Tsev Cov Kev Pabcuam Module 2: Kev Ua Haujlwm ntawm MCP-Hub Kev Koom Tes​​ 

Module 2: Kev Ua Haujlwm ntawm MCP-Hub Kev Koom Tes​​ 

Tshooj 1: Txheej Txheem Cej Luam​​ 

Module 2 piav qhia txog cov kev cai cog lus ntawm Medi-Cal Managed Care Plan (MCP) uas twb muaj lawm hauv cov ntsiab lus ntawm kev sib raug zoo ntawm MCP-Hub, thiab suav nrog cov ntaub ntawv hais txog:​​ 

  • Cov kev txiav txim siab txog kev cog lus rau MCPs thiab Hubs.​​ 
  • Pawg Neeg Sawv Cev.​​ 
  • Cov hom ntawv cog lus ntawm MCPs thiab Hubs.​​ 
  • Cov tub ceev xwm raws li txoj cai.​​ 
  • Cov kev xav tshwj xeeb rau Kev Tswj Xyuas Kev Kho Mob Zoo Dua (ECM), Kev Txhawb Nqa Hauv Zej Zog, Cov Kev Pabcuam Neeg Ua Haujlwm Saib Xyuas Kev Noj Qab Haus Huv Hauv Zej Zog (CHW), thiab cov kev pabcuam Doula.​​ 

Tom qab tshuaj xyuas Module 2, MCPs thiab Hubs yuav nkag siab zoo dua txog:​​ 

  • Cov kev cai uas twb muaj lawm uas siv rau kev koom tes ntawm MCP-Hub.​​ 
  • Yuav ua li cas txiav txim siab txog kev sib raug zoo ntawm daim ntawv cog lus.​​ 
  • Yuav ua li cas los ntawm kev sib tham txog kev cog lus.​​ 

Cov Ntsiab Lus Tseem Ceeb ntawm Module 2​​ 

Yog tias MCP thiab Hub nrhiav kev koom tes ua lag luam:​​ 

  • Lub Hub yuav tsum ua raws li cov cai ib yam li lwm cov neeg cog lus ua haujlwm rau lwm tus, raws li qhov tsim nyog, raws li hom kev pom zoo uas Lub Hub thiab MCP ua.​​ 
  • The MCPs must adhere to requirements set forth in the MCP Contract, respective program requirements, and All Plan Letter (APL) guidance, as applicable.​​ 

See the References and Additional Resources  for a list of applicable guidance and additional resources for this module.​​ 

Tshooj 2: Kev Muab Cai thiab Kev Cog Lus ntawm MCP-Hub​​ 

Pawg Neeg Sawv Cev​​ 

Kev muab txoj haujlwm tshwm sim thaum qee yam haujlwm thiab cov luag haujlwm ntawm MCP raws li Daim Ntawv Cog Lus MCP—xws li kev tswj hwm kev siv, kev lees paub, lossis kev ua cov ntaub ntawv thov—tau muab txoj haujlwm rau Tus Neeg Cog Lus Qis lossis Tus Neeg Cog Lus Qis. Cov kev cog lus cog lus ntawm MCP-Hub feem ntau yuav ua rau MCP muab qee yam (tab sis tsis yog txhua yam) ntawm lawv cov luag haujlwm thiab kev lav phib xaub rau Hub ncaj qha lossis tsis ncaj qha. Cov Chaw Hub no raug suav hais tias yog cov chaw ua haujlwm tswjfwm lossis ib feem ntawm cov neeg tau muab cai thiab raug rau tib cov txheej txheem cog lus thiab saib xyuas uas MCPs siv rau lwm cov neeg cog lus hauv qab, raws li siv tau. Thaum kawg, MCP tseem muaj lub luag haujlwm los xyuas kom ua raws li lub xeev thiab tsoomfwv cov cai. Kev saib xyuas cov chaw tswj hwm thiab cov chaw muab kev pabcuam ib nrab yog qhov tseem ceeb heev los tiv thaiv cov tswv cuab Medi-Cal los ntawm kev ua kom ntseeg tau tias Cov Neeg Cog Lus thiab Cov Neeg Cog Lus Hauv Qab Ua Tau raws li cov qauv thiab cov kev cai ntawm Medi-Cal, raws li siv tau.​​ 

A Hub that does not take on duties and obligations of the MCP but supports Network Providers in completing administrative activities may be considered a third-party vendor rather than a Subcontractor or Downstream Subcontractor (see reference to Aliados Health in Module 1). It is the responsibility of the MCP and Hub to determine the Hub’s role and ensure that agreements or contracts reflect the requirements of that role.​​ 

Kev Cog Lus MCP-Hub​​ 

Cov chaw pabcuam yuav poob rau hauv cov pawg neeg cog lus sib txawv nyob ntawm seb qhov ntau thiab tsawg ntawm cov haujlwm tau teev tseg hauv lawv cov ntawv cog lus ncaj qha lossis tsis ncaj qha nrog MCP. MCPs feem ntau yuav cog lus nrog Hubs ua Subcontractors, tab sis qee qhov Hubs yuav yog lwm hom koom haum:​​ 

Cov Neeg Cog Lus Ua Haujlwm Pab (Daim Ntawv Cog Lus Ua Haujlwm Pab nrog MCP):​​ 
Administrative Subcontractors: These entities handle administrative functions such as credentialing or claims processing.
Partially Delegated Subcontractors: These entities take on broader responsibilities, including obligations tied to specific Medi-Cal Member groups or certain service areas.
Downstream Subcontractors (Downstream Subcontractor Agreement with a Subcontractor or Downstream Subcontractor): Some Hubs are Downstream Administrative Subcontractors or Downstream Partially Delegated Subcontractors to the MCP. This would include, for example, an Independent Physician Association (IPA) with a partially delegated contract with an MCP entering into a Downstream Subcontractor Agreement with another organization (Organization A) to provide claims processing support. In that case, Organization A would be considered a Downstream Subcontractor of the MCP.
Network Providers (Network Provider Agreement with MCP or MCP’s Subcontractor or Downstream Subcontractor): Some Hubs order, refer, or render Covered Services in addition to their other Hub functions. These Hubs would be Network Providers in addition to being a Subcontractor or Downstream Subcontractor. Contracts with these Hubs would need to comply with the requirements for both (1) Subcontractor Agreements or Downstream Subcontractor Agreements, as applicable, and (2) Network Provider Agreements.
Third Party Vendors (Agreements with MCP Vary): Some Hubs centralize administrative functions for Network Providers without a direct or downstream contract with an MCP. These arrangements vary and may require vendors to enter into a Business Associates Agreement (BAA) with the MCP to meet Medi-Cal requirements.​​ 

See Types of Contracts Between MCPs and Hubs for more information, including a tool to help determine the appropriate contracting relationship category or categories for a given Hub organization.​​ 

