tseem ceeb rau cov neeg koom nrog xa mus thiab cov tswv cuab.
- Ib qho kev piav qhia ntawm ECM Cov Qauv Kev Xa Mus Los, uas ua qauv txheej txheem cov ntaub ntawv tag nrho cov kev npaj saib xyuas yuav sau rau ntawm ECM xa mus. Cov koom haum ua kev xa mus rau ECM yuav xa cov ntaub ntawv tib yam hauv ECM kev xa mus thoob plaws lub nroog thiab cov phiaj xwm saib xyuas uas tau tswj hwm es tsis yog nrhiav kev thov sib txawv rau cov ntaub ntawv xa mus.
- An overview of updated requirements for managed care plans to expand the use of ECM streamlined presumptive authorization so more ECM providers can start serving members right away. Select categories of ECM providers already contracted in a managed care plan’s ECM provider network will be able to initiate ECM for members and be paid for ECM services during a 30-day timeframe while waiting for a managed care plan’s authorization decision.
Cov ntaub ntawv los ntawm lub rooj sib tham hauv online muaj nyob rau ntawm lub vev xaib ECM thiab Community Supports.
Muab Kev Nkag Mus thiab Hloov Kho Kev Noj Qab Haus Huv (PATH) Peev Xwm thiab Cov Txheej Txheem Kev Hloov Pauv, Kev nthuav dav, thiab Kev Txhim Kho (CITED) Round 4 Daim Ntawv Thov
Thaum Lub Ib Hlis 6, 2025, DHCS yuav qhib PATH CITED Round 4 daim ntawv thov qhov rai. PATH CITED teg num muab nyiaj txiag los tsim kom muaj peev xwm thiab kev tsim kho ntawm cov neeg koom tes hauv av, suav nrog cov koom haum hauv zej zog, tsev kho mob, cov koom haum hauv nroog, Pawg Neeg, thiab lwm yam, kom koom nrog Medi-Cal kom tiav. Hnub kawg rau kev thov rau CITED Round 4 nyiaj txiag yog 11:59 teev tsaus ntuj PST thaum Lub Peb Hlis 7, 2025. Cov koom haum txaus siab raug txhawb kom nkag mus rau daim ntawv teev npe thiab cov ntaub ntawv qhia los pab npaj lawv daim ntawv thov. Thov xa cov lus nug rau cited@ca-path.com.
Long-Term Services and Supports (LTSS) Data Dashboard
Thaum Lub Kaum Ob Hlis 27, DHCS yuav tso tawm ib qho version tshiab ntawm LTSS Data Dashboard uas sib tham tau, txhim kho kev pom tseeb ntawm cov ntaub ntawv thiab kev nkag mus tau yooj yim. Lub dashboard qhia txog kev siv thiab cov ntaub ntawv txog pej xeem los ntawm cov nroog thiab cov phiaj xwm kev saib xyuas thiab tshawb nrhiav cov qauv ntawm kev ntsuas zoo, cov kev pabcuam, thiab cov pej xeem me thoob plaws California. Cov ntaub ntawv no yuav raug siv los txhim kho qhov zoo thiab kev ncaj ncees ntawm kev noj qab haus huv rau cov tswv cuab Medi-Cal uas nkag mus rau LTSS. Hauv qhov version tshiab tshaj plaws ntawm LTSS dashboard no, tus neeg siv interface tso cai rau ntau yam kev pom cov ntaub ntawv. Cov ntaub ntawv muaj nyob rau thoob plaws lub xeev, nrog rau lub peev xwm los lim los ntawm pawg hnub nyoog, txoj kev xa menyuam, ob qho kev tsim nyog, hom lus tseem ceeb, haiv neeg, pawg neeg tsawg, thiab poj niam txiv neej. Cov kev ntsuas tshiab ntsig txog tus nqi, lub sijhawm nyob, thiab qhov zoo tau suav nrog rau hauv qhov hloov tshiab no. Qhov pom kev nplua nuj ntawm cov ntaub ntawv hauv lub dashboard qhia txog DHCS txoj kev nce qib mus rau kev pom tseeb ntawm kev siv LTSS los ntawm kev saib xyuas hauv tsev kho mob mus rau kev pabcuam hauv tsev thiab hauv zej zog.
Smile Into 2025: Kev Tshaj Tawm Tshiab thiab Kev Pabcuam rau Medi-Cal Cov Tswvcuab
Raws li lub xyoo tshiab los txog, Smile California tab tom pab Medi-Cal cov tswv cuab pib xyoo 2025 nrog kev luag nyav zoo dua. Tsis ntev los no Facebook thiab Instagram Smile Alerts qhia txog qhov tseem ceeb ntawm kev tsim lub tsev kho hniav rau kev kuaj xyuas tsis tu ncua thiab tshawb pom ntxov ntawm cov teeb meem kho hniav. Qhov kev sib tw no yog txhawm rau txhawb cov tswv cuab los tshawb nrhiav lawv cov txiaj ntsig kho hniav, kho lawv cov kev saib xyuas hauv tsev, thiab nrhiav tus kws kho hniav zoo meej.
