Cov lus nug nquag nug (FAQ)
Kev Them Nqi thiab Kev Them Rov Qab
Leej twg yog tus muaj lub luag haujlwm them R&B rau cov tswv cuab Medi-Cal uas tsim nyog ob qho tib si (piv txwv li, Medicare yog thawj thiab Medi-Cal yog thib ob)?
Thaum ib tug Tswv Cuab uas muaj ob hom neeg nyob hauv ib lub Tsev Saib Xyuas Neeg Mob (SNF), Tsev Saib Xyuas Neeg Mob (NF), lossis Tsev Saib Xyuas Neeg Mob Qib Nruab Nrab (ICF) xaiv qhov chaw saib xyuas neeg mob thaum muaj xwm txheej ceev hauv Medicare, Medicare tseem yog tus them nqi tseem ceeb rau cov kev pabcuam saib xyuas neeg mob thaum muaj xwm txheej ceev ntawm tus Tswv Cuab. Lub MCP tseem yog tus saib xyuas kev them nqi chav tsev thiab khoom noj ntawm Medi-Cal sib cais. Kev them nqi chav tsev thiab khoom noj ntawm Medi-Cal yog ib qho kev lav phib xaub sib txawv. MCP tsis muab lossis pom zoo rau tus neeg muab kev pabcuam Medicare hospice rau tus tswv cuab. Lub luag haujlwm them nqi chav thiab khoom noj ntawm MCP hauv Medi-Cal tsis muab cai rau MCP cov neeg cog lus me los xa tus Tswv Cuab mus rau Tus Muab Kev Pabcuam Hospice hauv Network, thiab tsis them nqi raws li tus Tswv Cuab siv Tus Muab Kev Pabcuam Hospice hauv Network. MCP yuav tsum them nqi chav thiab khoom noj raws sijhawm rau tus kws kho mob hospice rau cov neeg nyob hauv SNF/NF lossis ICF uas tsim nyog ob qho tib si. Cov MCPs tsis tuaj yeem thov kev tso cai rau tus kws kho mob hospice kom them nqi rau MCP rau chav tsev thiab khoom noj uas Medi-Cal them thaum tus Tswv Cuab uas tsim nyog tau txais kev pabcuam hospice raws li Medicare. Tsis tas li ntawd xwb, MCPs tsis tuaj yeem yuam kom muaj daim ntawv piav qhia txog cov txiaj ntsig, cov lus qhia txog kev xa nyiaj, lossis tsab ntawv tsis kam lees los ntawm Medicare los nrog rau cov lus thov chav thiab pawg thawj coj. Cov MCPs yuav txheeb xyuas cov ntaub ntawv tsim nyog los tsim kom muaj lub luag haujlwm them nqi chav thiab khoom noj ntawm Medi-Cal, tab sis tsis yog hauv txoj kev uas xav tau cov ntaub ntawv tsis tsim nyog lossis ntau dhau lossis qhov yuav tsum tau kev pom zoo hauv kev kho mob.
Cov MCPs ntawm Medi-Cal tsis kam lees R&B vim tsis tau kev tso cai lossis vim tias tus neeg muab kev pabcuam hospice tsis nyob hauv network. Cov kws kho mob hospice ua tau dab tsi?
Hais txog Medi-Cal xwb Cov Tswv Cuab, MCPs tsis tuaj yeem yuam kom muaj kev tso cai ua ib qho kev them nqi rau chav thiab khoom noj rau Cov Tswv Cuab uas tau txais kev pabcuam hospice thiab nyob hauv SNF/NF lossis ICF. Cov MCPs tsis tuaj yeem tsis lees txais cov kev thov chav thiab pawg thawj coj rau cov Tswv Cuab uas muaj kev xaiv tsa hospice raug cai thiab tau txais kev tso cai saib xyuas hospice, txawm tias nyob hauv Network lossis sab nraud Network, vim tias kev tsis lees txais kev them nyiaj no yuav raug pom tias yog kev cuam tshuam rau kev sib raug zoo ntawm daim ntawv cog lus sau tseg ntawm tus Muab Kev Pabcuam hospice thiab SNF/NF lossis ICF chaw, vim nws cuam tshuam rau tus Muab Kev Pabcuam hospice lub luag haujlwm thiab lub peev xwm them chav thiab pawg thawj coj rau SNF/NF lossis ICF chaw.
