Kev tshuaj ntsuam thiab hloov cov cuab yeej kho mob rau Medi-Cal Kev Pabcuam Kev Puas Siab Puas Ntsws
Cov lus nug nquag
Lub hom phiaj ntawm cov cuab yeej
Yuav tsum tau siv cov cuab yeej
Tool Administration
Kev xeem
Kev xa mus
Txhais rau
Ua raws
Kev sib tshuam nrog lwm Txoj Cai
Lub hom phiaj ntawm cov cuab yeej
Vim li cas thiaj li tau txais kev tshuaj ntsuam xyuas thiab hloov pauv cov cuab yeej kho mob rau Medi-Cal Kev Pabcuam Kev Puas Siab Puas Ntsws?
The Department of Health Care Services (DHCS) California Advancing and Innovating Medi-Cal (CalAIM) initiative for “Screening and Transition of Care Tools for Medi-Cal Mental Health Services” aims to ensure individuals receive coordinated services across Medi-Cal mental health delivery systems and improve health outcomes. The goal is to ensure access to the right care, in the right place, at the right time.
Lub hom phiaj ntawm Cov Kev Ntsuam Xyuas Cov Neeg Laus thiab Cov Hluas rau Medi-Cal Cov Kev Pab Cuam Kev Puas Siab puas ntsws yog dab tsi?
Lub hom phiaj ntawm Cov Kev Ntsuas Cov Neeg Laus thiab Cov Hluas rau Medi-Cal Mental Health Services (tom qab no hu ua Cov Cuab Yeej Kev Ntsuas) yog los txiav txim siab qhov tsim nyog Medi-Cal kev kho mob hlwb kom xa mus rau ib tus neeg uas tsis tau txais kev pab kho mob hlwb tam sim no. Medi-Cal Managed Care Plans (MCPs) los yog county Behavioral Health Plans (BHPs) yuav tsum siv cov cuab yeej thaum hu los ntawm ib tug neeg, los yog ib tug neeg sawv cev yog tias muaj hnub nyoog qis dua 21 xyoos, nrhiav kev pab kho mob hlwb.
Puas yog Cov Kev Ntsuam Xyuas Cov Hluas zoo ib yam li DHCS-pom zoo Cov Hluav Taws Xob Hluav Taws Xob Hluav Taws Xob?
Tsis yog. Cov Kev Ntsuam Xyuas Cov Hluas rau Medi-Cal Cov Kev Pabcuam Kev Puas Siab Puas Ntsws thiab DHCS-pom zoo Cov Kev Ntsuas Cov Hluav Taws Xob Hluav Taws Xob yog cais thiab sib txawv.
Cov Kev Ntsuam Xyuas Cov Hluas rau Medi-Cal Kev Pabcuam Kev Puas Siab Puas Ntsws (Cov Kev Ntsuas Cov Hluas) tau tsim los ntawm DHCS hauv kev koom tes nrog cov neeg muaj feem cuam tshuam nrog lub hom phiaj ntawm kev txiav txim siab qhov tsim nyog Medi-Cal kev noj qab haus huv kev puas siab puas ntsws xa mus rau ib tus tub ntxhais hluas uas tsis tau txais kev pab kho mob hlwb tam sim no. MCPs/BHPs yuav tsum tau siv lub Youth Screening Tool thaum lawv raug hu los ntawm ib tug tub ntxhais hluas hnub nyoog qis dua 21 xyoos, los yog ib tug neeg sawv cev, nrhiav kev pab kho mob hlwb.
DHCS-pom zoo rau Cov Kev Ntsuas Cov Hluas Kev Raug Mob yog ib daim ntawv teev cov cuab yeej uas twb muaj lawm tau pom zoo los ntawm DHCS uas yuav siv tau rau cov tub ntxhais hluas txawm hais tias lawv tab tom tau txais kev pab kho mob puas siab puas ntsws los txiav txim seb tus tub ntxhais hluas puas tau txais kev nkag mus rau SMHS qhov kev xa khoom. DHCS-pom zoo Cov Kev Ntsuam Xyuas Cov Hluas Kev Txhaum Cai tsis yog tswj hwm los ntawm MCP/MHP txoj kab nkag tab sis yuav raug siv los ntawm cov kws kho mob lossis lwm cov neeg hauv zej zog. Saib APL 22-006 thiab BHIN 21-073 yog xav paub ntxiv.
Hauv qab no yog ob qho piv txwv los pab qhia meej qhov sib txawv ntawm Cov Kev Ntsuas Cov Hluas rau Medi-Cal Kev Pabcuam Kev Puas Siab Puas Ntsws thiab DHCS-pom zoo Cov Khoom Siv Tshuaj Ntsuam Xyuas Cov Hluas:
Piv txwv 1:
- Ib tug tub ntxhais hluas uas tam sim no tsis tau txais kev pab kho mob hlwb hu mus rau lawv lub zos MCP.
- MCP tswj xyuas Cov Kev Ntsuas Cov Hluas.
- The member’s Youth Screening Tool score leads the MCP to refer the member to the BHP for an assessment within the SMHS.
- Thaum qhov kev ntsuam xyuas, SMHS tus kws kho mob txiav txim siab tias nws yuav tsim nyog los tshuaj xyuas tus tswv cuab rau kev raug mob. Tus neeg zov me nyuam tswj hwm DHCS-pom zoo rau Cov Kev Ntsuas Cov Hluav Taws Xob Hluav Taws Xob ua ib feem ntawm kev txiav txim siab ntawm kev tsim nyog rau SMHS.
- Tus tswv cuab raug txiav txim siab kom tsim nyog rau SMHS. Tom qab kev soj ntsuam, ib txoj kev npaj kho mob raug tsim thiab pib kho.
Piv txwv 2:
- Tus kws kho menyuam yaus txiav txim siab tias nws tsim nyog los tshuaj xyuas cov hluas rau kev raug mob. Tus kws kho mob siv DHCS-pom zoo rau Cov Kev Ntsuas Cov Hluas thiab, tom qab tshuaj xyuas cov txiaj ntsig, tom qab ntawd xa cov tswv cuab ncaj qha mus rau BHP rau SMHS (tshaj qhov Kev Ntsuas Cov Hluas).
- BHP xa cov tswv cuab mus rau lub network SMHS tus kws kho mob, uas pib cov txheej txheem ntsuas.
Puas yog Cov Kev Ntsuam Xyuas Cov Cuab Yeej npaj los ua haujlwm raws li kev ntsuas los txiav txim siab txog kev kho mob uas tsim nyog?
Tsis yog. Cov cuab yeej tshuaj ntsuam tsis yog kev ntsuas thiab tsis hloov cov kev ntsuas. Cov cuab yeej tshuaj ntsuam xyuas txheeb xyuas qhov ntsuas thawj zaug rau cov kev xav tau ntawm kev puas siab puas ntsws ntawm ib tus neeg uas tsis tau txais kev pabcuam kev puas hlwb tam sim no. Cov cuab yeej tshuaj ntsuam xyuas seb tus neeg twg yuav tsum raug xa mus rau Managed Care Plan (MCP) lossis Behavioral Health Plan (BHP) kom tau txais kev ntsuam xyuas. Thaum Lub Tuam Txhab Tshuaj Ntsuam Xyuas tau raug tswj hwm lawm, tus neeg yuav raug xa mus rau Medi-Cal kev kho mob hlwb tsim nyog rau kev soj ntsuam kuaj mob.
Puas yog Cov Cuab Yeej Siv Tshuaj ntsuam xyuas qhov kev xav tau ntawm kev siv tshuaj yeeb?
Lub hom phiaj tseem ceeb ntawm Cov Cuab Yeej Kev Ntsuam Xyuas yog txhawm rau txheeb xyuas qhov tsim nyog tshaj plaws ntawm Medi-Cal kev noj qab haus huv kev puas siab puas ntsws thaum ib tug tswv cuab tsis tau txais kev pab kho mob hlwb tam sim no. Cov cuab yeej tshuaj ntsuam xyuas suav nrog cov lus nug ntsig txog kev siv tshuaj yeeb (SUD) uas tsis cuam tshuam rau qhov kev tshuaj ntsuam xyuas tab sis yuav xav tau kev xa mus rau SUD kev ntsuam xyuas yog tias ib tus neeg teb cov lus pom zoo.
