主页行为健康行政一体化​​ 

行为健康行政整合​​ 

常见问题​​ 

实施时间表​​ 

行为健康管理整合的每个阶段包含什么内容？​​ 

为了在 2027 年实现全州范围的行为健康行政整合，DHCS 将与各县合作，采用三阶段方式，在不同时间以不同程度整合不同组成部分。 制定分阶段实施计划是为了考虑到以下事实：一些组成部分可以在现有权力下进行整合，而且各县可能已经采取措施这样做，而其他组成部分可能需要卫生和客户服务部采取行动、州权力机构发生变化或联邦政府批准。​​ 

  • 第 1 阶段的重点是 2023 年至 2024 年间根据现有合同自愿整合县职能。​​  
  • 第 2 阶段将重点关注 2025 和 2026 日历年的自愿合同整合，针对自愿尽早采用整合合同的县，该阶段将于1 1 月 23 日、 2025 1 月 24 日生效。​​  
  • In Phase 3, all counties will be required to adopt integrated contracts effective January 1, 2027, as specified in CalAIM statute (AB 133).​​  

有关每个实施阶段的更多信息，请参阅行为健康行政整合概念文件。​​ 

DHCS 能否提供有关将综合 DHCS-县合同与日历年（而非财政年度）保持一致的提案的更多细节？​​ 

Currently, DHCS-County behavioral health contracts are aligned with the State Fiscal Year, which runs from July 1 to June 30. In AB 133, however, the Legislature directed DHCS and counties to execute integrated behavioral health contracts effective January 1, 2027. Having the integrated behavioral health contracts take effect at the beginning of the calendar year would align with the renewal of DHCS’ existing 1915(b) waiver and with Managed Care Plan (MCP) contract cycles, both of which already follow the calendar year. DHCS will work closely with counties and other key stakeholders to assess the implications of shifting the behavioral health contract cycle to the calendar year, and to ensure a successful transition to calendar year contract cycles.
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DHCS 将如何支持各县在1年2027月之前实现行为健康行政整合合规？​​ 

DHCS 承认县工作人员的时间有限，并且各县正在实施其他 CalAIM 政策改革。 DHCS 考虑到这些能力限制，制定了行为健康行政整合的分阶段实施方法，包括与其他 CalAIM 改革的协调。 DHCS 将继续进行广泛的利益相关者参与和技术援助，以确保各县拥有成功实施行为健康行政整合所需的信息、资源和技术援助。 参与将包括利益相关者工作组、信息网络研讨会、有针对性的宣传以及发布明确的指导和其他资源（视情况而定）。​​ 

对于不自愿进行早期合同整合的县来说，行为健康行政整合将会是什么样子？​​ 

在第 2 阶段（1 月 1 日 - 12 月 31 日：自愿合同整合）期间，未选择提前参与合同整合的县可以继续整合不需要 DHCS 额外指导的部分，例如与 24/7 接入热线、筛查、评估和治疗计划、质量改进和文化能力计划相关的流程，以及县数据存储和数据共享，为 1 月1 、 2027全面实施做准备。 这些县直到 2027 年才会参与需要综合合同权的部分（即外部质量审查 (EQR)、BH 审计和网络充分性认证）。​​ 

DMC 县​​ 

对于药物医疗补助 (DMC) 县来说，行为健康行政整合将会是什么样子？​​ 

DMC 县将继续在管理式医疗结构之外提供物质使用障碍 (SUD) 服务，同时参与该计划的所有其他适用方面，包括采用综合心理健康计划 (MHP) 并与卫生保健服务部 (DHCS) 签订 DMC 合同，以促进整合目标。​​ 

DMC-ODS区域模型​​ 

对于采用药物 Medi-Cal 有组织配送系统 (DMC-ODS) 区域模式的县，将如何实施行为健康行政整合？​​ 

DHCS 认识到 DMC-ODS 区域示范县有独特的实施考虑。在第 2 阶段（1/1/25-12/31/26：自愿合同整合），DHCS 将与参与 DMC-ODS 区域模型的县进行有针对性的利益相关者接触，为该模型的参与者提供行为健康行政整合实施信息。更多信息即将发布。​​ 

与其他 CalAIM 改革保持一致​​ 

行为健康行政整合是否需要 MCP 和行为健康计划 (BHP) 之间签署综合谅解备忘录 (MOU)？​​ 

Behavioral Health Administrative Integration does not require a new MOU between MCPs and Behavioral Health Plans (BHPs). BHPs may submit one integrated MOU template inclusive of MHP and DMC-ODS or DMC requirements that fulfills all requirements outlined in Behavioral Health Information Notice (BHIN) 23-056, 23-057, and 24-016.​​ 

行为健康管理整合如何与其他 CalAIM 政策改革（如“不走错门”、“文档重新设计”以及“标准化筛查和过渡工具”）保持一致？​​ 

DHCS 制定了行为健康行政整合框架和分阶段实施方法，以配合并创造机会支持和利用现有 CalAIM 计划的实施，澄清现有要求，并在筛查、评估和治疗计划的护理点推广最佳实践。 这些 CalAIM 举措已经包括政策变化，以协调 Medi-Cal SMHS 和物质使用障碍 (SUD) 服务的行政要求。 例如，CalAIM 包含成员访问标准更新，明确指出临床诊断不是在 SMH 或 DMC/DMC-ODS 交付系统中接受行为健康服务的先决条件；患有 MH 或 SUD 症状的个人可以在确定诊断的同时接受护理。 许多文档重新设计政策变化也适用于专业 BH 交付系统，包括消除静态治疗计划和采用问题列表。​​ 