Koom nrog peb pab neeg
DHCS tab tom nrhiav ib tus neeg muaj peev xwm thiab muaj kev txhawb siab los ua haujlwm xws li:
- Chief of the Managed Care Quality and Monitoring Division to lead compliance-related activities for the state’s Medi-Cal managed care plans. These activities include, but are not limited to, developing and implementing policies, establishing standard operating procedures, engaging in continual improvement efforts, providing technical assistance, and conducting risk analysis for managed care plan audit programs in partnership with DHCS’ Contract and Enrollment Review Division. Applications must be submitted by December 26.
DHCS tseem tab tom ntiav rau nws txoj cai tswjfwm kev noj qab haus huv, kev siv thev naus laus zis, thiab lwm pab pawg. Yog xav paub ntxiv, thov mus saib hauv CalCareers lub vev xaib.
Cov Rooj Sib Tham Cov Neeg Koom Tes thiab Webinar yuav los tom ntej
California Children’s Services (CCS) Advisory Group Meeting
Thaum Lub Ib Hlis Ntuj 8, 2025, DHCS yuav tuav lub rooj sib tham CCS Pawg Kws Pab Tswv Yim peb lub hlis twg. DHCS thiab CCS Advisory Group tus khub los xyuas kom cov me nyuam nyob rau hauv qhov kev pab cuam CCS/Whole Child Model (WCM) tau txais kev saib xyuas zoo thiab raws sij hawm. Cov txheej txheem txheej txheem suav nrog cov lus piav qhia ntawm CCS 2024 qhov tseem ceeb, saib ua ntej mus rau 2025, thiab hloov kho tshiab ntawm WCM nthuav dav, ECM, Medi-Cal Rx, thiab CCS Redesign Performance Measure Quality Subcommittee. Cov ntaub ntawv ntxiv thiab cov ntsiab lus ntawm lub rooj sib tham muaj nyob rau ntawm CCS Advisory Group lub vev xaib.
DHCS Lub Rooj Sib Tham Txog Kev Txom Nyem
DHCS koom tes nrog cov zej zog thoob plaws lub xeev los txhawb kev txo qhov kev raug mob thiab kev saib xyuas uas tsis muaj teeb meem ntau, tsom mus rau tus neeg mob hauv California txoj kev kho mob kev siv tshuaj yeeb dej cawv. DHCS txhawb kom cov neeg muab kev pab kho mob thiab cov neeg ua haujlwm kho mob siv tshuaj yeeb (xws li cov neeg ua haujlwm pabcuam zej zog, cov phooj ywg, cov neeg ua haujlwm pem hauv ntej, cov thawj tswj xyuas cov ntaub ntawv, cov kws tu mob, cov kws kho mob, thiab txhua tus neeg ua haujlwm hauv qhov chaw kho mob siv tshuaj yeeb) tuaj koom thiab kawm txog cov kev coj ua zoo tshaj plaws los siv cov ntsiab cai ntawm kev txo kev raug mob rau hauv kev kho mob siv tshuaj yeeb. Cov rooj sib tham yuav muaj nyob rau hauv Fresno County (Lub Ib Hlis 23, 2025), San Diego County (Lub Ob Hlis 11, 2025), thiab Los Angeles County (Lub Ob Hlis 27, 2025). Sau npe rau ntawm lub vev xaib ntawm qhov kev tshwm sim.
Coverage Ambassador Webinar Series: Justice-Involved Reentry Initiative thiab Children and Youth Behavioral Health InitiativeUpdate
Lub Ib Hlis 30, 2025, los ntawm 11 txog 11:45 teev sawv ntxov PST, DHCS yuav tuav ib qho Kev Ncaj Ncees-Involved Reentry Initiative thiab Children Youth Behavioral Health Initiative (CYBHI) hloov tshiab (qhov yuav tsum tau sau npe qib siab) ua ib feem ntawm Kev Pabcuam Ambassador webinar series. Qhov kev sib tham no yuav muab cov ncauj lus qhia ntxaws txog cov neeg muaj kev ncaj ncees uas tam sim no, lossis tau siv sijhawm, hauv tsev kaw neeg, cov chaw kho cov hluas, lossis cov tsev loj cuj thiab cov uas muaj kev pheej hmoo siab rau kev noj qab haus huv tsis zoo, raug mob, thiab tuag ntau dua li pej xeem. Lub rooj sib tham tseem yuav tsom mus rau cov kauj ruam tseem ceeb hauv California tab tom ua txhawm rau txhim kho cov txiaj ntsig kev noj qab haus huv tsis zoo rau cov tib neeg thaum lawv npaj rov qab mus rau lawv cov zej zog los ntawm kev ua haujlwm kom ntseeg tau tias lawv muaj kev pab cuam txuas ntxiv thaum lawv tso tawm. Tsis tas li ntawd, Coverage Ambassadors yuav kawm paub yuav ua li cas cov kev pab cuam me nyuam thaum ntxov yuav nthuav dav los ntawm CYBHI, uas yuav muab kev pabcuam kev puas hlwb rau menyuam yaus, hluas, thiab tsev neeg.