Yog tias ib tus neeg teb cov lus nug txog SUD, Managed Care Plan (MCP) lossis Behavioral Health Plan (BHP) yuav tsum muab lawv xa mus rau lub nroog BHP rau kev ntsuam xyuas SUD ntxiv rau ua kom tiav Cov Kev Ntsuas Ntsuas thiab ua kom muaj kev xa mus rau kev xa mus rau lub hlwb. Tus tswv cuab tuaj yeem tsis lees txais kev xa mus rau SUD kev ntsuas yam tsis muaj kev cuam tshuam rau lawv txoj kev xa mus rau kev puas hlwb.
Lub hom phiaj ntawm Txoj Kev Hloov Kho Kev Kho Mob rau Medi-Cal Cov Kev Pab Cuam Kev Puas Siab puas ntsws yog dab tsi?
Txoj Kev Hloov Kho Kev Kho Mob rau Medi-Cal Cov Kev Pabcuam Kev Puas Siab Puas Ntsws (tom qab no hu ua Transition of Care Tool) txhawb kev saib xyuas raws sij hawm thiab kev sib koom tes thaum cov tib neeg uas tam sim no tau txais kev pabcuam kev puas hlwb los ntawm Managed Care Plan (MCP) lossis Behavioral Health Plan (BHP) xav tau kev pabcuam hloov mus rau lwm qhov Medi-Cal kev noj qab haus huv ntawm lub hlwb lossis xav tau ntxiv cov kev pabcuam uas muab los ntawm cov kev pabcuam.
Puas yog Txoj Kev Hloov Kho Kev Kho Mob yog npaj los ua haujlwm raws li kev ntsuas los txiav txim siab txog kev kho mob uas tsim nyog?
No. The Transition of Care Tool is not an assessment and does not replace assessments. Furthermore, the Transition of Care Tool is not designed to determine whether an individual should transition between Medi-Cal mental health delivery systems or whether additional services provided by the other Medi-Cal mental health delivery system should be added to an individual’s existing mental health treatment. These determinations must be made by a clinician through a patient-centered decision process. The Transition of Care Tool leverages existing clinical information to document an individual’s mental health needs and support a referral for a transition of care or addition of services from the Managed Care Plan (MCP) or Behavioral Health Plan (BHP) as determined through an individualized clinical assessment of need.
Puas yog Cov Cuab Yeej Siv Tshuaj Ntsuam Xyuas thiab Hloov Kho Cov Cuab Yeej Kho Mob puas npaj los siv ua ke?
Tsis yog. Cov cuab yeej tshuaj ntsuam xyuas thiab kev hloov pauv ntawm Kev Kho Mob yog cov cuab yeej sib txawv nrog lub hom phiaj sib txawv. Cov cuab yeej tshuaj ntsuam xyuas yog rau cov tib neeg uas tam sim no tsis tau txais kev pabcuam kev puas hlwb thiab hu rau Managed Care Plan (MCP) lossis Behavioral Health Plan (BHP) kom txuas nrog cov kev pabcuam. Txoj Kev Hloov Kho Kev Kho Mob yog rau cov tib neeg uas tam sim no tau txais kev pabcuam kev puas siab puas ntsws los ntawm MCP lossis BHP, thiab cov uas xav tau lawv cov kev pabcuam hloov pauv ntawm Medi-Cal kev noj qab haus huv rau lub hlwb mus rau lwm qhov, lossis cov uas xav tau kev pabcuam ntxiv rau lawv cov kev kho mob los ntawm lwm qhov Medi-Cal kev noj qab haus huv rau lub hlwb.
DHCS puas yuav hloov kho cov cuab yeej? Yog muaj, thaum twg?
DHCS tuaj yeem hloov kho cov cuab yeej los txhim kho kev kho mob zoo, suav nrog cov kev hloov pauv ntawm txoj cai, hais txog cov teeb meem uas tau txheeb xyuas hauv kev saib xyuas, lossis teb cov lus tawm tswv yim rau cov koom nrog. Tsis muaj sijhawm teem sijhawm rau cov cuab yeej hloov tshiab. Managed Care Plans (MCPs) thiab Behavioral Health Plans (BHPs) yuav raug ceeb toom ua ntej sau ntawv txog cov kev hloov tshiab ua ntej.
Yuav tsum tau siv cov cuab yeej
Leej twg yuav tsum tau siv cov cuab yeej tshuaj ntsuam xyuas?
Cov Kev Npaj Saib Xyuas Kev Tswj Xyuas (MCPs) thiab Cov Kev Npaj Kho Mob Kev Coj Tus Kheej (BHPs) yuav tsum tau siv Cov Cuab Yeej Tshuaj Xyuas raws li tau teev tseg hauv APL 25-010 thiab BHIN 25-020 . Cov Cuab Yeej Tshuaj Xyuas tsis tas yuav siv rau cov kws kho mob hlwb (lossis lwm tus kws kho mob hauv zej zog) thaum cov tib neeg tiv tauj lawv ncaj qha los nrhiav kev pab kho mob hlwb.
Cov kws kho mob hlwb uas tau cog lus thiab cov tswv cuab uas nrhiav kev pab kho mob hlwb tau tiv tauj ncaj qha tuaj yeem pib txheej txheem kev ntsuam xyuas thiab muab kev pab rau cov tswv cuab thaum lub sijhawm ntsuam xyuas yam tsis tas siv Cov Cuab Yeej Ntsuam Xyuas, uas tau tso cai los ntawm Managed Care Plans (MCPs) thiab Behavioral Health Plans (BHPs), raws li Txoj Cai Tsis Muaj Qhov Rooj Tsis Zoo rau Kev Pab Kho Mob Hlwb uas tau piav qhia hauv APL 22-005 thiab BHIN 22-011. DHCS txhawb kom cov neeg muab kev pab txo qhov kev nyuaj siab rau cov tswv cuab thiab pib kev ntsuam xyuas thiab kev pabcuam raws sijhawm.
Puas yog Managed Care Plans (MCPs) thiab Behavioral Health Plans (BHPs) puas yuav tsum tau siv cov cuab yeej tshuaj ntsuam xyuas nrog txhua tus neeg uas hu rau lawv rau lub hom phiaj twg?
Tsis yog. MCPs thiab BHPs tsuas yog yuav tsum tau siv Cov Cuab Yeej Kev Ntsuam Xyuas thaum cov tib neeg uas tam sim no tsis tau txais kev pabcuam kev puas siab puas ntsws los ntawm Medi-Cal cov kab mob kev puas siab puas ntsws hu rau lawv nrhiav kev pabcuam kev puas hlwb. Cov cuab yeej tshuaj ntsuam tsis tas yuav siv rau hauv cov xwm txheej hauv qab no:
- Tus tswv cuab tam sim no tau txais kev pabcuam kev puas hlwb;
- Tus tswv cuab hu rau MCP lossis BHP rau lub hom phiaj uas tsis yog mus nrhiav kev pab kho mob hlwb; los yog
- A practitioner refers a member specifically to the MCP for NSMHS, or BHP for SMHS, based on an understanding of the member’s needs. If a practitioner refers a member directly to the MCP for NSMHS or the BHP for SMHS, the MCP/BHP should follow existing protocols for referrals in these scenarios.
Tsis tas li ntawd, Cov Cuab Yeej Kev Ntsuam Xyuas tsis hloov MCP lossis BHP cov cai thiab cov txheej txheem uas hais txog kev kho mob ceev lossis xwm txheej ceev. Yog tias ib tus neeg muaj kev kub ntxhov lossis muaj kev kub ntxhov ntawm kev puas siab puas ntsws, MCP lossis BHP yuav tsum ua raws li lawv cov txheej txheem xwm txheej ceev thiab teeb meem.
Puas yog Lub Tuam Txhab Tshawb Fawb yuav tsum tau siv rau cov tswv cuab uas hu lossis taug kev mus rau hauv tsev kho mob nrhiav kev pabcuam kev puas hlwb?
Tsis yog. Cov Cuab Yeej Tshuaj Xyuas no tsis tas yuav siv rau cov tswv cuab uas hu xov tooj lossis taug kev mus rau hauv cov chaw kho mob nrhiav kev pab kho mob hlwb. Cov kws kho mob hlwb uas raug cov tswv cuab tiv tauj ncaj qha los nrhiav kev pab kho mob hlwb tuaj yeem pib txheej txheem kev ntsuam xyuas thiab muab kev pab thaum lub sijhawm ntsuam xyuas yam tsis tas siv Cov Cuab Yeej Ntsuam Xyuas, raws li txoj cai Tsis Muaj Qhov Rooj Phem Rau Kev Pab Kho Mob Hlwb uas tau piav qhia hauv APL 22-005 thiab BHIN 22-011. Cov Cuab Yeej Tshuaj Xyuas tsis tas yuav siv rau cov kws kho mob hlwb, thiab MCPs/BHPs tsis tuaj yeem yuam kom cov kws kho mob hlwb siv cov Cuab Yeej Tshuaj Xyuas. Txoj cai ntawm Kev Tshuaj Xyuas thiab Kev Hloov Chaw ntawm Cov Cuab Yeej Saib Xyuas Kev Kho Mob yuav tsis cuam tshuam rau cov txheej txheem ua haujlwm rau cov tswv cuab nrhiav kev pabcuam ntawm cov chaw kho mob.