Cov Hom Kev Cog Lus Ntawm MCPs thiab Hubs​​ 

Subcontractors/Downstream Subcontractors                     MCPs may directly enter into Subcontractor Agreements with Hubs as Administrative Subcontractors or Partially Delegated Subcontractors. In addition, Subcontractors or Downstream Subcontractors may enter into Downstream Subcontractor Agreements with Hubs as Downstream Administrative Subcontractors or Downstream Partially Delegated Subcontractors.​​                               

Subcontractor Agreements. Per the MCP Contract, MCPs may directly enter into Subcontractor Agreements with qualified Subcontractors to delegate certain functions. Subcontractor Agreements must meet certain requirements outlined in detail below and in the MCP Contract.
Administrative Subcontractors
Partially Delegated Subcontractors
Fully Delegated Subcontractors
Downstream Subcontractor Agreements. MCPs may contract with Subcontractors who then enter into Downstream Subcontractor Agreements with entities for downstream services, as applicable. Downstream Subcontractors may also contract directly with entities for certain downstream services. Although the MCP would not hold the direct contract with the entity, the MCP maintains ultimate responsibility for that entity’s performance and compliance with applicable regulations, regardless of the layers of subcontracting.​​ 

DHCS txhais peb hom SubContractors rau cov ntawv cog lus ncaj qha nrog MCPs:​​                                                                      

DHCS txhais peb hom Downstream Subcontractors rau MCPs:​​                                                                      

Downstream Administrative Subcontractors
Downstream Partially Delegated Subcontractors
Downstream Fully Delegated Subcontractors​​ 

Piv txwv li, ib lub Hub yuav yog Tus Neeg Cog Lus Qis Dua yog tias nws tau cog lus nrog ib lub koom haum Muab Kev Pabcuam los txhawb kev cob qhia ntawm Tus Neeg Muab Kev Pabcuam, kev thov nyiaj, kev tshaj tawm, thiab lwm yam haujlwm tswj hwm rau cov Tswv Cuab Medi-Cal uas tau sau npe nrog MCP. Yog tias lub koom haum muab kev pabcuam xaj, xa mus, lossis muab cov Kev Pabcuam Uas Tau Them Ntxiv rau cov kev pabcuam kev tswjfwm, nws kuj yuav yog Tus Muab Kev Pabcuam Hauv Network.​​                                                                      

Cov Hubs yuav tsis yog Tus Neeg Cog Lus Ua Haujlwm Tag Nrho lossis Tus Neeg Cog Lus Ua Haujlwm Tag Nrho. Cov Neeg Cog Lus Uas Tau Muab Cai Tag Nrho thiab Cov Neeg Cog Lus Uas Tau Muab Cai Tag Nrho yog cov uas muaj lub luag haujlwm rau txhua txoj haujlwm ntawm Daim Ntawv Cog Lus MCP tshwj tsis yog cov uas raug txwv tsis pub ua hauv Daim Ntawv Cog Lus MCP, xws li kev muab txhua yam kev pabcuam Medi-Cal uas them rau cov tswv cuab Medi-Cal uas tsim nyog. Yog li ntawd, cov chaw no yuav tsis yog Hubs. Cov Neeg Cog Lus Uas Tau Muab Cai Tag Nrho feem ntau yog lwm cov MCPs.​​                                                                          

  • Network Providers. A Hub would contract both as (1) a Network Provider and (2) a Subcontractor or Downstream Subcontractor, as applicable, if the Hub is ordering, referring, or rendering covered Medi-Cal services in addition to its other duties as a Hub. If that is the case, MCPs must ensure the roles, functions, and payment structures for the Hub are clearly defined and documented in the MCP’s contracts and reporting to DHCS. Contracts with these Hubs would need to comply with the requirements for both (1) Subcontractor Agreements or Downstream Subcontractor Agreements, as applicable, and (2) Network Provider Agreements. See definitions below and refer to the MCP Contract and APL 19-001 or any superseding APL for more information on Network Provider Status.
           
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Tus Muab Kev Pabcuam Hauv Network​​ Tus Neeg Cog Lus Ua Haujlwm Ib Ntus lossis Tus Neeg Cog Lus Ua Haujlwm Ib Ntus​​ 
  • Network Provider means any provider or entity that has a Network Provider Agreement with the MCP, the MCP’s Subcontractor, or MCP’s Downstream Subcontractor, and receives Medi-Cal funding directly or indirectly to order, refer, or render Covered Services under the MCP Contract. A Network Provider is not a Subcontractor or Downstream Subcontractor by virtue of the Network Provider Agreement.​​ 
  • Yog tias ib lub Hub xaj, xa mus, lossis muab Cov Kev Pabcuam Uas Tau Them Raws Li Daim Ntawv Cog Lus MCP, ntxiv rau nws cov haujlwm ua ib lub Hub, nws yuav raug suav hais tias yog ob qho tib si (1) Tus Muab Kev Pabcuam Network thiab (2) Tus Neeg Cog Lus Qis lossis Tus Neeg Cog Lus Qis, raws li siv tau.​​ 
  • A Subcontractor means an individual or entity that has a Subcontractor Agreement with the MCP that relates directly or indirectly to the performance of the MCP’s obligations under the MCP contract. A Network Provider is not a Subonctractor solely because it enters into a Network Provider Agreement.​​ 
  • Tus Neeg Cog Lus Hauv Qab txhais tau tias yog ib tus neeg lossis ib lub koom haum uas muaj Daim Ntawv Cog Lus Hauv Qab nrog Tus Neeg Cog Lus Hauv Qab lossis Tus Neeg Cog Lus Hauv Qab. Tus Muab Kev Pabcuam Hauv Network tsis yog tus neeg cog lus hauv qab tsuas yog vim nws nkag mus rau hauv Daim Ntawv Cog Lus Muab Kev Pabcuam Hauv Network.​​ 
  • Yog tias lub hub tsuas yog muab cov kev pabcuam xws li kev tswj hwm Network, suav nrog kev cog lus rau tus neeg muab kev pabcuam, kev lees paub, lossis kev cob qhia, thiab tsis xaj, xa mus, lossis muab Cov Kev Pabcuam Uas Tau Them Raws li Daim Ntawv Cog Lus MCP, ces lub Hub tsuas yog suav tias yog Tus Neeg Cog Lus Qis lossis Tus Neeg Cog Lus Qis, raws li qhov siv tau, thiab tsis yog Tus Neeg Muab Kev Pabcuam Network.​​  
  • Hubs as Third-Party Vendors. Hubs that centralize administrative functions for Network Providers may contract under Third-Party Vendor agreements. These arrangements may require vendors to enter into a BAA with the MCP to safeguard and protect the confidentiality, integrity, and availability of protected health information (PHI) and other confidential data, and meet other requirements under the MCP Contract.​​                                                

