ຂ່າວເດັ່ນ​​ 

ການອະນຸມັດການແກ້ໄຂສາທິດ CalAIM​​ 

On August 23, the Centers for Medicare & Medicaid Services (CMS) approved an amendment to the California Advancing and Innovating Medi-Cal (CalAIM) Section 1115 demonstration waiver, allowing the state to implement county-based model changes in its Medi-Cal managed care program. The amendment includes expenditure authority to limit the choice of managed care plans (MCPs) in non-rural areas. This authority would apply in the metro, large metro, and urban counties intending to participate in the County Organized Health System (COHS) or Single Plan models.​​ 

For rural counties, CMS approved an amendment to the CalAIM Section 1915(b) waiver on June 26 to limit plan choice in rural counties to participate either in the COHS or Single Plan models. These county-based model changes will go into effect on January 1, 2024. Twelve counties will become COHS and three will become Single Plan model counties. For more information about all counties, their current and 2024 model type, and the MCPs operating in the county, please see the MCP county table.​​ 

ອັບເດດໂຄງການ​​ 

Medi-Cal Rx​​ 

ໃນວັນທີ 22 ສິງຫາ, ສູນບໍລິການລູກຄ້າ Medi-Cal Rx ໄດ້ຈັດຕັ້ງປະຕິບັດຄຸນສົມບັດການປັບປຸງການຮັບຮູ້ສຽງແບບໂຕ້ຕອບສຳລັບສະມາຊິກ, ຜູ້ສັ່ງຢາ, ຮ້ານຂາຍຢາ ແລະ ສາທາລະນະຊົນ. ການປັບປຸງລວມມີການສຳຫຼວດການໂທ, ເມນູຫຼັກເພື່ອເຮັດໃຫ້ການໂທມີປະສິດທິພາບຂຶ້ນ, ລະຫັດເພື່ອແຈ້ງໃຫ້ຕົວແທນຮູ້ກ່ຽວກັບເຫດຜົນຂອງການໂທ, ກັບຄືນໄປຫາເມນູຫຼັກເພື່ອໃຫ້ຜູ້ໂທສາມາດກວດສອບລາຍການບໍລິການດ້ວຍຕົນເອງຫຼາຍຢ່າງ, ແລະ ປັບປຸງພາສາ ແລະ ຕຳແໜ່ງຂອງການແຈ້ງເຕືອນໃຫ້ດີຂຶ້ນ.​​ 

On August 16, a New Start PA Reminder Alert was published about the prior authorization requirements that will be reinstated beginning on September 22 for new start enteral nutrition products for members 22 years of age and older.​​ 

ການສົ່ງຂໍ້ມູນ Medi-Cal ສຳລັບເດັກນ້ອຍ ແລະ ໄວລຸ້ນ​​ 

On August 25, DHCS distributed an informational mailing to Medi-Cal fee-for-service (FFS) members and/or their parents or guardians about the federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, known in California as Medi-Cal for Kids & Teens. The FFS mailing includes: (1) Medi-Cal for Kids & Teens brochures to improve member understanding of how Medi-Cal works for children, teens, and young adults, what it covers, and its role in preventive care screening, diagnosis, and treatment. The child brochure is for children up to age 12, and the teen brochure is for ages 12-20; and (2) “Medi-Cal for Kids & Teens: Your Medi-Cal Rights” guide to help members under age 21 understand their Medi-Cal benefits and their recourse if medically necessary care is denied, delayed, reduced, or stopped. The materials, including translations, are posted on the Medi-Cal for Kids & Teens webpage.​​ 

ເຂົ້າຮ່ວມທີມງານຂອງພວກເຮົາ​​ 

DHCS ກໍາລັງຈ້າງສໍາລັບທີມງານງົບປະມານ, ຊັບພະຍາກອນມະນຸດ, ທາງດ້ານກົດຫມາຍ, ການກວດສອບ, ນະໂຍບາຍສຸຂະພາບ, ແລະທີມງານເຕັກໂນໂລຊີຂໍ້ມູນຂ່າວສານຂອງພວກເຮົາ. ສໍາລັບຂໍ້ມູນເພີ່ມເຕີມ, ກະລຸນາເຂົ້າໄປທີ່ ເວັບໄຊທ໌ CalCareers.​​ 

DHCS is dedicated to providing equitable access to quality health care, leading to a healthy California for all. DHCS’ goals and objectives express the tremendous work DHCS is leading to transform our health care system and reflect the organizational culture we are building together.​​ 