Puas yog cov cuab yeej tshuaj ntsuam xyuas yuav tsum muaj thaum tus kws kho mob lossis tus kws kho mob xa cov tib neeg mus rau Managed Care Plan (MCP) rau cov kev pabcuam kev noj qab haus huv tsis yog tshwj xeeb (NSMHS) lossis Behavioral Health Plan (BHP) rau cov kev pabcuam kev noj qab haus huv tshwj xeeb (SMHS)?
No. If a provider or practitioner (e.g., a primary care physician or school nurse) specifically refers an individual to an MCP for NSMHS or to a BHP for SMHS based on an understanding of the individual’s needs, the MCP/BHP is not required to use the Screening Tools.
MCPs/BHPs should follow existing protocols for provider referrals in these scenarios. For example, counties may have established referral pathways whereby schools or other service providers that have already conducted some level of screening send individuals who likely require SMHS to the BHP, or MCPs may be contacted by individuals who have been referred by their provider specifically for individual psychotherapy services. If the referral already includes sufficient information about the individual’s needs, additional screening is not required.
Xwb, yog tias tus neeg thib peb (xws li tab sis tsis txwv rau tus kws kho mob) tsuas yog txuas tus neeg mus rau MCP/BHP raws li cov peev txheej (piv txwv li, muab MCP/BHP tus xov tooj rau lawv kom paub ntau ntxiv txog cov kev pabcuam twg yuav muaj rau lawv) yam tsis tau ua qhov kev tshuaj ntsuam lossis ntsuas luv luv los txiav txim qhov tsim nyog xa mus rau kev xa mus, Cov Kev Ntsuas yuav tsum tau siv.
Puas yog Managed Care Plans (MCPs)/Behavioral Health Plans (BHPs) puas yuav tsum tau siv Kev Tshuaj Ntsuam Xyuas thiab Hloov Cov Cuab Yeej Kho Mob nrog cov neeg tsis muaj ntawv pov hwm thiab/lossis cov neeg pov hwm ntiag tug?
Tsis yog. DHCS tsis tas yuav siv qhov Kev Tshuaj Ntsuam Xyuas thiab Hloov Kho Cov Cuab Yeej Kho Mob nrog cov tib neeg uas tsis tau teev npe hauv Medi-Cal.
Puas yog Managed Care Plans (MCPs)/Behavioral Health Plans (BHPs) puas yuav tsum tau siv Kev Tshuaj Ntsuam Xyuas thiab Hloov Kho Cov Cuab Yeej Thaum Medicare yog thawj tus neeg them nyiaj, txawm tias lub tsev kho mob tseem pab Medi-Cal cov tswv cuab?
Rau cov neeg uas muaj Medicare thiab Medi-Cal, Medicare yog thawj tus neeg them nyiaj. Medi-Cal tej zaum yuav them rau cov nqi them rau qee qhov kev them nqi lossis cov kev pabcuam ntxiv uas tsis tau them los ntawm Medicare. Yog tias tus neeg mob muaj qhov xav tau kev noj qab haus huv tseem ceeb, lawv tuaj yeem tsim nyog tau txais kev pabcuam tshwj xeeb rau kev puas hlwb los ntawm lawv lub County Mental Health Plans. MCPs thiab BHP cov chaw saib xyuas kev noj qab haus huv muab cov kab ke xa mus rau Medi-Cal kev pabcuam kev noj qab haus huv.
DHCS yuav tsum tau siv qhov Kev Ntsuam Xyuas thiab Hloov Kho Cov Cuab Yeej Kho Mob nrog cov tib neeg uas tau cuv npe hauv Medi-Cal. Txawm hais tias DHCS tsis tau tshaj tawm cov lus qhia ntawm cov cuab yeej tshuaj ntsuam thiab ob qhov tsim nyog, nws raug nquahu kom siv Cov Cuab Yeej Ntsuas Xyuas kom ntseeg tau tias lawv tau txais kev ntsuam xyuas hauv qhov tsim nyog xa khoom.
Yog xav paub ntxiv txog kev tsim nyog ob leeg thiab kev coj tus cwj pwm noj qab haus huv, thov siv daim ntawv qhia tseeb no.
Leej twg yuav tsum tau siv Cov Kev Hloov Kho Kev Kho Mob?
Managed Care Plans (MCPs) thiab Behavioral Health Plans (BHPs) yuav tsum tau siv qhov Transition of Care Tool los tswj kev hloov pauv ntawm ob txoj kev xa khoom raws li tau teev tseg hauv APL 25-010 thiab . MCPs thiab BHPs tuaj yeem xaiv kom cov neeg muab kev pabcuam siv Txoj Kev Hloov Kho Kev Khomob thaum hloov ib tus neeg mus rau, lossis ntxiv cov kev pabcuam los ntawm, lwm qhov kev pabcuam kev noj qab haus huv ntawm Medi-Cal. MCPs thiab BHPs yuav tsum xyuas kom meej tias lawv cov Subcontractors thiab Network Providers ua raws li tag nrho lub xeev thiab tsoom fwv cov cai thiab cov kev cai, daim ntawv cog lus, thiab lwm yam DHCS kev taw qhia.
Leej twg tuaj yeem txiav txim siab seb tus neeg twg uas tam sim no tau txais kev pabcuam kev puas siab puas ntsws los ntawm Managed Care Plan (MCP) lossis Behavioral Health Plan (BHP) yuav tsum tau txais kev pabcuam ntxiv los ntawm lwm qhov Medi-Cal kev kho mob hlwb (xws li, MCP lossis BHP) lossis xav kom lawv hloov mus rau lwm qhov Medi-Cal kev noj qab haus huv kev puas siab puas ntsws (xws li, MCP lossis BHP)
Kev txiav txim siab rau kev hloov pauv kev pabcuam rau thiab/lossis ntxiv cov kev pabcuam los ntawm lwm qhov kev pabcuam kev puas siab puas ntsws (xws li, MCP lossis BHP) yuav tsum tau ua los ntawm tus kws kho mob los ntawm tus neeg mob uas koom nrog kev txiav txim siab raws li APL 25-010 thiab BHIN 25-020. Tus kws kho mob yuav tsum ua raws li lawv qhov kev coj ua raws li California txoj cai lij choj thiab yog ib qho ntawm cov kws kho mob uas tau teev tseg hauv California Medicaid State Plan, Ntxiv 3 rau Daim Ntawv Cuam Tshuam 3.1-A, nplooj 2m-2p raws li cov chaw muab kev pab kho mob hlwb Rehabilitative. Cov kev cai lij choj uas twb muaj lawm yuav tsis hloov lossis hloov los ntawm APL 25-010 lossis BHIN 25-020.
Cov kws kho mob yuav paub li cas yog tias lawv yuav tsum siv Txoj Kev Hloov Kho Kev Kho Mob?
Managed Care Plans (MCPs)/Behavioral Health Plans (BHPs) yuav tsum tau siv Transition of Care Tool los xyuas kom cov tib neeg uas tau txais kev pab kho mob puas hlwb los ntawm ib lub Medi-Cal kev noj qab haus huv rau lub hlwb tau txais kev saib xyuas raws sij hawm thiab sib koom ua ke thaum: (1) lawv cov kev pabcuam uas twb muaj lawm yuav tsum tau hloov mus rau lwm qhov kev pabcuam; los yog (2) thaum cov kev pab cuam yuav tsum tau muab ntxiv rau lawv cov kev kho mob hlwb uas twb muaj lawm los ntawm lwm qhov kev xa tawm (raws li kev kho mob ib txhij raws li No Wrong Door (NWD) cov cai tau piav qhia hauv APL 22-005 thiab BHIN 22-011).