付款如何与行为健康行政整合协作？​​ 

Effective July 1, 2023 under the CalAIM Behavioral Health Payment Reform initiative, county Behavioral Health Plans transitioned from cost-based reimbursement funded via Certified Public Expenditures (CPEs) to fee-for-service reimbursement funded via Intergovernmental Transfers (IGTs), eliminating the need for reconciliation to actual costs.  As part of payment reform, both Specialty Mental Health (SMH) and SUD services transitioned from existing Healthcare Common Procedure Coding System (HCPCS) Level II coding to Level I coding, known as Current Procedural Terminology (CPT) coding, when possible. Behavioral Health Administrative Integration will not change covered Medi-Cal BH benefits or modify the components of payment reform for SMH, DMC, or DMC-ODS.  Behavioral Health Administrative Integration Initiative also does not change the way Medi-Cal SMHS and SUD services are financed in California; in other words, it will not change existing allocation methods or spending requirements for MH and SUD funding sources including 1991 and 2011 Realignment and MHSA. More information about Behavioral Health Payment Reform, including technical assistance materials, is available on the CalAIM BH Webpage. 
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会员体验​​ 

行为健康管理整合将如何改善会员体验？​​ 

在行为健康行政整合下协调或合并心理健康和 SUD 计划的行政要求将减少行为健康计划和提供者的复杂性和管理负担，从而提高会员体验的护理质量，因为变化将使提供者能够专注于改善护理服务，包括提供对同时发生的精神健康和 SUD 状况的护理。协调 SMHS 和 DMC/DMC-ODS 之间的管理要求也可能使提供商更容易参与这两个交付系统，从而可以为需要 SMHS 和 DMC/DMC-ODS 服务的个人提供更综合的护理。​​  

会员还可以访问综合会员手册，因此可以在一个位置（而不是两个位置）搜索 SMHS 和 SUD 服务。此外，将有一个单一的综合上诉/申诉流程，再次为会员提供一处完成此流程的途径，而不是针对 SMHS 和 SUD 服务的两个不同流程。最后，质量保证绩效改进 (QAPI) 和外部质量审查 (EQR) 活动将更加关注同时出现行为健康需求的会员的护理质量，并承认会员之间两种情况经常重叠。​​ 

DHCS- County Contracts​​ 

卫生保健服务部 (DHCS) 将如何处理综合合同中专业心理健康服务 (SMHS) 和药物医疗补助 (DMC) /药物医疗补助有组织配送系统 (DMC-ODS) 计划之间的要求和规定差异？​​ 

DHCS 使用现有的心理健康计划 (MHP) 合同样板作为开发综合合同样板的起点，然后根据需要修改和添加内容，以满足 DMC-ODS 或 DMC 的所有相关要求。 鉴于 DMC-ODS/SMHS 合同将构建为单一预付住院健康计划 (PIHP) 管理式医疗方案，DMC 县将继续运营 SMHS PIHP 和非管理式医疗 DMC 方案。 综合合同的某些部分被标识为特定于计划（例如，医疗必要性和服务定义），并且这些部分通常直接从 SMHS、DMC-ODS 和/或 DMC 的当前合同中复制。 对于合同中同样适用于 SMHS 和 DMC-ODS 或 DMC 计划的“综合”部分，DHCS 已根据需要进行了适度调整，以协调各计划之间的标准。 对于 DMC 县，某些 SMHS 管理式医疗功能已进行调整，需要特别关注同时存在行为健康需求的成员。​​  

行为健康行政整合是否意味着各县需要重组，以便精神健康和物质使用障碍系统都归县内的单一行为健康部门管辖？​​ 

不。 虽然从州和联邦法律的角度来看，各县（或各县的地区组）将运营一个综合的 Medi-Cal 行为健康计划，但各县可以继续根据自己的意愿构建内部运营。 例如，一些县选择将其行为健康人员合并到一个县部门，而其他县则保留单独的部门（或部门内的分部）负责专业精神健康和物质使用障碍业务。​​ 

Will there be an annual spending limit specified in the integrated contracts, similar to the current approach for counties’ DMC and DMC-ODS contracts? If not, will the removal of those annual limits affect State General Fund (SGF) contributions for, or any limits that may exist on, specific DMC or DMC-ODS services?​​ 

Currently, counties’ DMC and DMC-ODS contracts contain an annual spending limit, which must be amended if actual spending exceeds projections.  By contrast, MHP contracts are “zero dollar” contracts with no limit.​​ 

The integrated behavioral health contracts will be “zero dollar” contracts with no specified limit, similar to the current approach for MHP contracts.  All eligible county claims will be paid in accordance with the contract and applicable law.​​ 