Cov Cuab Yeej Sib Txuas Lus Cog Lus Hub-MCP​​ 

Cov Lus Qhia: Cov cuab yeej no siv tau los ntawm MCPs thiab Hubs los txiav txim siab txog pawg kev sib raug zoo ntawm daim ntawv cog lus rau ib lub koom haum Hub. Nws kuj tseem yuav pab tau rau kev txiav txim siab txog cov kev cai ntxiv rau cov koom haum Hub uas muab qee yam haujlwm.​​                                                                   

Cov Haujlwm ntawm Lub Koom Haum​​ Yog lawm​​ Tsis muaj​​ 
Puas yog lub koom haum muab cov haujlwm kev tswj hwm rau cov koom haum uas muab kev pabcuam ncaj qha?​​ Lub koom haum yuav yog tus neeg muag khoom sab nraud, Tus Neeg Cog Lus Ua Haujlwm Ib Ntus lossis Tus Neeg Cog Lus Ua Haujlwm Ib Ntus nyob ntawm seb lub koom haum twg muaj daim ntawv cog lus ncaj qha nrog MCP.​​ Lub koom haum yuav tsis haum rau ua ib lub Hub.​​ 
Lub koom haum Hub puas muaj daim ntawv cog lus ncaj qha nrog MCP?​​ Lub Koom Haum yog Tus Neeg Cog Lus Ua Haujlwm lossis Tus Muab Kev Pabcuam Network.​​ Lub Koom Haum yog Tus Neeg Cog Lus Ua Haujlwm Hauv Qab, Tus Muab Kev Pabcuam Hauv Network, lossis tus muab kev pabcuam sab nraud lossis tus muag khoom sab nraud.​​ 
Lub koom haum Hub puas muaj daim ntawv cog lus ncaj qha nrog MCP?​​ Lub Koom Haum yog Tus Neeg Cog Lus Ua Haujlwm lossis Tus Muab Kev Pabcuam Network.​​ Lub Koom Haum yog Tus Neeg Cog Lus Ua Haujlwm Hauv Qab, Tus Muab Kev Pabcuam Hauv Network, lossis tus muab kev pabcuam sab nraud lossis tus muag khoom sab nraud.​​ 
Puas yog lub koom haum Hub tsuas muab kev txhawb nqa kev tswj hwm xwb?​​ Lub koom haum yuav yog tus muag khoom sab nraud, Tus Neeg Cog Lus Ua Haujlwm lossis Tus Neeg Cog Lus Ua Haujlwm Sab Hauv Qab, nyob ntawm seb lub koom haum twg muaj daim ntawv cog lus ncaj qha nrog MCP.​​ Lub Koom Haum yog Ib Feem ntawm Tus Neeg Cog Lus Ua Haujlwm Hauv Qab, lossis​​ 
Puas yog lub koom haum Hub yuav muaj kev pheej hmoo nyiaj txiag rau ib pawg neeg, xws li los ntawm kev npaj them nyiaj rau ib tus neeg?​​ Additional Requirements may apply to the organization:
– Financial Viability
– Medical Loss Ratios (MLRs)
(See Module 3 for additional information)​​ 		Tsis muaj lwm yam yuav tsum tau ua.​​ 
Puas yog lub koom haum Hub tau muab ib pawg neeg tshwj xeeb rau cov tswv cuab Medi-Cal?​​ Additional requirements may apply to the organization:
– Population Needs Assessment (PNA)
(See Module 3 for additional information)​​ 		Tsis muaj lwm yam yuav tsum tau ua.​​ 

For more information on Subcontractor, Downstream Subcontractor, and Network Provider types and definitions, see References and Additonal Resources.​​ 

Tshooj 3: Txoj Cai thiab Cov Kev Cai ntawm MCP-Hub Subcontracting​​ 

Txoj Cai thiab Cov Kev Cai​​ 

Federal law and state policy allow Medi-Cal MCPs to delegate functions to Subcontractors or Downstream Subcontractors, including Hubs, provided the MCP maintains ultimate responsibility for the Hub’s performance and compliance with applicable regulations, regardless of the layers of subcontracting. Required MCP duties and obligations for working with Subcontractors and Downstream Subcontractors are outlined in Section 3.1 of Exhibit A, Attachment III of the MCP Contract. Federal law requires contracts or written arrangements between an MCP and any Subcontractor or Downstream Subcontractor, including Hubs, to meet requirements set forth in the MCP Contract.​​ 

Cov kev cai rau kev cog lus, kev saib xyuas, thiab kev soj ntsuam ntawm cov Chaw Pabcuam uas tau cog lus ua haujlwm sib txawv nyob ntawm cov haujlwm tshwj xeeb uas tau muab faib thiab seb Lub Chaw Pabcuam uas tau cog lus ua haujlwm puas lees txais kev pheej hmoo nyiaj txiag sawv cev rau MCP.​​ 

Cov Kev Cai rau Kev Cog Lus rau MCPs thiab Hubs​​ 

MCP requirements for Subcontractors and Downstream Subcontractors are outlined in the MCP Contract Exhibit A, Attachment III, Subsection 3.1 (Network Provider Agreements, Subcontractor Agreements, Downstream Subcontractor Agreements, and Contractor’s Oversight Duties) and Exhibit J (Delegation Reporting and Compliance Plan) that must be submitted to DHCS. MCPs must complete Exhibit J for each Hub in each county in which they operate.​​                                                              

Rau txhua lub luag haujlwm ntawm MCP uas tau muab rau Hub, txawm tias ncaj qha lossis tsis ncaj qha los ntawm kev cog lus ntxiv lossis kev xa ntawv, Daim Ntawv Cog Lus Subcontractor lossis Daim Ntawv Cog Lus Downstream Subcontractor nrog Hub yuav tsum muaj qee cov kev cai, suav nrog, tab sis tsis txwv rau:​​                                                              

  • Qhia meej txog txhua yam haujlwm, cov luag haujlwm, thiab cov luag haujlwm tshaj tawm uas tau muab faib rau.​​ 
  • Including the Hub’s agreement to perform the delegated activities, obligations, and reporting responsibilities in compliance with all applicable Medicaid laws and regulations, including sub regulatory guidance and contract provisions, and applicable state and federal laws.​​ 
  • Kev muab kev tshem tawm ntawm kev muab cov haujlwm lossis cov luag num lossis qhia meej lwm yam kev kho mob uas DHCS lossis MCP txiav txim siab tias Hub tsis ua haujlwm zoo.​​ 

Ntxiv rau cov kev cai uas tau teev tseg saum toj no, MCPs yuav tsum xyuas kom meej tias Hubs ua raws li txhua qhov kev cai uas tau teev tseg hauv MCP Daim Ntawv Cog Lus A, Daim Ntawv Txuas III thiab APL 23-006, lossis lwm yam APL uas hloov pauv.​​                                          

