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Care-Based Incentive (CBI) Summary

Lub Chaw Pabcuam Central California Alliance for Health CBI yog tsim los ntawm cov kev ntsuas los txhawb kev tiv thaiv kev noj qab haus huv thiab txuas Medi-Cal cov tswv cuab nrog lawv cov kws kho mob thawj zaug (PCPs).

Qhov kev pab cuam CBI muaj cov kev txhawb siab rau cov neeg muab kev pabcuam uas tau them rau cov chaw muab kev cog lus tsim nyog, suav nrog kev xyaum hauv tsev neeg, kev kho menyuam yaus thiab tshuaj kho mob sab hauv. Cov kev txhawb siab rau tus kws kho mob tau muab faib ua:

Programmatic kev ntsuas uas tau them txhua xyoo raws li tus nqi ntawm kev ua tau zoo hauv txhua qhov kev ntsuas.
Fee-For-Service (FFS) kev ntsuas uas tau them txhua lub hlis twg thaum qhov kev pabcuam tshwj xeeb raug ua, lossis kev ntsuas tau ua tiav.

Lub Alliance tseem muaj kev txhawb siab rau cov tswv cuab los ntawm cov Txoj Kev Pab Cuam Txiaj Ntsig rau Kev Noj Qab Haus Huv, uas yog them ncaj qha rau cov tswv cuab. Cov tswv cuab tsim nyog tau txais cov kev txhawb siab no yog tias lawv tau cuv npe nrog Medi-Cal los ntawm Alliance. Cov ntaub ntawv ntxiv txog kev txhawb siab rau cov tswv cuab tuaj yeem nrhiav tau ntawm Txoj Kev Pab Cuam Txiaj Ntsig rau Kev Noj Qab Haus Huv.

Cov ntsiab lus txhawb siab no muab cov ntsiab lus ntawm CBI program. Yog xav paub ntxiv txog kev them nyiaj txhawb siab rau tus kws kho mob, saib mus rau CBI Programmatic Measure Benchmarks thiab cov Alliance Provider Phau Ntawv Qhia.

Yog xav paub ntxiv txog CBI Program, xa mus rau qhov kev pab cuam xyoo 2024 thiab 2025 CBI Technical Specifications. Rau cov lus nug dav dav, hu rau koj Tus Neeg Saib Xyuas Kev Sib Raug Zoo lossis hu rau Chaw Pabcuam Kev Sib Raug Zoo ntawm (800) 700-3874, ext. 5504 ib.

2025 Summary of Changes

Tshiab Programmatic Measures

Cov kev ntsuas hauv qab no tau hloov pauv los ntawm kev tshawb nrhiav mus rau kev ntsuas programmatic:

Kev kuaj mob chlamydia hauv cov poj niam.
Kev kuaj mob qog nqaij hlav hauv plab.
Zoo-Me Nyuam Mus Saib Rau Hnub Nyoog 15 Hlis-30 Lub Hlis Lub Neej.

Ntsuas kev hloov

Mob ntshav qab zib HbA1c Kev Tswj Tsis Zoo> 9% hloov mus rau Ntshav Qab Zib Tsis Zoo> 9%. Kev ntsuas tau raug hloov kho los tshuaj xyuas cov xwm txheej glycemic tsis ntev los no tau txais los ntawm hemoglobin A1c [HbA1c] lossis ntsuas ntsuas ntsuas ntshav qab zib [GMI] kuaj.

Kev saib xyuas tom qab tso tawm

Qhov kev ntsuas no tau hloov kho rau:

Txais kev saib xyuas tom qab los ntawm cov kws kho mob tshwj xeeb.
Exclude members that were admitted to a Skilled Nursing Facility (SNF) on the same day of discharge.

Kev Tiv Thaiv Thaum Muaj Xwm Ceev

Qhov kev ntsuas no tau hloov kho kom tshem tawm kev mus ntsib kws kho mob sai.

Point Allocation Hloov

Total allowable points for Quality of Care measures changed from 38 points to 53 points.

Kev ntsuas nyiaj laus

Kev Ncaj Ncees Kev Noj Qab Haus Huv: Kev Mus Saib Xyuas Me Nyuam thiab Cov Hluas.
Kev ntsuas kev ua tau zoo.

