模块 2：运作 MCP-Hub 伙伴关系
第 1 部分：概述
模块 2 描述了 Medi-Cal 管理式医疗计划 (MCP) 在 MCP-Hub 关系中的现有合同要求，并包括以下信息：
- 多边协商程序和枢纽的签约考虑因素。
- 代表团。
- MCP 与 Hub 之间的合同类型。
- 法律依据。
- 强化护理管理 (ECM)、社区支持、社区健康护理工作者 (CHW) 服务和 Doula 服务的具体注意事项。
在学习了模块 2 之后，多边协商程序和枢纽将更好地了解：
- 适用于 MCP-Hub 伙伴关系的现有要求。
- 如何确定适当的合同关系。
- 如何通过合同讨论开展工作。
模块 2 主要收获
如果多边协商程序和枢纽中心寻求合作：
- 根据 Hub 和 MCP 签订的协议类型，Hub 应遵守与其他分包商相同的适用要求。
- The MCPs must adhere to requirements set forth in the MCP Contract, respective program requirements, and All Plan Letter (APL) guidance, as applicable.
See the References and Additional Resources for a list of applicable guidance and additional resources for this module.
第 2 部分：MCP-Hub 的授权和合同签订
代表团
当 MCP 合同规定的某些 MCP 职责和义务（如使用管理、凭证或索赔处理）委托给分包商或下游分包商时，即发生委托。 多边协商程序与枢纽的合同安排通常要求多边协商程序直接或间接地将其部分（但非全部）职责和义务委托给枢纽。这些中心被视为行政或部分授权实体，须遵守 MCP 对其他分包商采用的相同合同和监督流程（如适用）。MCP 仍对确保遵守州和联邦要求负最终责任。通过确保分包商和下游分包商符合 Medi-Cal 标准和要求（如适用），对行政和部分授权中心的监督对于保护 Medi-Cal 会员至关重要。
A Hub that does not take on duties and obligations of the MCP but supports Network Providers in completing administrative activities may be considered a third-party vendor rather than a Subcontractor or Downstream Subcontractor (see reference to Aliados Health in Module 1). It is the responsibility of the MCP and Hub to determine the Hub’s role and ensure that agreements or contracts reflect the requirements of that role.
MCP-Hub Contracting
根据与多边协商程序签订的直接或间接合同中规定的工作范围，中心可分为不同的承包商类别。多边协商程序通常会与作为分包商的中心签订合同，但有些中心可能是其他类型的实体：
分包商（与 MCP 签订的分包商协议）：
Administrative Subcontractors: These entities handle administrative functions such as credentialing or claims processing.
Partially Delegated Subcontractors: These entities take on broader responsibilities, including obligations tied to specific Medi-Cal Member groups or certain service areas.
Downstream Subcontractors (Downstream Subcontractor Agreement with a Subcontractor or Downstream Subcontractor): Some Hubs are Downstream Administrative Subcontractors or Downstream Partially Delegated Subcontractors to the MCP. This would include, for example, an Independent Physician Association (IPA) with a partially delegated contract with an MCP entering into a Downstream Subcontractor Agreement with another organization (Organization A) to provide claims processing support. In that case, Organization A would be considered a Downstream Subcontractor of the MCP.
Network Providers (Network Provider Agreement with MCP or MCP’s Subcontractor or Downstream Subcontractor): Some Hubs order, refer, or render Covered Services in addition to their other Hub functions. These Hubs would be Network Providers in addition to being a Subcontractor or Downstream Subcontractor. Contracts with these Hubs would need to comply with the requirements for both (1) Subcontractor Agreements or Downstream Subcontractor Agreements, as applicable, and (2) Network Provider Agreements.
Third Party Vendors (Agreements with MCP Vary): Some Hubs centralize administrative functions for Network Providers without a direct or downstream contract with an MCP. These arrangements vary and may require vendors to enter into a Business Associates Agreement (BAA) with the MCP to meet Medi-Cal requirements.
