Department of Health Care Services (DHCS) tab tom siv ib zaug $140 lab * Kev Ncaj Ncees thiab Kev Hloov Kho Kev Ua Haujlwm (EPT) rau kev saib xyuas thawj zaug txhawm rau txhim kho kev noj qab haus huv thiab txo qhov tsis sib xws los ntawm kev ua haujlwm ntawm cov qauv kev saib xyuas mus txog, txhim kho kev saib xyuas zoo, tus qauv them nqi , thiab xyaum kev hloov pauv. Cov kev siv zog no ua raws li cov qauv kev them nqi raws li tus nqi yuav tso cai rau Medi-Cal cov chaw muab kev pab cuam zoo dua rau lub xeev cov neeg muaj npe Medi-Cal ntau haiv neeg. Txhawm rau ua raws li cov hom phiaj ntawm DHCS Kev Ua Haujlwm Zoo thiab Lub Hom Phiaj thiab Kev Ncaj Ncees Txoj Cai Kev Noj Qab Haus Huv thiab"50 los ntawm 2025: Bold Goals" Initiative, cov nyiaj no yuav txhawb nqa kev hloov pauv hauv kev saib xyuas thawj zaug (pediatrics, tsev neeg xyaum, kev kho mob rau cov neeg laus, thawj zaug. saib xyuas OB/GYN, thiab cov kws kho mob coj tus cwj pwm hauv qhov chaw kho mob thawj zaug) thiab npaj lawv los koom nrog kev cog lus them nqi raws li tus nqi. Cov nyiaj no tau muab faib rau peb yam hauv cov theem ntawm lub xyoo txoj haujlwm tau piav qhia hauv qab no.
Medi-Cal Managed Care Plan (MCP) Cov Kev Pab Them Pib Pib Npaj Nyiaj Txhawb Kev Them Nyiaj
$ 25 million (12.5 million General Fund) incentivized MCPs to identify and work with small-to medium-sized independent practices in 2023 using a standardized assessment PhmCAT to support these practices as they developed practice transformation plans and applications to the larger EPT Provider Directed Payment Program.
EPT Tus Muab Kev Qhia Qhia Them Nyiaj
$ 97 million ($48.5 million General Fund) over 3 years supports delivery system transformation, specifically targeting primary care practices that provide primary care pediatrics, family medicine, internal medicine, primary care OB/GYN services, or behavioral health services that are integrated in a primary care setting to Medi-Cal members.
A tag nrho ntawm 197 qhov kev coj ua tau koom nrog hauv qhov kev pab cuam nrog lub peev xwm kom tau txais kev hloov pauv nyiaj siab tshaj plaws raws li Medi-Cal lub neej thiab ua tiav cov dej num / cov ntsiab lus tseem ceeb.
Cov txheej txheem xaiv rau Qhov Kev Pabcuam Kev Them Nqi Qhia tau suav nrog ob kauj ruam: (1) siv DHCS muab rubric, kev tshuaj xyuas thiab cov qhab nia qhab nia (tawm ntawm 90 tag nrho) ntawm txhua daim ntawv thov los ntawm MCP qhia hauv daim ntawv thov kev coj ua, thiab tom qab ntawd (2) DHCS tshuaj xyuas cov ntawv thov pom zoo los ntawm MCPs. Thov saib EPT Cohort 1 Selection Methodology kom paub meej txog cov txheej txheem xaiv rau kev coj ua.
Kev pab cuam thiab cov ntsiab lus tseem ceeb tsom mus rau cov kev tswj hwm pej xeem kev noj qab haus huv (PHM) hauv qab no: kev nkag mus, empanelment, cov ntaub ntawv los pab PHM, tus qauv kev saib xyuas (xws li kev noj qab haus huv, kev noj qab haus huv, thiab kev saib xyuas rau cov pej xeem ntawm kev tsom xam), kev them nqi raws li tus nqi, thiab cov ntsuas kev ua haujlwm tseem ceeb. Thov mus saib Lub Chaw Kawm Kev Noj Qab Haus Huv Pej Xeem kom paub ntxiv txog qhov tseem ceeb.
The Payment Structure suav nrog cov hauv qab no:
- Tag nrho cov peev xwm them nyiaj = Cov tswv cuab Medi-Cal tau txais (txij lub Kaum Ib Hlis 2024) × PMPY tus lej sib npaug.
- Kev them nyiaj ib ntus = Tag nrho cov peev txheej them nyiaj ÷ 23 lossis 25 lub sijhawm tseem ceeb (nyob ntawm seb muaj pes tsawg lub sijhawm tseem ceeb rau kev xyaum).
