Kev Pab Cuam Them Nqi Hloov Pauv thiab Kev Ua Haujlwm
Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tab tom siv ib qho kev pab cuam $ 140 lab * Kev Sib Luag thiab Kev Hloov Pauv (EPT) ib zaug rau cov kev kho mob thawj zaug los txhawb kev noj qab haus huv ntawm cov pej xeem thiab kev sib luag ntawm kev noj qab haus huv los ntawm kev ua haujlwm ntawm cov qauv kev kho mob sab saud, txhim kho qhov zoo ntawm kev kho mob, cov qauv them nqi raws li tus nqi, thiab kev hloov pauv kev kho mob. Cov kev siv zog no uas sib haum nrog cov qauv them nqi raws li tus nqi yuav tso cai rau cov chaw muab kev pabcuam Medi-Cal kom pab tau cov pej xeem Medi-Cal ntau haiv neeg hauv lub xeev zoo dua. Yuav kom ua raws li lub hom phiaj ntawm DHCS Comprehensive Quality and Strategy and Health Equity Roadmap thiab"50 by 2025: Bold Goals" Initiative, cov nyiaj no txhawb nqa kev hloov pauv ntawm kev xa khoom hauv kev kho mob thawj zaug (kev kho mob menyuam yaus, kev kho mob hauv tsev neeg, kev kho mob rau cov neeg laus, kev kho mob OB/GYN thawj zaug, thiab cov kws kho mob kev coj cwj pwm hauv kev kho mob thawj zaug) thiab npaj lawv kom koom nrog kev cog lus them nqi raws li tus nqi. Cov nyiaj no raug muab faib rau peb ntu thoob plaws hauv cov theem ntawm xyoo (cov) kev pab cuam piav qhia hauv qab no.
*Tus qauv thawj ntawm EPT muaj tag nrho $ 700 lab nyiaj txiag. Hauv qhov kawg ntawm Lub Xeev California Xyoo Nyiaj Txiag 2024-2025, cov nyiaj pab tau raug txo mus rau $ 140 lab.
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.
Tag nrho muaj 197 lub chaw kho mob koom nrog hauv qhov kev pab cuam no nrog rau lub peev xwm los khwv tau nyiaj them siab tshaj plaws raws li lub neej Medi-Cal uas tau muab rau thiab ua tiav cov haujlwm/cov hom phiaj tseem ceeb.
Cov txheej txheem xaiv rau Qhov Kev Pabcuam Them Nyiaj Uas Muab Los Ntawm Tus Muab Kev Pabcuam suav nrog ob kauj ruam: (1) siv cov qauv uas DHCS muab, kev tshuaj xyuas thiab kev ntsuas cov qhab nia (tawm ntawm 90 tag nrho) ntawm txhua daim ntawv thov los ntawm MCP uas tau qhia hauv daim ntawv thov kev xyaum, thiab tom qab ntawd (2) kev tshuaj xyuas DHCS ntawm cov ntawv thov uas MCP pom zoo. Thov saib EPT Cohort 1 Selection Methodology kom paub meej ntxiv txog cov txheej txheem xaiv cov chaw ua haujlwm.
Kev pab txog kev siv tshuab thiab cov ntsiab lus tseem ceeb tsom mus rau cov kev tswj hwm kev noj qab haus huv ntawm cov pej xeem (PHM): kev nkag mus, kev tswj hwm, cov ntaub ntawv los pab txhawb PHM, tus qauv kev saib xyuas (suav nrog kev noj qab haus huv ntawm lub hlwb, kev noj qab haus huv hauv zej zog, thiab kev saib xyuas rau cov pej xeem uas tsom mus rau), kev them nyiaj raws li tus nqi, thiab cov cim qhia kev ua tau zoo tseem ceeb. Thov mus saib Lub Chaw Kawm Txog Kev Noj Qab Haus Huv Rau Cov Neeg kom paub ntxiv txog cov ntsiab lus 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:
- Cov tswv cuab raug muab rau kev saib xyuas thawj zaug: 920
- Tus nqi ntxiv/ntxiv rau: $305
- Tag Nrho Cov Nyiaj Them Rau Kev Xyaum Ua (Tus tswv cuab uas tau muab x tus lej sib npaug): 920 x $305= $280,6000
- Kev Them Nyiaj Rau Ib Lub Caij Nyoog Uas Tau Ua Tiav (Tag Nrho Cov Nyiaj Them Rau Kev Xyaum Ua / 25 Lub Caij Nyoog): $11,224
Table 1.
| Chav kawm | Pib | End | Raws li Tus Tswv Cuab |
|---|---|---|---|
| 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 |
| VV | 120001 | 138000 | $23.00 Nws |
Txoj kev no siv rau txhua lub hom phiaj EPT. Qhov kev pab cuam EPT yuav tsum tau txais kev pom zoo txhua xyoo los ntawm CMS thiab yog li ntawd tej zaum yuav hloov pauv tau. Qhov kev pab cuam EPT yuav raug kev tso cai thiab kev siv nyiaj txiag yav tom ntej los ntawm California Legislature thiab kev pom zoo los ntawm tsoomfwv qib siab ntawm kev npaj them nyiaj.
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
- EPT FAQs
- Tus Kws Pab Tswv Yim Qhia Txog Kev Them Nyiaj Them Nqi Cov Lus Qhia
- Kev Taw Qhia Txog Kev Ua Haujlwm Pabcuam Ntiag Tug thiab Medi-Cal Managed Care Plans
- phmCAT Tool
- EPT Scoring Rubric rau MCPs
- EPT Initial Planning Incentive Payments Process
- Qhov Chaw Pabcuam Kawg Qhia Kev Them Nyiaj Them Nqi thiab Cov Ntsiab Lus Tseem Ceeb
- CY 2026 Preprint Approval Package
Txoj Cai Kev Pabcuam thiab Cov Ntaub Ntawv
- Phau Ntawv Qhia Kev Pab Txog Kev Siv EPT CY2025
- EPT-PL 25-001 Lub Hom Phiaj Txo Qhov Tsis Sib Xws ntawm EPT
- EPT-PL 25-002 Lub Hom Phiaj Txo Qhov Tsis Sib Xws ntawm EPT
Tiv tauj peb
Thov hu rau peb yog tias muaj lus nug ntawm ept@dhcs.ca.gov.