2024 Summary of Changes

Tshiab Programmatic Measures:

Kev Ntsuam Xyuas Lead Hauv Cov Me Nyuam: Qhov kev ntsuas no tau txav los ntawm kev tshawb nrhiav mus rau qhov kev ntsuas ntsuas.

Cov Nqi Them Tshiab-Rau-Service (FFS) Kev Ntsuas:

Diagnostic Accuracy thiab Completeness Training.
Cognitive Health Assessment Training and Attestation.
Social Determinants of Health (SDOH) ICD-10 Z-Code Xa.
Kev Txhim Kho Kev Ua Haujlwm Zoo

Kev ntsuas kev hloov:

Kev ntsuam xyuas kev noj qab haus huv thawj zaug tau raug hloov mus rau Kev teem caij noj qab haus huv thawj zaug.
Kev Ntsuam Xyuas Kev Nyuaj Siab thiab Kev Npaj Ua raws li tau hloov mus rau Kev Ntsuam Xyuas Kev Nyuaj Siab rau Cov Hluas thiab Cov Neeg Laus.
Kev Ntsuas Kev Ncaj Ncees Kev Noj Qab Haus Huv: Qhov no yog ib qho kev ntsuas kev noj qab haus huv, siv qhov ntsuas Kev Saib Xyuas Me Nyuam thiab Cov Hluas. Cov qhab nia yuav raug muab tsub yog tias tus nqi mus saib xyuas menyuam tau zoo raug txhim kho rau txhua haiv neeg / haiv neeg.

Kev ntsuas nyiaj laus:

Kev Ntsuas Lub Cev Qhov Ntsuas (BMI): Cov Me Nyuam & Cov Hluas
Kev txhaj tshuaj: Cov neeg laus

Cov Kev Tshawb Fawb Tshiab:

Kev Mus Saib Me Nyuam Zoo rau Hnub Nyoog 15 Lub Hlis - 30 Lub Hlis

Programmatic

Kev ntsuas kev sib koom tes saib xyuas - Kev ntsuas nkag
Ntsuas	Summary Definition	Kev Tsim Nyog Tswvcuab	Cov peev txheej	Cov ntsiab lus tau: 21.5
Adverse Childhood Experiences (ACEs) Kev tshuaj ntsuam xyuas hauv cov menyuam yaus thiab cov tub ntxhais hluas	Qhov feem pua ntawm cov tswv cuab muaj hnub nyoog ib txog rau 20 xyoo uas tau kuaj xyuas Adverse Childhood Experiences (ACEs) txhua xyoo uas siv cov cuab yeej tshuaj ntsuam xyuas.	≥5 Cov Neeg Tsim Nyog Txuas Txuas	Adverse Childhood Experiences (ACEs) hauv Cov Menyuam Yaus thiab Cov Hluas Cov Lus Qhia Kev tshuaj ntsuam cov lis dej num: G9919 - Kev tshuaj xyuas ua tau - cov txiaj ntsig zoo thiab kev pab ntawm cov lus pom zoo muab G9920 - Kev tshuaj xyuas ua tau - cov txiaj ntsig tsis zoo	3
Kev siv Dental Fluoride Varnish	Qhov feem pua ntawm cov tswv cuab muaj hnub nyoog rau lub hlis txog rau tsib xyoos (mus txog lossis ua ntej lawv lub hnub yug rau xyoo) uas tau txais tsawg kawg ib daim ntawv thov tshuaj fluoride los ntawm cov neeg ua haujlwm ntawm PCP lub chaw ua haujlwm hauv lub xyoo ntsuas.	≥5 Cov Neeg Tsim Nyog Txuas Txuas	Daim Ntawv Thov Kev Kho Hniav Fluoride Varnish Tip Sheet Fluoride Application Code: TIAB SA 99188	2
Kev tshuaj ntsuam kev loj hlob hauv thawj 3 xyoos	Qhov feem pua ntawm cov tswv cuab muaj hnub nyoog 1-3 xyoos tau tshuaj xyuas qhov kev pheej hmoo ntawm kev loj hlob, kev coj tus cwj pwm, thiab kev sib raug zoo qeeb uas siv cov cuab yeej tshuaj ntsuam xyuas tus qauv hauv 12 lub hlis dhau los lossis thawj hnub yug thib ob, lossis thib peb.	≥5 Cov Neeg Tsim Nyog Txuas Txuas	Kev tshuaj ntsuam xyuas kev loj hlob hauv thawj 3 Xyoo Daim Ntawv Qhia Kev ntsuam xyuas kev loj hlob Code: 96110	2
Kev teem caij noj qab haus huv thawj zaug	Cov tswv cuab tshiab uas tau txais kev teem caij noj qab haus huv tag nrho hauv 120 hnub ntawm kev tso npe nrog Alliance.	≥5 tsim nyog txuas cov tswvcuab txuas ntxiv mus rau npe tsis pub dhau 120 hnub ntawm kev tso npe (plaub hli)	DHCS MMCD Txoj Cai Tsab Ntawv 22-030 Rau ib daim ntawv teev tag nrho ntawm cov lis dej num saib Daim Ntawv Qhia Txog Kev Noj Qab Haus Huv Pib Pib.	4
Kev saib xyuas tom qab tso tawm **	Cov tswv cuab uas tau txais kev mus ntsib tom qab tso tawm tsis pub dhau 14 hnub tom qab tso tawm hauv tsev kho mob. Qhov kev ntsuas no tsuas yog cuam tshuam rau kev tshem tawm hauv tsev kho mob hnyav xwb. Kev mus ntsib chav xwm txheej ceev tsis tsim nyog.	≥5 Cov Neeg Tsim Nyog Txuas Txuas	Xov Tooj: 99202-99215, 99241-99245, 99341- 99350, 99381-99385, 99391-99395, 99429	10.5
Kev ntsuas kev saib xyuas – Kev ntsuas hauv tsev kho mob thiab tus neeg mob sab nraud
Ntsuas	Summary Definition	Kev Tsim Nyog Tswvcuab	Cov peev txheej	Cov ntsiab lus tau: 25.5