See Types of Contracts Between MCPs and Hubs for more information, including a tool to help determine the appropriate contracting relationship category or categories for a given Hub organization.
多氯联苯俱乐部与枢纽之间的合同类型
Subcontractors/Downstream Subcontractors MCPs may directly enter into Subcontractor Agreements with Hubs as Administrative Subcontractors or Partially Delegated Subcontractors. In addition, Subcontractors or Downstream Subcontractors may enter into Downstream Subcontractor Agreements with Hubs as Downstream Administrative Subcontractors or Downstream Partially Delegated Subcontractors.
Subcontractor Agreements. Per the MCP Contract, MCPs may directly enter into Subcontractor Agreements with qualified Subcontractors to delegate certain functions. Subcontractor Agreements must meet certain requirements outlined in detail below and in the MCP Contract.
Administrative Subcontractors
Partially Delegated Subcontractors
Fully Delegated Subcontractors
Downstream Subcontractor Agreements. MCPs may contract with Subcontractors who then enter into Downstream Subcontractor Agreements with entities for downstream services, as applicable. Downstream Subcontractors may also contract directly with entities for certain downstream services. Although the MCP would not hold the direct contract with the entity, the MCP maintains ultimate responsibility for that entity’s performance and compliance with applicable regulations, regardless of the layers of subcontracting.
DHCS 为与 MCP 直接签订合同的分包商定义了三种类型：
DHCS 为 MCP 定义了三种类型的下游分包商：
Downstream Administrative Subcontractors
Downstream Partially Delegated Subcontractors
Downstream Fully Delegated Subcontractors
例如，如果 Hub 与提供方组织签订合同，为加入 MCP 的 Medi-Cal 会员支持提供方培训、索赔、报告和其他管理功能，那么 Hub 就是下游分包商。如果医疗服务提供者机构除了提供行政服务外，还订购、转诊或提供承保服务，则也属于网络医疗服务提供者。
枢纽不会成为完全授权分包商或下游完全授权分包商。完全委托分包商和下游完全委托分包商负责 MCP 合同的所有功能，但 MCP 合同禁止的功能除外，如向符合条件的 Medi-Cal 会员提供所有 Medi-Cal 承保服务。因此，这些实体不属于枢纽。完全授权分包商通常是其他多边协商程序。
- Network Providers. A Hub would contract both as (1) a Network Provider and (2) a Subcontractor or Downstream Subcontractor, as applicable, if the Hub is ordering, referring, or rendering covered Medi-Cal services in addition to its other duties as a Hub. If that is the case, MCPs must ensure the roles, functions, and payment structures for the Hub are clearly defined and documented in the MCP’s contracts and reporting to DHCS. Contracts with these Hubs would need to comply with the requirements for both (1) Subcontractor Agreements or Downstream Subcontractor Agreements, as applicable, and (2) Network Provider Agreements. See definitions below and refer to the MCP Contract and APL 19-001 or any superseding APL for more information on Network Provider Status.
| 网络提供商 | 分包商或下游分包商 |
|---|---|
|
|
- Hubs as Third-Party Vendors. Hubs that centralize administrative functions for Network Providers may contract under Third-Party Vendor agreements. These arrangements may require vendors to enter into a BAA with the MCP to safeguard and protect the confidentiality, integrity, and availability of protected health information (PHI) and other confidential data, and meet other requirements under the MCP Contract.
