Behavioral Health Network Adequacy Oversight Branch(ビヘイビアヘルスネットワーク適切性監視ブランチ)
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The Behavioral Health Network Adequacy Oversight Branch (BHNAOB) is structurally within the Behavioral Health Oversight and Monitoring Division (BHOMD), which is a part of the Behavioral Health program of the Department of Health Care Services. Information about BHOMD can be found via the Behavioral Health Services homepage link at the top of this document. BHNAOB is responsible for the Medi-Cal Behavioral Health network adequacy program, the Behavioral Health Services Act network adequacy program, and formerly had administrative responsibility for the Behavioral Health Quality Improvement Program (BHQIP), which was sunset on June 30, 2024. The Network Adequacy Oversight Sections are responsible for the oversight and monitoring all behavioral health components of the Specialty Mental Health Services (SMHS) and Drug Medi-Cal Organized Delivery System (DMC-ODS) program, as well as timely access requirements for Drug Medi-Cal state plans due to parity requirements
ネットワーク妥当性監視セクション
The Network Adequacy Oversight Section (NAOS) is found within the BHNAOB. BHNAOB is found within BHOMD and is a part of the Behavioral Health program of DHCS.
DHCS contracts with counties that either provide, or arrange for the provision of, specialty mental health services and substance use treatment services to eligible Medi-Cal members.
NAOS performs compliance oversight and monitoring of the MHPs and DMC-ODS programs to ensure compliance with the network adequacy requirements set forth in Title 42 of the Code of Federal Regulations (CFR) and the network adequacy requirements of the Behavioral Health Services Act. NAOS primarily assesses the compliance of MHPs and DMC-ODS programs through its reviews of required submissions from these entities as part of an annual network certification process. NAOS, as necessary to ensure the adequacy of each provider network, identifies any deficiencies with current standards, including timely access standards as prescribed by WIC 14197 and provides technical assistance to the MHPs and DMC-ODS programs to resolve compliance issues. Where technical assistance is not effective, NAOS implements corrective measures such as corrective action plans and administrative or monetary sanctions.
NAOS also performs oversight, technical assistance, and monitoring related to improving access to care, which includes timely access requirements as defined in Welfare and Institutions Code 14197. These requirements include an initial request for first appointment or first specialty mental health service for new members, non-urgent follow-up appointments, and ensuring language assistance services are coordinated with scheduled appointments for health care services.
ここで特定されたネットワークの適切性に関するコンプライアンスおよび監視活動は、特にタイムリーなアクセス要件に関して、MHP、DMC-ODSプログラム、およびDMC州計画に特化したものです。マネージドケア品質監視部門は、マネージドケアプランのネットワークの適切性に関する要件を監視します。ネットワークの適切性に関する詳細情報（年次認証報告書、承認された代替アクセス基準、是正措置計画など）については、医療サービス局のネットワーク適切性に関するウェブページを参照してください。
Provided below are some federal and state laws applicable to NAOS. These laws are found within the CFR, and Welfare and Institutions Code (WIC).
準拠法
フェデラル：
- 42 CFR 438.206サービスの可用性
- 42 CFR 438.207 適切な容量とサービスの保証
- 42 CFR 438.68 ネットワーク妥当性基準
州(法令):
- HSCセクション1367.03
- WICセクション14197
州(規制):
- 28 CCRセクション1300.67.04
- 28 CCRセクション1300.67.2.2
関連情報
California Advancing and Innovation Medi-Cal (CalAIM):
メディケイドとメディカルジェネラル:
- メディケイドリソースブック
- 行動健康パリティと医療費負担適正化法
- メディケイドとCHIPにおけるメンタルヘルスパリティおよび依存症平等法の実施
- Medi-CalおよびBehavioral Health Services
連絡先
- 一般部門： BHOMD@dhcs.ca.gov
- 郡のサポート: CountySupport@dhcs.ca.gov
- NAOS: NAOS@dhcs.ca.gov
- BH CalAIM: BHCalAIM@dhcs.ca.gov