主页行为健康网络充分性监督处​​ 

行为健康网络充分性监督部门​​ 

返回行为健康服务主页。​​  

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​​ 

网络适足性监督科​​ 

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.​​  

此处确定的网络适当性合规和监测活动专门针对 MHP、DMC-ODS 计划和 DMC 州计划的及时访问要求。管理式医疗质量与监控部负责监控管理式医疗计划的网络适当性要求。有关网络适当性的更多信息，包括年度认证报告、已批准的替代访问标准和纠正行动计划，请参阅医疗服务部网络适当性网页。​​  

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

适用法律​​  

联邦：​​  

  • 42 CFR 438.206 服务可用性​​  
  • 42 CFR 438.207 保证充足的能力和服务​​  
  • 42 CFR 438.68 网络充足性标准​​  

州（法规）：​​  

  • HSC 第 1367.03 节​​  
  • WIC 第 14197 条​​  

国家（法规）：​​  

  • 28 CCR 第 1300.67.04 节​​  
  • 28 CCR 第 1300.67.2.2 节​​  

其他资源​​ 

加州先进创新医疗补助计划 (CalAIM)：​​ 

医疗补助 (Medicaid) 和加州医保 (Medi-Cal General)：​​ 

联系信息​​