Ambulatory Care Sensitive Admissions	Tus naj npawb ntawm kev saib xyuas kev thauj mus los yooj yim nkag mus (raws li txoj kev npaj qhia txog AHRQ) rau 1,000 tus tswvcuab tsim nyog hauv ib xyoos. Nco tseg: Qhov no yog ib qho kev ntsuas inverse; tus nqi qis dua ntawm kev lees paub tsim nyog rau ntau CBI cov ntsiab lus.	≥100 Cov Neeg Tsim Nyog Tsim Nyog Txuas Cov Tswvcuab	Ambulatory Care Sensitive Diagnosis Rau ib daim ntawv teev tag nrho ntawm cov lis dej num saib CBI Technical Specifications	7
Plan All-Cause Readmission	Tus naj npawb ntawm cov tswvcuab hnub nyoog 18 xyoo thiab laus dua nrog tus neeg mob hnyav thiab kev soj ntsuam nyob hauv lub xyoo ntsuas uas tau ua raws li kev npaj tsis tau npaj rau kev kuaj mob hauv 30 hnub. Nco tseg: Qhov no yog ib qho kev ntsuas inverse; tus nqi qis dua ntawm kev nyeem ntawv tsim nyog tau txais ntau cov ntsiab lus CBI.	≥100 Cov Neeg Tsim Nyog Tsim Nyog Txuas Cov Tswvcuab	Daim Ntawv Qhia Tag Nrho-Cause Readmission Tip Sheet Rau ib daim ntawv teev tag nrho ntawm cov lis dej num saib CBI Technical Specifications	10.5
Kev Tiv Thaiv Thaum Muaj Xwm Ceev	Tus nqi ntawm kev tiv thaiv ED thiab mus ntsib sai rau 1,000 tus tswvcuab hauv ib xyoos. Kev mus ntsib ceev suav yog ib nrab ntawm tus nqi raws li ED mus ntsib	≥100 Cov Neeg Tsim Nyog Tsim Nyog Txuas Cov Tswvcuab	Alliance Case Management thiab Care Coordination Programs Daim Ntawv Qhia Txog Kev Tiv Thaiv Thaum Muaj Xwm Ceev Daim Ntawv Qhia Txog Kev Tiv Thaiv Thaum Muaj Xwm Ceev	8
Kev ntsuas kev saib xyuas zoo
Ntsuas	Summary Definition	Kev Tsim Nyog Tswvcuab	Cov peev txheej	Cov ntsiab lus tau: 38
Kev kuaj mob cancer mis	Qhov feem pua ntawm cov poj niam hnub nyoog 50 - 74 xyoo uas tau kuaj mob qog noj ntshav rau lub mis rau lossis thaum Lub Kaum Hli 1 ob xyoos ua ntej Lub Sijhawm Ntsuas thiab qhov kawg ntawm Lub Sijhawm Ntsuas.	≥30 Cov Neeg Tsim Nyog Tsim Nyog Txuas Cov Tswvcuab	Daim ntawv qhia txog kev kuaj mob cancer mis Kev kuaj mob qog noj ntshav mis: 77061-77067 Rau ib daim ntawv teev tag nrho ntawm cov lis dej num saib CBI Technical Specifications	Ntau yam
Cervical Cancer Screening	Cov poj niam hnub nyoog 21-64 xyoo uas tau kuaj mob khees xaws ncauj tsev menyuam siv ob yam hauv qab no: 21-64 xyoo uas muaj lub ncauj tsev menyuam cytology ua nyob rau hauv 3 xyoo dhau los, pib thaum muaj hnub nyoog 21; los yog 30-64 xyoo uas muaj kev pheej hmoo siab ntawm lub ncauj tsev menyuam papillomavirus (hrHPV) kuaj tau ua nyob rau hauv 5 xyoo dhau los; los yog 30-64 xyoo uas muaj cervical cytology / HPV co-test ua nyob rau hauv 5 xyoo dhau los	≥30 Cov Neeg Tsim Nyog Tsim Nyog Txuas Cov Tswvcuab	Cervical Cancer Screening Tip Sheet Cervical Cancer Screening Codes: Q0091 - Kev siv cov cai no yuav ua kom muaj kev ua raws li tau txais, npaj thiab xa cov tshuaj smear ntawm ncauj tsev menyuam mus rau chav