Piv txwv ntawm Kev Them Nyiaj Scenario:
- Muab cov tswv cuab rau kev saib xyuas thawj zaug: 920
- Tus nqi sib tw / ntxiv rau: $ 305
- Tag Nrho Muaj Peev Xwm Kev Them Nyiaj (Tshem cov tswv cuab x tus lej sib npaug): 920 x $ 305 = $ 280,6000
- Them ib Milestone tau ua tiav (Tag nrho Cov Peev Xwm Kev Them Nyiaj / 25 qhov tseem ceeb): $ 11,224
Table 1.
A
| 1
| 500
| $ 580.00
|
B
| 501
| 700
| $ 397.00
|
C
| 701
| 850
| $ 349.00
|
D
| 851
| 1000
| $ 305.00
|
E
| 1001
| 1200
| $ 300.00
|
F
| 1201
| 1400
| $ 260.00
|
G
| 1401
| 1600
| $180.00
|
H
| 1601
| 1800
| $ 170.00
|
Kuv
| 1801
| 2000
| $ 162.00
|
J
| 2001
| 2250
| $ 144.00
|
K
| 2251
| 2500
| $ 146.00
|
L
| 2501
| 2750
| $ 145.00
|
M
| 2751
| 3000
| $ 121.00
|
N
| 3001
| 3250
| $ 110.00
|
O
| 3251
| 3500
| $ 106.00
|
P
| 3501
| 4000
| $ 95.00
|
Q
| 4001
| 4500
| $ 88.00
|
R
| 4501
| 5000
| $ 85.00
|
S
| 5001
| 5500
| $79.00 Nws |
T
| 5501
| 6000
| $77.00 Nws
|
U
| 6001
| 6500
| $ 61.50
|
V
| 6501
| 7000
| $ 50.25
|
W
| 7001
| 7500
| $ 59.00
|
X
| 7501
| 8000
| $ 53.00
|
Y
| 8001
| 8500
| $ 49.50 |
Z
| 8501
| 9000
| $ 50.50
|
AA
| 9001
| 9500
| $ 48.00
|
BB
| 9501
| 10000
| $ 46.00
|
CC
| 10001
| 11500
| $ 40.50
|
DD
| 11501
| 13000
| $ 45.00
|
EE
| 13001
| 14500
| $ 33.30
|
FF
| 14501
| 16000
| $ 40.00
|
GG
| 16001
| 17500
| $ 38.00
|
HH
| 17501
| 20000
| $ 37.00
|
II
| 20001
| 22500
| $ 36.50
|
JJ
| 22501
| 25000
| $ 31.50
|
KK
| 25001
| 27500
| $ 30.50
|
LL
| 27501
| 30000
| $ 28.50
|
MM
| 30001
| 35000
| $ 28.00
|
NN
| 35001
| 45000
| $ 26.00
|
OO
| 45001
| 55000
| $ 22.50
|
PP
| 55001
| 60000
| $ 28.50
|
QQ
| 60001
| 65000
| $23.00 Nws
|
RR
| 65001
| 75000
| $ 22.00
|
SS
| 75001
| 90000
| $ 22.00
|
TT
| 90001
| 105000
| $ 21.00
|
UU
| 105001
| 120000
| $18.00 Nws
|
Cov txheej txheem no siv tau rau txhua qhov EPT tseem ceeb. Qhov kev pabcuam EPT yuav raug tso cai txhua xyoo los ntawm CMS thiab yog li yuav raug xa mus rau cov kev hloov pauv. Qhov kev pab cuam EPT yog nyob rau yav tom ntej daim ntawv tso cai nyiaj txiag thiab kev tsim nyog los ntawm California Cov Cai Lij Choj thiab cov kev pom zoo los ntawm tsoom fwv tsim nyog ntawm kev them nyiaj ncaj qha.
Nco tseg: Kev xam nyiaj them rau xyoo 2024–2026 yog ua raws li CMS cov lus qhia tau tshaj tawm thaum Lub Peb Hlis 2025 thiab raws li lub Kaum Ib Hlis 2024 Medi-Cal cov tswv cuab suav, tsis suav nrog D-SNP cov tswv cuab (raws li CMS xav tau).
Population Health Learning Center
$ 18 million ($9 million General Fund) over 3 years funds the program office for the Provider Directed Payment Program. The program office will be monitoring and supporting implementation of practices' transformation activities, sharing, and spreading of best practices, facilitating technical assistance for practices (through state and national partners), and support the achievement of the state’s quality and health equity goals. DHCS partners with the Population Health Learning Center to provide the Learning Collaborative and serve as the program office for the Provider Directed Payment Program.
Cov peev txheej
Txoj Cai Kev Pabcuam thiab Cov Ntaub Ntawv
Tiv tauj peb
Thov hu rau peb nrog cov lus nug ntawm ept@dhcs.ca.gov