A “zero dollar” approach means there is no need for a fiscal amendment if overall spending under the contract is higher than expected. Implementing “zero dollar” does not modify SGF contributions for specific services (e.g., intensive outpatient and residential DMC-ODS services) and populations (e.g., ACA Optional Expansion).​​ 

有关各种专业行为健康服务和人群的资金的更多信息，请参阅https:/ /www.dhcs.ca.gov/services/MH/Pages/MedCCC-Library .aspx上的 DMC、DMC-ODS 和专业心理健康计费手册。 当前 DMC/DMC-ODS 手册的第 6 章包含有关资金的详细讨论，包括 SGF 捐款。
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Can the Department of Health Care Services (DHCS) provide additional clarification on the impact and operationalization of “zero dollar” contracts? Specifically, how will “zero dollar” contracts be operationalized between DHCS and counties, and how this could impact county contracts with community-based organizations (CBOs)?​​ 

A “zero dollar” approach means there is no need for a fiscal amendment if overall spending as part of the integrated contract is higher than expected. This approach avoids the administrative burden of contract amendments completed by counties and DHCS. The existing Mental Health Plan (MHP) contracts are already “zero dollar” with no issues. Therefore, DHCS does not anticipate any issues with the integrated contracts being zero-dollar. Furthermore, “zero dollar” financing should not have an impact on county contracts with CBOs. All eligible county and provider claims will continue to be paid in accordance with the contract and applicable law.​​ 

 早期合同整合会影响国家普通基金（SGF）吗？​​ 

 加州法律规定了如何使用现有的行为健康资金来支持心理健康和/或物质使用障碍服务。 综合合同的实施不会改变针对特定服务和人群的 SGF 贡献。​​ 

 对于早期整合合同的县，拨款分配是否会有所不同？ 如果是的话，能否详细说明如何与综合合同保持一致？​​ 

 Funding allocations and restrictions will not be modified or adjusted through CalAIM Behavioral Health Administrative Integration and will continue to necessitate dual processes for certain fiscal and accounting functions at the county level.​​ 

 根据综合合同，各县将如何索取与涵盖的 Medi-Cal 服务、质量保证和利用审查 (QA/UR)、合同相关的行政活动以及精神健康 Medi-Cal 行政活动 (MH MAA) 相关的费用？​​ 

  • Covered Medi-Cal Services for Members. Under the integrated contract, providers will continue to bill Medi-Cal behavioral health services to the appropriate program SMHS, DMC, or DMC-ODS), and counties will continue to use program-specific codes when they submit claims to DHCS for expenses related to those covered services. Adopting an integrated contract under Behavioral Health Administrative Integration does not require counties to make any changes to provider reimbursement rates, nor to the financing approach for the county’s share of Medi-Cal expenses.​​ 
  • QA/UR 和合同相关的管理活动。 DHCS 将对 QA/UR 和行政活动实施综合索赔。 在每个类别中，各县将报告综合合同下的总合格费用（尽管各县如果愿意的话，可以继续为自己的目的跟踪特定计划的小计）。 各县将被要求单独报告根据第 30 号提案有资格获得州政府资助的支出。​​ 
  • MH MAA。各县将继续通过 MH MAA 索赔流程以与目前索赔报销相同的方式索赔报销。​​     

24/7 全天候访问热线​​ 

对于综合的 24/7 接入热线，卫生保健服务部 (DHCS) 是否会要求各县使用本地电话号码，还是可以使用免费电话号码？​​ 

根据 DHCS 行为健康行政整合，拥有综合合同的县将运营一条综合的 24/7 接入热线，这意味着会员只需拨打一个号码即可获取有关专业心理健康服务 (SMHS) 和物质使用障碍 (SUD) 服务的信息。 对于 2025 年的自愿整合，DHCS 目前没有提出对接入线路要求进行任何其他更改。 各县可以继续使用本地电话号码或免费电话号码作为其综合 24/7 接入线路，这与当前要求一致，只要它们为 SMHS 和 SUD 服务提供单一免费电话号码即可。​​ 

全天候综合接入线路是否需要由县政府运营，还是县政府可以继续利用供应商/分包商？​​ 

签订综合合同的县将为所有寻求行为健康服务的 Medi-Cal 会员开通一条 24 小时接入热线，以便他们能够根据心理健康和物质使用障碍需求进行适当分类和筛查，并在同一通话中安排适当的后续预约，而无需挂断电话并拨打任何其他号码。 各县可继续利用供应商/分包商来配备人员并运营其全天候免费接入线路。​​ 