MCPs/BHPs yuav tsum hloov kho cov cai thiab cov txheej txheem raws li qhov xav tau kom ua tau raws li NWD cov cai thiab STT cov cai (APL 25-010 thiab BHIN 25-020) raws li MCPs/BHPs yog lub luag haujlwm los piav qhia cov kev cia siab rau kev siv Transition of Care Tool nrog cov kws kho mob thiab muab kev cob qhia txog kev siv cov cuab yeej li cas thiab thaum twg.
Puas yog Kev Hloov Kho Kev Kho Mob yuav tsum tau siv thaum ib tus neeg raug xa mus rau hauv tib txoj kev xa khoom?
No. The Transition of Care Tool is only required for use when an individual’s care is being transitioned to the other Medi-Cal mental health delivery system (i.e., Managed Care Plan (MCP) or Behavioral Health Plan (BHP)) or services are being added from the other mental health delivery system.
Puas yog Kev Hloov Kho Kev Kho Mob yuav tsum tau yog tias ib tus neeg tshuaj ntsuam xyuas rau hauv Managed Care Plan (MCP) lossis Behavioral Health Plan (BHP) tab sis lawv qhov kev soj ntsuam kuaj pom tias lawv nyob hauv lwm qhov system?
Yes. If an individual’s screening score from either the Adult or Youth Screening Tool results in a referral to the MCP/ BHP and their subsequent clinical assessment indicates that they should receive services in the other Medi-Cal mental health delivery system, the MCP/BHP should ensure the Transition of Care Tool is completed and the individual is referred to the other delivery system. Consistent with No Wrong Door policy described in APL 22-005 and BHIN 22-011, all clinically appropriate NSMHS and SMHS services delivered during the assessment process are covered and reimbursable, prior to the determination of a diagnosis or a determination that the member meets access criteria for NSMHS or SMHS, even if the assessment ultimately determines they need to be referred to the other Medi-Cal mental health delivery system, or that the member does not meet access criteria for NSMHS or SMHS.
Tool Administration
Puas yuav muaj kev cob qhia txog kev siv Cov Cuab Yeej Kev Ntsuas thiab Hloov Cov Cuab Yeej Kho Mob?
Cov Kev Npaj Saib Xyuas Kev Kho Mob (MCPs) thiab Cov Kev Npaj Kho Mob Kev Coj Tus cwj pwm (BHPs) muaj lub luag haujlwm cob qhia lawv cov neeg ua haujlwm txog kev siv cov cuab yeej. DHCS tau tuav cov kev pab cuam hauv webinars los muab cov ntaub ntawv hais txog lub hom phiaj thiab cov ntsiab lus ntawm cov cuab yeej, nrog rau cov kev cai cuam tshuam. Cov ntaub ntawv webinar muaj nyob rau ntawm nplooj ntawv web DHCS Screening and Transition of Care Tools for Medi-Cal Mental Health Services, nrog rau kev cob qhia ntawm lub vev xaib California Mental Health Services Authority (CalMHSA).
Cov lus nug ntxiv lossis cov teb puas tuaj yeem ntxiv rau Kev Ntsuam Xyuas thiab Hloov Kho Cov Cuab Yeej Kho Mob thiab/lossis cov cuab yeej puas tuaj yeem ua ke nrog cov cuab yeej uas twb muaj lawm?
Tsis yog. Cov lus nug ntxiv lossis cov teb yuav tsis raug muab ntxiv rau lossis tshem tawm ntawm Cov Cuab Yeej Kev Ntsuas lossis Kev Hloov Kho Cov Cuab Yeej. Tsis tas li ntawd, cov lus tshwj xeeb thiab kev txiav txim ntawm cov lus nug / teb hauv cov cuab yeej yuav tsum nyob twj ywm thiab tsis tau hloov kho thiab cov txheej txheem muab qhab nia rau Cov Cuab Yeej Ntsuas yuav tsis hloov pauv. Managed Care Plan (MCP) lossis Behavioral Health Plan (BHP) yuav tsum muaj cov txheej txheem ua raws li kev tswj hwm cov cuab yeej thiab tsis txhob hloov cov khoom siv no, xws li sau cov ntaub ntawv qhia tus kheej lossis nug cov lus nug los tswj kev xa mus, yog tso cai.
Cov cuab yeej tshuaj ntsuam xyuas qhov tsim nyog rau kev kho mob hlwb ua ntej kev ntsuam xyuas thiab yuav tsum tsis txhob koom nrog cov cuab yeej uas twb muaj lawm uas ua haujlwm rau tib lub hom phiaj. Txoj Kev Hloov Kho Kev Kho Mob txhawb nqa cov ntaub ntawv thiab kev sib koom ua haujlwm raws sijhawm rau kev hloov pauv ntawm kev saib xyuas mus rau, lossis ntxiv cov kev pabcuam los ntawm, lwm yam kev pabcuam kev puas hlwb thiab yuav tsum tsis txhob koom nrog cov cuab yeej uas twb muaj lawm uas ua haujlwm rau tib lub hom phiaj. Txoj Kev Hloov Kho Kev Kho Mob tsis txiav txim siab seb yuav hloov kho li cas, lossis seb cov kev pabcuam puas yuav tsum tau ntxiv los ntawm lwm qhov kev xa khoom thiab, yog li, tsis hloov cov cuab yeej lossis lwm yam kev pabcuam uas yuav txhawb nqa tus kws kho mob hauv kev txiav txim siab.
Cov pej xeem ntxiv puas tuaj yeem ntxiv rau Cov Cuab Yeej Ntsuas?
Tsis yog. Cov lus nug ntxiv thiab cov teb tsis tuaj yeem muab ntxiv rau hauv Cov Cuab Yeej Ntsuas. Yog tias Managed Care Plans (MCPs) lossis Behavioral Health Plans (BHPs) khaws cov ntaub ntawv pej xeem ua ntej lossis ua raws li kev tshuaj ntsuam xyuas (xws li ib feem ntawm kev txais tswv cuab thawj zaug lossis kev xa mus rau kev sib koom ua ke) cov txheej txheem no tsis suav tias yog ib feem ntawm kev tshuaj ntsuam thiab yuav tsis ua ntxiv rau cov cuab yeej Kev Ntsuas. Txawm li cas los xij, txhua yam txheej txheem los sau cov ntaub ntawv pej xeem ua ntej kev tshuaj ntsuam yuav tsum yog luv luv thiab yuav tsum tau ua raws li tam sim ntawd los ntawm kev tswj hwm ntawm Cov Neeg Laus lossis Cov Kev Ntsuam Xyuas Cov Hluas. DHCS txhawb nqa MCPs thiab BHPs kom kho cov cai, cov txheej txheem, thiab kev ua haujlwm raws li qhov tsim nyog los txhim kho cov tswv cuab kev paub. MCPs thiab BHPs yuav tsum zam kom tsis txhob muaj cov txheej txheem tshuaj ntsuam xyuas rau cov kev pabcuam kev puas siab puas ntsws uas dhau los lossis tsis sib haum nrog Kev Ntsuam Xyuas thiab Hloov Kho Cov Cuab Yeej Kho Mob thiab nrog rau cov lus qhia.
Puas muaj cov ntaub ntawv ntxiv uas yuav tsum muab sau ua ntawv lossis cov ntawv txuas rau Cov Cuab Yeej Tshuaj Xyuas?
MCPs/BHPs tuaj yeem qhia cov ntaub ntawv ntxiv uas yog ib feem ntawm kev xa mus, xws li cov ntawv sau thaum lub sijhawm tshuaj ntsuam, yog tias muaj thiab tsim nyog. Txawm li cas los xij, cov ntsiab lus ntawm Kev Ntsuas Cov Cuab Yeej yuav tsis hloov pauv. Managed Care Plans (MCPs)/Behavioral Health Plans (BHPs) yuav tsis hloov qhov kev txiav txim lossis lo lus ntawm cov lus nug nyob rau hauv Cov Cuab Yeej Ntsuas thiab cov lus nug ntxiv yuav tsis muab ntxiv rau cov cuab yeej.
Puas yog cov neeg tswj xyuas Cov Cuab Yeej Kev Ntsuam Xyuas tuaj yeem sib txawv ntawm cov lus tshwj xeeb yog tias lawv raug nug kom qhia meej cov lus nug?