Cov Cuab Yeej Cog Lus Ua Haujlwm Rau MCP-Hub​​ 

Daim Ntawv Teev Cov Lus Cog Tseg rau MCP-Hub Subcontracting​​ 

Cov Ntawv Cog Lus Subcontractor thiab Cov Ntawv Cog Lus Downstream Subcontractor nrog Hubs ua raws li cov cai tib yam uas siv rau lwm cov kev sib raug zoo ntawm MCP subcontracting. Ib yam li lwm tus Subcontractor lossis Downstream SubContractor, MCPs yuav tsum tshaj tawm txhua qhov kev pabcuam cog lus nrog Hubs rau DHCS. Cov qauv ntawm Daim Ntawv Cog Lus Nrog Tus Neeg Cog Lus Ua Haujlwm thiab Daim Ntawv Cog Lus Nrog Tus Neeg Cog Lus Ua Haujlwm yuav tsum xa mus rau DHCS kom lawv tshuaj xyuas thiab pom zoo.​​ 

Instructions: Use the checklist below when developing a Subcontractor Agreement or Downstream Subcontractor Agreement with a Hub. Please note that this checklist is not exhaustive and that MCPs must still comply with all Subcontractor Agreement and Downstream Subcontractor Agreement requirements in the MCP Contract and other authorities.​​ 

Txhua Daim Ntawv Cog Lus Cog Tseg rau Tus Neeg Cog Lus thiab Daim Ntawv Cog Lus Cog Tseg rau Tus Neeg Cog Lus yuav tsum​​ :​​ 

  1. Piav qhia meej txog txhua yam haujlwm uas tau muab faib, lub luag haujlwm, thiab kev tshaj tawm uas yuav tsum tau ua.​​ 
  2. Specify that the Subcontractor or Downstream Subcontractor is bound by the same obligations and requirements as the MCP per its contract with DHCS, as applicable.​​ 
  3. Suav nrog cov lus uas ua kom ntseeg tau tias Tus Neeg Cog Lus Ua Haujlwm lossis Tus Neeg Cog Lus Ua Haujlwm ua raws li txhua txoj cai lij choj thiab cov cai ntawm Medicaid.​​ 
  4. Muab ib txoj kev rau kev tshem tawm txoj cai yog tias Tus Neeg Cog Lus Ua Haujlwm lossis Tus Neeg Cog Lus Ua Haujlwm tsis ua tau raws li qhov xav tau ntawm kev ua tau zoo.​​ 
  5. Include a Subcontractor’s or Downstream Subcontractor’s ownership and control disclosures per APL 23-006 or any superseding APL.​​ 
  6. Qhia meej txog lub luag haujlwm ntawm Tus Neeg Cog Lus Ua Haujlwm Ib Ntus lossis Tus Neeg Cog Lus Ua Haujlwm Ib Ntus uas yuav tsum tau tshaj tawm cov ntaub ntawv rau MCP.​​ 
  7. Qhia meej cov cai thiab cov txheej txheem rau kev daws teeb meem kev tsis pom zoo lossis kev tsis sib haum xeeb ntawm MCP thiab Hub.​​ 
  8. Piav qhia txog kev kho kom raug thiab/lossis kev rau txim nyiaj txiag rau Cov Neeg Cog Lus Ua Haujlwm lossis Cov Neeg Cog Lus Ua Haujlwm Thaum pom tias tsis ua raws li cov lus cog tseg ntawm lawv daim ntawv cog lus lossis txhua yam kev cai ntawm Medi-Cal.​​ 

Tom qab Daim Ntawv Cog Lus Subcontractor lossis Daim Ntawv Cog Lus Downstream Subcontractor tau muaj nyob rau hauv qhov chaw, MCPs yuav tsum:​​ 

  1. Xa daim ntawv cog lus qauv mus rau DHCS kom lawv tshuaj xyuas thiab pom zoo.​​ 
  2. Ntsib nrog Tus Neeg Cog Lus Ua Haujlwm lossis Tus Neeg Cog Lus Ua Haujlwm Hauv Qab kom tshuaj xyuas cov cai thiab cov txheej txheem tseem ceeb.​​ 
  3. Qhia meej meej tias MCP yuav saib xyuas kev ua raws li cov cai ntawm daim ntawv cog lus li cas.​​ 
  4. Yog tias Tus Neeg Cog Lus Ua Haujlwm lossis Tus Neeg Cog Lus Ua Haujlwm Hauv Qab tab tom muaj kev pheej hmoo nyiaj txiag, xyuas kom meej tias muaj ib txoj hauv kev los soj ntsuam thiab saib xyuas kev ua lag luam nyiaj txiag tsis tu ncua.​​ 
  5. Xyuas kom tus SubContractor lossis Downstream Subcontractor ua raws li cov kev cai tsis muaj kev ntxub ntxaug raws li txoj cai lij choj hauv tebchaws thiab xeev.​​ 
  6. Saib xyuas qhov zoo thiab kev ua raws li txoj cai ntawm txhua cov ntaub ntawv sib koom, suav nrog Encounter Data, Provider Network files, thiab cov ntawv qhia uas yuav tsum tau ua (piv txwv li, kev xa txhua peb lub hlis).​​ 
  7. Ua raws li cov cai ntawm cov ntaub ntawv rau pej xeem, suav nrog kev cia siab kom pom tseeb rau cov chaw cog lus.​​ 
  8. Tshaj tawm txog kev sib raug zoo ntawm cov neeg sawv cev hauv Daim Ntawv Qhia J ntawm Daim Ntawv Cog Lus MCP.​​ 
  9. Tshaj tawm tus qauv kev xaiv tsa rau pej xeem rau ntawm lub vev xaib MCP, raws li qhov xav tau.​​ 

Cov Cuab Yeej Soj Ntsuam: Cov Kev Xav Txog Ua Ntej Kev Cog Lus Rau MCP​​ 

Cov lus nug hauv qab no piav qhia txog cov kev xav tau rau MCPs rau kev ntsuam xyuas thiab kev ua haujlwm koom tes nrog cov koom haum Hub.​​ 