数据共享与隐私​​ 

根据综合合同，第 42 条联邦法规 (CFR) 第 2 部分对物质使用障碍 (SUD) 数据的保护是否适用于整个行为健康计划 (BHP)？​​ 

  1. The integrated Behavioral Health Plan (BHP) contract does not require the county’s entire BHP to comply with 42 CFR Part 2 (“Part 2″) protections for SUD data. Counties have the ability to designate a “Part 2 Component” within their integrated BHP, just as counties currently designate Part 2 and non-Part-2 Components within the overall county government. Only the Part 2 Component must comply with Part 2 requirements for patient consent, over and above baseline requirements under the Health Insurance Portability and Accountability Act (HIPAA) privacy rule.​​ 
    • Under an integrated BHP contract, the Part 2 Component must include, at a minimum, county-operated and county-employed SUD providers, and any others who meet the federal definition of a “Part 2 Program” (e.g., people or entities that hold themselves out as providing, and provide, SUD diagnosis, treatment, or referral for treatment.) See below for the complete definition. If a large provider offers a mix of SUD and non-SUD services, it may be possible to designate specific individuals or units within that provider in the Part 2 Component, without making the entire provider subject to Part 2.​​ 
    • 在县级选择下，县可以选择将县 SMHS 提供商纳入其第 2 部分组成部分。 各县可能希望权衡以下因素：​​ 
      • 将 SMHS 提供商纳入第 2 部分组件将促进 SMHS 和 SUD 护理系统之间的数据共享。 这可以消除电子健康记录 (EHR) 中额外的患者同意和防火墙的需要，因为第 2 部分的同意要求不适用于第 2 部分组件内为诊断、治疗或转诊治疗而进行的数据共享。​​ 
      • 将 SMHS 提供商纳入第 2 部分组件时，他们在与第 2 部分组件之外的个人或实体共享数据时必须遵守第 2 部分的要求。​​ 
    • The Part 2 Program definition does not include the administrative functions performed by health plans. Therefore, as counties decide which individuals, entities, and functions to include under their Part 2 Components, they are likely not required to include county staff activities that relate to administration of the Medi-Cal BHP (as opposed to activities performed by county-operated providers that relate to SUD diagnosis, treatment, or referral).​​ 
    • Part 2 governs the flow of information. Therefore, counties are not required to maintain physical separation between individuals and entities that are/aren’t subject to Part 2, as long as the county has implemented appropriate firewalls to ensure that individuals outside the Part 2 Component are not able to access protected Part 2 information without the necessary member consent.​​ 
    • California Health and Safety Code (H&S) section 11845.5 still applies to SUD services that are not provided through Medi-Cal. Welfare and Institutions Code section 14184.102(j) exempts CalAIM from H&S 11845.5. CalAIM captures substantially all of Medi-Cal.​​  

Definition of a “Part 2 Program”​​ 

Part 2 does not apply to all SUD information. Rather, Part 2 requirements apply to records that (1) reveal information about a patient’s SUD conditions or treatment, and (2) are held by a “Part 2 Program.” A Part 2 Program is defined as any of the following people/entities who receive federal funding (including Medicaid reimbursement):1​​ 

  1. An individual or entity (other than a general medical facility) who holds itself out as providing and provides SUD diagnosis, treatment, or referral for treatment; or​​ 
  2. 在综合医疗机构内：​​ 
    • 已确定的子单位，声称自己提供 SUD 诊断、治疗或转诊服务；或​​ 
    • Medical personnel or other staff in a general medical facility whose primary function is the provision of SUD diagnosis, treatment, or referral and who are identified as such providers. 

      According to Substance Abuse and Mental Health Services Administration (SAMHSA), a provider may “hold itself out” as providing SUD services if it, among other activities, obtains a state license specifically to provide SUD services, advertises SUD services, has a certification in addiction medicine, or posts statements on its website about the SUD services it provides.2 

      1 42 C.F.R. § 2.11

      2 SAMHSA, Substance Use and Confidentiality Regulations (October 27, 2023), https://www.samhsa.gov/about-us/who-we-are/laws-regulations/confidentiality-regulations-faqs​​ 

Under integrated contracts, will 42 Code of Federal Regulations (CFR) Part 2 data protections impact a county’s ability to co-locate specialty mental health services (SMHS) and substance use disorder (SUD) programs?​​ 

Part 2 compliance focuses on flows of information, not physical barriers. Therefore, Part 2 does not prevent co-location of providers as long as minimum Part 2 requirements are met (e.g., firewalls between staff or electronic health record (EHR) systems that are/aren’t part of the Part 2 Component).​​ 

当各县实施行为健康行政整合时，DHCS 可以提供哪些资源来支持各县遵守有关物质使用障碍数据隐私的 42 CFR 第 2 部分法规？​​ 

DHCS is committed to ensuring that behavioral health data are shared and stored as efficiently as possible while maintaining privacy protections for members, including the federal “Part 2″ confidentiality rules for substance use disorder-related information. To support county programs and behavioral health providers in maintaining compliance with 42 CFR Part 2 and other privacy laws as they advance data sharing capabilities and practices, DHCS is exploring opportunities for developing a template “universal release” form (the ASCMI form, see question below) that can be used to obtain individual authorizations for data sharing, including sharing with MCPs and other service providers. DHCS will also consider other opportunities for guidance, and potentially shared learning or other technical assistance, throughout the implementation period.​​ 

目前正在进行的授权共享机密 Medi-Cal 信息 (ASCMI) 试点如何与行为健康行政整合保持一致？​​ 

The ASCMI Initiative seeks to promote coordinated, person-centered care for Medi-Cal members by providing tools that streamline consent to share health and social services information, including mental health and substance use disorder information. The ASCMI tools include the ASCMI Form (standardized release of information form) and the Consent Management Platform (electronic platform that will store and manage a member’s data sharing consent preferences). DHCS envisions Medi-Cal members and providers would be able to access the Consent Management Platform to view, submit, modify, or revoke consent enabling seamless data sharing under Behavioral Health Administrative Integration.​​ 