Hub-MCP 合同关系工具
说明： 多方协商中心和枢纽中心可使用此工具确定特定枢纽中心组织的适当承包关系类别。它还有助于确定对提供某些功能的枢纽组织的额外要求。
| 组织职能 | 是的 | 不 |
|---|---|---|
| 本组织是否将提供直接服务的组织的行政职能集中化？ | 该组织可能是第三方供应商、分包商或下游分包商，具体取决于与 MCP 直接签订合同的实体。 | 组织可能不适合成为枢纽。 |
| 枢纽组织是否直接与 MCP 签订合同？ | 组织是分包商或网络提供商。 | 组织是下游分包商、网络提供商或网络外提供商或第三方供应商。 |
| 枢纽组织是否直接与 MCP 签订合同？ | 组织是分包商或网络提供商。 | 组织是下游分包商、网络提供商或网络外提供商或第三方供应商。 |
| 枢纽组织是否只提供行政支持？ | 该组织可能是第三方供应商、行政分包商或下游行政分包商，具体取决于与 MCP 直接签订合同的实体。 | 本组织是部分授权分包商的下游分包商，或 |
| 枢纽组织是否承担某个人群的财务风险，例如通过按人头付费的安排？ | Additional Requirements may apply to the organization: – Financial Viability – Medical Loss Ratios (MLRs) (See Module 3 for additional information) | 无额外要求。 |
| 枢纽组织是否指定了特定的 Medi-Cal 会员人群？ | Additional requirements may apply to the organization: – Population Needs Assessment (PNA) (See Module 3 for additional information) | 无额外要求。 |
For more information on Subcontractor, Downstream Subcontractor, and Network Provider types and definitions, see References and Additonal Resources.
第 3 部分：MCP-Hub 分包法律授权和要求
法律授权和要求
Federal law and state policy allow Medi-Cal MCPs to delegate functions to Subcontractors or Downstream Subcontractors, including Hubs, provided the MCP maintains ultimate responsibility for the Hub’s performance and compliance with applicable regulations, regardless of the layers of subcontracting. Required MCP duties and obligations for working with Subcontractors and Downstream Subcontractors are outlined in Section 3.1 of Exhibit A, Attachment III of the MCP Contract. Federal law requires contracts or written arrangements between an MCP and any Subcontractor or Downstream Subcontractor, including Hubs, to meet requirements set forth in the MCP Contract.
对分包中心的合同签订、监督和监测要求各不相同，具体取决于授权的具体职能以及分包中心是否代表多边协商程序承担财务风险。
多边协商中心和枢纽中心的分包要求
MCP requirements for Subcontractors and Downstream Subcontractors are outlined in the MCP Contract Exhibit A, Attachment III, Subsection 3.1 (Network Provider Agreements, Subcontractor Agreements, Downstream Subcontractor Agreements, and Contractor’s Oversight Duties) and Exhibit J (Delegation Reporting and Compliance Plan) that must be submitted to DHCS. MCPs must complete Exhibit J for each Hub in each county in which they operate.
对于直接或间接通过更多层次的合同或授权委托给枢纽的任何 MCP 义务，与枢纽签订的分包商协议或下游分包商协议必须包含某些条款，包括但不限于
- 明确所有授权活动、义务和相关报告责任。
- Including the Hub’s agreement to perform the delegated activities, obligations, and reporting responsibilities in compliance with all applicable Medicaid laws and regulations, including sub regulatory guidance and contract provisions, and applicable state and federal laws.
- 当 DHCS 或 MCP 认定 Hub 的表现不令人满意时，规定撤销授权活动或义务，或指定其他补救措施。
除上述要求外，MCP 必须确保 Hubs 遵守 MCP 合同附录 A 附录 III 和APL 23-006 或任何后续 APL 中列出的所有要求。
MCP-Hub 分包工具
MCP-Hub 分包协议核对表
与中心的分包商协议和下游分包商协议遵循适用于其他 MCP 分包关系的相同规则。与任何分包商或下游分包商一样，MCP 必须向 DHCS 报告与 Hubs 签订的所有合同服务。分包商协议和下游分包商协议模板必须提交 DHCS 审查和批准。
Instructions: Use the checklist below when developing a Subcontractor Agreement or Downstream Subcontractor Agreement with a Hub. Please note that this checklist is not exhaustive and that MCPs must still comply with all Subcontractor Agreement and Downstream Subcontractor Agreement requirements in the MCP Contract and other authorities.