Cov lus nug hauv Cov Cuab Yeej Kev Ntsuam Xyuas yuav tsum tau nug tag nrho siv cov lus tshwj xeeb uas tau muab rau hauv lub cuab yeej thiab hauv qhov kev txiav txim tshwj xeeb cov lus nug tshwm sim hauv cov cuab yeej, txog qhov uas tus neeg tuaj yeem teb tau. Tej zaum yuav muaj qee qhov uas tus neeg tswj xyuas qhov kev tshuaj ntsuam xyuas kom meej meej cov lus nug rau tus neeg tuaj yeem teb tau. Raws li ib feem ntawm kev siv cov cuab yeej tshuaj ntsuam xyuas, Managed Care Plans (MCPs) thiab Behavioral Health Plans (BHPs) yuav tsum tau cob qhia cov neeg ua haujlwm txog cov txheej txheem los teb cov lus thov kom meej meej uas ua raws li lub hom phiaj ntawm cov lus nug thiab cov kev cai sab hauv uas twb muaj lawm.
Puas yog kev sib txawv ntawm cov lus tshwj xeeb hauv Cov Cuab Yeej Kev Ntsuam Xyuas tso cai ua ib feem ntawm kev txhais lus?
Yog lawm. Kev sib txawv ntawm cov lus tshwj xeeb ntawm kev tshuaj ntsuam cov lus nug yog tso cai ua ib feem ntawm kev txhais lus rau lwm hom lus. Txawm li cas los xij, Managed Care Plans (MCPs)/Behavioral Health Plans (BHPs) tsuas yog sib txawv ntawm cov lus hauv cov ntawv txhais lus yog tias lawv, lossis ib lub koom haum sawv cev, tau ua kom muaj kev sim ntxiv cov kev txhais lus hauv zej zog uas qhia tau hais tias xav tau kev hloov pauv hauv cov lus kom tau raws li cov tswv cuab xav tau. DHCS tau muab cov ntawv txhais lus ntawm Cov Cuab Yeej Kev Ntsuam Xyuas muaj nyob rau ntawm Kev Tshawb Fawb thiab Hloov Kho Cov Cuab Yeej web page.
Yog xav paub ntxiv txog kev cai coj noj coj ua thiab kev hais lus, BHPs yuav tsum xa mus rau California Code Regulations (CCR) Title 9 tshooj 1810.410 thiab BHIN 20-070, Cov Ntaub Ntawv Cov Lus Qhia, lossis kev hloov kho tom ntej.
Yog xav paub ntxiv txog tsoom fwv teb chaws thiab lub xeev cov cai hais txog kev tsis muaj kev ntxub ntxaug, kev ntxub ntxaug kev ntxub ntxaug, kev pab hais lus, thiab kev sib txuas lus nrog cov neeg muaj kev tsis taus, MCPs yuav tsum siv APL 25-005 , Cov Qauv rau Kev Txiav Txim Cov Lus Nug, Cov Kev Cai Tsis Muaj Kev Cai Lij Choj, thiab Kev Pab Cuam Lus, thiab lwm hom kev hloov tshiab, lossis lwm yam hloov tshiab.
Thaum ib tug neeg teb tias yog rau cov lus nug 6, 7, lossis 9 ntawm Lub Tuam Txhab Saib Xyuas Cov Hluas, vim li cas cov lus qhia xav kom tus neeg tshuaj ntsuam txwv tsis pub kuaj? Tus kws tshuaj ntsuam puas tuaj yeem nug cov lus nug ntxiv?
If a child/youth, or the person responding on their behalf, responds “Yes” to question 6, 7, or 9, in the Youth Screening Tool, they meet criteria to access specialty mental health services per APL 22-006 and BHIN 21-073, or subsequent updates. In these cases, the appropriate delivery system for clinical assessment (i.e., the Behavioral Health Plans (BHP)) has already been determined and, therefore, the remainder of the screening is not required. To minimize burden on the individual, the screener must conclude the screening and refer the individual to the BHP for clinical assessment and must not ask the remaining screening questions.
Puas yog Managed Care Plans (MCPs) thiab Behavioral Health Plans (BHPs) yuav tsum tsim kom muaj Kev Ntsuam Xyuas thiab Hloov Cov Cuab Yeej Kho Mob rau hauv lawv cov ntaub ntawv kho mob hluav taws xob?
Tsis yog. DHCS tau muab Kev Tshuaj Ntsuam Xyuas thiab Hloov Kho Cov Cuab Yeej Kho Mob raws li cov ntaub ntawv PDF sau tau tab sis tsis xav kom MCPs thiab BHPs siv hom ntawv tshwj xeeb los tswj cov cuab yeej. MCPs thiab BHPs tuaj yeem xaiv los siv cov ntawv sau PDF lossis tuaj yeem tsim cov cuab yeej rau hauv cov txheej txheem uas twb muaj lawm, xws li cov ntaub ntawv kho mob hauv hluav taws xob, tsuav yog cov lus tshwj xeeb, kev txiav txim ntawm cov lus nug, thiab cov txheej txheem ntsuas hauv Cov Cuab Yeej Ntsuas tseem tsis raug thiab tsis kho thiab cov lus tshwj xeeb thiab kev txiav txim ntawm thaj chaw hauv Kev Hloov Kho Kev Kho Mob tseem nyob twj ywm thiab tsis kho.
Yuav Ua Li Cas Cov Kev Npaj Kho Tus Cwj Pwm (BHPs) yuav tsum thov rau cov dej num ua tiav raws li ib feem ntawm Kev Ntsuam Xyuas thiab Hloov Cov Cuab Yeej Kho Mob?
Kev tshuaj ntsuam xyuas thiab kev hloov pauv ntawm Cov Cuab Yeej Kho Mob ua qauv ua cov haujlwm uas twb muaj lawm hauv cov nroog, suav nrog kev txiav txim siab txog kev saib xyuas tsim nyog rau cov tib neeg nrhiav kev pabcuam kev puas hlwb thiab pab txhawb kev hloov pauv ntawm kev saib xyuas thaum muaj kev hloov pauv. Lub nroog yuav raug them rov qab rau cov dej num no, suav nrog kev tswj xyuas cov cuab yeej thiab kev xa mus rau kev sib koom ua ke, raws li qhov tsim nyog los ntawm ntau txoj hauv kev uas twb muaj lawm, xws li Medi-Cal tus nqi tswj hwm, Mental Health Medi-Cal Administration Activities (MH MAA), thiab/los yog Kev Tswj Xyuas Cov Cai, thaum muaj feem xyuam. Txoj hauv kev siv los ntawm BHPs yuav txawv nyob ntawm tus txheej txheem hauv nroog, kev tsim nyog rau cov tswv cuab rau cov kev pabcuam, thiab lwm yam.
Rau kev them nyiaj rov qab los ntawm MH MAA, Txoj Haujlwm 4: Medi-Cal Kev Tshaj Tawm (MH-MAA Implementation Plan, p. 8) yog qhov tsim nyog los thov kev tshuaj ntsuam xyuas thiab xa mus los ntawm cov neeg ua haujlwm tsis muaj ntawv tso cai, qhov Kev Ua Haujlwm 16: Kev Tswj Xyuas Cov Ntaub Ntawv Tsis Qhib (p. 14) tsim nyog thov thaum kev tshuaj xyuas thiab kev sib koom ua ke xa mus los ntawm Cov Neeg Ua Haujlwm Kws Kho Mob.
Kev xeem
Qhov Kev Ntsuas Cov Cuab Yeej Ntsuas Ntsuas Qhov Ntsuas Qhov Ntsuas yog dab tsi?
Cov qhab nia uas tau tsim los ntawm Cov Cuab Yeej Tshuaj Xyuas txiav txim siab seb tus neeg ntawd puas yuav raug xa mus rau Managed Care Plan (MCP) lossis Behavioral Health Plans (BHP) rau kev ntsuam xyuas kev kho mob. Qhov qhab nia tshuaj ntsuam tsis txiav txim siab txog qib kev saib xyuas lossis cov kev pabcuam twg tsim nyog rau kev kho mob. Cov kev txiav txim siab no yog ua thaum lub sijhawm ntsuam xyuas kev kho mob thiab cov kev pabcuam tsim nyog rau kev kho mob yuav raug muab thaum lub sijhawm ntsuam xyuas, raws li txoj cai Tsis Muaj Qhov Rooj Tsis Ncaj Ncees raws li tau piav qhia hauv APL 22-005 thiab BHIN 22-011.
If an individual has a total screening score of “0″ does that mean they do not require mental health services in either delivery system?
No. If an individual has a screening score of “0,” they should be referred to the Managed Care Plan (MCP) for clinical assessment. Please refer to the scoring rubrics located in the Adult Screening Tool for Medi-Cal Mental Health Services and the Youth Screening Tool for Medi-Cal Mental Health Services for additional information and instruction.