DHCS 于 2023 年在三个国家进行了试点，以测试对 ASCMI 工具的兴趣和接受度。请参阅ASCMI 试点评估报告以了解更多信息。利用试点中的反馈和经验教训，DHCS 正在完善 ASCMI 表格并制定全州同意管理平台的设计、资金和实施计划。完善的 ASCMI 表格和有关同意管理平台的更多详细信息将于 2025 年发布。
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综合行为健康数据系统项目如何与行为健康管理整合保持一致？​​ 

综合行为健康数据系统项目旨在确定技术解决方案，以实现数据收集和报告、分析和其他数据相关功能的现代化和简化，并开发一个整合来自 12 个现有行为健康数据系统的数据的综合报告和分析平台。 DHCS 将在内部和利益相关者之间进行协调，以确保综合行为健康数据系统项目的实施与行为健康行政整合之间的一致性。​​ 

文化能力计划​​ 

各县是否会收到模板或指导来帮助制定一致且有影响力的文化能力计划？​​ 

是的。DHCS 正在开发供县使用的综合文化能力计划模板。​​ 

外部质量评审 (EQR)​​ 

外部质量评审（EQR）在综合合同下如何发挥作用？​​ 

根据综合合同，药物 Medi-Cal 有组织配送系统 (DMC-ODS) 各县将接受单一、综合的 EQR，该 EQR 同时涉及专业心理健康服务 (SMHS) 和 DMC-ODS 计划。 药物 Medi-Cal (DMC) 县将继续仅因其 SMHS 活动而接收 EQR。​​ 

How will DHCS ensure that the integrated EQR process includes adequate focus on both mental health and substance use disorder priorities aren’t lost in the aim to have an integrated EQR?​​ 

DHCS designs its EQR approach across all programs (SMHS, SUD, Managed Care and Dental) in compliance with federal regulations at Title 42, Part 437, Subpart E of the Code of Federal Regulations.
With respect to the integrated behavioral health EQR under Behavioral Health Administrative Integration, DHCS will work with stakeholders to ensure that EQR—and other oversight mechanisms—include appropriate measures regarding the provision of high-quality mental health and substance use disorder treatment services, including services to treat co-occurring conditions.​​ 

根据现有的心理健康计划 (MHP) 和药物 Medi-Cal 有组织交付系统 (DMC-ODS) 合同，各县预计为每个项目完成一个临床绩效改进项目 (PIP) 和一个非临床 PIP，总共四个 PIP。 在综合合同下，各县是否仍需要完成四项 PIP？​​ 

根据联邦法律，所有拥有综合合同的县都必须实施至少两个 PIP：一个临床 PIP 和一个非临床 PIP。​​ 


  • 对于综合 DMC-ODS 县，PIP 可能涉及专业心理健康服务 (SMHS)、DMC-ODS 或两者。​​ 



  • 对于综合药物医疗补助 (DMC) 县，两个 PIP 都必须与 SMHS 相关，可能包括特别关注同时患有物质使用障碍 (SUD) 的成员。​​ 


与现有合同一致，DHCS 可能要求综合县完成特定的 PIP 和/或额外的 PIP。​​ 

Compliance Reviews (or “BH Audits”)​​ 

What will counties’ compliance reviews look like under Behavioral Health Administrative Integration?​​ 

As part of Behavioral Health Administrative Integration, DHCS will develop a streamlined compliance review for both SMHS and SUD. Adopting integrated reviews will be one of several policy changes that DHCS will implement to restructure and refocus SMHS and DMC/DMC-ODS compliance reviews (or “BH audits”) to support CalAIM goals. DHCS will continue to release guidance on these policy updates and will seek feedback on options for streamlining or integrating compliance monitoring during stakeholder engagement for BH Administrative Integration.​​ 

行为健康（BH）审计在结构和频率方面在综合合同下如何运作？​​ 

拥有综合合同的县将接受年度综合 BH 审计，以评估其对综合合同的遵守情况，包括专门针对专业心理健康服务 (SMHS) 和物质使用障碍 (SUD) 服务的具体要素。 这一综合流程将适用于药物医疗补助有组织配送系统 (DMC-ODS) 和药物医疗补助 (DMC) 县，并将在安排和审查期方面继续遵循州财政年度 (SFY)。 综合 BH 审计将遵循 BHIN 23-044 中所述的针对特定县的系统方法。​​ 

综合行为健康 (BH) 审计是否除了包括专业心理健康服务 (SMHS) 和药物医疗补助 (DMC) /药物医疗补助有组织交付系统 (DMC-ODS) 服务之外，还包括对药物使用预防、治疗和康复服务综合拨款 (SUBG) 服务的审查？​​ 

目前，DHCS 同时对 SUBG 和 DMC/DMC-ODS 进行年度合规性审查。目前，DHCS 预计 SUBG 审查将与综合 BH 审计相结合，包括年度合规性审查以及每三年至少一次的现场审查。DHCS 将发布有关协调和简化行为健康计划监督的更多指导。​​ 