Cov neeg muab kev pab cuam Hospice yuav tsum siv cov txheej txheem thov rov hais dua nrog MCP. Cov kws kho mob tuaj yeem xa daim ntawv tsis txaus siab rau cov kws kho mob nrog Lub Chaw Haujlwm Saib Xyuas Kev Kho Mob (DMHC) yog tias MCP tsis yog lub phiaj xwm ntawm Lub Nroog Lub Chaw Tswj Xyuas Kev Kho Mob (COHS). Thaum kawg, cov neeg muab kev pab tuaj yeem koom nrog cov txheej txheem daws teeb meem kev tsis sib haum xeeb nrog MCP.
Puas yog cov tswv cuab uas tsim nyog tau txais Medi-Cal R&B thov kev pab raug tsis lees txais?
Tsis yog. Medi-Cal tsis tuaj yeem tsis lees paub R&B cov kev thov rau cov tswv cuab Medi-Cal uas tsim nyog tau txais kev pabcuam hospice. DHCS tau piav qhia qhov yuav tsum tau ua no hauv APL25-008, nrog rau cov lus qhia txog txoj cai tom qab ntawd rau lub Xya Hli 27, 2026, uas qhia rau Medi-Cal MCPs kom them cov nqi thov R&B ua qhov kev them nyiaj hla mus rau cov tswv cuab Medi-Cal uas tsim nyog ob leeg uas nyob hauv Cov Chaw Saib Xyuas Neeg Mob thiab tau txais kev saib xyuas hospice. APL kuj lees paub tias Medi-Cal MCPs yuav tsis tas yuav tsum tau kev tso cai ua ntej thiab yuav tsum them cov nqi no txawm tias tus neeg muab kev pab tu neeg mob hauv tsev laus puas nyob hauv network los xij.
Puas yuav tsum tau them cov nqi thov R&B rau DHCS lossis Medi-Cal MCP?
Cov kws kho mob Hospice yuav tsum xa cov ntawv thov R&B rau DHCS rau cov tswv cuab Medi-Cal FFS thiab MCP rau cov tswv cuab Medi-Cal managed care, nyob ntawm seb puas tsim nyog.
Yuav ua li cas nrog kev tsim nyog rov qab?
Muaj qee qhov xwm txheej txwv uas tsis pub cov kws kho mob tswj tau qhov twg uas yuav ua tsis tau daim ntawv pov thawj Medi-Cal Hospice Program nrog DHCS raws sijhawm hauv tsib hnub ntawm kev xaiv cov tswv cuab ntawm Medi-Cal FFS - kev tsim nyog rov qab los yog ib qho ntawm cov xwm txheej ntawd. Thaum tau lees paub qhov tsim nyog rov qab los, DHCS yuav xav txog qhov kev lees paub raws sijhawm thiab tso cai rau kev them rov qab rau cov kev pabcuam hospice pib txij li hnub tsim nyog ntawm tus tswv cuab, tsuav yog txhua yam kev pab them nqi Medi-Cal, kev them nqi, thiab cov ntaub ntawv pov thawj tau ua tiav, uas suav nrog tab sis tsis txwv rau cov hauv qab no:
- Tus neeg muab kev pab cuam hospice tsis tau thiab tsis tuaj yeem paub tias tus tswv cuab Medi-Cal FFS tsim nyog tau txais cov kev pab cuam hospice thaum lub sijhawm xaiv tsa, thiab tuaj yeem muab cov ntaub ntawv pov thawj ntawm cov hauv qab no:
- Cov pov thawj ntawm kev tsim nyog rov qab los
- Daim Ntawv Pov Thawj Pabcuam Medi-Cal Hospiceuas tau xa thiab tau pom zoo
- Ib qho CTI
Cov MCPs ntawm Medi-Cal puas yuav ua raws li Medi-Cal txoj cai tshiab txog kev them nqi kho mob hospice thiab kev them nqi, suav nrog kev tswj kev siv, cov kev cai ntawm TAR, thiab lub sijhawm saib xyuas?
