首頁行為健康管理整合​​ 

行為健康行政整合​​ 

經常問的問題​​ 

實施時間表​​ 

行為健康管理整合的每個階段包括什麼？​​ 

為了在 2027 年實現全州行為健康管理整合，DHCS 將使用三階段方法與各縣合作，其中不同的組件將在不同的時間以不同程度集成。 分階段實施計劃旨在考慮到某些組件可以在現有機關下集成，縣可能已採取措施來做到這一點，而其他組件可能需要 DHCS 採取行動，更改州機關或聯邦批准。​​ 

  • 第一階段專注於 2023 年和 2024 年期內，根據現有合同的縣職能自願整合。​​  
  • 第二階段將專注於 2025 年和 2026 年的自願合同整合，對於自願採用綜合合約的縣，由 2025 年 1 月 1 日起生效。​​  
  • In Phase 3, all counties will be required to adopt integrated contracts effective January 1, 2027, as specified in CalAIM statute (AB 133).​​  

有關每個實施階段的更多信息，請參閱行為健康行政整合概念文件。​​ 

DHCS 可否提供更多詳細信息，以便將 DHCS-縣綜合合約與日曆年度而不是會計年度一致的建議？​​ 

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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在 2027 年 1 月 1 之前，DHCS 將如何支持各縣實現行為健康行政管理整合的合規？​​ 

DHCS 承認縣員工時間有限，並且各縣正在實施其他 CalAIM 政策改革。 DHCS 開發了行為健康管理整合的分階段實施方法，考慮到這些能力限制，包括與其他 CalAIM 改革進行協調。 DHCS 將繼續進行廣泛的利益相關者參與和技術協助，以確保各縣擁有成功實施行為健康行政整合所需的信息，資源和技術幫助。 參與活動將包括利害關係人工作小組、資訊網路研討會、有針對性的外展，以及發布明確的指導和其他資源，視情況而定。​​ 

對於不志願提早合同整合的縣，行為健康行政管理整合將是什麼樣的？​​ 

在第二階段期間（1/1/25-12/31/26：自願合約整合）期間，不選擇早期合同集成的縣可以繼續集成不需要 DHCS 額外指導的元件，例如與 24/7 接入線有關的流程、篩選、評估和治療計劃、質量改善和文化能力計劃，以及縣數據存儲和數據共享，以準備 1, 2027 之前完全實施。 在 2027 年前，這些縣不會參與需要綜合合約權限的組件（即外部質量審查（EQR）、BH 審計和網絡充足性認證）的組件。​​ 

DMC 縣​​ 

藥物醫療（DMC）縣的行為健康行政管理整合將是什麼樣的？​​ 

DMC 縣將繼續在受管理護理架構以外提供藥物使用障礙（SUD）服務，同時參與此計劃的所有其他適用方面，包括通過與醫療護理服務部（DHCS）採用綜合心理健康計劃（MHP）和 DMC 合同，以促進整合目標。​​ 

DMC-ODS 區域模型​​ 

對於屬於藥物中藥組織配送系統（DMC-ODS）區域模型的縣，行為健康行政管理整合將如何實施？​​ 

DHCS 認識到 DMC-ODS 區域模型縣存在獨特的實作考量。在第二階段（1/1/25-12/31/26：自願合約整合）中，DHCS 將與參與 DMC-ODS 區域模式的各地進行針對性利害關係人參與，為此模型參與者提供行為健康行政管理整合的實施信息。更多信息即將推出。​​ 

與其他卡拉伊姆改革一致​​ 

行為健康行政整合是否需要 MCP 和行為健康計劃之間的綜合諒解備忘錄（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.​​ 

行為健康管理整合如何與其他 CalAIM 政策改革，例如沒有錯門，文檔重新設計和標準化篩選和過渡工具等一致？​​ 

DHCS 開發了行為健康管理整合框架和分階段實施方法，以符合並創造機會，以支持和利用現有 CalAIM 計劃的實施，澄清現有要求，並在照顧問、評估和治療計劃時促進最佳實踐。 這些 CalAIM 計劃已包括政策變更，這些政策變更可協調 Medi-Cal SMHS 和藥物使用障礙（SUD）服務的行政要求。 例如，CalAIM 包含了成員訪問準則更新，這些更新說明臨床診斷並不是在 SMH 或 DMC/DMC-ODS 傳遞系統中接受行為健康服務的先決條件；患有 MH 或 SUD 症狀的個人可能在確定診斷時獲得照護。 許多文件重新設計原則變更也適用於特殊的 BH 交付系統，包括消除靜態治療計劃和採用問題清單。​​ 