Yuav ua li cas yog tias tus neeg tswj xyuas qhov Kev Ntsuam Xyuas Cov Cuab Yeej tsis pom zoo nrog cov qhab nia ntsuam xyuas? Puas yog Managed Care Plans (MCPs) thiab Behavioral Health Plans (BHPs) puas yuav tsum tau ua raws li qhov kev xa mus rau kev xa mus los ntawm cov qhab nia ntsuam xyuas?
Cov tib neeg yuav tsum raug xa mus rau qhov tsim nyog Medi-Cal kev noj qab haus huv kev puas siab puas ntsws (piv txwv li, MCP lossis BHP) rau kev soj ntsuam kuaj mob raws li lawv cov qhab nia kuaj. Cov cuab yeej tshuaj ntsuam xyuas yog tsim los rau kev tswj hwm los ntawm MCP thiab BHP cov neeg ua haujlwm, muaj ntawv tso cai lossis tsis muaj ntawv tso cai, thiab tsis tas yuav tsum muaj kev txiav txim siab kho mob. Thaum xa mus rau MCP lossis BHP, tus neeg yuav tau txais kev soj ntsuam kuaj mob uas yuav txiav txim siab txog qib kev saib xyuas thiab cov kev pabcuam uas tsim nyog.
In certain circumstances, the MCP or BHP may override the Screening Tool score when the result is inconsistent with the member’s clinical presentation (e.g., the Screening Tool score does not capture the need for specialty mental health services (SMHS) in members who are unable to respond to the Screening Tool questions due to serious mental health symptoms). Overriding the Screening Tool score shall only be conducted by specified practitioners of SMHS as defined in the State Plan or specified practitioners of non-specialty mental health services (NSMHS). MCPs/BHPs are responsible for ensuring that all practitioners deliver services within their scope of practice under California law. See APL 25-010 and BHIN 25-020 for MCP/BHP practitioner types that may override the Screening Tool score.
Cov kws kho mob puas siab puas ntsws tshwj xeeb lossis tsis yog tshwj xeeb puas raug tso cai hla cov qhab nia Kev Ntsuas?
Kev hloov qhov qhab nia ntawm Cov Cuab Yeej Tshuaj Xyuas yuav tsum tau ua los ntawm cov kws kho mob tshwj xeeb uas ua haujlwm nrog MCP/BHP lossis cov neeg cog lus raws li tau teev tseg hauv APL 25-010 thiab BHIN 25-020.. MCPs/BHPs muaj lub luag haujlwm los xyuas kom meej tias txhua tus kws kho mob muab cov kev pabcuam hauv lawv qhov kev xyaum raws li txoj cai lij choj California.
Saib APL 25-010 lossis BHIN 25-020 kom paub ntxiv txog cov hom kws kho mob uas tau tso cai hloov qhov qhab nia Screening Tool.
Ib tug neeg ua haujlwm uas tsis yog kws kho mob puas tuaj yeem siv Cov Cuab Yeej Tshuaj Xyuas thiab tom qab ntawd sab laj nrog tus kws kho mob kom hloov qhov qhab nia?
BHIN 25-020; APL 25-010; Ntxiv 3 rau Daim Ntawv Txuas 3.1-A
DHCS xav kom xa mus thiab cov kauj ruam tom ntej tom qab kev siv Cov Cuab Yeej Tshuaj Xyuas tshwm sim tam sim ntawd thiab tsis muaj kev ncua sijhawm rau kev tshuaj xyuas kev kho mob lossis kev saib xyuas. Cov Phiaj Xwm Kev Noj Qab Haus Huv Tus Cwj Pwm (BHPs) thiab Cov Phiaj Xwm Kev Saib Xyuas Kev Tswj Xyuas (MCPs) yuav tsum xyuas kom meej tias cov tswv cuab tau txais kev saib xyuas raws sijhawm raws li cov txiaj ntsig ntawm Cov Cuab Yeej Tshuaj Xyuas, thiab yuav tsum tsis txhob siv cov txheej txheem ua haujlwm uas ncua kev nkag mus rau kev saib xyuas kom tso cai rau kev sab laj kho mob ntxiv.
Txawm hais tias cov neeg ua haujlwm uas tsis muaj daim ntawv tso cai hauv Behavioral Health Plan (BHP) lossis Mental Health Plan (MHP) yuav ua tiav kev siv Cov Cuab Yeej Tshuaj Ntsuam Xyuas, kev hloov pauv tsuas yog tso cai thaum tus kws kho mob tshwj xeeb ntawm Specialty Mental Health Services (SMHS) lossis Non-Specialty Mental Health Services (NSMHS) ua, raws li tau txhais hauv State Plan, thiab tsuas yog thaum tus kws kho mob ntawd tab tom siv Cov Cuab Yeej Tshuaj Ntsuam Xyuas thiab siv lawv tus kheej qhov kev txiav txim siab thaum lub sijhawm siv.
Kev sib tham tiag tiag ntawm tus neeg ua haujlwm uas tsis muaj daim ntawv tso cai thiab tus kws kho mob uas muaj daim ntawv tso cai uas tsim nyog los hloov qhov qhab nia ntawm cov cuab yeej tshuaj ntsuam yuav tsim nyog rau qee qhov xwm txheej, yog tias cov txheej txheem no tsis ncua sijhawm nkag mus rau kev ntsuam xyuas kev kho mob, kev xa mus, lossis kauj ruam tom ntej. Txhua qhov kev hloov pauv ntawm cov qhab nia ntawm Cov Cuab Yeej Tshuaj Ntsuam Xyuas yuav tsum tshwm sim tsuas yog thaum tus kws kho mob tshwj xeeb tab tom siv cov cuab yeej thiab siv lawv tus kheej qhov kev txiav txim siab hauv kev kho mob thaum lub sijhawm thawj zaug siv Cov Cuab Yeej Tshuaj Ntsuam Xyuas thiab tsis yog tom qab. Kev ncua kev xa mus rau kev sab laj tom qab kev tshuaj ntsuam xyuas ua rau muaj kev nkag mus tsis raws sijhawm thiab tsis sib xws nrog lub hom phiaj ntawm txoj cai.
Puas Muaj Peev Xwm Tswj Xyuas Kev Npaj (MCPs) / Kev Npaj Kho Tus Cwj Pwm (BHPs) ntxiv ib ntu rau Cov Cuab Yeej Kev Ntsuas nrog cov ntaub ntawv pov thawj?
No. MCPs/BHPs should not alter the content of the Screening Tool forms. MCPs and BHPs must record overrides as well as the rationale through the MCP/BHP’s preferred monitoring method (Electronic Health Records (EHRs), excel spreadsheets, etc.). Override rationale and other information (additional override notes) should be shared when referring a member to the appropriate Medi-Cal mental health delivery system following administration of the Screening Tool
Puas muaj ib txoj hauv kev muab qhab nia rau Kev Hloov Kho Cov Cuab Yeej?
No. The Transition of Care Tool supports timely and coordinated care when adding a service from the other Medi-Cal mental health delivery system (i.e., Managed Care Plan (MCP) or Behavioral Health Plan (BHP)) or completing a transition of care to the other Medi-Cal mental health delivery system. The tool does this by providing a standardized process for sharing information and facilitating timely coordination across delivery systems. The tool is not meant to be diagnostic, and it is also not meant to replace existing DHCS criteria for access to specialty and non-specialty mental health services. MCPs and BHPs should follow existing access criteria and processes when determining whether a transition of care to, or addition of services from, the other delivery system is necessary for a member. Importantly, the determination as to whether a transition of care or addition of services should occur must be made by a clinician. This approach preserves flexibility for MCPs and BHPs; if an MCP or BHP uses an existing rubric that aligns with the access criteria, this policy does not prohibit them from continuing to use it to support determination of whether a referral for a transition of care to, or addition of services from, the individual’s MCP or BHP is needed. Once a determination has been made to transition care to, and/or add services from, the other delivery system, MCPs and BHPs are required to use the Transition of Care Tool to facilitate the referral.
Puas Muaj Peev Xwm Tswj Xyuas Kev Npaj (MCPs) thiab Kev Npaj Kho Tus Cwj Pwm (BHPs) siv cov rubric lossis cov txheej txheem thaum ua tiav Cov Kev Hloov Kho Kev Kho Mob?
