Tswj Kev Pabcuam Sijhawm Ntev thiab Kev Pabcuam thiab Dual Cov Kev Xav Tau Tshwj Xeeb
Rov qab mus rau Kev Pabcuam Kev Sib Txuas rau Cov Neeg Tau Txais Kev Pabcuam Dual
Pib txij xyoo 2023, CalAIM cov cai txhais tau tias muaj kev saib xyuas ntau dua rau cov uas xav tau Kev Pabcuam Sijhawm Ntev thiab Kev Pabcuam lossis cov uas tsim nyog tau txais Medicare thiab Medi-Cal dua.
Sijhawm ntawm Kev Hloov
2022
- Launch CalAIM Community Supports, cov kev pab tshiab muab los ntawm Medi-Cal cov kev pab them nqi kho mob raws li kev them nqi rau cov kev pab cuam kho mob ib txwm muaj lossis teeb tsa
- Txhua Medi-Cal cov kev npaj saib xyuas tau raug txhawb kom muaj ntau ntawm 14 Cov Kev Pabcuam Zej Zog uas tau pom zoo ua ntej raws li qhov ua tau thiab muaj rau cov tswvcuab Medi-Cal uas tsim nyog txawm hais tias lawv tsim nyog rau Kev Pabcuam Saib Xyuas Kev Kho Mob
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CalAIM Enhanced Care Management (ECM) muaj rau thawj cov pej xeem ntawm kev tsom xam uas suav nrog
- Cov tib neeg thiab tsev neeg muaj kev tsis muaj tsev nyob;
- Cov neeg siv siab ntawm kev zam ED, tsev kho mob, luv luv SNF;
- Cov neeg laus uas muaj mob hnyav lossis xav tau Kev Pabcuam Kev Siv Tshuaj; thiab
- Cov tib neeg hloov los ntawm kev raug kaw
2023
- Lub Ib Hlis Ntuj Tim 1: Lub Xeev yuav tsum tau tso npe kawm tag nrho ntawm cov neeg tau txais txiaj ntsig zoo dual rau hauv Managed Care Plans (MCPs) rau Medi-Cal cov txiaj ntsig, suav nrog ob tus neeg nyob hauv Long-Term Care (LTC)
- Lub Ib Hlis 1: Txhua tus MCPs yuav yog lub luag haujlwm rau tag nrho cov txiaj ntsig LTC ntawm cov chaw thiab cov tsev hauv qab no:
- Skilled Nursing Facility (SNF), ob qho tib si pub dawb thiab hauv tsev kho mob SNFs
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Lub Ib Hlis 1: Medicare Medi-Cal Plans (MMPs) muaj nyob rau hauv cov nroog nram qab no: Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, thiab Santa Clara. Txhua tus tswvcuab Cal MediConnect (CMC) hla taug kev mus rau qhov sib piv D-SNP thiab MCPs.
- Lub Ib Hlis 1: nthuav cov pej xeem ntawm kev tsom mus rau ECM uas suav nrog
- Cov neeg laus tsim nyog rau LTC thiab muaj kev pheej hmoo ntawm kev ua haujlwm; thiab
- Cov neeg nyob hauv tsev laus hloov mus rau hauv zej zog
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Lub Xya Hli 1: Txhua tus MCPs yuav dhau los ua lub luag haujlwm rau tag nrho cov txiaj ntsig LTC ntawm cov chaw thiab cov tsev hauv qab no:
- Intermediate Care Facility (ICF)
- Intermediate Care Facility for Developmentally Disabled (ICF/DD);
- ICF/DD-Habilitative;
- KuvCF/DD-Nursing;
- Subacute Chaw;
- Pediatric Subacute Facility
Cov peev txheej ntxiv
CalAIM MLTSS & Duals Integration Workgroup
CalAIM MLTSS thiab Duals Integration Workgroup yog ib lub koom haum koom tes nrog rau qhov kev siv zog no, suav nrog cov phiaj xwm kev noj qab haus huv, cov neeg muaj feem cuam tshuam, thiab US Centers for Medicare & Medicaid Services (CMS). Pawg Neeg Ua Haujlwm no muab lub sijhawm rau cov neeg koom nrog los muab kev tawm tswv yim thiab qhia cov ntaub ntawv hais txog txoj cai, kev ua haujlwm, thiab lub tswv yim rau Lub Tsev Haujlwm txoj kev hloov pauv rau ob tus neeg tsim nyog thiab CCI kev hloov pauv hauv CalAIM txoj haujlwm.
Tiv tauj peb