付款將如何與行為健康管理整合進行？​​ 

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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會員體驗​​ 

行為健康管理整合將如何改善會員體驗？​​ 

在行為健康管理整合下的心理健康和 SUD 計劃之間的行政要求調整或合併將減少行為健康計劃和提供者的複雜性和行政負擔，從而改善成員經歷的護理質量，因為改變將使提供者能夠專注於改善照護提供，包括為同時發生的精神健康和 SUD 條件提供照顧。在 SMHS 和 DMC/DMC-ODS 之間調整管理要求也可以使供應商更容易參與這兩種傳遞系統，這可以為需要 SMHS 和 DMC/DMC-ODS 服務的個人提供更多整合的照護。​​  

會員還可以訪問整合的會員手冊，因此可以在一個地點而不是兩個地點搜索 SMHS 和 SUD 服務。此外，將有一個單一整合的上訴/申訴流程，再次為會員提供一個訪問地點以完成此過程，而不是針對 SMHS 和 SUD 服務的兩個不同流程。最後，質量保證績效改善（QAPI）和外部質量檢討（EQR）活動將加強關注對同時出現行為健康需求的會員的護理質量，並承認這兩種情況在會員之間經常重疊。​​ 

DHCS- County Contracts​​ 

醫療保健服務部將如何解決綜合合約中特殊精神健康服務（SMHS）和藥物醫療藥物（DMC）/藥物醫療有組織派遞系統（DMC-ODS）計劃之間的要求和法規的差異？​​ 

DHCS 使用現有的心理健康計劃 (MHP) 合同樣板作為開發綜合合約標誌的起點，然後根據需要修改和添加內容，以符合 DMC-ODS 或 DMC 的所有相關要求。 雖然 DMC-ODS/SMHS 合約將構建為單一預付住院健康計劃（PIHP）託管護理計劃，DMC 縣將繼續運營 SMHS PIHP 和非管理護理 DMC 計劃。 整合合約的某些部分被識別為特定程序（例如醫療必要性和服務定義），這些部分通常直接從 SMHS、DMC-ODS 和/或 DMC 的現行合同中複製。 對於合約的「整合」部分，這些部分均適用於 SMHS 和 DMC-ODS 或 DMC 程序，DHCS 根據需要進行微小的調整，以使計劃之間的標準進行一致。 對於 DMC 縣，某些 SMHS 管理的護理功能已經調整，以要求對同時出現行為健康需求的成員特別關注。​​  

行為健康行政整合是否意味著縣需要重組，以便心理健康和藥物使用障礙系統都在縣內的單一行為健康部門下？​​ 

不 儘管從州和聯邦法律的角度來看，縣（或地區縣群）將運行一個綜合的 Medi-Cal 行為健康計劃，但縣可能會繼續根據自己認為合適的方式構建其內部運營。 例如，一些縣選擇將其行為健康人員整合在單一縣部門下，而其他縣維持單獨的部門（或部門內部門），進行專科心理健康和藥物使用障礙操作。​​ 

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).​​ 

有關各種專業行為健康服務和人群資助的其他信息，請參閱 DMC、DMC-ODS 和特殊心理健康計費手冊，可在 https://www.dhcs.ca.gov/services/MH/Pages/MedCCC-Library .aspx 提供。 目前的《DMC/DMC-ODS》手冊的第六章包含有關資金的詳細討論，包括 SGF 的貢獻。
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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.​​ 

 早期合約整合會影響國家一般資金（SGF）嗎？​​ 

 加州法律規定了如何使用行為健康現有的資金來支持心理健康和/或藥物使用障礙服務。 實施綜合合約並不會改變 SGF 為特定服務和人口提供的供款。​​ 

 對於早期整合合同的縣，區塊補助分配會不同嗎？ 如果是這樣，請否提供詳細資料，瞭解這將如何與綜合合約一致？​​ 

 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.​​ 

 根據綜合合約，各縣將如何索償與涵蓋的 Medi-Cal 服務、質量保證 & 使用率審查（QA/UR）、合同相關的行政活動和心理健康醫療行政活動（MH MAA）有關的開支？​​ 

  • 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 和合同相關的行政活動。 DHCS 將針對 QA/UR 和行政活動實施綜合申請。 在每個類別中，各縣將根據綜合合約報告合資格支出總額（儘管各縣可以根據自己的意願繼續跟踪計劃特定的小計劃的小計劃）。 根據提案 30，各縣將需要單獨報告符合國家資助的開支。​​ 
  • 明翰·馬亞。各縣將繼續通過 MH MAA 索償程序，以與目前申請補償的方式相同。​​     