每份分包商协议和下游分包商协议必须 ：
- 明确概述所有授权活动、责任和所需报告。
- Specify that the Subcontractor or Downstream Subcontractor is bound by the same obligations and requirements as the MCP per its contract with DHCS, as applicable.
- 包括确保分包商或下游分包商遵守所有适用的医疗补助法律法规的语言。
- 如果分包商或下游分包商未能达到预期绩效，提供撤销授权的程序。
- Include a Subcontractor’s or Downstream Subcontractor’s ownership and control disclosures per APL 23-006 or any superseding APL.
- 明确分包商或下游分包商向 MCP 报告数据的责任。
- 明确规定解决 MCP 与 Hub 之间分歧或争议的政策和程序。
- 说明在发现分包商或下游分包商不遵守其协议条款或 Medi-Cal 要求时对其采取的纠正措施和/或经济制裁。
分包商协议或下游分包商协议签订后，多边协商程序必须
- 将协议模板提交 DHCS 审查和批准。
- 与分包商或下游分包商会面，审查主要政策和程序。
- 明确说明多边协商程序将如何监督合同要求的遵守情况。
- 如果分包商或下游分包商承担财务风险，则应确保有一个定期评估和监控财务可 行性的系统。
- 确保分包商或下游分包商遵守联邦和州法律规定的非歧视要求。
- 监控所有共享数据的质量和合规性，包括就诊数据、提供方网络文件和所需报告（如季度报告）。
- 遵守公共记录要求，包括对签约实体的透明度要求。
- 在 MCP 合同附件 J 中报告委托关系。
- 按要求在多边协商程序网站上公开发布授权模式。
评估工具：MCP 分包前注意事项
以下一系列问题概述了多边协商进程在评估和实施与枢纽组织的伙伴关系时应考虑的因素。
签订合同的考虑因素
- 该中心属于哪类组织（MSO/ASO、IPA、医疗集团、非营利组织、县卫生部门等）？
- 中心是否是代表医疗保险计划承担管理承保福利或服务风险的组织？
- 中枢的能力体现在哪些方面？中心是否有行政管理能力、经验和预算资源来履行委托的合同义务（如资格认证和/或付款处理）？
- 哪些职能将下放给 Hub，哪些职能将由 MCP 保留？
- 中心是否与其他 MCP 和医疗服务提供者签订了提供 Medi-Cal 服务（如 ECM、社区支持、CHW 和/或 Doula 服务）的现有合同和/或 BAA？
- 中心是否有明确的组织结构，规定了领导作用和决策过程？
- What is the Hub’s staffing model and capacity to provide Medi-Cal services?
- 枢纽中心是否同意多边协商程序进行合规审计？
- 中心是否有指定的合规官？
业务& 服务
- 中心提供哪些行政管理功能（如集中签约、转介管理、报告等）？
- 中心提供哪些直接服务（如有）？如果是，它们为哪些人群服务？
- 中心是否有标准化的政策、程序和工作流程？
- What is the Hub’s process for handling Network Provider and Medi-Cal Member complaints?
网络管理
- 中心通过其网络满足与健康有关的社会需求（HRSN）的能力如何？
- If the Hub is delegated to conduct credentialling on behalf of the MCP, what credentialing process does the Hub have in place to ensure quality across its Network?
- Hub 如何评估新的提供商并将其纳入其网络？
- 枢纽中心有哪些程序来支持小型、多样化和/或地方所有的网络提供商更容易地与多方保健中心签订合同？
- 中心向其网络提供哪些培训和技术援助
- 中心如何确保其网络反映所服务社区和县的人口情况？
- 中心如何监控网络提供商的绩效/解决绩效不佳或不合规问题？
- 中心如何监控网络提供商的绩效/解决绩效不佳或不合规问题？
数据管理
- 中心具有哪些数据共享功能（如集成电子病历、病例管理平台等）？
- 中心有哪些闭环转诊管理和向医疗中心报告的系统？
- Can the Hub integrate its technology and exchange data with the MCP’s existing data systems?