DHCS 打算如何在时间范围内实施行为健康 (BH) 审计，以及在何处/如何整合某些审计以简化响应？对于早期整合合同的县来说？? 能否澄清时间表以及在何处/如何整合某些审计以简化回应？​​ 

 Counties with integrated contracts will receive annual, integrated BH audits effective January 1, 2026 (after the integrated contracts have been in effect for a full year). Following the effective date, these counties will be audited according to the requirements outlined in the integrated contract and will receive a single, integrated findings report. Integrated BH audits will continue to follow the state fiscal year in terms of scheduling and review periods. BH audits will follow the systemic county-specific approach, as described in BHIN 23-044.​​ 

网络充足性​​ 

综合网络适足性认证如何运作？ 卫生保健服务部 (DHCS) 是否会要求各县除了提交每月的 274 电子数据交换 (274 标准) 提供商网络数据外，还提交年度网络充分性认证工具 (NACT) 和及时访问数据？​​ 


  • 对于签订综合合同的县，DHCS 将通过单一的综合报告流程进行年度网络充分性认证。各县将完成一份单一的、综合的网络充分性提交（使用BHIN 23-042中描述的 274 标准）并及时访问报告。这些提交将继续遵循州财政年度（SFY）。对于 2025 年的自愿整合，DHCS 目前并未提议对网络充分性或及时访问标准进行任何实质性更改。​​  



    • 药物 Medi-Cal 有组织配送系统 (DMC-ODS) 县和精神健康计划 (MHP)将被要求每年提交专业精神健康服务 (SMHS) 和物质使用障碍 (SUD) 服务的综合网络充分性认证文件，如BHIN 25-013中所述。DHCS 将通过单一、综合的报告流程进行年度网络认证，包括收集综合 274 电子数据交换（274 标准）提供商网络数据。​​ 

      • DMC-ODS 县还需要按照 BHIN 25-013中所述的 274 标准每月向 DHCS 提交提供商网络数据。虽然 DHCS 将使用 274 标准数据来评估具有综合合同的 DMC-ODS 县的网络充足性合规性，但在 DHCS 发布 BHIN 或其他正式指导以通知各县这一变化之前，274 标准不会正式取代 NACT 成为非综合DMC-ODS 县的主要分析来源。提交期结束后，DHCS 将向每个县提供一份综合调查报告，描述每个必需要素是否已满足网络充分性标准。​​ 




    对于药物医疗补助 (DMC) 县， DHCS 仅要求提交综合及时访问数据工具 (TADT)，其中将包括 SUD 和 SMHS 的及时访问数据。DHCS 仍将要求向 SMHS 提交剩余的网络充分性数据和文档。详细说明网络认证结果的综合报告将发送给签订了综合合同的 DMC 县，但只有及时访问标准结果才适用于 SUD 服务。其余结果仅适用于 SMHS。
    ​​ 


卫生保健服务部 (DHCS) 是否会调整或改变用于评估综合合同下网络充分性的方法？​​ 

自 1 月1 、 2025日起，DHCS 不会改变用于确定自愿选择实施综合合同的药物 Medi-Cal 有组织配送系统 (DMC-ODS) 县的网络充分性合规性的方法。 DHCS 愿意接受各县和其他利益相关者的反馈，以了解对BHIN 23-041中目前概述的网络适足性标准进行潜在实质性修订的优点，例如协调专业心理健康服务 (SMHS) 和物质使用障碍 (SUD) 服务的能力方法，以及与 Medi-Cal 管理式医疗计划的网络适足性方法进行额外的协调。
​​ 

如果县不满足网络充足性要求，卫生保健服务部 (DHCS) 会发布纠正行动计划 (CAP) 吗？ 报告和潜在的 CAP 是单一的吗，还是精神健康计划 (MHP) 和药物 Medi-Cal 有组织交付系统 (DMC-ODS) 分别需要一份？​​ 

对于综合合同不符合一项或多项网络充分性要求的县，DHCS 将批准单一的综合 CAP，以解决专业心理健康服务 (SMHS) 和物质使用障碍 (SUD) 计划（如适用）的缺陷。 根据批准的 CAP，DHCS 可能会要求后续提交其他文件以证明合规性。 该县将继续执行 CAP，直至所有缺陷得到解决。​​  

DHCS 将如何确保新的网络充分性流程仍然能够充分关注物质使用障碍和心理健康优先事项？​​ 

当各县根据行为健康行政整合采用综合合同时，它们仍将遵守与管理现有心理健康计划和 DMC-ODS 计划相同的网络充分性标准，这些标准要求计划分别拥有充足且强大的心理健康或物质使用障碍提供者网络。 现有的网络充分性方法在网络容量评估中纳入了估计的精神健康和物质使用障碍患病率。 DHCS 将与利益相关者合作监测关注问题，以确保精神健康和物质使用障碍服务保留足够的网络，同时能够提供对并发疾病的治疗。​​ 

供应商监督​​ 

行为健康行政整合将如何影响提供者？​​ 

此项举措不会强制要求提供商层面的护理模式发生改变，提供商仍然可以选择提供 SMHS、DMC/DMC-ODS 服务或两者兼有。 DHCS 预计，作为该计划的一部分而实施的行政简化将提高服务提供商的效率，使其能够更轻松地参与 SMH 和 DMC/DMC-ODS 计划，并且如果服务提供商选择这样做的话，还可以提供同时进行的专业行为健康服务。​​ 