全天候接入線​​ 

對於整合的 24/7 接入線，衛生護理服務部（DHCS）是否要求各縣使用當地電話號碼，還是可以使用免費電話號碼？​​ 

在 DHCS 行為健康行政整合下，擁有綜合合同的縣將運營一個整合的 24/7 訪問線，這意味著成員可以撥打單一號碼以訪問有關專業精神健康服務（SMHS）和藥物使用障礙（SUD）服務的信息。 對於 2025 年的自願整合，DHCS 目前沒有針對接入線需求提出任何其他更改。 只要它們為 SMHS 和 SUD 服務提供單一免費電話號碼，縣可以繼續使用本地電話號碼或免費電話號碼為其集成的 24/7 接入線符合當前要求。​​ 

整合的 24/7 接入線是否需要由縣營運，還是縣能繼續使用供應商/分包商嗎？​​ 

有綜合合同的縣，預計將為所有尋求行為健康服務的 Medi-Cal 成員營運單一 24 小時接入線，以便他們可以適當的分類和篩選心理健康和藥物使用障礙需求，並在同一電話中安排適當的跟進約會，而無需關閉電話並撥打任何額外電話。 縣可能會繼續利用供應商/分包商給員工，並運營他們的 24/7 免費通道。​​ 

資料分享 & 隱私權​​ 

根據綜合合約，42 條聯邦法規（CFR）第 2 部分對物質使用障礙（SUD）數據的保護是否適用於整個行為健康計劃（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.​​ 
    • 根據縣選擇，縣可以選擇將縣 SMHS 提供商納入其第 2 部分中。 各縣可能希望衡量以下因素：​​ 
      • 將 SMHS 提供商納入第 2 部分組件中，將促進 SMHS 和 SUD 護理系統之間的數據共享。 這可能無需在電子健康紀錄 (EHR) 中需要額外的患者同意和防火牆，因為第 2 部分同意要求不適用於在第 2 部分內的數據共享以進行診斷、治療或轉介治療。​​ 
      • 在與第 2 部分組件以外的個人或實體共用資料時，將 SMHS 提供者納入第 2 部分組件中，必須遵守第 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. 在一般醫療設施內：​​ 
    • 表明提供並提供 SUD 診斷、治療或轉介的已識別子單位；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).​​ 

隨著各縣實施行為健康行政整合，DHCS 可以提供哪些資源來支持縣維持有關物質使用障礙數據隱私的 42 CFR 第 2 部分法規遵守？​​ 

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.​​ 

目前正在進行的共享機密醫療資訊 (ASCMI) 授權試點如何與行為健康管理整合一致？​​ 

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 於 2023 年在三個國家進行了試驗，以測試對 ASCMI 工具的興趣和接受性。請參閱 ASCMI 試點評估報告以了解更多信息。DHCS 利用試點中獲得的反饋和教訓，正在改進 ASCMI 表格，並為全州同意管理平台開發設計，資金和實施計劃。精細的 ASCMI 表格和有關同意管理平台的其他詳細信息將於 2025 年發布。
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綜合行為健康數據系統項目如何與行為健康管理整合一致？​​ 

綜合行為健康數據系統項目旨在找出技術解決方案，以現代化和簡化數據收集和報告，分析和其他數據相關功能，並開發整合了來自 12 個現有行為健康數據系統的數據的綜合報告和分析平台。 DHCS 將在內部和與利益相關者進行協調，以確保全面行為健康數據系統項目的實施和行為健康行政整合之間的一致性。​​ 

文化能力計劃​​ 

各縣是否會收到模板或指導以幫助制定一致且具影響力的文化能力計劃？​​ 

是的DHCS 正在開發整合的文化能力計劃模板，以供縣使用。​​ 

外部品質評論 (EQR)​​ 

在綜合合約下，外部質量審查 (EQR) 將如何運作？​​ 

根據綜合合同，藥物醫療有組織交付系統（DMC-ODS）各縣將進行一個單一的綜合檢測試驗證，該服務涵蓋特殊心理健康服務（SMHS）和 DMC-ODS 計劃。 藥物醫療局（DMC）縣將繼續僅針對其 SMHS 活動獲得 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.​​ 

根據現有的心理健康計劃（MHP）和藥物醫療有組織交付系統（DMC-ODS）合同，各縣預計每個計劃完成一個臨床績效改善項目（PIP）和一個非臨床 PIP，總計四個 PIP。 根據綜合合同，各縣還需要完成四個 PIP 嗎？​​ 