ກອງປະຊຸມຜູ້ມີສ່ວນກ່ຽວຂ້ອງ ແລະກອງປະຊຸມທາງເວັບທີ່ຈະມາເຖິງ​​ 

ການລວມເອົາການປະຕິບັດທີ່ໄດ້ຮັບຂໍ້ມູນຈາກການບາດເຈັບເຂົ້າໄປໃນ Webinar ການບໍລິການສຸຂະພາບຈະເລີນພັນ​​ 

ໃນວັນທີ 30 ສິງຫາ, ຕັ້ງແຕ່ເວລາ 12 ໂມງ ຫາ 13:30 ໂມງ, DHCS ແລະສູນຝຶກອົບຮົມການປ້ອງກັນລັດຄາລິຟໍເນຍ ຈະເປັນເຈົ້າພາບຈັດກອງປະຊຸມທາງເວັບກ່ຽວກັບການລວມເອົາການປະຕິບັດທີ່ໄດ້ຮັບຂໍ້ມູນຈາກການບາດເຈັບເຂົ້າໃນການບໍລິການສຸຂະພາບການຈະເລີນພັນ. ການດູແລທີ່ອີງໃສ່ຂໍ້ມູນຈາກການບາດເຈັບຮັບຮູ້ເຖິງຄວາມຕ້ອງການທີ່ຈະເຂົ້າໃຈປະສົບການຊີວິດຂອງລູກຄ້າເພື່ອໃຫ້ການດູແລທີ່ມີປະສິດທິພາບ ແລະ ມີທ່າແຮງທີ່ຈະປັບປຸງການມີສ່ວນຮ່ວມຂອງຄົນເຈັບ, ການຍຶດໝັ້ນໃນການປິ່ນປົວ, ແລະ ຜົນໄດ້ຮັບດ້ານສຸຂະພາບ. ສຳລັບຜູ້ທີ່ບໍ່ສາມາດເຂົ້າຮ່ວມການສຳມະນາທາງເວັບສົດໄດ້, ບົດບັນທຶກ ແລະ ການບັນທຶກການສຳມະນາທາງເວັບ, ພ້ອມກັບຊັບພະຍາກອນເພີ່ມເຕີມ, ຈະມີໃຫ້ຢູ່ໃນ ເວັບໄຊທ໌ Family PACT.​​ 

ຊົນເຜົ່າແລະຜູ້ອອກແບບໂຄງການສຸຂະພາບອິນເດຍປະຈໍາໄຕມາດ Webinar​​ 

On August 30, from 2 to 3 p.m., DHCS will host a webinar (advance registration required) for tribal and Indian health program representatives to provide feedback on DHCS initiatives with specific impact to tribes, Indian health programs, and American Indian Medi-Cal members. The webinar will provide information about State Plan Amendments, waivers, and demonstrations proposed for submission to CMS, including the Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) Medicaid section 1115 demonstration and transitional rent services amendment to the CalAIM section 1115 demonstration. Email questions or comments to TribalAffairs@dhcs.ca.gov.​​ 

ຄວາມທ່ຽງທຳ ແລະການປະຕິບັດການຫັນປ່ຽນໂຄງການການຈ່າຍເງິນ Webinar​​ 

On August 30, from 3 to 4 p.m., DHCS will host an Equity and Practice Transformation Payments Program Webinar (advance registration required) to share an update on the Equity and Practice Transformation Payments Program, which is a one-time $700 million primary care practice transformation program initiative to advance health equity and population health and invest in upstream care models. Details about the Provider Directed Payment Program will be discussed during the webinar; the program application and other materials will be posted on the DHCS website in the future. Please email ept@dhcs.ca.gov with any questions.​​ 

ທູດການຄຸ້ມຄອງ DHCS: ຝຶກອົບຮົມ Webinar ຂອງຄູຝຶກ​​ 

On August 31, from 10 to 11:30 a.m., DHCS will host a webinar on Coverage Ambassadors: Train the Trainer. The webinar will serve as a training session for Coverage Ambassadors to better assist their communities as California resumes standard Medi-Cal operations and communicates the importance of members renewing their Medi-Cal coverage. The webinar will also describe the resources available and how to use them. For more information, visit the Coverage Ambassadors Coverage Ambassadors webpage. Join the Coverage Ambassadors mailing list to receive the latest information and updated toolkits as they become available.​​ 

