Cov Cuab Yeej Siv MCP-Hub: Ib Qho Chaw Pab rau MCPs thiab CalAIM Cov Neeg Muab Kev Pabcuam
Txheej txheem cej luam
In partnership with the Department of Health Care Services (DHCS) and the California Health Care Foundation (CHCF), Aurrera Health Group developed a toolkit with guidance applicable to Medi-Cal Managed Care Plans (MCPs) and “community care hub” organizations (Hubs). Hubs are entities that serve as intermediaries between Medi-Cal MCPs and community-based organizations (CBOs) and Providers that deliver services to address health related social needs (HRSNs).
DHCS txhawb kom siv cov Hubs kom txog thaum nws txo cov teeb meem rau CBOs, cov kws kho mob hauv zej zog, thiab lwm cov kws kho mob uas hais txog HRSNs los cog lus nrog MCPs thiab koom nrog hauv Medi-Cal txoj kev xa khoom. Kev koom tes nrog Hubs tuaj yeem tsim kev ua haujlwm zoo rau MCPs thiab Cov Chaw Muab Kev Pabcuam, nthuav cov Networks los ntawm kev pab cov Chaw Muab Kev Pabcuam hauv zej zog, ntau haiv neeg koom nrog Medi-Cal, thiab txhawb nqa kev xa cov txiaj ntsig Medi-Cal.
Phau Ntawv Qhia Siv Cov Cuab Yeej
Cov cuab yeej no yog rau MCPs, cov Hubs uas twb muaj lawm, thiab cov koom haum uas xav ua Hubs los txhawb kev xa cov kev pabcuam Medi-Cal. Nws suav nrog ntau yam modules uas qhia txog cov cib fim, cov kev cai yooj yim, kev xav txog, thiab muab cov cuab yeej siv tau los txhawb MCPs thiab Hubs kom ua haujlwm tau zoo hauv kev cog lus ua haujlwm pub dawb.
Cov cuab yeej no muaj cov ntu hauv qab no:
Module 1: Functions of a Hub
- Section 1: Overview
- Ntu 2: Piv Txwv Cov Haujlwm ntawm Hub
- Section 3: Hub Spotlight
Module 2: MCP-HUB Partnerships
Section 1: Overview
Section 2: MCP-Hub Delegation and Contracting
Types of Contracts Between MCPs and Hubs
Hub-MCP Contracting Relationship Tool
Section 3: MCP-Hub Subcontracting Legal Authority and Requirements
Subcontracting Requirements for MCPs and Hubs
MCP-Hub Subcontracting Tools
Section 4: Considerations for ECM, Community Supports, Community Health Worker (CHW), and Doula Services
Considerations for ECM
Considerations for Community Supports
Considerations for CHW Services
Considerations for Doula Services
Section 5: References and Additional Resources
Module 3: Kev Saib Xyuas & Kev Soj Ntsuam ntawm Cov Chaw Pabcuam
Section 1: Overview
Section 2: MCP Oversight and Monitoring Requirements for Hubs
MCP-Hub Compliance Requirements Checklist
Section 3: Data and Qualilty Improvement Requirements for Hubs
Data Reporting Requirements
Quality Improvement Requirements
MCP-Hub Quality Improvement Tool
Section 4: Additional Considerations for Hubs That Assume Financial Risk or Cover Specific Medi-Cal Member Populations
Financial Viability Requirements
Population Needs Assessment Requirements
Medical Loss Ratios (MLRs)
Section 5: Summary of MCP Oversight Responsibilities
Section 6: References
Cov ntaub ntawv ntxiv
Cov Chaw Pab Nyiaj Txiag Rau Vaj Tse thiab Chaw Pabcuam Yooj Yim
Tom qab nyeem cov cuab yeej no, cov nyeem ntawv yuav nkag siab:
Tus nqi ntawm cov chaw pabcuam hauv kev pab txhawb kev sib txuas ntawm MCPs thiab cov tes hauj lwm ntawm cov koom haum muab kev pabcuam ncaj qha thiab cov neeg muab kev pabcuam ib leeg thiab txo qhov hnyav ntawm kev cog lus;
Cov haujlwm dav dav uas Hubs muab;
Cov kev cai uas twb muaj lawm uas MCPs yuav tsum ua raws li thaum cog lus nrog Hubs; thiab
MCP Kev Ua Raws Cai thiab kev saib xyuas lub luag haujlwm
Sau ntawv
- DHCS txhawb kom MCPs cog lus nrog Hubs tab sis tsis tas yuav tsum tau.