根據聯邦法律，所有具有綜合合同的縣都必須至少實施兩個 PIP：一個臨床 PIP 和一個非臨床 PIP。​​ 


  • 對於綜合 DMC-ODS 縣，PIP 可能涉及特殊精神健康服務（SMHS）、DMC-ODS 或兩者。​​ 



  • 對於綜合藥物醫療（DMC）縣，兩個 PIP 都必須與 SMHS 相關，可能包括對同時發生的物質使用障礙（SUD）需求的成員特別關注。​​ 


與現有合同一致，DHCS 可能會要求整合縣完成特定 PIP 和/或其他 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.​​ 

在結構和頻率方面，行為健康（BH）審計將如何在綜合合約下進行？​​ 

擁有綜合合同的縣將獲得年度綜合 BH 審計，該審計評估符合綜合合同的是否遵守，包括專業精神健康服務（SMHS）和藥物使用障礙（SUD）服務的特定要素。 這個綜合過程將適用於藥物醫藥有組織配送系統（DMC-ODS）和藥物醫藥（DMC）縣，並在安排和審查期間方面將繼續遵循州會計年度（SFY）。 綜合 BH 審計將採用 BHIN 23-044 中所述的特定縣內的系統性方法。​​ 

綜合行為健康 (BH) 稽核是否包括檢討藥物使用預防、治療和恢復服務批次撥款 (SUBG) 服務以及特殊精神健康服務 (SMHS) 和藥物醫療服務 (DMC-ODS) 服務？​​ 

目前，DHCS 會針對 SUBG 進行年度合規檢討，並與 DMC/DMC-ODS 的同時進行年度合規檢討。目前，DHCS 預計 SUBG 檢討將與綜合 BH 審計結合，包括年度合規檢討，並每三年至少進行一次現場審查。DHCS 將發布有關調整和簡化行為健康計劃之間的監督的額外指導。​​ 

DHCS 打算如何根據時間範圍進行的行為健康（BH）稽核運作，以及某些稽核將在何處/如何整合以簡化響應？對於提早整合合同的縣？?是否有關時間範圍，以及某些審計將在何處或如何整合以簡化回應的方式提供澄清？​​ 

 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.​​ 

網路充足性​​ 

整合式網路充足性認證將如何運作？ 除了每月 274 個電子數據交換（274 標準）提供者網絡數據之外，衞生護理服務部（DHCS）是否要求各縣提交年度網絡充足認證工具（NACT）和及時訪問數據？​​ 


  • 對於擁有綜合合同的縣，DHCS 將通過單一整合的報告流程進行年度網絡充足性認證。各縣將完成一份整合式提交網絡充足性（使用 BHIN 23-042 中描述的 274 標準）並及時訪問報告。這些提交將繼續遵循州財政年度（SFY）。對於 2025 年的自願整合，DHCS 目前沒有提議對網絡充足性或及時訪問的標準進行任何實質變更。​​  



    對於藥物醫療（DMC）縣，DHCS 只要求提交集成的及時訪問數據工具（TADT），該工具將包括 SUD 和 SMHS 的及時訪問數據。DHCS 仍將要求將剩餘的網絡充足數據和文件提交給 SMHS。詳細網絡認證結果的綜合報告將通過綜合合同發送給 DMC 縣，但只有及時訪問標準結果才適用於 SUD 服務。其餘的結果僅適用於 SMHS。
    ​​ 


衞生護理署會否調整或更改用於評估綜合合約網絡充足性的方法？​​ 

DHCS 將不會更改用於自願執行整合合同生效的藥物醫療中心組織配送系統（DMC-ODS）的國家用於確定網絡充足性合規性的方法。1 2025 DHCS 對目前在 BHIN 23-041 中概述的網絡充足標準的潛在實質修訂的優點，例如調整特殊精神健康服務（SMHS）和藥物使用障礙（SUD）服務之間的能力方法，以及與 Medi-Cal 管理護理計劃的網絡充足方法進行額外的一致性。
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如果各縣不符合網絡充足要求，衛生護理服務部（DHCS）是否會發出糾正行動計劃（CAPS）？ 報告和潛在的 CAP 是否是單一的，還是在心理健康計劃（MHP）和藥物醫藥有組織傳遞系統（DMC-ODS）分別需要一個？​​ 

對於沒有符合一個或多個網絡充足要求的綜合合同的縣，DHCS 將批准一個集成的 CAP，以解決特殊精神健康服務（SMHS）和藥物使用障礙（SUD）計劃的缺陷，視適用情況。 根據核准的 CAP，DHCS 可能會要求後續提交額外文件以證明合規性。 該縣將繼續使用 CAP，直到所有缺陷被清除為止。​​  