Cov MCPs ntawm Medi-Cal yuav tsum muab cov txiaj ntsig zoo ib yam li Medi-Cal FFS los ntawm qhov kev pom ntawm kev them nqi; txawm li cas los xij, ua ib feem ntawm kev hloov kho tshiab rau txoj cai them nqi thiab kev them nqi hauv ob qho tib si Medi-Cal Provider Manual thiab APL, Medi-Cal MCPs tuaj yeem xaiv tab sis tsis tas yuav tsum siv kev tso cai ua ntej (PA; sib npaug rau qhov yuav tsum tau ua Medi-Cal FFS TAR) ua ib feem ntawm lawv cov kev tswj hwm kev siv rau plaub theem ntawm kev saib xyuas hospice.
Puas yog Medi-Cal txoj cai them nqi thiab kev them nqi tshiab, suav nrog kev tswj kev siv / TAR cov cai, siv rau D-SNP Medicare / Medi-Cal duals?
Cov cai tsim nyog ob zaug hauv APL 25-008 siv tau. Cov MCPs tsis tuaj yeem xav tau PA rau Medi-Cal R&B rau cov rooj plaub Medicare hospice.
Yog tias cov kev thov rau cov kev pabcuam hospice raug tsis lees paub vim "tsis muaj cai" yuav ua li cas?
Cov kws kho mob Hospice muaj lub luag haujlwm los xyuas kom meej tias cov neeg uas lawv pab tsim nyog tau txais Medi-Cal ua ntej muab kev pab. Yog ua tsis tau li ntawd yuav ua rau tsis kam lees qhov kev thov thiab tus neeg muab kev pabcuam lub luag haujlwm rau cov kev pabcuam hospice. Txawm li cas los xij, yog tias tus neeg muab kev pab cuam hospice ntseeg tias qhov kev thov tsis lees txais rau "tsis muaj cai" yog qhov yuam kev, tus neeg muab kev pab cuam hospice yuav tsum ua raws li cov kauj ruam saum toj no los thov rov hais dua qhov kev thov tsis lees txais.
Puas muaj kev txwv rau tus naj npawb ntawm cov chaw pabcuam hospice uas tus kws kho mob tuaj yeem ua tus Thawj Coj Kho Mob?
Txoj cai Medi-Cal tsis hais txog qhov yuav tsum tau ua li ntawd. Ib yam li ntawd, cov cai Medicare tsis teev tseg qhov txwv (saib 42 CFR Ntu 418). Txawm li cas los xij, cov koom haum hospice muaj lub luag haujlwm ywj pheej los xyuas kom ua raws li cov cai ntawm lub xeev thiab/lossis tsoomfwv teb chaws, thiab ob qho tib si Medicare thiab DHCS tuaj yeem tshuaj xyuas cov chaw muab kev pabcuam txhua lub sijhawm kom ntseeg tau tias ua raws li txoj cai.
Puas yuav tsum muaj TARs thaum Medicare them nqi rau cov neeg mob hospice tab sis Medi-Cal tsuas yog them rau Chav & Rooj Noj Mov (R&B) xwb?
Tsis yog. TARs yuav tsis siv rau R&B. Txawm hais tias kev tswj hwm kev siv tshiab yuav siv rau txhua qib kev saib xyuas hospice, R&B raug tshem tawm ntawm cov kev cai TAR/PA.
Puas yuav tsum muaj TARs rau cov tswv cuab Medi-Cal uas tsim nyog ob qho tib si (piv txwv li, Medicare (thawj) thiab Medi-Cal (theem ob))?
Yog. Yog tias Medi-Cal raug them nqi rau txhua yam kev pabcuam hospice, yuav tsum muaj TAR raws li tau teev tseg hauv txoj cai them nqi thiab kev them nqi tshiab.
