互通性
在聯邦和州法規的指導下，互操作性專案確保健康照護服務部 (DHCS) 遵守法規，促進病患資料存取、付款人資料交換和醫療服務提供者名錄更新。互操作性可讓醫療系統之間無縫共用病患資料，促進照護協調並改進療效。DHCS 致力於開發安全的應用程式介面 (API)，讓加州人能輕鬆存取其健康資料，並致力於賦予個人管理其健康的能力，以及建立連線的醫療照護生態系統，以創造更健康的加州。
Medi-Cal 付費服務優先授權指標報告
DHCS 必須每年報告 Medi-Cal 和兒童健康保險計劃 (CHIP) 付費服務 (FFS) 的優先授權總計指標，以符合CMS 互操作性和優先授權最終規定(CMS-0057-F)。公開報告這些指標可提高透明度和問責性，幫助 Medi-Cal 和 CHIP FFS 會員瞭解事先授權程序，並讓提供者和利害關係人能夠評估付款者的績效和行政效率。該報告包括存取需要事先授權的所有 Medi-Cal 和 CHIP FFS 項目和服務（不包括藥物）的資訊，以及上一個日曆年這些項目和服務的事先授權請求資料。
如有任何關於事先授權指標報告的問題或意見，請聯絡 DHCS 互通性團隊，郵箱地址為interoperability@dhcs.ca.gov 。
2025 年優先授權指標報告
- Medi-Cal - 2025 年 Medi-Cal 付費服務醫療和行為健康項目及服務的優先授權指標
- Medi-Cal 牙科 - 2025 年 Medi-Cal 付費服務牙科項目和服務的事先授權指標
- 加州兒童服務 - 2025 年加州兒童服務 (CCS) 項目和服務的優先授權指標
第三方應用程式開發人員
有意透過 Patient Access API 提供健康資料的第三方應用程式開發人員必須透過 DHCS 註冊並取得認證。
請發送電子郵件至interop-api@dhcs.ca.gov申請註冊。
聯邦指引
- 聯邦醫療保險和醫療補助中心 (CMS)：互通性
- 內容管理系統互通性和患者訪問最終規則 (CMS-9115-F)
- CMS 互通性和患者訪問最終規則資料表
- CMS 互通性與事先授權最終規則 (CMS-0057-F)
- CMS 互通性和預先授權最終規則資料表
- CMS 實作指南和標準
- CMS 藍色按鈕 2.0
管理護理計劃指引
- All Plan Letter 22-026: Interoperability and Patient Access Final Rule This All Plan Letter (APL) notifies all Medi-Cal managed care health plans (MCPs) of the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access final rule requirements as required by federal law.
- All Plan Letter 22-013: Interoperability and Patient Access Final Rule This APL notified all Dental Managed Care (DMC) Plans about the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access final rule requirements.
心理健康計畫指南
- Behavioral Health Information Notice No: 22-068 This Behavioral Health Information Notice was used to notify all Mental Health Plans (MHPs) and Drug Medi-Cal Organized Delivery System (DMC-ODS) counties about the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access final rule requirements.
管理護理計劃指南 & 行為健康計劃/縣
- Managed Care Plans and Behavioral Health Plans/Counties This site provides additional information for Managed Care Plans and Behavioral Health Plans/Counties regarding California’s Data Exchange Framework, CalAIM Data Sharing Authorization Guidance, Consent Forms and Consent Management, Data Submission Requirements, and other topics.
國家指引
- Data Exchange Framework – CDII (ca.gov) California’s Data Exchange Framework (DxF) is the first-ever, statewide data-sharing agreement that will accelerate and expand the exchange of information among healthcare entities across the state. Beginning in January 2024, the DxF includes a single data sharing agreement and a common set of policies and procedures to govern and require the exchange of health and human services information in California. The DxF builds upon the federal Trusted Exchange Framework and Common Agreement (TEFCA), which establishes a foundation for nationwide interoperability.
- State Health Information Guidance (SHIG) The SHIG is a collaboration of the Center for Data Insights and Innovation with various organizations to develop specific materials to help clarify federal and state laws that affect disclosure and sharing of health information.
- Data Exchange and Sharing The Department of Health Care Services (DHCS) is advancing health information exchange and data sharing to improve the care and outcomes for Medi-Cal Members as California continues its journey into data-driven, value-based health care. Data sharing is foundational to care coordination and is essential to supporting whole-person care programs such as Enhanced Care Management, Community Supports, Population Health management, and other Medi-Cal initiatives.
前身專案
- State Medicaid Health Information Plan (March 2022) The final State Medicaid Health Information Technology Plan (SMHP) presents the impact of the Medi-Cal Promoting Interoperability Program, formerly known as the Medi-Cal Electronic Health Record Incentive Program. The SMHP includes the findings of a health information technology assessment completed by researchers at the University of California, San Francisco in February 2022.
- Medi-Cal Promoting Interoperability Program The Health Information Management Division (HIMD), formerly the Office of Health Information Technolgy, was established in DHCS to develop goals and metrics for for the program, establish policies and procedures, and to implement systems to disburse, track, and report the incentive payments. The Promoting Interoperability Program officially ended in December 2021.
- California Health Information Exchange Onboarding Program (Cal-HOP) All Cal-HOP project activity concluded effective September 30, 2021. Cal-HOP provided up to $50 million in state and federal funding to Qualified Health Information Organizations (QHIOs) to support Medi-Cal providers’ access and use health information exchange (HIE) technology to improve the quality and effectiveness of care for Medi-Cal beneficiaries.
- California Technical Assistance Program In November 2015, the California Technical Assistance Program (CTAP) was launched with $37.5 million in federal and state funds. This program was designed to provide assistance to professionals in adopting, implementing, upgrading and meaningfully using certified electronic health record technology. CTAP concluded in November 2020.