Txoj Kev Hloov Kho Kev Kho Mob tsis yog txhais tau tias yuav kuaj xyuas lossis hloov DHCS cov txheej txheem uas twb muaj lawm rau kev nkag mus rau cov kev pabcuam tshwj xeeb thiab tsis yog tshwj xeeb rau kev puas siab puas ntsws raws li tau teev tseg hauv APL 22-006 thiab BHIN 21-073, lossis hloov tshiab tom ntej. Hloov chaw, Txoj Kev Hloov Kho Kev Kho Mob muab cov txheej txheem txheej txheem rau kev sib qhia cov ntaub ntawv thiab ua kom muaj kev sib koom ua ke raws sij hawm thoob plaws cov txheej txheem xa khoom thaum ntxiv cov kev pab cuam los ntawm, lossis ua tiav kev hloov pauv kev saib xyuas mus rau, lwm qhov Medi-Cal kev kho mob hlwb.
Kev txiav txim siab seb puas yuav hloov pauv kev saib xyuas lossis ntxiv cov kev pabcuam yuav tsum yog los ntawm tus kws kho mob raws li tau teev tseg hauv APL 25-010 thiab BHIN 25-020 . MCPs thiab BHPs tuaj yeem tsim cov txheej txheem, uas tuaj yeem suav nrog kev siv rubric lossis lwm yam txheej txheem, los txhawb qhov kev txiav txim siab no. Thaum ib tus kws kho mob txiav txim siab txog kev hloov pauv kev saib xyuas mus rau, thiab / lossis ntxiv cov kev pabcuam los ntawm, lwm qhov kev xa tawm, MCPs thiab BHPs yuav tsum siv Cov Kev Hloov Kho Kev Kho Mob los pab txhawb kev xa mus.
Cov kev tsis sib haum xeeb ntawm kev muab kev pabcuam ntawm MCPs thiab BHPs yuav tsum tau daws raws li DHCS cov lus qhia txog cov txheej txheem daws teeb meem uas tau teev tseg hauv APL 21-013 thiab BHIN 21-034.
Kev xa mus
Puas yog Managed Care Plans (MCPs) / Behavioral Health Plans (BHPs) yuav tsum tau tshaj tawm Daim Ntawv Ceeb Toom Txog Kev Ua Haujlwm (NOA) / Daim Ntawv Ceeb Toom Txog Kev Txiav Txim Siab Tsis Zoo (NOABD) yog tias ib tus neeg raug xa mus rau lwm qhov Medi-Cal kev noj qab haus huv ntawm lub hlwb raws li lawv cov qhab nia ntsuam xyuas?
Tsis yog. MCPs/BHPs yuav tsum tsis txhob muab NOA/NOABD yog tias ib tug neeg raug xa mus rau lwm qhov Medi-Cal kev noj qab haus huv kev puas siab puas ntsws rau kev ntsuam xyuas raws li lawv cov qhab nia ntsuam xyuas. Cov cuab yeej tshuaj ntsuam xyuas tsis txiav txim siab txog qhov txiaj ntsig lossis kev tsim nyog tau txais kev pabcuam, tab sis hloov kho qhov kev xa mus rau kev kho mob hlwb uas tsim nyog rau kev ntsuam xyuas thawj zaug rau Medi-Cal cov tswvcuab uas tam sim no tsis tau txais kev pabcuam kev puas hlwb thaum lawv hu rau MCP/BHP nrhiav kev pabcuam kev puas hlwb.
Yog xav paub ntxiv txog NOA/NOABD cov cai, MCPs thiab BHPs yuav xa mus rau APL 21-011 thiab BHIN 25-014, raws li.
Leej twg yog lub luag haujlwm rau kev sib koom tes xa mus rau lwm qhov kev xa khoom?
Thaum MCPs thiab BHPs thaum kawg yog lub luag haujlwm rau thiab yuav tsum tau ua kom muaj kev sib koom tes ntawm kev xa mus los ntawm kev xa khoom, cov neeg muab kev pabcuam raug tso cai los tswj kev xa mus rau lwm qhov kev xa tawm sawv cev rau cov tswvcuab hloov pauv ntawm cov khoom xa tuaj kom txhim kho cov txheej txheem no, yog tias tsim nyog.
(Ntxiv Lub Xya hli ntuj 2025) Managed Care Plans (MCPs)/Behavioral Health Plans (BHPs) yuav tsum ua li cas thaum ib tug tswvcuab poob rau kev soj ntsuam, tsis kam muab kev pab cuam thaum lub sij hawm xa mus, los yog nug kom nyob twj ywm hauv ib qho kev xa tawm? Yog tias ib tus neeg tau txais kev tshuaj ntsuam xyuas hauv ib qho kev xa khoom (MCP lossis BHP) tab sis tsis kam xa mus rau lwm qhov kev xa mus rau kev ntsuam xyuas lossis thov kom nyob twj ywm hauv qee qhov kev xa khoom, cov txheej txheem xa khoom (MCP lossis BHP) uas tswj xyuas qhov kev tshuaj ntsuam yuav tsum muab kev ntsuam xyuas. Raws li Txoj Cai Tsis Muaj Qhov Rooj Rau Kev Kho Mob Puas Hlwb tau piav qhia hauv APL 22-005 thiab BHIN 22-011, MCPs thiab BHPs tuaj yeem tau txais cov nyiaj them rov qab rau kev ntsuam xyuas thiab cov kev pabcuam kho mob uas tsim nyog thaum lub sijhawm ntsuam xyuas, tsis hais seb qhov kev ntsuam xyuas tau tshwm sim hauv cov txheej txheem kev sib ntsib ntawm tus kheej.
Thaum soj ntsuam, yog tias ib tus neeg tsis ua raws li cov txheej txheem nkag mus rau kev xa khoom uas ua tiav qhov kev ntsuam xyuas, MCP lossis BHP yuav tsum tau tshaj tawm Daim Ntawv Ceeb Toom Txog Kev Ua Haujlwm (NOA) / Daim Ntawv Ceeb Toom Txog Kev Txiav Txim Siab Tsis Zoo (NOABD) thiab siv Cov Kev Hloov Kho Kev Kho Mob los pab txhawb kev hloov pauv kev saib xyuas mus rau lwm qhov kev kho mob hlwb.
DHCS tsis tau muab kev taw qhia txog qhov tsawg kawg nkaus ntawm kev nthuav tawm kev sim thaum lub sij hawm tau txais kev tso cai rau MCP/BHP hloov tau tab sis tej zaum yuav ua tau yav tom ntej. DHCS txhawb MCPs thiab BHPs los tsim cov txheej txheem hauv zos los daws qhov xwm txheej no thiab hloov kho lawv cov P&Ps thiab MOUs kom ntseeg tau tias ua raws.
What should a Behavioral Health Plan (BHP) do if a Medi-Cal member’s screening score requires a referral to a Managed Care Plan (MCP), but the member is not enrolled in an MCP?
If a Medi-Cal member’s screening score requires a referral to an MCP but the Medi-Cal member is not enrolled in an MCP, the BHP must provide an assessment or facilitate enrollment in an MCP and coordinate the Medi-Cal member’s referral to ensure a timely clinical assessment.
Raws li Txoj Cai Tsis Muaj Qhov Rooj Rau Kev Kho Mob Puas Hlwb hauv APL 22-005 thiab BHIN 22-011, BHPs tuaj yeem tau txais cov nyiaj them rov qab rau qhov kev ntsuam xyuas thiab cov kev pabcuam uas tau muab rau lub sijhawm ntsuas, tsis hais seb qhov kev ntsuam xyuas tau ua raws li cov txheej txheem kev xa mus rau lwm qhov. Yog tias BHP ua qhov kev ntsuam xyuas thiab cov kev pabcuam kev puas siab puas ntsws tshwj xeeb (NSMHS) raug pom zoo, BHPs yuav tsum pab txhawb kev saib xyuas cov haujlwm, suav nrog kev ua raws li cov txheej txheem uas twb muaj lawm los pab txhawb MCP rau npe thiab/lossis txuas tus neeg mus rau Tus Nqi-rau-Service (FFS) tus kws kho mob rau NSMHS.
Feem ntau cov tswv cuab Medi-Cal yuav tsum tau tso npe rau hauv MCP. DHCS Health Care Options (HCO) Branch muab cov ntaub ntawv thiab cov kev pab cuam los txhawb Medi-Cal cov tswv cuab rau npe. HCO tseem tuaj yeem txhawb nqa Medi-Cal cov tswv cuab hauv kev nrhiav FFS tus kws kho mob yog tias tsim nyog. Yog xav paub ntxiv, mus saib ntawm DHCS cov vev xaib hauv qab no:
- Leej Twg Yuav Tsum Sau Npe: Qhia meej txog cov tswv cuab Medi-Cal twg yuav tsum tau rau npe rau hauv ib txoj kev npaj thiab cov uas raug zam (xws li cov tswv cuab tau txais kev pab cuam los ntawm Indian Health Provider lossis los ntawm Foster Care).