DHCS 將如何確保新的網絡充足程序仍可確保充足的關注物質使用障礙和心理健康優先事項？​​ 

當各縣採用行為健康行為管理整合下的綜合合同時，它們將繼續受管理現有心理健康計劃和 DMC-ODS 計劃相同的網絡充足標準的約束，這些標準要求計劃分別擁有足夠且強大的心理健康或藥物使用障礙提供者的網絡。 現有的網絡充足性方法在評估網絡容量中納入估計的心理健康和藥物使用障礙的普遍率。 DHCS 將與利害關係人合作監察擔憂，以確保精神健康和藥物使用障礙服務保持足夠的網絡，同時還可以為同時發生的疾病提供治療。​​ 

供應商監督​​ 

行為健康行政整合將如何影響提供者？​​ 

這項計劃不會強制在提供者層級改變護理模式，提供者仍然可以選擇是否提供 SMHS、DMC/DMC-ODS 服務，還是兩者。 DHCS 預計，作為此計劃的一部分實施的管理簡化將為提供者提高效率，從而使其更容易參與 SMH 和 DMC/DMC-ODS 計劃，並在提供者選擇這樣做時提供同時發生的特殊行為健康服務。​​ 

行為健康行政整合將如何影響與專業精神健康服務（SMHS）和藥物使用障礙（SUD）計劃合約的 Medi-Cal 計劃提供商的審計或監控？​​ 

根據現有合同，藥物醫藥組織配送系統（DMC-ODS）和藥物醫藥（DMC）計劃（但不是心理健康計劃（MHP）），必須對其合約提供商進行年度現場審查。 根據綜合合約，各縣將需要對所有交付系統的所有合約提供商執行以下操作（服務專業精神健康服務（SMHS）或 DMC-ODS 成員的網絡外提供商除外）：​​ 

  • 進行年度合規審查（辦公室或現場）​​ 
  • 對組織提供商至少每 3 年進行一次現場合規審查（但不適用於與該縣直接簽約的個別 SMHS 從業員）​​ 
  • 在發行後的兩週內向 DHCS 提交監察和審計報告的副本​​ 
  • 遵守以下標準化程序：​​ 
    • 針對供應商缺陷的各縣校正行動計劃（CAP）程序（主要基於目前的 DMC-ODS/DMC 程序）​​ 
    • 對於 SUD 提供者，加利福尼亞成果測量系統（CalOMS）和毒品和酒精治療訪問報告（DATAR）要求（現在已在 DMC 和 DMC-ODS 計劃中標準化）。​​ 

為了滿足提供者監督要求，各縣可以接受另一縣完成的特殊心理健康服務（SMHS）合規審查嗎？​​ 

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.​​ 

現有 Medi-Cal 網站認證工具有預期的變更嗎？各縣是否負責以與目前的專業精神健康服務（SMHS）認證流程類似的方式認證藥物 Medi-Cal 有組織分配系統（DMC-ODS）計劃？​​ 

衛生護理服務部（DHCS）將繼續認證合同的藥物醫療服務（DMC）提供商，而縣將認證合同的專業精神健康服務（SMHS）提供商。DHCS 不預計提供者網站認證工具有任何變更。​​ 

特定行為健康提供者類型和服務的標準​​ 

什麼是臨床實習生？​​ 

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.​​  

假期的臨床實習生可否提供特殊行為健康服務？​​    

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.​​  

正在尋求臨床社會工作者（CSW）、婚姻和家庭治療師（MFT）或專業臨床顧問（PCC）許可證的個人可以在他們的助理申請處理期間提供特殊行為健康服務嗎？​​   

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.”​​  

是否需要縣行為健康計劃（BHP）允許臨床實習生或臨床社會工作者（CSW）、婚姻和家庭治療師（MFT）或專業臨床輔導員（PCC）候選人提供專業行為健康服務？​​  

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. 
​​ 

持牌心理健康專業人員（LMHP）和治療藝術持牌執業者（LPHA）有什麼區別？​​  

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,​​ 
  • 持牌職業護士，​​  
  • 持牌職業治療師，以及​​   
  • 持牌精神科技師。​​  

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

臨床社會工作者（CSW）、婚姻和家庭治療師（MFT）和專業臨床顧問（PCC）候選人的「90 天規則」何時開始？​​   

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.”​​  

為了提供 Medi-Cal 申請或提供服務，各縣應否將研究生實習藥師計算為臨床實習生？​​ 

不 各縣必須確保所有指定臨床實習生（CT）符合所有 CT 資格標準，包括積極參加教育計劃，根據 BHIN 24-043， SPA 23-0026 和 SPA 24- 0041。例如，已畢業並正在等待完整許可證但目前尚未註冊或參加教育實習的實習藥劑師不應將被歸類為 CT。​​