Webinar ການປະຕິຮູບດ້ານການເງິນຂອງສະຖາບັນພະຍາບານ​​ 

On September 7, from 2 to 3 p.m., DHCS will host a virtual stakeholder webinar to discuss the development of the Skilled Nursing Facility Workforce Standards Program and provide updates on other nursing facility financing reform programs authorized by Assembly Bill 186 (Chapter 46, Statutes of 2022). Stakeholder input will be accepted. Additional information is available on the Nursing Facility Financing Reform (AB 186) webpage.​​ 

ໂຄງການຄຸ້ມຄອງເຄື່ອງຊ່ວຍຟັງສຳລັບເດັກນ້ອຍ (HACCP) Webinar ສໍາລັບຄອບຄົວ ແລະຄູ່ຮ່ວມງານຊຸມຊົນ​​ 

On September 12, from 11 a.m. to 12 p.m., DHCS will host a HACCP webinar to share guidance with families and communities about applying for hearing aid coverage and helping children to maximizing their HACCP benefits once enrolled. DHCS welcomes newly interested families, those who are currently participating in HACCP, and community partners supporting families and children to join this webinar for program updates, tips, and a Q&A session. For more information, please visit www.dhcs.ca.gov/haccp.​​ 

ກອງປະຊຸມຄະນະປະຕິບັດງານການຈັດຕັ້ງປະຕິບັດ Doula​​ 

ໃນວັນທີ 14 ກັນຍາ, ຕັ້ງແຕ່ເວລາ 12 ໂມງ ຫາ 14 ໂມງ, DHCS ຈະເປັນເຈົ້າພາບຈັດກອງປະຊຸມກຸ່ມເຮັດວຽກກ່ຽວກັບການຈັດຕັ້ງປະຕິບັດ Doula ຄັ້ງທີສາມ. ລິ້ງເພື່ອຮັບຟັງກອງປະຊຸມຈະຖືກໂພສລົງໃນ ໜ້າເວັບ Doula Services ເປັນຜົນປະໂຫຍດ Medi-Cal ພາຍໃນວັນທີ 31 ສິງຫາ. ກອງປະຊຸມຈະປະກອບມີບົດລາຍງານກ່ຽວກັບຂໍ້ສະເໜີເສັ້ນທາງການດູແລການເກີດລູກຂອງ DHCS ແລະບົດບາດຂອງ doulas, ແລະການວາງແຜນສຳລັບກອງປະຊຸມໃນອະນາຄົດ. ກຸ່ມເຮັດວຽກມີຄວາມຮັບຜິດຊອບໃນການທົບທວນວິທີການເພີ່ມຄວາມພ້ອມຂອງການບໍລິການ doula ຜ່ານໂຄງການເຜີຍແຜ່ການສຶກສາ, ການກຳນົດ ແລະ ຫຼຸດຜ່ອນອຸປະສັກຕໍ່ການບໍລິການ doula, ແລະ ການແກ້ໄຂຄວາມລ່າຊ້າໃນການຈ່າຍເງິນ ແລະ ການຊົດເຊີຍໃຫ້ແກ່ doula ແລະ ສະມາຊິກ.​​ 

Webinar ສໍາລັບຜູ້ໃຫ້ບໍລິການທາງການແພດແລະຜູ້ຊ່ຽວຊານດ້ານການໄດ້ຍິນ​​ 

On September 14, from 12 to 1 p.m., DHCS will host a HACCP webinar to share information with providers to help pediatric patients and their families maximize HACCP benefits. The training session will address program requirements for families to apply for coverage and the claims submission process for audiologists, otolaryngologists, physicians, and their office staff. For more information, please visit www.dhcs.ca.gov/haccp.​​ 

ໃນກໍລະນີທີ່ທ່ານພາດມັນ​​ 

ຄາລິຟໍເນຍຂະຫຍາຍການເຂົ້າເຖິງການປິ່ນປົວຢາ Opioid ໃນຄຸກແລະສານຢາເສບຕິດ​​ 

On August 22, DHCS announced it will expand Medication Assisted Treatment (MAT) to jails and drug courts it will expand Medication Assisted Treatment (MAT) to jails and drug courts. The $2.9 million in funding will go to 29 counties to support the development or expansion of access to MAT. By bringing county teams together in a learning collaborative, county agencies and providers serving justice-involved residents can more effectively coordinate and further build system capacity to ensure access to effective treatment and recovery supports. This expansion will better serve residents in need, and MAT, specifically, has been shown to reduce criminal activity and reincarceration to better serve the entire community.​​ 

