專案更新​​ 

梅迪卡爾出生統計​​ 

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.​​ 

這些檔案提供在醫院環境中出生的加州居民的摘要表，包括孕婦人口統計資料，例如年齡、分娩方式，以及特定的生產結果，包括低出生體重和早產。這些表格也包括已知會影響生產結果的主要併發症和健康行為，例如孕前體重和懷孕期間吸煙。此外，DHCS 還列出由私人保險提供資金的嬰兒出生率、由其他公共資金來源提供資金的嬰兒出生率，以及未投保母親的嬰兒出生率。​​ 

Medi-Cal 是加州母嬰健康照護服務的重要付款來源。2022 年，Medi-Cal 計畫資助了 44.6% 的住院加州居民分娩。在 Medi-Cal 資助的 183,844 名新生兒中，78.2%是參加管理性護理的母親所生。​​ 

適用於醫療服務提供商的新卡拉艾姆資源​​ 

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.​​ 

這些資源旨在幫助已與 Medi-Cal 管理性護理計劃簽約或計劃與 Medi-Cal 管理性護理計劃簽約以提供 ECM 及／或社區支援服務的機構。請將問題提交至ta-marketplace@ca-path.com。​​ 

2023 年度網絡認證（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 數據的延誤和不完整是 DHCS 為了加強 DHCS 監控會員獲得行為健康照護的能力而對及時獲得數據報告方法進行改進的直接結果。在行為健康計劃網絡審查中，有幾個 Medi-Cal 藥物有組織遞送系統 (DMC-ODS) 計劃和縣級心理健康計劃未達到一個或多個網絡充足性標準，需要向 DHCS 提交並完成 CAP，詳細說明他們將馬上採取的行動，以證明符合標準。​​ 

由於 Medi-Cal 管理性護理計劃的 AAS 系統和行為健康計劃的資料報告要求有重大改變，許多計劃在 ANC 審查中提交不正確和／或不完整的資料。DHCS 估計，許多 CAP 將透過解決資料報告問題來解決，並不表示不符合網路充足性標準。​​ 

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.​​ 

加入我們的團隊​​ 

DHCS 正在尋找一個有才華和有動力的個人，在審計和調查中擔任合同和註冊部（CERD）主任。 主管負責規劃、組織和指導健康計劃、提供者和藥物 Medi-Cal 組織配送系統合規審查的活動。 主管還帶領與 Medi-Cal 和其他 DHCS 計劃的計劃完整性有關的政策和程序的開發和實施。 申請必須在十二月 6 2024 之前提交。​​ 

DHCS 還正在招聘其健康政策，信息技術和其他團隊。 有關更多信息，請訪問 CalCareers 網站。​​ 

即將舉行的利害關係人會議和網絡​​ 

DHCS 減少危害高峰會​​ 

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.​​ 

兒童助聽器保障計劃網絡研討會​​ 

12 月 3 日，太平洋標準時間上午 11 點至下午 12 點，DHCS 將舉辦網絡研討會，與家庭和社區合作夥伴分享有關申請助聽器保障並最大限度地提高兒童助聽器保障計劃福利後的指導。 有關更多信息和預先註冊，請訪問兒童助聽器保障計劃網頁。​​ 

如果你錯過了​​ 

行為健康轉型政策手冊單元 1 公眾評論期​​ 

11 月 8 日，DHCS 開始行為健康轉型政策手冊模組 1的公眾評論期，並將在 12 月 2 日前接受意見。最終的政策手冊將於 2025 年初發佈，將指導各縣實施行為健康轉型，即加州在全州範圍內改善心理健康和藥物使用障礙服務的倡議，提高所有加州人的可及性和支援。我們邀請您檢閱《政策手冊》單元 1，並提供您的意見。您的反饋對於塑造加州行為健康服務和支援的未來至關重要。若要瞭解如何使用《政策手冊》工具提供反饋 意見 ，請觀看發佈在「 公眾意見期」網頁 上的說明培訓視訊。有關具體的公眾評論相關查詢，請發送電子郵件至 BHTPolicyFeedback@dhcs.ca.gov。​​