Xov xwm tshaj plaws
Rov qab mus rau Lub Kaum Ob Hlis 2021 Cov Neeg Koom Tes Kev Sib Txuas Lus Hloov Kho
California Advancing and Innovating Medi-Cal (CalAIM) Hloov tshiab
Mandatory Managed Care Enrollment
Kev tso npe saib xyuas yuav tsum tau tswj hwm yuav ua tus txheej txheem rau npe los pab xyuas kom cov pej xeem tsiv mus nyob nruab nrab ntawm cov nroog yuav tsum tau ua raws li qhov yuav tsum tau ua, yog li tshem tawm qhov sib txawv ntawm cov txiaj ntsig raws li txoj cai pab, pej xeem, thiab thaj chaw nyob. Muaj ob theem rau kev tso npe saib xyuas kev tswj hwm yuav tsum:
- Rau Theem I, DHCS tau xa thawj daim ntawv ceeb toom rau cov neeg tau txais txiaj ntsig thiab cov lus nug nquag nug (FAQ) cov ntaub ntawv nyob rau lub Kaum Hli kom cuam tshuam rau cov neeg tau txais txiaj ntsig txog lawv txoj kev hloov mus rau hauv kev tswj hwm lossis kev them nqi rau kev pabcuam (FFS), pib txij lub Ib Hlis 1, 2022.
- Rau Theem II, DHCS tau xa daim ntawv ceeb toom thib ob rau cov neeg tau txais txiaj ntsig thiab cov FAQs thaum lub Kaum Ib Hlis txog lawv txoj kev hloov. DHCS kuj tau xa Medi-Cal Managed Care Choice Packets rau cov neeg tau txais kev pab tsim nyog tau txais kev tso npe rau kev npaj kho mob (MCP) thaum kawg lub Kaum Ib Hlis.
Managed Care Benefit Standardization
Kev tswj hwm kev saib xyuas tus qauv yuav pab ua kom muaj kev sib luag ntawm cov txiaj ntsig xa los ntawm kev tswj hwm kev saib xyuas thiab FFS thoob plaws lub xeev, txo qhov nyuaj thiab lub nroog-rau-lub nroog sib txawv. Raws li kev tsim cov txiaj ntsig zoo, kev hloov pauv hauv nruab nrog cev loj (tam sim no tsuas yog cov txiaj ntsig tau txais txiaj ntsig hauv County Organized Health Systems (COHS) counties) yuav raug muab kos rau hauv Medi-Cal MCPs thoob plaws lub xeev rau txhua tus tswv cuab Medi-Cal rau npe hauv MCP, pib lub Ib Hlis 1, 2022. Tsis tas li ntawd, Multipurpose Senior Services Program (MSSP) yuav raug muab tshem tawm rau FFS thiab ua haujlwm raws li 1915(c) MSSP zam kev pab cuam hauv txhua lub nroog ua qauv qhia kev Coordinated Care Initiative (CCI), pib lub Ib Hlis Ntuj 1, 2022. Thaum Lub Kaum Ib Hlis, MCPs hauv CCI cov nroog tau xa cov ntawv ceeb toom rau cov neeg tau txais txiaj ntsig thiab Daim Ntawv Ceeb Toom Cov Ntaub Ntawv Ntxiv rau cov neeg tau txais txiaj ntsig cuam tshuam txog kev tshem tawm ntawm MSSP cov kev pabcuam.
Dental Initiatives
Thaum Lub Cuaj Hlis 28, DHCS tau xa Daim Ntawv Hloov Kho Txoj Kev Npaj Hauv Xeev (SPA) 21-0019 mus rau Lub Chaw rau Medicare & Medicaid Services (CMS) kom tsoomfwv pom zoo rau CalAIM cov kev pib kho hniav. Lub SPA tab tom raug tshuaj xyuas; lub sijhawm tawm tswv yim rau pej xeem tau xaus rau lub Cuaj Hlis 6. Cov ntawv ceeb toom ntawm FFS thiab chaw kho mob safety net (SNC) tau muab luam tawm rau ntawm cov vev xaib Medi-Cal thiab Medi-Cal Dental . Thov mus saib lub vev xaib DHCS kom paub ntxiv txog txhua qhov kev pab kho hniav ntawm CalAIM, suav nrog cov ntawv thov thiab cov kev cai them nqi SNC.
Medi-Cal Qhov Kev Pab Cuam Tiv Thaiv Kab Mob Khaus Viv-19
DHCS is allocating up to $350 million to incentivize COVID-19 vaccination efforts in the Medi-Cal managed care delivery system for the service period of September 1, 2021, through February 28, 2022. Medi-Cal MCPs are eligible to earn incentive payments for activities designed to close vaccination gaps with their enrolled members, and to address vaccine uptake disparities for specific age and race/ethnicity groups. MCPs may earn up to $50 million for achieving specified process measures and $200 million for outcome measures, with $100 million available for MCPs to use for direct member incentives. Effective September 1, 2021, all 25 full-service MCPs and one population-specific health plan were approved for participation in the program, and DHCS will provide payment allocations for the approved vaccination response plans. DHCS provided baseline data (as of August 29, 2021) to the plans for vaccine uptake outcome measures on October 4, and the MCPs submitted baseline data for their process measures on October 30. The first achievement assessment period ended on October 31. Future achievement assessments will occur in January and March 2022. The high-performance pool component of the incentive program is being developed. For more information, please refer to All Plan Letter 21-010.