- 枢纽如何监控数据质量、安全性、透明度和合规性？
财务模式& 可持续性
- Hub 采用什么付款模式向网络提供商付款？
- 中心如何支持网络提供商的能力建设？
- How does the Hub’s payment model support the financial sustainability of Network Providers?
社区参与
- 中心如何吸引和支持社区成员？
- 中心是否有将 Medi-Cal 会员和社区反馈纳入其运作的程序？
- 中心与其他医疗保健机构、地方政府实体（如县行为健康或地方卫生辖区）以及其他社区合作伙伴保持着怎样的关系？
第 4 部分：ECM、社区支持、社区保健员 (CHW) 和 Doula 服务的注意事项
允许 MCP 与 Hubs 签订合同，以管理强化护理管理 (ECM)、社区支持以及 CHW 和/或 Doula 福利。对于所有计划，与中心签约提供这些服务的多方合作伙伴计划必须确保中心遵守多方合作伙伴计划合同中规定的所有要求、各自的计划要求以及相关的 APL 指南。
Enhanced Care Management (ECM) is a whole-person, interdisciplinary approach to care that addresses the clinical and non-clinical needs of high-cost and/or high-need eligible Medi-Cal Members who meet ECM Populations of Focus (POF) eligibility criteria through a systematic coordination of services and comprehensive care management that is community-based, interdisciplinary, high-touch, and person-centered. For more information, see the MCP Contract and the ECM Policy Guide.
Community Supports are substitute services or settings to those required under the California Medicaid State Plan that Medi-Cal MCPs may select and offer to their Members when the substitute service or setting is medically appropriate and more cost-effective than the service or setting listed in the California Medicaid State Plan, such as emergency department visits, hospital or skilled nursing facility admission, or a discharge delay. Community Supports are optional services that MCPs may choose to offer to eligible Medi-Cal Members, with the exception of Transitional Rent, which MCPs will be required to provide starting January 1, 2026. A complete list of DHCS-approved Community Supports can be found in the MCP Contract, Community Supports Policy Guide Volume 1, and Community Supports Policy Guide Volume 2.
CHW Services are an integral part of ECM and Community Supports that consist of an array of preventative health services aimed at preventing or managing disease, disability, and other health conditions and promoting physical and behavioral health and well-being for Medi-Cal Members. CHWs may include service professionals known by a variety of job titles, including promotoras, community health representatives, navigators, and other non-licensed public health workers, including violence prevention professionals, and as set forth in APL 24-006 or any superseding APL. See the DHCS website and the MCP Contract for more information about CHW services.
Doula Services provide health education advocacy, and physical, emotional and nonmedical support to Medi-Cal Members and their families throughout pregnancy, labor, birth and the postpartum period, including support for and after miscarriage and abortion. See the DHCS DHCS website, APL 23-024 or any superseding APL, and the MCP Contract for more information about the Doula benefit.
企业内容管理的考虑因素
与 Hubs 签订部分或全部管理 ECM 服务合同的 MCP 必须确保 Hubs 遵守与其签订合同的所有相关计划要求。无论是否存在签约中心，MCP 仍有责任确保 ECM 提供者满足 Medi-Cal 会员的临床和非临床需求，并提供所有核心服务内容。多边协商进程可与枢纽签订合同，由枢纽提供：
- 对符合条件的 Medi-Cal 会员开展外联和参与活动。
- 全面评估和护理管理计划。
- 加强护理协调。
- 促进健康。
- 全面的过渡性护理。
- Medi-Cal 成员和家庭支持。
- 协调和转介社区和社会支持服务。
除了提供这些核心内容中的一项或多项外，签约中心还可与 MCP 协调，确定并向符合重点人群 (POF) 标准的 MCP Medi-Cal 会员提供 ECM，并确保符合 ECM 提供商标准条款和条件 (STC)、MCP 的 ECM 护理模式 (MOC) 以及 ECM 遭遇数据报告要求。
一些 ECM 提供商可能没有专门的州一级注册途径。这些医疗服务提供者必须通过 MCP 审查，才能作为 ECM 医疗服务提供者参与。为从监禁中过渡的个人 POF 提供服务的 ECM 提供商是唯一需要遵守额外提供商要求的 ECM 提供商。
与中心签订 ECM 管理合同的 MCP 必须更新其 MOC，以说明合同安排。多边协商程序必须确保合同反映：
- MCP 合同要求。
- ECM 和社区支持合同模板中列出的要求。
- ECM 和社区支持提供方标准条款和条件 (STC)。
- APL 23-032 or any superseding APL, as applicable.