Cov Kev Xav Txog Kev Cog Lus​​ 

  1. Lub Hub yog hom koom haum twg (MSO/ASO, IPA, Medical Group, nonprofit, County health department, thiab lwm yam)?​​  
  2. Puas yog Lub Chaw Pabcuam (Hub) yog ib lub koom haum uas yuav muaj kev pheej hmoo los tswj cov txiaj ntsig lossis kev pabcuam uas tau them rau sawv cev rau MCP?​​  
  3. Cov peev xwm ua tau pom tseeb ntawm Hub yog dab tsi? Lub Chaw Pabcuam puas muaj peev xwm ua haujlwm, muaj kev paub dhau los, thiab muaj peev txheej nyiaj txiag los ua kom tiav cov luag haujlwm raws li tau cog lus tseg (piv txwv li, kev lees paub thiab/lossis kev ua cov nyiaj them)?​​ 
  4. Cov haujlwm twg yuav raug muab rau Hub thiab cov haujlwm twg yuav raug khaws cia los ntawm MCP?​​ 
  5. Lub Chaw Pabcuam puas muaj cov ntawv cog lus thiab/lossis BAAs uas twb muaj lawm nrog lwm cov MCPs thiab Cov Chaw Muab Kev Pabcuam rau kev xa cov kev pabcuam Medi-Cal, xws li ECM, Kev Txhawb Nqa Hauv Zej Zog, CHW thiab/lossis Doula cov kev pabcuam?​​  
  6. Lub Chaw Pabcuam puas muaj cov qauv kev teeb tsa kom meej nrog cov luag haujlwm ua thawj coj thiab cov txheej txheem txiav txim siab?​​  
  7. What is the Hub’s staffing model and capacity to provide Medi-Cal services?​​ 
  8. Lub Chaw Saib Xyuas Kev Ua Raws Cai puas yuav pom zoo rau MCP qhov kev tshuaj xyuas kev ua raws cai?​​ 
  9. Lub Chaw Hub puas muaj ib tug Neeg Saib Xyuas Kev Ua Raws Cai?​​ 

Kev Ua Haujlwm & Kev Pabcuam​​ 

  1. Lub Hub muab cov haujlwm tswj hwm dab tsi (piv txwv li, kev cog lus hauv nruab nrab, kev tswj hwm kev xa mus, kev tshaj tawm, thiab lwm yam)?​​  
  2. Lub Hub muab cov kev pabcuam ncaj qha dab tsi (yog tias muaj)? Yog tias muaj, lawv pab cov pej xeem twg?​​  
  3. Lub Hub puas muaj cov cai thiab cov txheej txheem thiab cov txheej txheem ua haujlwm uas tau teeb tsa tus qauv?​​ 
  4. What is the Hub’s process for handling Network Provider and Medi-Cal Member complaints?​​ 

Kev Tswj Xyuas Network​​ 

  1. Lub Hub muaj peev xwm li cas los daws cov kev xav tau kev noj qab haus huv hauv zej zog (HRSNs) los ntawm nws lub Network?​​  
  2. If the Hub is delegated to conduct credentialling on behalf of the MCP, what credentialing process does the Hub have in place to ensure quality across its Network?​​  
  3. Lub Hub soj ntsuam thiab coj cov Neeg Muab Kev Pabcuam tshiab rau hauv nws lub Network li cas?​​  
  4. Lub Hub muaj cov txheej txheem dab tsi los txhawb cov Chaw Muab Kev Pabcuam Network me, ntau haiv neeg, thiab/lossis cov chaw hauv zos kom yooj yim dua rau kev cog lus nrog MCPs?​​ 
  5. Lub Hub muab kev cob qhia thiab kev pab txog kev txawj dab tsi rau nws lub Network​​ 
  6. Lub Hub ua li cas thiaj xyuas kom meej tias nws lub Network qhia txog cov pej xeem ntawm cov zej zog thiab lub nroog lossis cov nroog uas nws pabcuam?​​ 
  7. Lub Hub saib xyuas kev ua tau zoo ntawm Network Provider/daws teeb meem kev ua tsis tau zoo lossis kev tsis ua raws li txoj cai li cas?​​  
  8. Lub Hub saib xyuas kev ua tau zoo ntawm Network Provider/daws teeb meem kev ua tsis tau zoo lossis kev tsis ua raws li txoj cai li cas?​​  

Kev Tswj Xyuas Cov Ntaub Ntawv​​ 

  1. Lub Hub muaj peev xwm sib qhia cov ntaub ntawv dab tsi (piv txwv li, Cov Ntaub Ntawv Kho Mob Hluav Taws Xob uas sib koom ua ke, lub platform tswj cov ntaub ntawv, thiab lwm yam)?​​   
  2. Lub Hub muaj cov txheej txheem twg rau kev tswj hwm kev xa mus kaw thiab kev tshaj tawm rau MCPs?​​  
  3. Can the Hub integrate its technology and exchange data with the MCP’s existing data systems?​​  
  4. Lub Hub saib xyuas qhov zoo ntawm cov ntaub ntawv, kev ruaj ntseg, kev pob tshab, thiab kev ua raws li txoj cai li cas?​​  

Cov Qauv Nyiaj Txiag & Kev Ruaj Ntseg​​ 

  1. Lub Hub siv cov qauv them nyiaj twg los them rau Cov Neeg Muab Kev Pabcuam Network?​​  
  2. Lub Hub txhawb nqa kev txhim kho peev xwm rau Cov Neeg Muab Kev Pabcuam Network li cas?​​ 
  3. How does the Hub’s payment model support the financial sustainability of Network Providers?​​  

Kev koom tes hauv zej zog​​ 

  1. Lub Hub koom nrog thiab txhawb nqa cov tswv cuab hauv zej zog li cas?​​ 
  2. Lub Hub puas muaj cov txheej txheem rau kev koom ua ke Medi-Cal Cov Tswv Cuab thiab cov lus taw qhia hauv zej zog rau hauv nws cov haujlwm?​​  
  3. Lub Hub muaj kev sib raug zoo li cas nrog lwm lub koom haum saib xyuas kev noj qab haus huv; cov koom haum tsoomfwv hauv zos, xws li kev noj qab haus huv ntawm lub nroog lossis cov chaw saib xyuas kev noj qab haus huv hauv zos; thiab lwm tus neeg koom tes hauv zej zog?​​  

Tshooj 4: Kev Xav Txog ECM, Kev Txhawb Nqa Hauv Zej Zog, Tus Neeg Ua Haujlwm Saib Xyuas Kev Noj Qab Haus Huv Hauv Zej Zog (CHW), thiab Cov Kev Pabcuam Doula​​ 

Cov MCPs raug tso cai cog lus nrog Hubs los tswj hwm Kev Tswj Xyuas Kev Kho Mob Zoo Dua (ECM), Kev Txhawb Nqa Hauv Zej Zog, thiab cov txiaj ntsig CHW thiab/lossis Doula. Rau txhua qhov kev pab cuam, MCPs uas cog lus nrog Hubs los muab cov kev pabcuam no yuav tsum xyuas kom meej tias Hubs ua raws li txhua qhov yuav tsum tau teev tseg hauv Daim Ntawv Cog Lus MCP, cov kev cai ntawm qhov kev pab cuam, thiab cov lus qhia APL cuam tshuam.​​ 

Enhanced Care Management (ECM) is a whole-person, interdisciplinary approach to care that addresses the clinical and non-clinical needs of high-cost and/or high-need eligible Medi-Cal Members who meet ECM Populations of Focus (POF) eligibility criteria through a systematic coordination of services and comprehensive care management that is community-based, interdisciplinary, high-touch, and person-centered. For more information, see the MCP Contract and the ECM Policy Guide.​​ 