kuaj es tsis yog cia siab rau lub chaw kuaj mob kom xa daim ntawv thov. Txhawm rau tshem tawm cov tswv cuab los ntawm kev ntsuas: Z90.710 - tsis muaj lub ncauj tsev menyuam thiab lub tsev menyuam Z90.712 - tsis muaj lub ncauj tsev menyuam nrog lub tsev menyuam Q51.5 - agenesis thiab aplasia ntawm ncauj tsev menyuam (Tuaj yeem siv rau tus txiv neej-rau-poj niam hloov pauv) Rau ib daim ntawv teev tag nrho ntawm cov lis dej num saib CBI Technical Specifications	Ntau yam
Kev Saib Xyuas Menyuam Yaus thiab Cov Hluas (3-21 xyoos)	Qhov feem pua ntawm cov tswv cuab hnub nyoog 3–21 xyoo uas muaj tsawg kawg yog ib qho kev saib xyuas zoo nrog PCP lossis tus kws kho mob OB/GYN thaum lub xyoo ntsuas.	≥30 Cov Neeg Tsim Nyog Tsim Nyog Txuas Cov Tswvcuab	Phau Ntawv Qhia Txog Kev Saib Xyuas Menyuam Yaus thiab Cov Hluas Zoo-Koom Haum Codes: 99382-99385, 99392-99395, Z00.00-Z00.01, Z00.121-Z00.129, Z01.411, Z01.419, Z00.2, Z00.3, Z02.5 .1, Z76.2	Ntau yam
Kev kuaj mob chlamydia hauv cov poj niam *	Cov poj niam hnub nyoog 16 txog 24 xyoo uas raug txheeb xyuas tias yog kev sib deev thiab leej twg muaj tsawg kawg yog ib qho kev kuaj mob chlamydia thaum lub xyoo ntsuas	≥30 Cov Neeg Tsim Nyog Tsim Nyog Txuas Cov Tswvcuab	Kev kuaj mob chlamydia hauv Cov Poj Niam Tip Sheet Kev kuaj kab mob chlamydia: 87110, 87270, 87320, 87490-87492, 87810	Ntau yam
Kev kuaj mob qog nqaij hlav hauv plab *	Qhov feem pua ntawm cov tswv cuab 45-75 xyoo uas muaj kev tshuaj xyuas tsim nyog rau kev mob qog nqaij hlav hauv plab. Rau cov tswv cuab 46-75 xyoo siv ib qho ntawm cov hauv qab no: Fecal occult ntshav kuaj hauv xyoo tas los. Sigmoidoscopy yooj yim hauv 5 xyoo dhau los. Colonoscopy hauv 10 xyoo dhau los. CT colonography hauv 5 xyoo dhau los. Cov quav DNA (sDNA) nrog FIT kuaj hauv 3 xyoos dhau los.	≥30 Cov Neeg Tsim Nyog Tsim Nyog Txuas Cov Tswvcuab	Daim ntawv qhia txog kev kuaj mob khees xaws mis Fecal occult blood test CPT lis dej num: 82270, 82274 Flexible sigmoidoscopy CPT codes: 45330-45335, 45337, 45338, 45340-45342, 45346, 45347, 45349, 45350 Colonoscopy codes: CPT: 44388-44394, 44401-44408, 45378-45382, 45384-45386, 45388-45393, 45398 ICD-9: 45.22, 45.23, 45.25, 45.42, 45.43 CT colonography CPT lis dej num: 74261-74263 Cov quav DNA (sDNA) nrog FIT CPT code: 81528	Ntau yam
Kev Ntsuam Xyuas Kev Nyuaj Siab rau Cov Hluas thiab Cov Neeg Laus	Qhov feem pua ntawm cov tswvcuab hnub nyoog 12 xyoos thiab laus dua uas tau kuaj mob rau kev nyuaj siab siv lub hnub nyoog tsim nyog tus qauv, ua thaum Lub Ib Hlis 1 thiab Kaum Ob Hlis 1 ntawm lub sijhawm ntsuas.	≥30 Cov Neeg Tsim Nyog Tsim Nyog Txuas Cov Tswvcuab	Daim Ntawv Qhia Txog Kev Nyuaj Siab rau Cov Hluas thiab Cov Neeg Laus LOINC Cov Cai: 89208-3, 89209-1, 89205-9, 71354-5, 90853-3, 48545-8, 48544-1, 55758-7, 44261-6, 89204-6, 89204-2, , 71777-7, ib	Ntau yam