多方保健中心应与签约的中心合作，共同制定 ECM 福利的管理办法，以确保为 Medi-Cal 会员提供一致、优质的护理，满足个性化的护理需求。
See the ECM Policy Guide for additional information. See Module 3 for more information on compliance for contracted Hubs that assume risk or cover populations for specific Medi-Cal Members.
社区支持的考虑因素
与枢纽中心签订部分或全部社区支持服务管理合同的多方合作伙伴计划必须确保签约枢纽中心遵守与其签订合同的所有相关计划要求。核心服务内容包括
- DHCS 规定的所有计划和报告要求、适用的州和联邦法律法规、MCP 合同和 APL 要求，包括上诉权。
- 所有社区支持项目的报告要求。
鼓励但不要求所有 MCP 向符合条件的 Medi-Cal 会员提供社区支持服务，但过渡性租金除外，MCP 必须从 1 月开始为特定 POF 提供过渡性租金，1 ，2026 。有意与 MCP 合作管理社区支持的签约中心应与 MCP 协调，以确认 MCP 提供哪些社区支持。
与枢纽中心签订社区支持管理合同的多方协商程序必须更新其 MOC，以说明合同安排。多边协商程序必须确保合同反映：
- MCP 合同要求。
- ECM 和社区支持合同模板中列出的要求。
- ECM 和社区支持提供者 STC。
- APL 21-017或任何后续 APL（如适用）。
多方保健计划应与签约中心就社区支持福利的管理方法进行合作，以确保为 Medi-Cal 会员提供一致、高质量的护理，满足个性化的护理需求。
See the Community Supports Policy Guide Volume 1 and Community Supports Policy Guide Volume 2 for additional information. See Module 3 for more details around compliance for contracted Hubs that assume risk or cover specific Medi-Cal Member populations.
CHW 服务的考虑因素
MCPs that contract with Hubs for the administration and/or delivery of CHW benefits must adhere to requirements set forth in APL 24-006 or any superseding APL, as well as the Medi-Cal Provider Manual and MCP Contract, as applicable, including with respect to:
- CHW Provider Requirements and Qualifications. Supervising Providers must ensure that CHWs meet the requirements and qualifications outlined in Medi-Cal policy and APL 24-006, or any superseding APL. MCPs must ensure that Supervising Providers, or their Subcontractors or Downstream Subcontractors contracting with or employing CHWs to provide covered CHW services to Medi-Cal Members, verify that CHWs have adequate supervision and training. MCPs must also have a process for verifying qualifications and experience of Supervising Providers. MCPs must develop and submit policies and procedures to ensure that CHW Supervising Providers are certifying that their CHWs have the appropriate training, qualifications, and supervision.