- Cov cuab yeej siv no tsis suav nrog txoj cai tshiab lossis qhia txog cov kev cai tshiab rau MCPs tab sis txhawb nqa cov lus qhia uas twb muaj lawm uas cuam tshuam rau MCPs thiab Hubs uas xav koom tes rau kev tswj hwm thiab kev xa khoom ntawm ntau yam kev pabcuam Medi-Cal suav nrog, tab sis tsis txwv rau, Kev Tswj Xyuas Kev Kho Mob Zoo (ECM), Kev Txhawb Nqa Hauv Zej Zog, Cov Kev Pabcuam Neeg Ua Haujlwm Kev Noj Qab Haus Huv Hauv Zej Zog (CHW), thiab cov kev pabcuam Doula.
- DHCS lees paub tias nws yuav siv sijhawm rau cov Hubs thiab MCPs uas twb muaj lawm uas muaj kev sib raug zoo kom ntseeg tau tias txhua qhov kev cai ntawm Subcontractor, Downstream SubContractor, thiab Network Provider raug ua tiav, raws li qhov siv tau. Cov MCPs raug txhawb kom tiv tauj lawv cov Thawj Coj Daim Ntawv Cog Lus DHCS kom thov kev pab txog kev ua haujlwm kom ua raws li cov cai ntawm Subcontractor, Downstream Subcontractor, thiab Network Provider raws li tau teev tseg hauv daim ntawv cog lus ntawm MCP nrog DHCS (MCP Contract), raws li qhov siv tau. Yog muaj lus nug ntxiv, thov hu rau koj tus Thawj Saib Xyuas Daim Ntawv Cog Lus DHCS.
Webinars
Kev Koom Tes ntawm MCP-Hub: Cov Cuab Yeej Siv rau Cov Phiaj Xwm thiab Cov Chaw Muab Kev Pabcuam CalAIM Kev Sib Tham Hauv Is Taws Nem Txog Cov Ntaub Ntawv
Lub Ib Hlis 16, 2026, 1:00 – 2:30pm
Cov Ntawv Qhia Txog Kev Nthuav Qhia
Cov Ntaub Ntawv Sau Tseg Hauv Webinar (Aurrera Health Group)
Resource Library
Managed Care All Plan Letters (APLs)
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
Tshawb Nrhiav Cov Chaw Pabcuam Hauv Zej Zog Medi-Cal Tshiab: Cov ntaub ntawv hais txog qhov xwm txheej tam sim no ntawm cov chaw pabcuam uas twb muaj lawm thiab cov chaw pabcuam tshiab hauv Medi-Cal.
Daim Ntawv Cog Lus Xyoo 2024 MCP Boilerplate
Phau Ntawv
Qhia Txog
Txoj Cai PHM Ntawv Qhia Txog
Tus Muab Kev Pabcuam Medi-Cal {cph0} Cov Kev Pabcuam Tiv
Thaiv Kev Noj Qab Haus Huv Hauv Zej Zog {cph0} Cov Kev Pabcuam Doula Cov Kev Pabcuam DHCS rau Cov Neeg Ua Haujlwm Kev Noj Qab Haus Huv Hauv Zej Zog Cov Kev Pabcuam DHCS rau Cov Kev Pabcuam Doula
Phau Ntawv Qhia Txog Txoj Cai
ECM cph0} Phau Ntawv Qhia Txog Txoj Cai Txhawb Nqa Hauv Zej
Zog {cph0} Phau Ntawv Qhia Txog Txoj Cai Txhawb Nqa Hauv
Zej Zog Ntu 2 Cov Kev Cai ntawm
Daim Ntawv Cog Lus ECM thiab Kev Txhawb Nqa Hauv Zej Zog Cov Lus Cog Tseg thiab Cov Cai ntawm ECM thiab Kev Txhawb Nqa Hauv Zej Zog Cov Lus Qhia Txog Kev Them Nqi thiab
Kev Them Nqi ntawm ECM thiab Kev Txhawb Nqa Hauv Zej Zog {cph0} Kev Sib Koom Cov Ntaub Ntawv Qib Tswv Cuab Ntawm MCPs thiab Cov Kws Muab Kev Pabcuam ECM Cov
Qauv thiab Cov
Qauv Ntawv ntawm
ECM {cph0} Cov Kev Pabcuam Hauv Zej
Zog Cov Lus Qhia
Txog Sib Koom Cov Ntaub Ntawv ntawm Cov
Tswv Cuab {cph0}
Cov Lus Qhia Txog Kev Siv Kev Xa Mus Rau Qhov Kaw Cov Chaw Pab Nyiaj Txiag Rau Cov Tsev Nyob Yooj Yim Cov Kev Pabcuam Kev Pab Cuam Cov Lus Qhia Txog Kev Tso Cai Sib Koom Cov Ntaub Ntawv CalAIM