Mob ntshav qab zib mellitus > 9% *	Qhov feem pua ntawm cov tswv cuab 18-75 xyoo uas muaj ntshav qab zib (hom 1 thiab hom 2) uas nws qhov kev ntsuas glycemic tsis ntev los no (hemoglobin A1c [HbA1c] lossis ntsuas ntsuas ntsuas ntshav qab zib [GMI]) yog> 9% hauv xyoo ntsuas. Lub hom phiaj ntsuas yog rau cov tswv cuab kom tsis ua raws li qhov muaj HbA1c lossis GMI tsawg dua 9% thiab tswj tau zoo. Tus nqi qis dua qhia tau tias kev ua tau zoo dua. Cov tswv cuab uas tsis muaj chaw kuaj mob lossis tsis muaj nqi kuaj xa mus, kev thov tsis muaj HbA1c tus nqi, lossis tus nqi HbA1c> 9 % raug suav hais tias ua raws li qhov ntsuas no.	≥30 Cov Neeg Tsim Nyog Tsim Nyog Txuas Cov Tswvcuab	Ntshav Qab Zib HbA1c Tswj Tsis Zoo> 9% Daim Ntawv Qhia Kev Kawm Txuj Ci Kev Noj Qab Haus Huv thiab Kev Tswj Xyuas Kab Mob CPT Codes: 83036, 83037 (Non Medi-Cal nyiaj pab code) LOINC Codes: 17855-8, 17856-6, 4548-4, 4549-2, 96595-4, 97506-0 CPT II Cov txiaj ntsig (Point of Service Labs): 3044F, 3046F, 3051F, 3052F	Ntau yam
Kev txhaj tshuaj: Cov tub ntxhais hluas	Qhov feem pua ntawm cov tub ntxhais hluas muaj hnub nyoog 13 xyoos uas tau txhaj tshuaj tiv thaiv kab mob meningococcal ib koob, ib koob tshuaj tiv thaiv kab mob tetanus, diphtheria toxoids thiab acellular pertussis (Tdap), thiab ua tiav cov tshuaj tiv thaiv tib neeg papillomavirus (HPV) koob los ntawm lawv lub hnub yug 13 xyoos.	≥30 tsim nyog txuas cov tswv cuab	Kev txhaj tshuaj tiv thaiv: Daim Ntawv Qhia Cov Hluas Immunization Codes: Meningococcal - 90619, 90733, 90734 TIAB SA - 90715 HPV – 90649, 90650, 90651	Ntau yam
Kev txhaj tshuaj: Me nyuam (Cov lus qhia 10)	Qhov feem pua ntawm cov menyuam uas tau txais tag nrho Cov tshuaj tiv thaiv hauv qab no (Combo 10) los ntawm lawv lub hnub yug thib ob: 4 DTaP (thawj koob tshuaj 42 hnub los yog ntau tshaj tom qab yug me nyuam) los yog anaphylaxis los yog encephalitis vim yog kab mob diphtheria, tetanus los yog pertussis tshuaj tiv thaiv kab mob pertussis. 3 IPV lossis anaphylaxis vim yog txhaj tshuaj tiv thaiv IPV (thawj koob tshuaj 42 hnub lossis ntau dua tom qab yug menyuam). 1 MMR (thaum los yog nruab nrab ntawm tus me nyuam thawj thiab thib ob hnub yug), keeb kwm ntawm qhua pias, mumps thiab rubella mob los yog anaphylaxis vim yog txhaj tshuaj tiv thaiv MMR. 3 Hib (thawj koob tshuaj 42 hnub lossis ntau dua tom qab yug me nyuam) lossis anaphylaxis vim yog txhaj tshuaj tiv thaiv Hib. 3 HepB (thawj koob tshuaj xoom mus rau plaub lub lis piam ntawm hnub nyoog), keeb kwm ntawm cov tshuaj tiv thaiv kab mob siab B lossis anaphylaxis vim yog txhaj tshuaj tiv thaiv kab mob siab B. 1 VZV (nyob rau lossis nruab nrab ntawm tus menyuam thawj thiab thib ob hnub yug), keeb kwm ntawm varicella zoster (kab mob pox) lossis anaphylaxis vim yog txhaj tshuaj tiv thaiv VZV. 4 PCV (thawj koob tshuaj 42 hnub lossis ntau dua tom qab yug me nyuam) lossis anaphylaxis vim yog cov tshuaj tiv thaiv kab mob pneumococcal conjugate. 