Community Supports are substitute services or settings to those required under the California Medicaid State Plan that Medi-Cal MCPs may select and offer to their Members when the substitute service or setting is medically appropriate and more cost-effective than the service or setting listed in the California Medicaid State Plan, such as emergency department visits, hospital or skilled nursing facility admission, or a discharge delay. Community Supports are optional services that MCPs may choose to offer to eligible Medi-Cal Members, with the exception of Transitional Rent, which MCPs will be required to provide starting January 1, 2026. A complete list of DHCS-approved Community Supports can be found in the MCP Contract, Community Supports Policy Guide Volume 1, and Community Supports Policy Guide Volume 2.​​ 

CHW​​  Services are an integral part of ECM and Community Supports that consist of an array of preventative health services aimed at preventing or managing disease, disability, and other health conditions and promoting physical and behavioral health and well-being for Medi-Cal Members. CHWs may include service professionals known by a variety of job titles, including promotoras, community health representatives, navigators, and other non-licensed public health workers, including violence prevention professionals, and as set forth in APL 24-006 or any superseding APL. See the DHCS website and the MCP Contract for more information about CHW services.​​ 

Doula Services provide health education advocacy, and physical, emotional and nonmedical support to Medi-Cal Members and their families throughout pregnancy, labor, birth and the postpartum period, including support for and after miscarriage and abortion. See the DHCS DHCS website, APL 23-024 or any superseding APL, and the MCP Contract for more information about the Doula benefit.​​ 

Cov Kev Xav Txog rau ECM​​ 

Cov MCPs uas muaj daim ntawv cog lus nrog Hubs rau kev tswj hwm ib feem lossis tag nrho ntawm cov kev pabcuam ECM yuav tsum xyuas kom meej tias Hubs ua raws li txhua qhov kev cai ntawm qhov kev pab cuam uas lawv tau cog lus. Txawm hais tias muaj ib lub Hub uas tau cog lus los xij, MCP tseem muaj lub luag haujlwm los xyuas kom meej tias cov neeg muab kev pabcuam ECM daws cov kev xav tau hauv kev kho mob thiab tsis yog kev kho mob ntawm cov tswv cuab Medi-Cal thiab muab txhua yam kev pabcuam tseem ceeb. Cov MCPs yuav cog lus nrog Hubs los muab:​​                                                     

  • Kev ncav cuag thiab kev koom tes rau cov tswv cuab Medi-Cal uas tsim nyog.​​ 
  • Cov phiaj xwm ntsuam xyuas thiab tswj kev saib xyuas uas muaj txhij txhua.​​ 
  • Kev sib koom tes zoo dua ntawm kev saib xyuas.​​ 
  • Kev txhawb nqa kev noj qab haus huv.​​ 
  • Kev saib xyuas kev hloov pauv tag nrho.​​ 
  • Kev txhawb nqa rau cov tswv cuab thiab tsev neeg ntawm Medi-Cal.​​ 
  • Kev sib koom tes thiab kev xa mus rau cov kev pabcuam hauv zej zog thiab kev txhawb nqa hauv zej zog.​​ 

Ntxiv rau kev muab ib lossis ntau yam ntawm cov khoom tseem ceeb no, lub Hub cog lus yuav koom tes nrog MCP los txheeb xyuas thiab muab ECM rau cov tswv cuab Medi-Cal ntawm MCP uas ua tau raws li cov qauv ntawm Populations of Focus (POF) thiab xyuas kom ua raws li ECM Provider Standard Terms and Conditions (STCs), MCP's ECM Model of Care (MOC), thiab ECM Encounter Data cov kev cai tshaj tawm.​​             

Tej zaum yuav muaj ib txhia Chaw Muab Kev Pabcuam ECM uas tsis muaj txoj kev rau npe kawm ntawv tshwj xeeb hauv xeev. Cov Chaw Muab Kev Pabcuam no yuav tsum tau MCP tshuaj xyuas kom thiaj li koom nrog ua Cov Chaw Muab Kev Pabcuam ECM. Cov Chaw Muab Kev Pabcuam ECM uas pabcuam rau Cov Neeg Hloov Chaw ntawm Kev Raug Kaw POF yog tib cov Chaw Muab Kev Pabcuam ECM uas raug rau cov kev cai ntxiv ntawm Chaw Muab Kev Pabcuam.​​             

Cov MCPs uas cog lus nrog Hubs rau kev tswj hwm ECM yuav tsum hloov kho lawv cov MOC los piav qhia txog kev cog lus. Cov MCPs yuav tsum xyuas kom meej tias cov ntawv cog lus qhia txog:​​                                                     

  • Cov kev cai ntawm daim ntawv cog lus MCP.​​ 
  • Cov kev cai uas tau teev tseg hauv ECM thiab Cov Qauv Cog Lus Txhawb Nqa Zej Zog.​​   
  • Cov Cai thiab Cov Kev Cai ntawm ECM thiab Kev Txhawb Nqa Hauv Zej Zog ntawm Tus Muab Kev Pabcuam (STCs).​​   
  • APL 23-032 or any superseding APL, as applicable.​​                                  

Cov MCPs yuav tsum koom tes nrog cov Hubs uas tau cog lus txog txoj hauv kev los tswj cov txiaj ntsig ECM kom ntseeg tau tias muaj kev saib xyuas zoo thiab ruaj khov rau cov Tswv Cuab Medi-Cal, uas tau tsim los rau cov kev xav tau kev saib xyuas tus kheej.​​                                   

See the ECM Policy Guide for additional information. See Module 3 for more information on compliance for contracted Hubs that assume risk or cover populations for specific Medi-Cal Members.​​ 

Kev Xav Txog Kev Txhawb Nqa Hauv Zej Zog​​ 

Cov MCPs uas muaj daim ntawv cog lus nrog Hubs rau kev tswj hwm ib feem lossis tag nrho ntawm cov kev pabcuam Txhawb Nqa Zej Zog yuav tsum xyuas kom meej tias cov Hubs uas tau cog lus ua raws li txhua qhov kev cai ntawm qhov kev pab cuam uas lawv tau cog lus. Cov khoom tseem ceeb ntawm kev pabcuam suav nrog:​​ 

  • Txhua qhov kev pab cuam thiab kev tshaj tawm uas DHCS tau teev tseg, cov kev cai lij choj thiab cov cai ntawm lub xeev thiab tsoomfwv teb chaws, Daim Ntawv Cog Lus MCP, thiab cov kev cai ntawm APL, suav nrog cov cai thov rov hais dua.​​ 
  • Cov kev cai tshaj tawm rau txhua qhov kev sib ntsib ntawm Kev Txhawb Nqa Hauv Zej Zog.​​               

Txhua tus MCP raug txhawb kom muab kev txhawb nqa hauv zej zog rau cov tswv cuab Medi-Cal uas tsim nyog, tshwj tsis yog Transitional Rent, uas yog qhov yuav tsum tau ua rau MCPs muab pib txij lub Ib Hlis 1, 2026, rau cov POF tshwj xeeb. Cov Chaw Cog Lus uas tau cog lus tias yuav koom tes nrog MCPs los tswj hwm Kev Txhawb Nqa Hauv Zej Zog yuav tsum sib koom tes nrog MCP kom paub meej tias MCP muab Kev Txhawb Nqa Hauv Zej Zog twg.​​            

