热门新闻
加州推进和创新 Medi-Cal (CalAIM) 更新
强制性管理式医疗登记
强制性管理式医疗登记将使登记流程标准化，以帮助确保在各县之间流动的人口遵守相同的要求，从而消除根据援助代码、人口和地理位置而产生的福利差异。 强制性管理式医疗登记分为两个阶段：
- 对于第一阶段，DHCS 于 10 月份向受影响的受益人邮寄了第一份受益人通知和一份常见问题 (FAQ) 文件，介绍他们从1 1 月到2022 1 月过渡到管理式医疗或按服务收费 (FFS) 交付系统的事宜。
- 对于第二阶段，DHCS 于 11 月邮寄了第二批受益人通知和有关其过渡的常见问题解答。 DHCS 还于 11 月底向符合管理式医疗计划 (MCP) 资格的受益人邮寄了 Medi-Cal 管理式医疗选择包。
管理式医疗福利标准化
管理式医疗福利标准化将有助于确保全州范围内管理式医疗和按地施行医疗服务 (FFS) 所提供的福利的一致性，从而减少复杂性和县与县之间的差异。 根据福利标准化，主要器官移植（目前仅在县级组织医疗系统 (COHS) 县中是一项承保福利）将纳入全州范围内 Medi-Cal MCP 中，适用于所有参加 MCP 的 Medi-Cal 会员，该福利将于1 1 月 1 日、 2022 1 月 1 日生效。 此外，多功能老年服务计划 (MSSP) 将剥离为 FFS，并作为 1915(c) MSSP 豁免福利在所有协调护理计划 (CCI) 示范县运营，该政策将于 1 月1 、 2022生效。 11 月，CCI 县的 MCP 向受影响的受益人邮寄了有关 MSSP 服务豁免的受益人通知和补充信息通知文件。
牙科计划
On September 28, DHCS submitted State Plan Amendment (SPA) 21-0019 to the Centers for Medicare & Medicaid Services (CMS) for federal approval of CalAIM dental initiatives. The SPA is under review; the public comment period ended on September 6. The FFS and safety net clinic (SNC) provider bulletins are published on the Medi-Cal and Medi-Cal Dental websites. Please visit the DHCS website for more information about each CalAIM dental initiative, including required forms and SNC billing requirements.
Medi-Cal COVID-19 疫苗接种激励计划
DHCS is allocating up to $350 million to incentivize COVID-19 vaccination efforts in the Medi-Cal managed care delivery system for the service period of September 1, 2021, through February 28, 2022. Medi-Cal MCPs are eligible to earn incentive payments for activities designed to close vaccination gaps with their enrolled members, and to address vaccine uptake disparities for specific age and race/ethnicity groups. MCPs may earn up to $50 million for achieving specified process measures and $200 million for outcome measures, with $100 million available for MCPs to use for direct member incentives. Effective September 1, 2021, all 25 full-service MCPs and one population-specific health plan were approved for participation in the program, and DHCS will provide payment allocations for the approved vaccination response plans. DHCS provided baseline data (as of August 29, 2021) to the plans for vaccine uptake outcome measures on October 4, and the MCPs submitted baseline data for their process measures on October 30. The first achievement assessment period ended on October 31. Future achievement assessments will occur in January and March 2022. The high-performance pool component of the incentive program is being developed. For more information, please refer to All Plan Letter 21-010.