Hla mus rau Cov Ntsiab Lus Tseem Ceeb​​ 

Kev Tshawb Fawb Txog Kev Kho Mob thiab Kev Npaj Kho Kom Zoo​​ 

Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) ua haujlwm nrog Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DMHC) txhawm rau ua cov kev tshawb fawb kho mob niaj hnub ntawm Medi-Cal Managed Care Health Plans (MCPs) ntawm cov neeg xaiv txhua xyoo. Daim ntawv ntsuam xyuas kho mob yog ib qho kev ntsuam xyuas tag nrho ntawm MCP txoj kev ua raws li txoj cai tswj xyuas kev noj qab haus huv Sijhawm (Knox-Keene Health Care Service Plan Act).​​ 

DHCS 'Managed Care Quality and Monitoring Division (MCQMD) yog lub luag haujlwm los xyuas kom meej tag nrho cov kev saib xyuas thiab kev saib xyuas ntawm MCPs. MCQMD tau xaiv Lub Chaw Saib Xyuas Daim Ntawv Cog Lus & Kev Sau Npe (CERD) ntawm DHCS' Kev Tshawb Fawb thiab Kev Tshawb Fawb (A&I) txhawm rau ua cov kev soj ntsuam uas raug cai.​​ 

MCQMD thiab A&I tau koom tes ua ke los tsim Cov Kev Pabcuam Kev Pabcuam (TAG) rau txhua yam ntawm 6 pawg kev tshuaj xyuas hauv qab no. Cov TAGs tau tsim los txheeb xyuas cov ntsiab lus tseem ceeb uas yuav raug soj ntsuam ntau los qhia rau MCPs ntawm cov txheej txheem tshawb xyuas thiab ua kom pom tseeb.​​ 

  1. Kev tswj kev siv​​ 
  2. Case Management thiab Kev Sib Koom Tes ntawm Kev Kho Mob​​ 
  3. Nkag mus thiab Muaj​​ 
  4. Tswvcuab Txoj Cai​​ 
  5. Kev Txhim Kho Zoo​​ 
  6. Kev Tswj Xyuas thiab Kev Tswj Xyuas Kev Muaj Peev Xwm​​ 
  7. Kev Pabcuam Hauv Xeev​​ 

DHCS ua qhov kev tshawb pom qhov tseeb hais txog lub peev xwm ntawm MCPs los muab cov kev pabcuam kev noj qab haus huv zoo, kev ua haujlwm zoo ntawm kev txheeb xyuas cov phooj ywg, thiab cov txheej txheem tswj kev siv, thiab kev ua tau zoo tag nrho hauv kev muab cov txiaj ntsig kev noj qab haus huv rau nws cov neeg kawm. Cov kev tshuaj xyuas no pab DHCS nrog rau nws txoj kev saib xyuas tag nrho, thiab txheeb xyuas thaj chaw ntawm kev tsis ua raws cai, uas yog lub hauv paus rau kev kho kom raug.​​ 

MCPs yuav tsum tau muab Daim Phiaj Xwm Kho Kom Zoo (CAP) thaum ua tiav ntawm DHCS Kev Tshawb Fawb Kev Kho Mob lossis lwm yam kev soj ntsuam xyuas qhov kev tshawb pom tau pom. DHCS ua CAP kev ntsuam xyuas thiab muab kev pab cuam los xyuas kom meej tias ua raws.​​ 

Daim Ntawv Ceeb Toom Txog Kev Kho Mob thiab Cov Kev Npaj Kho Kom Zoo:​​ 

Saib hauv qab no rau Daim Ntawv Tshaj Qhia Kev Tshawb Fawb tsis ntev los no thiab cov phiaj xwm kho kom raug​​ 

