Tsev Cov Kev Pabcuam Kev Tshuaj Xyuas Kev Kho Mob thiab Cov Phiaj Xwm Kho Kom Zoo

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

The Department of Health Care Services (DHCS) works with the Department of Managed Health Care (DMHC) to conduct routine medical surveys of Medi-Cal Managed Care Health Plans (MCPs) on selected populations on an annual basis. The medical survey is a comprehensive evaluation of the MCP’s compliance with managed health care law Period(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.

Kev tswj kev siv
Case Management thiab Kev Sib Koom Tes ntawm Kev Kho Mob
Nkag mus thiab Muaj
Tswvcuab Txoj Cai
Kev Txhim Kho Zoo
Kev Tswj Xyuas thiab Kev Tswj Xyuas Kev Muaj Peev Xwm
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 Txog Kev Tshawb Fawb

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

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

Tshaj tawm​​

Aetna Better Health of California​​

AIDS Healthcare Foundation​​

Alameda Alliance for Health​​

Anthem Blue Cross Partnership Plan​​

Blue Shield ntawm CA Promise Health Plan​​

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

CalOptima yog​​

CalViva Health​​

CenCal Health​​

Central California Alliance for Health​​

Community Health Group Partnership Plan​​

Txoj Kev Npaj Kho Mob Hauv Zej Zog ntawm Imperial Valley​​

Contra Costa Health Plan​​

Gold Coast Health Plan​​

Health Net Community Solutions, Inc.​​

Health Plan ntawm San Joaquin​​

Health Plan ntawm San Mateo​​

Inland Empire Health Plan​​

Kern Health Systems​​

Kaiser​​

LA Care Health Plan​​

Molina Healthcare ntawm California Partner Plan, Inc.​​

Partnership Health Plan of California​​

Rady Children’s Hospital-San Diego​​

San Francisco Health Plan​​

Santa Clara Family Health Plan​​

Senior Care Action Network Plan Health Plan​​

United Healthcare Community Plan of California, Inc.​​

Kho kom raug Action Plans​​

Aetna Better Health of California​​

AIDS Healthcare Foundation​​

Alameda Alliance for Health​​

Anthem Blue Cross Partnership Plan​​

Blue Shield ntawm CA Promise Health Plan​​

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

CalOptima yog​​

CalViva Health​​

CenCal Health​​

Central California Alliance for Health​​

Community Health Group Partnership Plan​​

Contra Costa Health Plan​​

Gold Coast Health Plan​​

Health Net Community Solutions, Inc.​​

Health Plan ntawm San Joaquin​​

Health Plan ntawm San Mateo​​

Inland Empire Health Plan​​

Kern Health Systems​​

Kaiser​​

LA Care Health Plan​​

Molina Healthcare ntawm California Partner Plan, Inc.​​

Partnership Health Plan of California​​

Rady Children’s Hospital-San Diego​​

San Francisco Health Plan​​

Santa Clara Family Health Plan​​

Senior Care Action Network Plan Health Plan​​

United Healthcare Community Plan of California, Inc.​​

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

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

Tshaj tawm

Aetna Better Health of California

AIDS Healthcare Foundation

Alameda Alliance for Health

Anthem Blue Cross Partnership Plan

Blue Shield ntawm CA Promise Health Plan

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

CalOptima yog

CalViva Health

CenCal Health

Central California Alliance for Health

Community Health Group Partnership Plan

Txoj Kev Npaj Kho Mob Hauv Zej Zog ntawm Imperial Valley

Contra Costa Health Plan

Gold Coast Health Plan

Health Net Community Solutions, Inc.

Health Plan ntawm San Joaquin

Health Plan ntawm San Mateo

Inland Empire Health Plan

Kern Health Systems

Kaiser

LA Care Health Plan

Molina Healthcare ntawm California Partner Plan, Inc.

Partnership Health Plan of California

Rady Children’s Hospital-San Diego

San Francisco Health Plan

Santa Clara Family Health Plan

Senior Care Action Network Plan Health Plan

United Healthcare Community Plan of California, Inc.

Kho kom raug Action Plans

Aetna Better Health of California

AIDS Healthcare Foundation

Alameda Alliance for Health

Anthem Blue Cross Partnership Plan

Blue Shield ntawm CA Promise Health Plan

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

CalOptima yog

CalViva Health

CenCal Health

Central California Alliance for Health

Community Health Group Partnership Plan

Contra Costa Health Plan

Gold Coast Health Plan

Health Net Community Solutions, Inc.

Health Plan ntawm San Joaquin

Health Plan ntawm San Mateo

Inland Empire Health Plan

Kern Health Systems

Kaiser

LA Care Health Plan

Molina Healthcare ntawm California Partner Plan, Inc.

Partnership Health Plan of California

Rady Children’s Hospital-San Diego

San Francisco Health Plan

Santa Clara Family Health Plan

Senior Care Action Network Plan Health Plan

United Healthcare Community Plan of California, Inc.