Cov kev cai TAR rau cov kev pabcuam hospice pib thaum twg?
Rau Tus Nqi-Rau-Kev Pabcuam (FFS), Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) xav tias yuav tso tawm txoj cai them nqi thiab daim ntawv them nqi tshiab los ntawm phau ntawv qhia rau tus neeg muab kev pabcuam, qee lub sijhawm thaum kawg ntawm xyoo 2026 lossis thaum ntxov xyoo 2027, uas yuav piav qhia txog txhua yam kev tswj hwm kev siv, suav nrog cov kev cai TAR. Rau kev tswj hwm kev saib xyuas, APL hloov tshiab yuav tsum tau tso tawm tom qab xyoo 2026.
Puas yog TARs tseem yuav tsum tau rau kev saib xyuas neeg mob hauv tsev kho mob dav dav (GIP) xwb?
Tsis yog. Thaum siv txoj cai them nqi thiab txoj cai them nqi tshiab, TARs yuav siv rau txhua qib kev saib xyuas hospice, suav nrog GIP, raws li tau teev tseg.
Puas yuav tsum muaj TARs rau chav thiab pawg thawj coj saib xyuas R&B lossis Chaw Saib Xyuas Neeg Mob Txawj (SNF)?
Tsis yog. R&B yuav tsis xav tau TAR.
Thaum twg yuav tsum muaj TARs raws li Medi-Cal lub sijhawm kho mob tshiab?
Cov sijhawm kho mob Medi-Cal yuav raug txhais hauv txoj cai, suav nrog thaum twg yuav tsum xa daim TAR.
Puas yuav tsum tau kev pom zoo ua ntej xa daim ntawv TAR tom ntej?
Tsis yog. Txhua TAR yog khi rau lub sijhawm tshwj xeeb ntawm kev saib xyuas. Txawm tias lub sijhawm saib xyuas yav dhau los ntawm TAR tseem tos seb puas muaj TAR los xij, DHCS txhawb kom cov kws kho mob hospice xa TAR raws sijhawm kom ntseeg tau tias kev ua tiav tuaj yeem tshwm sim raws sijhawm.
Puas yog TAR xaus rau nruab nrab lub hlis yuav tsum tsis txhob them nyiaj?
Cov kev thov tsuas yog yuav raug them rov qab rau cov hnub ntawm cov kev pabcuam (DOS) uas sib raug rau lub sijhawm saib xyuas TAR uas tau pom zoo. Cov kev thov nrog DOS sab nraum lub sijhawm saib xyuas TAR uas tau pom zoo yuav raug tsis lees paub.
Puas yog cov ntaub ntawv pov thawj, Daim Ntawv Pov Thawj Txog Kev Mob Thaum Kawg (CTI), thiab Daim Phiaj Xwm Kev Kho Mob (POC) yuav tsum phim TAR uas tau pom zoo rau lub sijhawm kho mob?
Yog. CTI thiab POC yuav tsum sib phim nrog txhua lub sijhawm saib xyuas thiab TAR uas tau pom zoo. Phau ntawv qhia txog tus neeg muab kev pabcuam yuav muab cov lus qhia txog yam uas yuav tsum xa nrog TAR.
Tus lej '900' yog dab tsi thiab vim li cas nws thiaj tseem ceeb?
The 900 code is a unique indicator added to the Medi-Cal billing system after DHCS receives a valid Hospice Program Attestation form. Claims will be denied without this code.
Kev xa daim ntawv pov thawj ntawm qhov kev pab cuam Hospice Program cuam tshuam li cas rau kev them nyiaj rov qab?
No form = No 900 Code = No Payment. Late or missing forms result in denied claims.
Yog tias kuv tsis tau xa daim ntawv thov ua ntej tsib hnub, yuav ua li cas?
Late submissions are non-compliant and result in reimbursement only from the date the form is received.
Yuav ua li cas yog Hospice Kev Xaiv Tsa lossis Cov Ntawv Ntxiv Ntxiv raug tso tseg?
