Medicaid Managed Care Final Rule Information
Lub Chaw Pabcuam Medicare thiab Medicaid (CMS) tau tshaj tawm Txoj Cai Kawg ntawm Medicaid thiab Children's Health Insurance Program (CHIP) Managed Care (Txoj Cai Kawg), uas sib phim txoj haujlwm kev pabcuam Medicaid managed care nrog lwm cov kev pabcuam kev pov hwm kev noj qab haus huv. Txoj Cai Kawg yuav siv tau rau lub Xya Hli 5, 2016 thiab siv rau Medi-Cal Managed Care Plans, County Mental Health Plans (MHPs), Drug Medi-Cal Organized Delivery System (DMC-ODS) Pilot Counties, thiab Dental Managed Care Plans. Cov MHP hauv Lub Nroog raug suav hais tias yog Cov Phiaj Xwm Kho Mob Hauv Tsev Kho Mob Ua Ntej (PIHPs), thiab yog li ntawd yuav tsum ua raws li Txoj Cai Kawg thiab Txoj Cai Kev Noj Qab Haus Huv Lub Siab thiab Kev Sib Luag ntawm Kev Quav Tshuaj (MHPAEA) uas suav nrog hauv Txoj Cai Kawg.
DHCS tab tom siv cov kev hloov pauv txoj cai uas yog los ntawm cov kev cai ntawm Txoj Cai Kawg thiab cov kev cai ua raws li MHPAEA uas suav nrog. Cov kev sib txuas thiab cov peev txheej hauv qab no yog muab los pab cov MHP hauv nroog thiab cov neeg koom nrog nkag mus rau cov ntaub ntawv dav dav txog Txoj Cai Kawg, California txoj Kev Npaj Ua Raws Cai MHPAEA, thiab cov Ntawv Ceeb Toom Txog Cov Ntaub Ntawv.
- Lub vev xaib DHCS Medicaid Managed Care muaj cov ntaub ntawv dav dav, cov sijhawm teem tseg, thiab cov peev txheej txog Txoj Cai Kawg thiab MHPAEA Parity cov kev cai.
- Lub vas sab ntawm MHSUDS Cov Ntawv Ceeb Toom muaj cov ntawv ceeb toom txog Txoj Cai Kawg thiab kev hloov pauv txoj cai ntawm MHPAEA.
Txhua nqe lus nug ntsig txog cov ntsiab lus ntawm nplooj ntawv no, lossis cov lus nug txog Txoj Cai Kawg thiab MHPAEA kev ua raws cai tuaj yeem xa mus rau MHSDFinalRule@dhcs.ca.gov.
Network txaus
Txoj Cai Medicaid Managed Care Final Rule xav kom cov xeev tsim lub sijhawm thiab nyob deb ntawm cov qauv kev noj qab haus huv rau cov neeg laus thiab menyuam yaus (kev noj qab haus huv hlwb thiab SUDS). Peb feem ntawm Medicaid Managed Care Final Rule suav nrog feem ntau ntawm cov qauv kev tsim nyog hauv network tau teev tseg hauv Title 42 ntawm Txoj Cai Tswjfwm Ntiag Tug:
- Tshooj 438.68, Cov qauv kev tsim nyog hauv lub network, xav kom cov xeev tsim cov qauv siv sijhawm thiab nyob deb rau cov neeg laus thiab menyuam yaus kev noj qab haus huv (kev puas siab puas ntsws thiab kev kho mob SUD).
- Tshooj 438.206, Muaj cov kev pabcuam, xav kom Cov Kev Npaj kom ua tau raws li Lub Xeev cov qauv rau kev nkag mus rau kev saib xyuas thiab kev pabcuam raws sijhawm, suav nrog qhov ceev ntawm qhov xav tau kev pabcuam.
- Tshooj 438.207, Kev lees paub txog kev muaj peev xwm txaus thiab cov kev pabcuam, xav kom txhua Txoj Kev Npaj xa cov ntaub ntawv mus rau DHCS, hauv ib hom ntawv teev tseg los ntawm DHCS, kom pom tau tias nws ua raws li cov cai hauv qab no:
- Muab cov kev pabcuam tsim nyog uas tsim nyog rau tus naj npawb ntawm cov neeg tau txais kev pabcuam rau thaj chaw pabcuam (xws li lub nroog); thiab,
- Tuav lub network ntawm cov chaw muab kev pabcuam, ua haujlwm nyob rau hauv qhov kev coj ua raws li Lub Xeev txoj cai lij choj, uas txaus rau tus lej, sib xyaw, thiab thaj chaw faib khoom kom tau raws li qhov xav tau ntawm cov neeg tau txais txiaj ntsig xav tau hauv thaj chaw pabcuam (ie, lub nroog).
Thaum Lub Ob Hlis 13, 2018, DHCS tau tshaj tawm Mental Health and Substance Use Disorder Services (MHSUDS) Cov Ntaub Ntawv Ceeb Toom No. 18-011, Tsoom Fwv Teb Chaws Network Adequacy Standards for Mental Health Plans (MHPs) thiab Drug Medi-Cal Organized Delivery System (DMC-ODS) Pilotade Counties, 42 ntawm Txoj Cai ntawm Tsoom Fwv Teb Chaws Txoj Cai Tshooj 438.68, raws li tau teev tseg hauv Tshooj 738, Txoj Cai ntawm 2017 (Kev Sib Koom Tes 205).
DHCS tau ua ib qho kev soj ntsuam ntawm MHP cov kev pabcuam tshwjxeeb rau kev puas hlwb (SMHS) network. DHCS tau tshuaj xyuas kom ua raws li cov hauv qab no:
- Sijhawm thiab nyob deb - daim ntawv qhia txog thaj chaw nkag;
- Cov txheej txheem kev siv lwm yam;
- Network muaj pes tsawg leeg thiab muaj peev xwm;
- Muaj peev xwm pab lus; thiab,
- System infrastructure.
Cov txiaj ntsig ntawm DHCS qhov kev tshuaj xyuas tau piav qhia meej hauv cov ntawv qhia hauv qab no:
- SMHS Network Certification Cover Letter
- Network Certification Specialty Mental Health Services txhua xyoo
-
Tsab ntawv txiav txim - San Joaquin County Mental Health Plan
-
Daim Ntawv Qhia Txog Kev Pom Zoo Txog Kev Sib Txuas Lus Xyoo 2019 - Txoj Kev Npaj Kho Mob Hlwb
Mental Health Plans Network Certification thiab Network Adequacy Archive
Yog tias koj muaj lus nug txog cov kev cai txaus ntawm lub network, thov hu rau DHCS ntawm MHSDFinalRule@dhcs.ca.gov
Rov qab mus rau nplooj ntawv Qhia Txog Kev Kho Mob puas hlwb