- Txoj Kev Sau Npe: Qhia seb Medi-Cal cov tswv cuab tuaj yeem tso npe rau hauv MCP online, hauv xov tooj, xa ntawv, lossis ntawm tus kheej.
- Tiv Tauj Peb: Muab cov ntaub ntawv tiv tauj rau HCO.
Puas yog Managed Care Plans (MCPs) thiab Behavioral Health Plans (BHPs) tau tso cai rov tshuaj xyuas tib neeg yog tias lawv xav tias lawv tsis tau qhab nia zoo?
Tsis yog. Thaum ib tus neeg raug xa mus rau MCP lossis BHP tom qab siv Cov Cuab Yeej Ntsuas, qhov tau txais MCP lossis BHP yuav tsis rov tshuaj xyuas tib neeg. Yog tias ib tus neeg raug xa mus rau MCP lossis BHP raws li cov qhab nia tsim los ntawm kev tswj hwm ntawm Kev Tshuaj Ntsuam Xyuas, MCP lossis BHP yuav tsum ua kom tus neeg tau txais kev saib xyuas raws sijhawm, suav nrog kev soj ntsuam raws sijhawm, ua raws li cov qauv uas twb muaj lawm thiab cov kev pabcuam kev puas hlwb uas tsim nyog.
Yuav sai npaum li cas tom qab tau txais kev xa mus los ntawm lwm qhov kev xa tawm yuav tsum Managed Care Plans (MCPs) thiab Behavioral Health Plans (BHPs) muab sijhawm teem rau kev soj ntsuam kuaj mob?
In accordance with AB 205, plans must comply with the appointment time standards pursuant to Section 1300.67.2.2 of Title 28 of the California Code of Regulations (CCR), as well as the standards set forth in contracts between DHCS and plans. Appointment time standards begin from the time of the initial request for health care services by an enrollee or the enrollee’s treating provider. If one Medi-Cal mental health delivery system (i.e., MCP or BHP) is referring an individual to the other mental health delivery system based on their screening score, appointment time standards would begin the day the MCP or BHP receives the referral. If a Medi-Cal mental health delivery system (i.e., the MCP or BHP) is referring an individual for a clinical assessment within its own delivery system based on their screening score, appointment time standards would begin the day the individual contacted the MCP or BHP initially seeking services.
Yuav ua li cas yog tias ib tug neeg raug xa mus rau Managed Care Plan (MCP) lossis Behavioral Health Plan (BHP) raws li lawv cov qhab nia ntsuam xyuas, tab sis lawv qhov kev ntsuam xyuas tom qab qhia tias lawv nyob hauv lwm qhov kev xa khoom?
Thaum Cov Kev Ntsuam Xyuas Cov Cuab Yeej yog npaj los coj cov tib neeg mus rau qhov tsim nyog tshaj plaws rau kev soj ntsuam kuaj mob thiab cov kev kho mob tsim nyog, tej zaum yuav muaj qhov xwm txheej thaum qhov kev soj ntsuam kuaj mob (uas khaws cov ntaub ntawv ntxiv) qhia tias tus neeg yuav tsum tau txais kev pabcuam hauv lwm qhov kev xa khoom. Hauv cov xwm txheej no, kev txiav txim siab txog qib kev saib xyuas thiab kev kho mob uas tsim nyog los ntawm kev soj ntsuam kev soj ntsuam yuav ua qhov tseem ceeb tshaj qhov kev xa mus rau kev xa mus los ntawm cov qhab nia ntsuam xyuas. Yog tias qhov no tshwm sim, MCP lossis BHP yuav siv Txoj Kev Hloov Kho Kev Kho Mob los pab txhawb kev hloov pauv kev saib xyuas mus rau lwm qhov kev kho mob hlwb. Raws li ib feem ntawm cov txheej txheem no, MCP lossis BHP yuav tsum koom tes nrog lwm cov kev pabcuam kev noj qab haus huv ntawm lub hlwb, suav nrog kev ua kom cov txheej txheem xa mus tiav, tus neeg tau txais kev pabcuam nrog tus kws khomob hauv cov txheej txheem tshiab, tus kws khomob tshiab lees txais kev saib xyuas ntawm tus kheej, thiab kev pabcuam khomob tau tsim muaj rau tus neeg.
Managed Care Plans (MCPs)/Behavioral Health Plans (BHPs) yuav tsum ua li cas yog tias lawv muaj teeb meem hu rau ib tus neeg uas tau raug xa mus rau MCP lossis BHP cov kev pabcuam?
MCPs thiab BHPs yuav tsum muaj kev sib koom tes ua ke los pab txhawb kev xa mus rau lwm qhov Medi-Cal kev kho mob hlwb. Xws li kev sib koom tes yuav tsum suav nrog cov txheej txheem los daws cov xwm txheej uas muaj teeb meem ua rau kev sib cuag nrog tus neeg. Raws li APL 25-010 thiab BHIN 25-020 , MCPs thiab BHPs yuav tsum hloov kho cov cai, cov txheej txheem, thiab cov ntawv sau cia ntawm kev nkag siab hauv kev ua raws li Medi-Cal kev noj qab haus huv ntawm lub paj hlwb kom ua raws li txoj cai. DHCS cia siab tias MCPs thiab BHPs yuav tsum ua raws li lawv tus kheej cov cai thiab cov txheej txheem, ua raws li CalAIM cov cai, thiab ua kom muaj kev ntseeg zoo los tiv tauj cov tswv cuab los pab txhawb kev xa mus.
Txhais rau
Puas yog DHCS yuav muab cov ntawv txhais lus ntawm Cov Cuab Yeej Ntsuas?
Yog lawm. DHCS tau tshaj tawm cov kev txhais lus ntawm Cov Neeg Laus thiab Cov Hluas Kev Tshuaj Ntsuam Xyuas hauv 12 hom lus. Kev txhais lus tuaj yeem nkag mus rau ntawm Kev Tshawb Fawb thiab Kev Hloov Kho Cov Cuab Yeej Kho Mob lub vev xaib.
Ua raws
Puas muaj kev tshaj tawm cov cai rau Kev Ntsuam Xyuas thiab Kev Hloov Kho Cov Cuab Yeej?
DHCS npaj siab los soj ntsuam qhov Kev Ntsuam Xyuas thiab Kev Hloov Pauv Kev Pabcuam Kev Pabcuam rau lub sijhawm los xyuas kom cov tib neeg tau txais kev saib xyuas tsim nyog thiab sijhawm sijhawm. Raws li ib feem ntawm cov txheej txheem no, kev qhia ntxiv yuav raug thov.
Kev sib tshuam nrog Lwm Txoj Cai
Yuav Ua Li Cas Cov Cuab Yeej Ntsuas Ua Raws Li Txoj Cai Tsis Muaj Qhov Rooj?
Cov Cuab Yeej Tshuaj Xyuas thiab Kev Hloov Chaw Saib Xyuas tsis sib haum thiab yuav tsum txhawb nqa lub hom phiaj ntawm txoj cai Tsis Muaj Qhov Rooj Tsis Ncaj Ncees. Cov cuab yeej no tsom mus rau kev coj cov tib neeg mus rau lub qhov rooj "yog" txij thaum pib lossis pab hloov cov tswv cuab mus rau lawv lub qhov rooj "tom ntej" kom yooj yim li sai tau. Lub hom phiaj yog kom ntseeg tau tias cov tib neeg tau txais kev taw qhia mus rau qhov kev xa khoom zoo tshaj plaws rau kev ntsuam xyuas thiab kev pabcuam siv txoj hauv kev txheem. Ntxiv mus, cov kws kho mob hlwb uas cov tswv cuab uas nrhiav kev pab kho mob hlwb tau tiv tauj ncaj qha tuaj yeem pib txheej txheem kev ntsuam xyuas thiab muab kev pab thaum lub sijhawm ntsuam xyuas yam tsis tas siv Cov Cuab Yeej Ntsuam Xyuas, raws li Txoj Cai Tsis Muaj Qhov Rooj Tsis Zoo rau Kev Pab Kho Mob Hlwb uas tau piav qhia hauv APL 22-005 thiab BHIN 22-011.