- 加州医疗保险会员享受保健工作者服务的资格标准。MCP 必须确保监管医疗服务提供者遵守提供 CHW 服务的资格要求，包括与促进数据驱动方法有关的要求，以确定和了解符合 CHW 服务资格的优先人群。
- 提供方注册。網絡醫療保健提供者（包括作為 CHW 服務的監督醫療保健提供者）必須根據 MCP 合約和APL 22-013或任何更新的 APL 註冊為 Medi-Cal 醫療保健提供者。
- 获得保健工作者服务。市级保健中心负责确保签约的中心在其服务区域内促进获得保健工作者服务并监控足够的网络。
杜拉服务的注意事项
For the administration and/or delivery of Doula services, MCPs that contract with Hubs must adhere to the requirements outlined in APL 23-024 or any superseding APL as well as the Medi-Cal Provider Manual and the MCP Contract, as applicable, including:
- 杜拉提供者的要求和资格。MCP 必须向 Doulas 提供有关 MCP 服务和流程的初始和持续培训及资源，包括通过 MCP 为产前、围产期和产后会员提供的任何服务。此外，要求 MCP 在管理 Doula 服务方面提供技术支持，确保对 MCP 合同中的所有服务要求以及 DHCS 发布的任何相关指南负责。
- Medi-Cal 會員使用 Doula 服務的資格準則。MCP 必须确保签约中心遵守向 Medi-Cal 会员提供 Doula 服务的资格要求。
- 提供方注册。作為 Doula 服務提供者的網絡醫療服務提供者必須根據 APL 22-013 或任何替代 APL 註冊為 Medi-Cal 醫療服務提供者。
- 获得 Doula 服务。MCP 必须确保签约中心促进杜拉护理的普及，并帮助监督网络，以确保有足够数量的杜拉满足会员的需求。满足网络充足性要求是医疗保险计划的责任。
第 5 部分：参考资料和其他资源
主要参考资料
2024 MCP 模板合同
管理式医疗所有计划信函 (APL)
APL 23-006：授权和分包商网络认证
APL 23-032：强化护理管理要求
APL 21-017：社区支持要求
APL 24-006：社区保健员服务福利
APL 23-024：杜拉服务
APL 19-001：加州医疗保险管理式保健计划关于网络提供方地位的指导意见
PHM 政策指南
ECM政策指南
社区支持政策指南第一卷
社区支持政策指南第二卷
MCP ECM 和社区支持合同模板条款
ECM 和社区支持提供方标准条款和条件
企业内容管理和社区支持计费和发票指南（2023 年 4 月更新）
Note: An updated version of this resource will be released in late 2025.
Member-Level Information Sharing Between MCPs and ECM Providers
ECM Referrals Standards and Form Templates
Community Supports Member Information Sharing Guidance
DHCS Resources for Community Health Workers
DHCS Resources for Doula Services
其他资源
分包商类型和定义
| 分包商类型 | 2024 年多边协商程序合同定义 |
|---|---|
| 行政分包商 |
根据 MCP 合同承担 MCP 行政义务的分包商。行政义务包括全权证书核实或报销处理等职能。但是，与协调或直接向加州医疗保险会员提供医疗服务有关的职能（如护理协调）不属于行政职能。 |
| 部分授权分包商 | 分包商根据 MCP 合同承担 MCP 的部分但非全部责任和义务，例如，包括有关特定 Medi-Cal 会员人群的义务或有关特定服务的义务。个体医生协会和医疗集团通常作为部分委托分包商运作。 |
| 完全授权分包商 | A Subcontractor that contractually assumes all duties and obligations of the MCP under the MCP Contract, except those contractual duties and obligations where delegation is legally or contractually prohibited. A managed care plan can operate as a Fully Delegated Subcontractor. Note: A hub would not take on this role. |
| 下游行政分包商 | 根据 MCP 合同，按合同承担分包商行政义务的下游分包商。行政义务包括证书核实或报销处理等职能。但是，为加州医疗保险会员协调或直接提供医疗服务的职能，如使用管理（UM）或护理协调，不属于行政职能。 |
| 下游部分授权分包商 | 下游分包商根据 MCP 合同承担分包商的部分但非全部责任和义务，例如，包括有关特定 Medi-Cal 会员人群的义务或有关特定服务的义务。个体医生协会和医疗集团通常作为下游部分委托分包商运营。 |
| 下游完全授权分包商 | 下游分包商通过分包商承担 MCP 合同规定的 MCP 的所有责任和义务，但法律或合同禁止授权的合同责任和义务除外。管理式医疗计划可以作为下游受权分包商开展业务。注：枢纽不会承担这一角色。 |