Tahanan Sangay ng Pangangasiwa ng Kasapatan ng Network ng Kalusugan ng Pag-uugali​​ 

Sangay ng Pangangasiwa sa Kasapatan ng Network ng Kalusugan ng Pag-uugali​​ 

Bumalik sa homepage ng Mga Serbisyo sa Kalusugang Pangkaisipan.​​  

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​​ 

Network Adequacy Oversight Section​​ 

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.​​  

Ang mga aktibidad sa pagsunod at pagsubaybay sa kasapatan ng network na natukoy dito ay partikular sa mga MHP, programa ng DMC-ODS, at mga plano ng estado ng DMC partikular para sa mga kinakailangan sa napapanahong pag-access. Sinusubaybayan ng Managed Care Quality and Monitoring Division ang mga kinakailangan sa kasapatan ng network para sa mga Managed Care Plan. Mangyaring sumangguni sa webpage ng Department of Health Service Network Adequacy para sa karagdagang impormasyon na may kaugnayan sa network adequacy, kabilang ang mga Taunang Ulat sa Sertipikasyon, mga aprubadong Alternatibong Pamantayan sa Pag-access, at mga Plano ng Pagkilos na Pangwasto.​​  

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

Mga Naaangkop na Batas​​  

Pederal:​​  

  • 42 CFR 438.206 Availability ng Mga Serbisyo​​  
  • 42 CFR 438.207 Pagtitiyak ng Sapat na Kapasidad at Mga Serbisyo​​  
  • 42 CFR 438.68 Mga Pamantayan sa Kasapatan ng Network​​  

Estado (Mga Batas):​​  

  • HSC Seksyon 1367.03​​  
  • WIC Seksyon 14197​​  

Estado (Mga Regulasyon):​​  

  • 28 CCR Seksyon 1300.67.04​​  
  • 28 CCR Seksyon 1300.67.2.2​​  

Karagdagang Mga Mapagkukunan​​ 

California Advancing and Innovation Medi-Cal (CalAIM):​​ 

Medicaid at Medi-Cal General:​​ 

Impormasyon sa Pakikipag-ugnayan​​