Cov MCPs uas muaj daim ntawv cog lus nrog Hubs rau kev tswj hwm ntawm Kev Txhawb Nqa Hauv Zej Zog yuav tsum hloov kho lawv daim MOC los piav qhia txog kev cog lus. Cov MCPs yuav tsum xyuas kom meej tias cov ntawv cog lus qhia txog:​​  

  • Cov kev cai ntawm daim ntawv cog lus MCP.​​ 
  • Cov kev cai uas tau teev tseg hauv ECM thiab Cov Qauv Cog Lus Txhawb Nqa Zej Zog.​​   
  • ECM thiab Cov Kev Pabcuam Hauv Zej Zog STCs.​​   
  • APL 21-017 lossis lwm yam APL hloov pauv, raws li siv tau.​​                                          

Cov MCPs yuav tsum koom tes nrog cov Hubs uas tau cog lus txog txoj hauv kev los tswj cov txiaj ntsig ntawm Community Supports kom ntseeg tau tias muaj kev saib xyuas zoo thiab ruaj khov rau cov tswv cuab Medi-Cal, uas tau tsim los rau cov kev xav tau kev saib xyuas tus kheej.​​            

See the Community Supports Policy Guide Volume 1 and Community Supports Policy Guide Volume 2 for additional information. See Module 3 for more details around compliance for contracted Hubs that assume risk or cover specific Medi-Cal Member populations.​​ 

Cov Kev Xav Txog CHW Cov Kev Pabcuam​​ 

MCPs that contract with Hubs for the administration and/or delivery of CHW benefits must adhere to requirements set forth in APL 24-006 or any superseding APL, as well as the Medi-Cal Provider Manual  and MCP Contract, as applicable, including with respect to:​​   

  • CHW Provider Requirements and Qualifications. Supervising Providers  must ensure that CHWs meet the requirements and qualifications outlined in Medi-Cal policy and APL 24-006, or any superseding APL. MCPs must ensure that Supervising Providers, or their Subcontractors or Downstream Subcontractors contracting with or employing CHWs to provide covered CHW services to Medi-Cal Members, verify that CHWs have adequate supervision and training. MCPs must also have a process for verifying qualifications and experience of Supervising Providers. MCPs must develop and submit policies and procedures to ensure that CHW Supervising Providers are certifying that their CHWs have the appropriate training, qualifications, and supervision.​​  
  • Cov Qauv Tsim Nyog Rau Cov Tswv Cuab Medi-Cal rau CHW Cov Kev Pabcuam. Cov MCPs yuav tsum xyuas kom meej tias Cov Neeg Saib Xyuas Kev Pabcuam ua raws li cov cai tsim nyog rau kev muab cov kev pabcuam CHW, suav nrog cov uas cuam tshuam nrog kev pab txhawb cov txheej txheem tsav los ntawm cov ntaub ntawv los txiav txim siab thiab nkag siab txog cov pej xeem tseem ceeb uas tsim nyog rau cov kev pabcuam CHW.​​  
  • Kev Sau Npe Rau Cov Kws Muab Kev Pab. Cov Chaw Muab Kev Pabcuam hauv Network, suav nrog cov neeg ua haujlwm ua Tus Saib Xyuas Cov Kev Pabcuam CHW, yuav tsum tau sau npe ua Cov Chaw Muab Kev Pabcuam Medi-Cal raws li Daim Ntawv Cog Lus MCP thiab APL 22-013 lossis lwm yam APL hloov chaw.​​ 
  • Nkag mus rau CHW Cov Kev Pabcuam. Cov MCPs muaj lub luag haujlwm los xyuas kom meej tias cov Hubs uas tau cog lus txhawb kev nkag mus rau thiab saib xyuas cov Networks txaus hauv lawv thaj chaw pabcuam rau CHW cov kev pabcuam.​​                             

Cov Kev Xav Txog Rau Cov Kev Pabcuam Doula​​ 

For the administration and/or delivery of Doula services, MCPs that contract with Hubs must adhere to the requirements outlined in APL 23-024 or any superseding APL as well as the Medi-Cal Provider Manual and the MCP Contract, as applicable, including:​​  

  • Cov Kev Cai thiab Kev Tsim Nyog ntawm Tus Muab Kev Pabcuam Doula. Cov MCPs yuav tsum muab kev cob qhia thiab cov peev txheej rau Doulas thawj zaug thiab txuas ntxiv mus txog thaum kawg ntawm lub xyoo txog cov kev pabcuam thiab cov txheej txheem ntawm MCP, suav nrog txhua yam kev pabcuam uas muaj los ntawm MCP rau cov tswv cuab ua ntej yug menyuam, thaum yug menyuam tas, thiab tom qab yug menyuam. Ntxiv rau, MCPs yuav tsum muab kev txhawb nqa kev txawj ntse hauv kev tswj hwm cov kev pabcuam Doula, xyuas kom muaj kev lav ris rau txhua qhov kev xav tau kev pabcuam uas muaj nyob hauv Daim Ntawv Cog Lus MCP, thiab txhua cov lus qhia cuam tshuam uas DHCS tau muab.​​ 
  • Cov Qauv Tsim Nyog Rau Cov Tswv Cuab Medi-Cal rau Cov Kev Pabcuam Doula. Cov MCPs yuav tsum xyuas kom meej tias cov Hubs uas tau cog lus ua raws li cov cai tsim nyog rau kev muab cov kev pabcuam Doula rau cov tswv cuab Medi-Cal.​​  
  • Kev Sau Npe Rau Cov Kws Muab Kev Pab. Cov Chaw Muab Kev Pabcuam hauv Network uas ua haujlwm ua Cov Chaw Muab Kev Pabcuam Doula yuav tsum tau sau npe ua Cov Chaw Muab Kev Pabcuam Medi-Cal raws li APL 22-013, lossis lwm yam APL uas hloov pauv.​​ 
  • Nkag mus rau Doula Cov Kev Pabcuam. Cov MCPs yuav tsum xyuas kom meej tias cov Hubs uas tau cog lus txhawb kom nkag mus rau Doula care thiab pab saib xyuas cov Networks kom ntseeg tau tias muaj Doulas txaus los ua kom tau raws li qhov xav tau ntawm lawv cov Tswv Cuab. Kev ua kom tau raws li qhov yuav tsum tau ua ntawm Network yog lub luag haujlwm ntawm MCP.​​                