Hauv Case Koj Tsis Tau Nws
CMS Pom Zoo Rau California Txoj Haujlwm BH-CONNECT Los Hloov Kev Pabcuam Kev Noj Qab Haus Huv Tus Kheej
CMS tau pom zoo rau California Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) ua qauv qhia. Qhov kev hloov pauv no yuav nthuav dav nkag mus rau cov kev pabcuam kev coj tus cwj pwm tseem ceeb rau cov tswvcuab Medi-Cal uas muaj kev xav tau kev noj qab haus huv thiab kev siv yeeb tshuaj. Nws koom nrog tsoomfwv, xeev, thiab kev nqis peev hauv zej zog los tsim kom muaj kev noj qab haus huv zoo dua qub, muaj kev ncaj ncees rau kev noj qab haus huv uas yog qhov tseem ceeb rau cov kev daws teeb meem hauv zej zog. Los ntawm kev txo cov kev mus saib xyuas xwm txheej ceev thiab cov chaw nyob hauv tsev, BH-CONNECT yuav pab cov neeg California kom muaj kev ruaj ntseg thiab rov qab los thaum tsim kom muaj kev coj tus cwj pwm zoo rau cov neeg ua haujlwm noj qab haus huv thiab kev pabcuam kev pabcuam.
DHCS muab khoom plig $65 lab rau cov koom haum hauv zej zog thiab pab pawg neeg rau kev tiv thaiv kev siv yeeb tshuaj rau cov hluas
Thaum Lub Kaum Ob Hlis 19, DHCS tau muab nyiaj ze li $ 65.5 lab hauv kev pab nyiaj rau 95 cov tub ntxhais hluas ua haujlwm pabcuam hauv zej zog thiab Pab Pawg Pab Pawg txhawm rau nthuav dav cov kev pabcuam tiv thaiv kev siv tshuaj yeeb. Cov koom haum yuav tau txais tag nrho cov khoom plig rau cov nyiaj pab txog $ 1 lab rau lub sijhawm peb xyoos los siv Elevate Youth California qhov kev pab cuam hauv cov neeg tau nyiaj tsawg, cov neeg tsis muaj peev xwm thiab cov zej zog muaj xim. Cov nyiaj pab no yuav txhawb nqa cov tub ntxhais hluas hauv California thoob plaws lub xeev kom noj qab haus huv los ntawm kev qhia lawv txog kev pheej hmoo ntawm kev siv tshuaj yeeb thiab yuav tiv thaiv lawv li cas.
DHCS Awards $19.3 lab los txhim kho Opioid kho
Thaum Lub Kaum Ob Hlis 17, DHCS tau muab ntau dua $ 19 lab rau 25 lub koom haum los txhawb kev kho mob opioid uas tsis muaj teeb meem ntau ntawm cov kev pab cuam txhaj tshuaj (SSP) txij lub Cuaj Hlis 30, 2024, txog rau lub Cuaj Hlis 29, 2027. Cov neeg tau txais txiaj ntsig suav nrog SSPs uas muab lossis txhawb nqa cov kev pabcuam kev noj qab haus huv hauv California, xws li kev ntsuam xyuas, kev sau ntawv yuav tshuaj, thiab kev tswj hwm cov tshuaj rau kev kho mob ntawm kev siv tshuaj opioid. Qhov project no nthuav dav cov kev pabcuam SSP uas twb muaj lawm hauv cov zej zog California thiab txhawb kev koom ua ke ntawm cov kev pabcuam kho mob siv opioid thiab lwm yam kev pabcuam txo kev raug mob rau hauv cov chaw uas twb muaj lawm. Qhov no ua rau cov neeg mob tau txais kev txhawb nqa ntau ntxiv thiab txo lossis tshem tawm cov teeb meem rau kev nkag mus, pib, thiab txuas ntxiv kev kho mob siv opioid.