项目更新​​ 

Medi-Cal 出生统计数据​​ 

DHCS recently posted the 2007-2022 Medi-Cal Birth Statistics on the Open Data Portal. These machine-readable files are designed to be user-friendly and promote seamless access to better inform the public, stakeholders, and researchers. The data provide extensive information about births and birth outcomes for Medi-Cal members using data from the California Department of Public Health vital records and Medi-Cal eligibility information.​​ 

这些档案提供了在医院分娩的加州居民的分娩情况汇总表，包括产妇的人口统计数据（如年龄、分娩方式）和部分分娩结果（包括出生体重不足和早产）。表格还包括已知会影响分娩结果的主要合并症和健康行为，如孕前体重和孕期吸烟。此外，DHCS 还介绍了由私人保险资助的分娩、由其他公共资金来源资助的分娩以及未投保母亲的分娩情况。​​ 

加州医疗保险是加州母婴保健服务的重要支付来源。2022 年，加州医疗保险计划资助了 44.6% 的加州居民住院分娩。在 Medi-Cal 资助的 183 844 名新生儿中，78.2% 的母亲参加了管理性保健。​​ 

面向 Medi-Cal 提供商的新 CalAIM 资源​​ 

On November 12, DHCS launched a series of new resources to help providers succeed in California Advancing and Innovating Medi-Cal (CalAIM) opportunities. The resources are available in the Providing Access and Transforming Health (PATH) On-Demand Resource Library and include Medi-Cal Managed Care 101 for Community Supports Providers, Medi-Cal Managed Care 101 for Enhanced Care Management (ECM) Providers, and a CalAIM Navigator video series.​​ 

这些资源旨在帮助与 Medi-Cal 托管护理计划签约或计划与 Medi-Cal 托管护理计划签约以提供 ECM 和/或社区支持服务的组织。请将问题提交至ta-marketplace@ca-path.com。​​ 

2023 年度网络认证 (ANC)​​ 

On October 31, DHCS submitted the 2023 ANC to the federal Centers for Medicare & Medicaid Services (CMS), inclusive of Medi-Cal managed care plan and behavioral health plan networks. The 2023 ANC was originally due to CMS on June 28, 2024, but DHCS requested an extension because DHCS operationalized enhancements to its monitoring processes that resulted in a significant increase in the volume of Medi-Cal managed care plan alternative access standard requests (AAS) and a delay in county data reporting and incomplete data submissions for behavioral health plans.​​ 

For Medi-Cal managed care plans, the increased AAS volume does not indicate a change in member access to care and is a direct result of DHCS strengthening the system platform and methodology for measuring compliance with time or distance standards, in collaboration and alignment with the Department of Managed Health Care. The new system platform and methodology strengthen DHCS’ ability to monitor member access to care, better reflect the member experience, and apply a consistent approach across all populations, enabling DHCS to target resources to areas with true gaps in access. Several Medi-Cal managed care plans did not meet AAS submission requirements and are required to complete a Corrective Action Plan (CAP) detailing the actions they will immediately implement to ensure compliance.​​ 

BHP 数据的延迟和不完整是 DHCS 改进及时获取数据报告方法的直接结果，目的是加强 DHCS 监测会员获得行为健康护理的能力。在行为健康计划网络审查中，一些药物加州医疗保险组织交付系统（DMC-ODS）计划和县精神健康计划没有达到一个或多个网络适当性标准，因此需要向 DHCS 提交并完成一份 CAP，详细说明他们将立即采取的行动，以证明其符合标准。​​ 

由于 Medi-Cal 管理性医疗计划的 AAS 系统和行为健康计划的数据报告要求发生了重大变化，许多计划在 ANC 审查中提交了不正确和/或不完整的数据。DHCS 估计，许多 CAP 将通过解决数据报告问题得到解决，并不表明不符合网络适当性标准。​​ 

By November 29, DHCS will post the ANC results for Medi-Cal managed care plan and behavioral health plan networks on the Network Adequacy webpage. These results will also include the Subcontractor Network Certification (SNC) for Medi-Cal managed care plan networks. Medi-Cal managed care plans are required to undergo a SNC annually that is separate and distinct from the ANC submission process. Under the SNC, Medi-Cal managed care plans must hold their subcontractors and downstream subcontractors to the same network adequacy components DHCS requires of Medi-Cal managed care plans through the ANC (i.e., time or distance, timely access, provider-to-member ratio, and mandatory provider-type contracting requirements). All managed care plans met the SNC submission requirements as required by All Plan Letter 23-006.​​ 

Additionally, DHCS is implementing strategies to monitor and improve access to care for Medi-Cal members. These strategies focus on aligning access standards across managed care delivery systems, identifying gaps in access to care and formulating strategies to eliminate those gaps over time, and developing enhanced tools for ongoing access monitoring.​​ 

加入我们的团队​​ 

DHCS 正在寻找一位有才华、有上进心的个人担任审计和调查部门合同和招生部门 (CERD) 的主管。 主管负责规划、组织和指导健康计划、提供者和药物 Medi-Cal 有组织的交付系统的合规性审查活动。 该局长还领导制定和实施与 Medi-Cal 和其他 DHCS 计划的计划完整性相关的政策和程序。 申请必须在2024年 12 月6日前提交。​​ 

DHCS 还在为其健康政策、信息技术和其他团队招聘人员。 欲了解更多信息，请访问CalCareers 网站。​​ 

即将举行的利益相关方会议和网络研讨会​​ 

DHCS 减害峰会​​ 

DHCS aims to collaborate with communities across the state to promote harm reduction within California’s substance use disorder treatment system and create low-barrier, patient-centered care. DHCS encourages substance use disorder treatment providers and staff (including social workers, peers, front desk staff, case managers, nurses, physicians, and all staff in substance use disorder treatment settings) to attend and learn about best practices for incorporating the tenets of harm reduction into substance use disorder treatment. Summits will be held in Fresno, Los Angeles, and San Diego counties in winter 2025. Register on the event website.​​ 

儿童助听器覆盖计划网络研讨会​​ 

12 月 3 日太平洋标准时间上午 11 点至中午 12 点，DHCS 将举办一场网络研讨会，与家庭和社区伙伴分享有关申请助听器保险以及在注册后最大限度地利用儿童助听器保险计划福利的指导。 如需了解更多信息并进行预先注册，请访问儿童助听器覆盖计划网页。​​ 

如果你错过了​​ 

行为健康转型政策手册模块 1 公众意见征询期​​ 

11 月 8 日，健康与社会服务部开启了《行为健康转型政策手册》模块 1的公众意见征集期，并将在 12 月 2 日前接受意见。最终的《政策手册》将于 2025 年初发布，它将指导各县实施行为健康转型，这是加州在全州范围内改善精神健康和药物使用障碍服务的一项举措，旨在提高所有加州人获得服务的机会并为他们提供支持。我们邀请您审查《政策手册》第 1 单元，并提出您的意见。您的反馈对于塑造加州行为健康服务和支持的未来至关重要。要了解如何使用《政策手册》工具提供反馈意见，请观看公众意见征集期网页上发布的指导培训视频。有关公众评论的具体询问，请发送电子邮件至BHTPolicyFeedback@dhcs.ca.gov。​​