行为健康行政整合将如何影响与专业心理健康服务 (SMHS) 和物质使用障碍 (SUD) 计划签约的 Medi-Cal 计划提供商的审计或监控？​​ 

根据现有合同，药物医疗补助有组织配送系统 (DMC-ODS) 和药物医疗补助 (DMC) 计划（但不包括精神健康计划 (MHP)）必须对其签约提供商进行年度现场审查。 根据综合合同，各县将被要求为所有交付系统的所有合同提供商（为专业心理健康服务 (SMHS) 或 DMC-ODS 成员提供服务的网络外提供商除外）做以下事情：​​ 

  • 进行年度合规审查（办公室或现场）​​ 
  • 对组织提供商至少每 3 年进行一次现场合规性审查（但不针对与县直接签约的个人 SMHS 从业人员）​​ 
  • 在发布后两周内向 DHCS 提交监测和审计报告副本​​ 
  • 遵守以下标准化程序：​​ 
    • 针对提供商缺陷的县纠正行动计划 (CAP) 程序（主要基于当前 DMC-ODS/DMC 程序）​​ 
    • 对于 SUD 提供商，加州成果测量系统 (CalOMS) 和药物与酒精治疗获取报告 (DATAR) 要求（现已在 DMC 和 DMC-ODS 计划中标准化）。​​ 

为了满足提供商监督要求，各县可以接受另一个县完成的专业心理健康服务 (SMHS) 合规审查吗？​​ 

Yes. Under the integrated contract, counties must conduct annual compliance reviews and triennial on-site reviews for most network providers. Currently, for Drug Medi-Cal (DMC) providers, counties are able to accept a compliance review conducted by another county. This avoids duplicative reviews for providers that participate in multiple counties’ Medi-Cal programs. DHCS is extending this same flexibility to SMHS provider reviews: a county may accept a compliance review completed by another county for a SMHS provider contracted with both counties. DHCS will clarify this policy in a future amendment to the integrated contract.​​ 

How will the transition from fiscal year (FY) to calendar year (CY) contracts impact counties’ provider contracts, provider monitoring, and Corrective Action Plans (CAPs) for providers?​​ 

The transition from fiscal year (FY) to calendar year (CY) contracts does not require any changes to the timing of counties’ provider contracts, provider monitoring, or provider Corrective Action Plans (CAPs). Counties determine the timing of a provider’s review based on when that provider’s last review occurred. The provider review timing is not reset under the integrated contract.​​ 

现有的 Medi-Cal 站点认证工具是否预计会发生变化？各县是否将负责以类似于当前专业心理健康服务 (SMHS) 认证流程的方式认证药物 Medi-Cal 有组织配送系统 (DMC-ODS) 计划？​​ 

卫生保健服务部 (DHCS) 将继续对签约的药物医疗补助 (DMC) 提供商进行认证，而各县将对签约的专业心理健康服务 (SMHS) 提供商进行认证。DHCS 预计提供商站点认证工具不会发生任何变化。​​ 

特定行为健康提供者类型和服务的标准​​ 

什么是临床实习生？​​ 

Supplements 3 and 7 to Attachment 3.1-A of the Medicaid State Plan defines Clinical Trainee as an unlicensed individual who is enrolled in a post-secondary educational program that is required for the individual to obtain licensure as a Licensed Mental Health Professional or Licensed Practitioner of the Healing Arts; is participating in a practicum, clerkship, or internship approved by the individual’s program; and meets all relevant requirements of the program and/or applicable licensing board to participate in the practicum, clerkship or internship and provides rehabilitative mental health services or substance use disorder treatment services, including, but not limited to, all coursework and supervised practice requirements.​​  

休假的临床实习生可以提供专业行为健康服务吗？​​    

Clinical Trainees who are on leave of absence from their program may be reimbursed for providing Medi-Cal specialty behavioral health services if the following conditions are met:​​  

  • They are still enrolled in a post-secondary educational program, such as those offered by a university, community college, or vocational school, that is required for the individual to obtain licensure as a Licensed Mental Health Professional (LMHP) or Licensed Practitioner of the Healing Arts (LPHA)​​  
  • They are providing services as part of a practicum, clerkship, or internship approved by the individual’s program; and​​   
  • They meet all relevant program requirements and/or applicable licensing board requirements to participate in the practicum, clerkship, or internship, including all coursework and supervised practice requirements.​​  

Please refer to Supplements 3 and 7 to Attachment 3.1-A of the Medicaid State Plan and Behavioral Health Information Notice (BHIN) 24-023 for additional information on Clinical Trainees.​​  

正在努力获得临床社会工作者 (CSW)、婚姻和家庭治疗师 (MFT) 或专业临床咨询师 (PCC) 执照的个人在其助理申请待决期间可以提供专业行为健康服务吗？​​   

Yes. Behavioral Health Information Notice (BHIN) 24-023 clarifies that behavioral health plans may allow CSW, MFT, and PCC candidates who have graduated from a master’s program to provide and bill for specialty behavioral health services as an Associate CSW, Associate MFT, or Associate PCC if they have submitted their application for associate registration to the California Board of Behavioral Sciences (BBS) within 90-days of their degree award date and are completing supervised experience toward licensure. Department of Health Care Services (DHCS) will reimburse for services rendered while their BBS application is pending, regardless of the number of days it takes for BBS to approve the application.​​  