Tshaj tawm​​ 

Aetna Better Health of California​​ 

2023 Kev Tshawb Fawb Kev Tshawb Fawb Tshaj Tawm
​​ 

2023 Qhia
​​ 

AIDS Healthcare Foundation​​ 

2023 Kev Tshawb Fawb Kev Tshawb Fawb Tshaj Tawm
​​ 

2024 Qhia
​​ 

Alameda Alliance for Health​​ 

2023 Kev Tshawb Fawb Txog Kev Tshawb Fawb​​ 

2025​​  Qhia​​ 

Anthem Blue Cross Partnership Plan​​ 

2023 Kev Tshawb Fawb Kev Tshawb Fawb Tshaj Tawm
​​ 

2024 Qhia
​​ 

Blue Shield ntawm CA Promise Health Plan​​ 

2023 Kev Tshawb Fawb Kev Tshawb Fawb Tshaj Tawm
​​ 

2024 Qhia
​​ 

California Kev Noj Qab Haus Huv thiab Kev Noj Qab Haus Huv​​ 

2023 Kev Tshawb Fawb Kev Tshawb Fawb Tshaj Tawm
​​ 

2024 Qhia
​​ 

CalOptima yog​​ 

2023 Kev Tshawb Fawb Txog Kev Tshawb Fawb​​ 

2025​​  Qhia​​ 

CalViva Health​​ 

2023 Kev Tshawb Fawb Kev Tshawb Fawb Tshaj Tawm
​​ 

2024 Qhia
​​ 

CenCal Health​​ 

2023 Kev Tshawb Fawb Kev Tshawb Fawb Tshaj Tawm
​​ 

2024 Qhia
​​ 

Central California Alliance for Health​​ 

2023 Kev Tshawb Fawb Kev Tshawb Fawb Tshaj Tawm
​​ 

2025​​  Qhia​​ 

Community Health Group Partnership Plan​​ 

2023 Kev Tshawb Fawb Kev Tshawb Fawb Tshaj Tawm
​​ 

2024 Qhia
​​ 

Contra Costa Health Plan​​ 

2023 Kev Tshawb Fawb Kev Tshawb Fawb Tshaj Tawm
​​ 

2024 Qhia
​​ 

Gold Coast Health Plan​​ 

2023 Kev Tshawb Fawb Kev Tshawb Fawb Tshaj Tawm
​​ 

2024 Qhia
​​ 

Health Net Community Solutions, Inc.​​ 

2023 Kev Tshawb Fawb Kev Tshawb Fawb Tshaj Tawm
​​ 

2024 Qhia
​​ 

Health Plan ntawm San Joaquin​​ 

2023 Kev Tshawb Fawb Kev Tshawb Fawb Tshaj Tawm
​​ 

2024 Qhia
​​ 

Health Plan ntawm San Mateo​​ 

2023 Kev Tshawb Fawb Kev Tshawb Fawb Tshaj Tawm
​​ 

2024 Qhia
​​ 

Inland Empire Health Plan​​ 

2023 Kev Tshawb Fawb Kev Tshawb Fawb Tshaj Tawm
​​ 

2024 Qhia
​​ 

Kern Health Systems​​ 

2023 Kev Tshawb Fawb Kev Tshawb Fawb Tshaj Tawm
​​ 

2024 Qhia
​​ 

Kaiser​​ 

2023 Kev Tshawb Fawb Txog Kev Tshawb Fawb (Sacramento)
​​ 

2023 Kev Tshawb Fawb Txog Kev Tshawb Fawb (San Diego)
​​ 

2024 Qhia
​​ 

LA Care Health Plan​​ 

2023 Kev Tshawb Fawb Kev Tshawb Fawb Tshaj Tawm
​​ 

2024 Qhia 
​​ 

Molina Healthcare ntawm California Partner Plan, Inc.​​ 

2023 Kev Tshawb Fawb Kev Tshawb Fawb Tshaj Tawm
​​ 

2024 Report
​​ 

2025 Qhia
​​ 

Partnership Health Plan of California​​ 

2023 Kev Tshawb Fawb Kev Tshawb Fawb Tshaj Tawm
​​ 

2024 Qhia
​​ 

Rady Children's Hospital-San Diego​​ 

2021​​  Qhia​​ 

San Francisco Health Plan​​ 

