홈 행동 건강 네트워크 적정성 감독 부서​​ 

행동 건강 네트워크 적정성 감독 지부​​ 

행동 건강 서비스 홈페이지로 돌아갑니다.​​  

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​​ 

네트워크 적정성 감독 섹션​​ 

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.​​  

여기에서 확인된 네트워크 적정성 준수 및 모니터링 활동은 적시 액세스 요구 사항에 대한 MHP, DMC-ODS 프로그램 및 DMC 주 계획에 특별히 적용됩니다. 매니지 케어 품질 및 모니터링 부서에서는 매니지 케어 플랜에 대한 네트워크 적정성 요건을 모니터링합니다. 연례 인증 보고서, 승인된 대체 액세스 표준, 시정 조치 계획 등 네트워크 적정성과 관련된 자세한 내용은 미국 보건부 의료 서비스 네트워크 적정성 웹페이지를 참조하세요.​​  

Provided below are some federal and state laws applicable to NAOS. These laws are found within the CFR, and Welfare and Institutions Code (WIC).​​  

적용 법률​​  

연방:​​  

  • 42 CFR 438.206 서비스 가용성​​  
  • 42 CFR 438.207 적절한 용량 및 서비스 보장​​  
  • 42 CFR 438.68 네트워크 적정성 표준​​  

상태(법령):​​  

  • HSC 섹션 1367.03​​  
  • WIC 섹션 14197​​  

상태(규정):​​  

  • 28 CCR 섹션 1300.67.04​​  
  • 28 CCR 섹션 1300.67.2.2​​  

추가 리소스​​ 

캘리포니아 발전 및 혁신 Medi-Cal (CalAIM):​​ 

메디케이드 및 Medi-Cal 일반:​​ 

연락처 정보​​