Tshooj 5: Cov Ntaub Ntawv Siv thiab Cov Kev Pab Ntxiv​​ 

Cov Lus Qhia Tseem Ceeb​​ 

Daim Ntawv Cog Lus Boilerplate Xyoo 2024 MCP​​ 
Managed Care All Plan Letters (APLs)​​ 
APL 23-006: Kev Pom Zoo rau Kev Tswj Xyuas thiab Kev Cog Lus Hauv Network​​ 
APL 23-032: Cov Kev Cai Tswj Xyuas Kev Kho Mob Zoo Dua​​ 
APL 21-017: Cov Kev Cai Txhawb Nqa Hauv Zej Zog​​ 
APL 24-006: Cov Kev Pabcuam rau Cov Neeg Ua Haujlwm Saib Xyuas Kev Noj Qab Haus Huv Hauv Zej Zog​​ 
APL 23-024: Cov Kev Pabcuam Doula​​ 
APL 19-001: Cov Lus Qhia Txog Kev Npaj Kho Mob Medi-Cal Managed Care Health Plan txog Cov Xwm Txheej ntawm Network Provider​​ 
PHM Txoj Cai Qhia​​ 
ECM Txoj Cai Qhia​​ 
Zej Zog Txhawb Nqa Txoj Cai Phau Ntawv Qhia Volume 1​​ 
Zej Zog Txhawb Nqa Txoj Cai Qhia Phau Ntawv Teev Npe 2​​ 
MCP ECM thiab Kev Txhawb Nqa Hauv Zej Zog Cov Kev Cai Daim Ntawv Cog Lus​​ 
Cov Cai thiab Cov Kev Cai ntawm Tus Muab Kev Pabcuam rau ECM thiab Kev Txhawb Nqa Hauv Zej Zog​​ 
ECM thiab Lub Zej Zog Txhawb Nqa Cov Lus Qhia Txog Kev Them Nqi thiab Kev Sau Nqi (Hloov Kho Lub Plaub Hlis Ntuj Xyoo 2023)​​ 
Note: An updated version of this resource will be released in late 2025.
Member-Level Information Sharing Between MCPs and ECM Providers
ECM Referrals Standards and Form Templates
Community Supports Member Information Sharing Guidance
DHCS Resources for Community Health Workers
DHCS Resources for Doula Services​​ 

Cov Kev Pabcuam Ntxiv​​ 

Cov Hom Neeg Cog Lus thiab Cov Lus Txhais​​ 

Hom Tus Neeg Cog Lus Ua Haujlwm​​ Cov Lus Txhais ntawm Daim Ntawv Cog Lus 2024 MCP​​ 
Tus Neeg Cog Lus Ua Haujlwm​​ 

Ib Tus Neeg Cog Lus Ua Haujlwm Pab Cuam uas ua raws li daim ntawv cog lus lees txais cov luag haujlwm tswj hwm ntawm MCP raws li Daim Ntawv Cog Lus MCP. Cov luag haujlwm tswjfwm suav nrog cov haujlwm xws li kev txheeb xyuas daim ntawv pov thawj lossis kev ua cov ntaub ntawv thov. Txawm li cas los xij, cov haujlwm ntsig txog kev sib koom tes lossis xa cov kev pabcuam kho mob ncaj qha rau cov Tswv Cuab Medi-Cal, xws li Kev Sib Koom Tes Saib Xyuas Kev Kho Mob tsis yog cov haujlwm tswj hwm.​​  

Tus Neeg Cog Lus Ua Haujlwm Ib Nrab​​ Ib Tus Neeg Cog Lus Ua Haujlwm uas ua raws li daim ntawv cog lus lees txais qee yam, tab sis tsis yog txhua yam, lub luag haujlwm thiab lub luag haujlwm ntawm MCP raws li daim ntawv cog lus MCP, suav nrog, piv txwv li, lub luag haujlwm hais txog cov pej xeem Medi-Cal Member tshwj xeeb lossis lub luag haujlwm hais txog cov kev pabcuam tshwj xeeb. Cov koom haum kws kho mob thiab cov pab pawg kho mob feem ntau ua haujlwm ua Cov Neeg Cog Lus Ib Nrab.​​ 
Tus Neeg Cog Lus Ua Haujlwm Tag Nrho​​ A Subcontractor that contractually assumes all duties and obligations of the MCP under the MCP Contract, except those contractual duties and obligations where delegation is legally or contractually prohibited. A managed care plan can operate as a Fully Delegated Subcontractor. Note: A hub would not take on this role.​​  
Tus Neeg Cog Lus Hauv Paus Hauv Qab​​ Ib Tus Neeg Cog Lus Hauv Qab uas ua raws li daim ntawv cog lus lees txais cov luag haujlwm tswj hwm ntawm Tus Neeg Cog Lus Hauv Qab raws li Daim Ntawv Cog Lus MCP. Cov luag haujlwm tswjfwm suav nrog cov haujlwm xws li kev txheeb xyuas daim ntawv pov thawj lossis kev ua cov ntaub ntawv thov. Txawm li cas los xij, cov haujlwm uas muaj feem cuam tshuam nrog kev sib koom tes lossis xa cov kev pabcuam kho mob ncaj qha rau cov tswv cuab Medi-Cal, xws li Kev Tswj Xyuas Kev Siv (UM) lossis Kev Sib Koom Tes Saib Xyuas Kev Kho Mob, tsis yog cov haujlwm tswj hwm.​​  
Tus Neeg Cog Lus Ua Haujlwm Ib Nrab Ntawm Cov Neeg Ua Haujlwm Hauv Qab​​ Ib Tus Neeg Cog Lus Hauv Qab uas ua raws li daim ntawv cog lus lees txais qee yam, tab sis tsis yog txhua yam, lub luag haujlwm thiab lub luag haujlwm ntawm Tus Neeg Cog Lus Hauv Qab raws li Daim Ntawv Cog Lus MCP, suav nrog, piv txwv li, lub luag haujlwm hais txog cov pej xeem Medi-Cal lossis lub luag haujlwm hais txog cov kev pabcuam tshwj xeeb. Cov koom haum kws kho mob thiab cov pab pawg kho mob feem ntau ua haujlwm ua Cov Neeg Cog Lus Ua Haujlwm Ib Nrab Ntawm Cov Neeg Ua Haujlwm.​​ 
Tus Neeg Cog Lus Ua Haujlwm Tag Nrho Hauv Qab​​ Ib Tus Neeg Cog Lus Hauv Qab uas ua raws li daim ntawv cog lus lees txais txhua txoj haujlwm thiab lub luag haujlwm ntawm MCP raws li Daim Ntawv Cog Lus MCP, los ntawm Tus Neeg Cog Lus Hauv Qab, tshwj tsis yog cov luag haujlwm thiab lub luag haujlwm ntawm daim ntawv cog lus uas kev xa tawm raug cai lossis daim ntawv cog lus txwv tsis pub. Ib txoj kev npaj kho mob uas tswj hwm tuaj yeem ua haujlwm ua tus neeg cog lus qis dua. Lus Cim: Ib lub Hub yuav tsis ua lub luag haujlwm no.  ​​