Please refer to Business and Professions Code (BPC) for CSWs (BPC 4996.23), MFTs (BPC 4980.43), and PCCs (BPC 4999.46), as well as guidance published by BBS for additional information regarding requirements of the “90 Day Rule.”​​  

县行为健康计划 (BHP) 是否要求允许临床实习生或临床社会工作者 (CSW)、婚姻和家庭治疗师 (MFT) 或专业临床咨询师 (PCC) 候选人提供专业行为健康服务？​​  

Department of Health Care Services (DHCS) encourages county behavioral health plans (BHPs) to utilize provider types that meet the needs of their Medi-Cal members. DHCS allows counties to use Clinical Trainees and individuals who have submitted their application for associate registration to the Board of Behavioral Sciences (BBS) within 90-days of their degree award date to provide certain Specialty Mental Health Services (SMHS) and Drug Medi-Cal-Organized Delivery System (DMC-ODS) services as outlined in Behavioral Health Information Notice (BHIN) 24-023. DHCS does not require counties to use Clinical Trainees or individuals who are in the process of registration but have not yet received confirmation of associate registration from BBS. BHPs have discretion to determine their provider networks and specify contract terms.​​   

Please refer to Supplements 3 and 7 to Attachment 3.1-A of the Medicaid State Plan and BHIN 24-023 for additional information on Clinical Trainees and individuals who are in the process of obtaining their associate registration through BBS. 
​​ 

执业心理健康专业人士 (LMHP) 和执业治疗师 (LPHA) 之间有什么区别？​​  

Use of Licensed Mental Health Professional (LMHP) and Licensed Practitioner of the Healing Arts (LPHA) varies by behavioral health delivery system.​​   

LMHP is a term used in the Specialty Mental Health (SMH) delivery system to identify a select group of provider types that provide rehabilitative mental health services. An LMHP includes the following providers:​​   

  • Licensed Physicians​​ 
  • Licensed Psychologists (includes Waivered Psychologists),​​   
  • Licensed Clinical Social Workers (includes Waivered or Registered Clinical Social Workers),​​   
  • Licensed Professional Clinical Counselors (includes Waivered or Registered Professional Clinical Counselors),​​   
  • Licensed Marriage and Family Therapists (includes Waivered or Registered Marriage and Family Therapists),​​  
  • Registered Nurses (includes Certified Nurse Specialists and Nurse Practitioners),​​  
  • Licensed Vocational Nurses,​​    
  • Licensed Psychiatric Technicians, and​​   
  • Licensed Occupational Therapists.​​  

LPHA is a term used in the Drug Medi-Cal (DMC) and Drug Medi-Cal Organized Delivery System (DMC-ODS) to identify a select group of provider types that provide substance use disorder (SUD) and expanded SUD treatment services, respectively. An LPHA includes the following providers:​​  

  • Physician,​​  
  • Nurse Practitioner,​​ 
  • Physician Assistant,​​ 
  • Registered Nurse,​​   
  • Registered Pharmacist,​​ 
  • Licensed Clinical Psychologist,​​   
  • Licensed or Registered Clinical Social Worker,​​  
  • Licensed or Registered Professional Clinical Counselor,​​  
  • Licensed or Registered Marriage and Family Therapist,​​ 
  • 执业护士，​​  
  • 持牌职业治疗师，以及​​   
  • 执业精神科技术员。​​  

Please refer to Supplements 3 and 7 to Attachment 3.1-A of the Medicaid State Plan for additional information on LMHPs and LPHAs.​​   

对于临床社会工作者 (CSW)、婚姻和家庭治疗师 (MFT) 和专业临床咨询师 (PCC) 候选人，“90 天规则”何时开始执行？​​   

The “90 Day Rule” set by the California Board of Behavioral Sciences (BBS) allows candidates to count supervised experience toward licensure when gained during the window of time between the degree award date and the issue date of the associate registration number. To be eligible for the 90 Day Rule, a Clinical Social Worker (CSW), Marriage Family Therapist (MFT), or Professional Clinical Counselor (PCC) candidate must submit their application for associate registration to the BBS within 90-days of their degree award date. Degree award date may vary by educational program but is typically defined as the final day of the term in which the student completes all requirements to graduate from their program.​​   

Please refer to Business and Professions Code (BPC) for CSWs (BPC 4996.23), MFTs (BPC 4980.43), and PCCs (BPC 4999.46), as well as guidance published by BBS for additional information regarding requirements of the “90 Day Rule.”​​  

各县是否应将研究生实习药剂师算作临床培训生，以便申请 Medi-Cal 或提供服务？​​ 

不可以。各县必须确保所有指定的临床实习生 (CT) 符合所有 CT 资格标准，包括根据BHIN 24-043 、 SPA 23-0026和SPA 24-0041积极参加教育计划。例如，已经毕业并正在等待获得正式执照但目前尚未注册或参加教育实习的实习药剂师不应归类为 CT。​​