2023 Kev Tshawb Fawb Kev Tshawb Fawb Tshaj Tawm
​​ 

2024 Qhia
​​ 

2025 Qhia 
​​ 

Santa Clara Family Health Plan​​ 

2023 Kev Tshawb Fawb Kev Tshawb Fawb Tshaj Tawm
​​ 

2025​​  Qhia​​ 

Senior Care Action Network Plan Health Plan​​ 

2023 Kev Tshawb Fawb Kev Tshawb Fawb Tshaj Tawm
​​ 

2024 Qhia
​​ 

2025 Qhia 
​​ 

United Healthcare Community Plan of California, Inc.​​ 

2022 Qhia
​​ 

Kho kom raug Action Plans​​ 

Aetna Better Health of California​​ 

2023 Corrective Action Plan
​​ 

AIDS Healthcare Foundation​​ 

Txoj Kev Npaj Kho Kom Zoo tau ua tiav​​ 

Alameda Alliance for Health​​ 

Txoj Kev Npaj Kho Kom Zoo tau ua tiav​​ 

Anthem Blue Cross Partnership Plan​​ 

Txoj Kev Npaj Kho Kom Zoo tau ua tiav​​ 

Blue Shield ntawm CA Promise Health Plan​​ 

2024 Corrective Action Plan
​​ 

California Kev Noj Qab Haus Huv thiab Kev Noj Qab Haus Huv​​ 

Kev Kho Kom Zoo Tsis Xav Tau​​ 

CalOptima yog​​ 

Txoj Kev Npaj Kho Kom Zoo tau ua tiav​​ 

CalViva Health​​ 

2024 Corrective Action Plan
​​ 

CenCal Health​​ 

2024 Corrective Action Plan
​​ 

Central California Alliance for Health​​ 

Txoj Kev Npaj Kho Kom Zoo tau ua tiav​​ 

Community Health Group Partnership Plan​​ 

2024 Corrective Action Plan
​​ 

Contra Costa Health Plan​​ 

Txoj Kev Npaj Kho Kom Zoo tau ua tiav​​ 

Gold Coast Health Plan​​ 

2023 Corrective Action Plan
​​ 

Health Net Community Solutions, Inc.​​ 

Txoj Kev Npaj Kho Kom Zoo tau ua tiav​​ 

Health Plan ntawm San Joaquin​​ 

Txoj Kev Npaj Kho Kom Zoo tau ua tiav​​ 

Health Plan ntawm San Mateo​​ 

2023 Corrective Action Plan
​​ 

Inland Empire Health Plan​​ 

2023 Corrective Action Plan
​​ 

Kern Health Systems​​ 

Txoj Kev Npaj Kho Kom Zoo tau ua tiav​​ 

Kaiser​​ 

Txoj Kev Npaj Kho Kom Zoo tau ua tiav​​ 

LA Care Health Plan​​ 

Txoj Kev Npaj Kho Kom Zoo tau ua tiav​​ 

Molina Healthcare ntawm California Partner Plan, Inc.​​ 

2024 Corrective Action Plan
​​ 

Partnership Health Plan of California​​ 

2023 Corrective Action Plan
​​ 

Rady Children's Hospital-San Diego​​ 

Kev Kho Kom Zoo Tsis Xav Tau​​ 

San Francisco Health Plan​​ 

2024 Corrective Action Plan
​​ 

Santa Clara Family Health Plan​​ 

Txoj Kev Npaj Kho Kom Zoo tau ua tiav​​ 

Senior Care Action Network Plan Health Plan​​ 

United Healthcare Community Plan of California, Inc.​​ 

Kev Kho Kom Zoo Tsis Xav Tau​​ 

Archived Reports thiab CAPS​​ 

Hnub hloov tshiab kawg: 10/1/2025 12:53 PM​​