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領導轉型
10 月 2021，州長加文·紐森任命米歇爾·巴斯為 DHCS 董事，從 9 月 15 日起生效。 Baass 之前自 2017 年起擔任加州衛生和人類服務局（CHHSA）計劃和財政事務辦公室副秘書長和副秘書。 在加入 CHHSA 之前，Baass 在立法機構工作了 13 年，擔任各種角色。 她認為自己的新角色是解決醫療保健公平和差異的機會，以便所有加利福尼亞州人都有機會獲得健康成果。 巴斯取代威爾·萊特伯恩，他於 2020 年退休，在全球大流行期間擔任 DHCS 董事。
加州推進和創新加州醫療補助健康保健計劃 (CalAIM)
On October 1, Medi-Cal managed care plans (MCP) submitted their Model of Care (MOC) for Enhanced Care Management (ECM) and Community Supports (formerly called “In Lieu of Services”). These submissions include initial ECM and Community Supports provider capacity and other critical information, including organizational descriptions, key policies and procedures, and provider contract boilerplates related to the transition of the Health Homes and Whole Person Care pilot programs to the ECM and Community Supports benefits. ECM and Community Supports are scheduled to go live on January 1, 2022.
ECM and Community Supports are foundational components of CalAIM. ECM will be a whole-person, interdisciplinary approach to comprehensive care management that addresses the clinical and non-clinical needs of high-cost, high-need managed care members through systematic coordination of services that is community-based, interdisciplinary, high-touch, and person-centered. Community Supports are medically appropriate and cost-effective alternatives to services covered under the State Plan. Community Supports are optional services for MCPs to provide and optional for managed care members to access. For more information about ECM and Community Supports, please visit the DHCS website.
MCP 採購時間表和模型變更更新
DHCS is adjusting the release date of the Medi-Cal MCP Request for Proposal (RFP) to February 2, 2022. Though the RFP was scheduled to be released at the end of 2021, this change will not affect the implementation date of January 1, 2024. Additional time is needed to address stakeholder comments received during the comment period for the draft RFP. DHCS is also timing the release of the final RFP so that it does not coincide with the winter holiday period. County Managed Care Transition to Local Plan: Letter of Intent Instructions, and notified them of their conditional approval to advance to the next stage of the assessment process. DHCS has authority to determine which, and how many, MCPs the state contracts with for Medi-Cal services in all counties. DHCS’ evaluation includes assessment of historical quality of care performance and the financial health and viability of the plan.
The conditionally approved counties must now submit an approved county ordinance to DHCS by October 10. By December 3, MCPs are required to submit to DHCS a network contracting strategy for review. A final list of counties approved to move forward with a Plan Model change, will be posted at Plan Model County Changes in early November. Final approval to implement on January 1, 2024, will be based upon MCP operational readiness and Centers for Medicare & Medicaid Services (CMS) approval.
DHCS’ determination will be guided by the best interests of Medi-Cal beneficiaries and DHCS’ goals for the Medi-Cal managed care delivery system under CalAIM: drive quality of care improvements, streamline and reduce complexity, and build upon whole-person care approaches. Additional information is available on the DHCS website.
中醫新冠肺炎疫苗接種激勵計劃
DHCS is allocating up to $350 million to incentivize COVID-19 vaccination efforts in the Medi-Cal managed care delivery system from September 1, 2021, through February 28, 2022. Medi-Cal MCPs are eligible to earn incentive payments for activities that are designed to close vaccination gaps with their enrolled members, and to address vaccine uptake disparities for specific age and race/ethnicity groups. MCPs collectively may earn up to $50 million for achieving specified process measures and $200 million for outcome measures, with $100 million available for all MCPs to use for direct member incentives. DHCS will issue payment allocations upon approval of the MCP’s Vaccination Response Plan, and will assess program achievements in October 2021, January 2022, and March 2022. All 25 full-service MCPs, one population-specific health plan, and one Cal MediConnect plan submitted a Vaccination Response Plan and were approved for participation in the program. For more information, please visit the DHCS website.