ລັດຂະຫຍາຍການເປັນຄູ່ຮ່ວມງານລິເລີ່ມຂອງໂຮງຮຽນ CalHOPE​​ 

On August 24, DHCS announced the extension of the CalHOPE Schools Initiative through June 30, 2024 the extension of the CalHOPE Schools Initiative through June 30, 2024. The initiative provides free resources for school personnel, youth, and parents surrounding three powerful films that address student social-emotional and mental health needs: A Trusted Space: Redirecting Grief to Growth, Angst: Building Resilience, and Stories of Hope Shorts.​​ 

ຄວາມຄິດເຫັນປະຈຳອາທິດຂອງ Capitol ກ່ຽວກັບການກຳນົດຄືນ Medi-Cal​​ 

ໃນວັນທີ 20 ສິງຫາ, Capitol Weekly ດໍາເນີນການ ຄວາມຄິດເຫັນ ຂອງ LA Care CEO John Baackes. LA Care ແມ່ນໜຶ່ງໃນແຜນການດູແລທີ່ຄຸ້ມຄອງໂດຍ Medi-Cal ໃນເຂດ Los Angeles County. ທ່ານ Baackes ໄດ້ຮຽກຮ້ອງໃຫ້ “ພວກເຮົາທຸກຄົນ - ເພື່ອນບ້ານ, ຄູ່ຮ່ວມງານໃນລັດຖະບານ, ແລະ ຜູ້ສະໜັບສະໜູນຊຸມຊົນ - ເຮັດທຸກສິ່ງທີ່ພວກເຮົາສາມາດເຮັດໄດ້ເພື່ອຮັກສາເພື່ອນມິດ ແລະ ເພື່ອນບ້ານຂອງພວກເຮົາໃຫ້ມີປະກັນໄພ” ໂດຍ Medi-Cal.​​ 

ໃນຂະນະທີ່ທ່ານພົວພັນກັບສະມາຊິກ Medi-Cal, ກະລຸນາແບ່ງປັນຄໍາແນະນໍາທີ່ເປັນປະໂຫຍດໃຫ້ເຂົາເຈົ້າຮັກສາການຄຸ້ມຄອງຂອງເຂົາເຈົ້າໄວ້. ຖ້າວັນທີຕໍ່ອາຍຸການມີສິດໄດ້ຮັບຂອງເຂົາເຈົ້າແມ່ນຢູ່ໃນເດືອນມິຖຸນາ ຫຼື ເດືອນກໍລະກົດ, ມັນກໍ່ຍັງບໍ່ຊ້າເກີນໄປ. ພວກເຂົາສາມາດສົ່ງຄືນຊຸດຕໍ່ອາຍຸ Medi-Cal ຂອງພວກເຂົາໄປທີ່ຫ້ອງການຂອງເຂດປົກຄອງທ້ອງຖິ່ນໃນມື້ນີ້ເພື່ອໃຫ້ການຄຸ້ມຄອງຂອງພວກເຂົາກັບຄືນສູ່ວັນຕໍ່ອາຍຸເດີມ. ນອກຈາກນັ້ນ, ຖ້າສະມາຊິກ Medi-Cal ໄດ້ຍ້າຍຖິ່ນຖານ ຫຼື ຂໍ້ມູນຕິດຕໍ່ຂອງເຂົາເຈົ້າມີການປ່ຽນແປງໃນສອງສາມປີທີ່ຜ່ານມາ, ເຂົາເຈົ້າຄວນຮັບປະກັນວ່າຫ້ອງການເຂດປົກຄອງທ້ອງຖິ່ນຂອງເຂົາເຈົ້າມີຂໍ້ມູນປະຈຸບັນຂອງເຂົາເຈົ້າເພື່ອໃຫ້ເຂົາເຈົ້າສາມາດຕິດຕໍ່ໄດ້ດ້ວຍຂໍ້ມູນການຕໍ່ອາຍຸທີ່ສຳຄັນ. ແລະ ຖ້າສະມາຊິກໄດ້ຮັບຊຸດຕໍ່ອາຍຸ Medi-Cal ທາງໄປສະນີໃນຊອງສີເຫຼືອງ, ພວກເຂົາຕ້ອງປະຕິບັດຢ່າງວ່ອງໄວເພື່ອຮັກສາຕົນເອງ ແລະ ຄອບຄົວຂອງພວກເຂົາໃຫ້ປອດໄພໂດຍການສົ່ງເອກະສານຕໍ່ອາຍຸຄືນ.​​