2 lossis 3 RV (thawj koob tshuaj 42 hnub lossis ntau dua tom qab yug menyuam) lossis anaphylaxis vim yog txhaj tshuaj tiv thaiv kab mob rotavirus. 1 HepA (nyob rau lossis nruab nrab ntawm tus menyuam lub hnub yug thawj thiab thib ob), keeb kwm ntawm kab mob siab A lossis anaphylaxis vim yog txhaj tshuaj tiv thaiv kab mob siab A. 2 Tus kab mob khaub thuas (cov tshuaj tiv thaiv 180 hnub lossis ntau dua tom qab yug me nyuam txog lossis thaum tus menyuam hnub yug thib ob) lossis anaphylaxis vim yog txhaj tshuaj tiv thaiv kab mob khaub thuas.	≥30 Cov Neeg Tsim Nyog Tsim Nyog Txuas Cov Tswvcuab	Kev txhaj tshuaj: Cov Me Nyuam (Combo 10) Daim Ntawv Qhia Rau ib daim ntawv teev tag nrho ntawm cov lis dej num saib CBI Technical Specifications	Ntau yam
Kev tshuaj ntsuam txhuas hauv cov menyuam yaus	Qhov feem pua ntawm cov menyuam yaus hnub nyoog 2 xyoos uas muaj ib lossis ntau dua capillary lossis venous lead ntshav kuaj rau cov tshuaj lom tshuaj txhuas los ntawm lawv lub hnub yug thib ob	≥30 Cov Neeg Tsim Nyog Tsim Nyog Txuas Cov Tswvcuab	Kev tshuaj ntsuam txhuas hauv cov ntawv qhia me nyuam Lead Screening Codes: 83655 Rau ib daim ntawv teev tag nrho ntawm cov lis dej num saib CBI Tech Specs.	Ntau yam
Kev Mus Saib Me Nyuam Zoo hauv Thawj 15 Lub Hlis	Cov tswv cuab hnub nyoog 15 lub hlis uas muaj 6 lossis ntau dua kev mus ntsib tus menyuam zoo nrog PCP thaum thawj 15 lub hlis ntawm lub neej.	≥30 Cov Neeg Tsim Nyog Tsim Nyog Txuas Cov Tswvcuab	Zoo-Me Nyuam Mus Saib Thawj 15 Lub Hlis Daim Ntawv Qhia Well-Child Visit Codes: 99381, 99382, 99391, 99392, 99461, Z00.110-Z00.129, Z00.2 Z02.5, Z76.1, Z76.2	Ntau yam
Kev Mus Saib Me Nyuam Zoo rau Hnub Nyoog 15 Hlis-30 Lub Hlis Lub Neej *	Qhov feem pua ntawm cov tswv cuab muaj hnub nyoog 30 lub hlis uas muaj ob lossis ntau dua kev mus ntsib tus menyuam zoo nrog PCP ntawm tus menyuam hnub yug 15 hli ntxiv rau ib hnub thiab hnub yug 30 hli.	≥30 Cov Neeg Tsim Nyog Tsim Nyog Txuas Cov Tswvcuab	Phau Ntawv Qhia Txog Kev Noj Qab Haus Huv Me Me rau Hnub nyoog 15-30 Lub Hlis Well-Child Visit Codes: 99382, 99392, 99461, Z00.121, Z00.129, Z00.2, Z76.1, Z76.2, Z02.5	Ntau yam
Kev ntsuas ntsuas
Ntsuas	Summary Definition	Kev Tsim Nyog Tswvcuab	Cov peev txheej	Cov ntsiab lus ua tau
Tswj ntshav siab	Cov tswvcuab hnub nyoog 18–85 xyoo uas tau kuaj pom tias muaj ntshav siab (HTN) thiab nws cov ntshav siab tau tswj tau zoo (140/90 mm Hg) hauv 12 lub hlis dhau los. Kev nyeem ntawv BP yuav tsum tshwm sim rau lossis tom qab hnub kuaj HTN thib ob.	≥30 Cov Neeg Tsim Nyog Tsim Nyog Txuas Cov Tswvcuab	Tswj Cov Ntshav Qab Zib Cov Lus Qhia Tswj Cov Ntshav Siab Codes: 3074F, 3075F, 3077F, 3078F, 3079F, 3080F	N/A

* Kev ntsuas tshiab rau 2025 ** Kev ntsuas hloov rau 2025

Nqi-rau-Service

Xyaum Tswj Kev Ntsuas
Ntsuas	Summary Definition	Cov peev txheej
Adverse Childhood Experiences (ACEs) Kev cob qhia thiab kev lees paub	Cov phiaj xwm them nyiaj rau cov kws kho mob, uas suav nrog cov kws kho mob nruab nrab, txhawm rau ua tiav DHCS ACEs kev cob qhia thiab ua pov thawj. Txoj kev npaj them $200 rau txhua pab pawg uas tus kws kho mob ua raws.	$200 kev them nyiaj ib zaug tom qab tau txais lub xeev ceeb toom ntawm kev cob qhia thiab kev lees paub tiav. Kev them nyiaj tsis rov tshwm sim txhua xyoo lossis peb lub hlis twg. CBI Technical Specifications
Cwj pwm kev noj qab haus huv kev koom ua ke	Kev npaj them $1,000 ib zaug them rau cov neeg muab kev pabcuam rau kev ua tiav ntawm NCQA Distinction in Behavioral Health Integration. Kev them nyiaj yog ua ib zaug tom qab kev sib txawv tau txais los ntawm Alliance.	$1,000 ib zaug them nyiaj rau kev ua tiav ntawm NCQA Distinction in Behavioral Health Integration. Kev them nyiaj tsis rov tshwm sim txhua xyoo lossis peb lub hlis twg. CBI Technical Specifications
Cognitive Health Assessment Training and Attestation	Cov phiaj xwm them nyiaj rau cov kws kho mob, uas suav nrog cov kws kho mob nruab nrab, ua kom tiav DHCS kev paub txog kev ntsuas kev noj qab haus huv thiab kev lees paub. Txoj kev npaj them rau txhua pab pawg CBI $200 uas tus kws kho mob ua raws.	$200 them ib zaug Kev them nyiaj ib zaug tom qab tau txais lub Xeev ceeb toom ntawm kev cob qhia thiab kev lees paub tiav. Kev them nyiaj tsis rov tshwm sim txhua xyoo lossis peb lub hlis twg. CBI Technical Specifications
Diagnostic Accuracy thiab Completeness Training	Txoj kev npaj yuav them rau cov chaw muab kev pab ua kom tiav CMS Diagnostic Accuracy thiab Completeness Training.	$200 ib zaug them nyiaj tom qab tau txais daim ntawv pov thawj ceeb toom ntawm kev kawm tiav. Kev them nyiaj tsis rov tshwm sim txhua xyoo lossis peb lub hlis twg.
Kev Txhim Kho Kev Ua Haujlwm Zoo	Kev npaj them rau cov chaw muab kev pabcuam $1,000 rau txhua qhov chaw ua haujlwm uas ua tiav Alliance muab Kev Txhim Kho Kev Ua Haujlwm Zoo. Tsuas yog cov chaw ua haujlwm nrog kev ntsuas qis dua qhov ua tau zoo tsawg kawg nkaus, ntsuas ntawm 50 feem pua ntawm 2024-xyoo programmatic them nyiaj tau txais kev them nyiaj rau kev ua tiav Cov Kev Txhim Kho Kev Ua Haujlwm Zoo.	$1,000 ib zaug them nyiaj tom qab ceeb toom ntawm qhov project tiav. Kev them nyiaj tsis rov tshwm sim txhua xyoo lossis peb lub hlis twg.
Patient Centered Medical Home (PCMH) Kev lees paub	Kev npaj them nyiaj ib zaug ntawm $2,500 rau cov neeg muab kev pabcuam rau kev ua tiav ntawm NCQA kev lees paub lossis Lub Koom Haum Koom Tes (TJC) ntawv pov thawj. Ib daim qauv ntawm kev lees paub / ntawv pov thawj yuav tsum tau txais los ntawm Alliance.	$2,500 them ib zaug. Kev them nyiaj tsis tshwm sim txhua xyoo lossis peb lub hlis twg. Rau cov neeg muab kev pabcuam xa lawv thawj daim ntawv thov rau NCQA PCMH Recognition, siv Alliance luv nqi code CCAAHA rau txuag 20% ntawm koj tus nqi pib ua ntawv thov. CBI Technical Specifications
Social Determinants of Health (SDOH) ICD-10 Z Code Submission	Kev npaj yuav them cov tsev kho mob uas xa DHCS Social Determinants of Health (SDOH) qhov tseem ceeb ICD-10 Z-codes.	$250 cov nyiaj them txhua lub hlis twg rau cov ntawv thov xa nrog qhov tseem ceeb SDOH Z cov lej, nrog $1,000 qhov nyiaj them siab tshaj plaws. Kev them nyiaj tsis rov tshwm sim txhua xyoo lossis peb lub hlis twg.

CBI ncua sij hawm

Member Health Rewards Program

Cov lus nug?
Hu rau koj Tus Neeg Saib Xyuas Kev Sib Raug Zoo lossis hu rau Chaw Pabcuam ntawm (800) 700-3874 ext. 5504 ib

Tswj Kev Kho Mob

Care-Based Incentive (CBI) Summary

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Kev Pabcuam Tswvcuab

Lub Alliance

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