Tus Neeg Ua Haujlwm Saib Xyuas Kev Noj Qab Haus Huv yuav ceeb toom rau lub koom haum Hospice txog kev kho kom raug sai li sai tau.
Kuv tuaj yeem nrhiav DHCS Hospice Program cov ntaub ntawv tiv toj qhov twg?
Lub vas sab hauv internet ntawm DHCS Hospice Program muaj cov neeg tiv tauj, cov peev txheej, thiab cov hloov tshiab tshiab. Koj tuaj yeem xa koj cov lus nug mus rau MCHospiceClerk@DHCS.ca.gov lossis hu rau (916) 552-9200.
What is the “5-Day Rule” for the attestation submission?
Hospice providers must submit the Attestation Form within five (5) calendar days of the member’s hospice election date:
- For FFS members: DHCS must receive the form within 5 days.
- For MC members: The MCP must receive the form within 5 days.
Cov ntawv xa tuaj lig tsis ua raws li txoj cai thiab ua rau:
- Tej zaum yuav tsis pub them nyiaj rau ob peb hnub ua ntej tau txais.
- Reimbursement only from the date the form is received
Puas muaj qhov tshwj xeeb rau txoj cai 5 hnub?
Yog. DHCS yuav tso cai rau cov kev zam tshwj xeeb hauv cov xwm txheej tsawg, xws li:
- Tej xwm txheej ntuj tsim los yog xwm txheej ceev: Qhov no suav nrog hluav taws kub, dej nyab, av qeeg, lossis lwm yam xwm txheej uas cuam tshuam kev ua haujlwm.
- Kev ua tsis tiav ntawm lub kaw lus lossis kev siv tshuab: DHCS lub kaw lus tsis ua haujlwm lossis kev xa email tsis ua haujlwm uas ua rau tsis tuaj yeem xa tau raws sijhawm.
- Cov chaw muab kev pab tu neeg mob uas tau ntawv pov thawj tshiab: Kev nkag mus rau hauv DHCS system tseem tsis tau tso cai thiab/lossis qeeb hauv kev nkag mus tom qab tau ntawv pov thawj.
- Retroactive Medi-Cal Eligibility: Hospice provider was not and could not have been reasonably aware that the Medi-Cal member was eligible for hospice services at the time of election. For this item, hospice providers must document and provide: Proof of retroactive eligibility;Valid hospice Attestation form;Certification of terminal illness; andAdministrative corrections, if any.
For any of the above exceptions, please note that DHCS will only accept late attestation forms when the delay is beyond the hospice provider’s control and the hospice provider’s actions or inactions did not otherwise contribute to or result in the delay. Absent an approved exception from DHCS, hospice services rendered under a late Medi-Cal Hospice Attestation form will not be eligible for any reimbursement.
How do I know whether to send the form to DHCS or an MCP?
Tshawb xyuas tus tswv cuab txoj cai rau hnub xaiv tsa hospice siv:
- MEDS (Lub Txheej Txheem Ntaub Ntawv Txog Kev Tsim Nyog ntawm Medi-Cal)
- POS (Qhov Chaw Pabcuam) system
Tsis tas li ntawd, xyuas seb puas muaj kev sau npe MCP rov qab los tiv thaiv kev xa mus tsis raug.
Cov txheej txheem tshiab no puas siv tau rau Medi-Cal fee-for-service (FFS) thiab cov tswv cuab ntawm managed care?
Tsis yog. Cov txheej txheem tshiab no tsuas yog siv rau cov tswv cuab ntawm Medi-Cal FFS uas xaiv los txais cov kev pabcuam hospice xwb.
Puas yuav tsum muaj NOE rau cov tswv cuab Medi-Cal uas tsim nyog ob zaug?
Yog. Txawm tias Medi-Cal yog tus them nqi thib ob thiab Medicare yog tus them nqi tseem ceeb, daim ntawv NOE uas siv tau rau txhua tus tswv cuab Medi-Cal (ob qho tib si FFS thiab kev tswj hwm kev saib xyuas) uas xaiv los txais cov kev pabcuam hospice.
Do hospice providers need to submit a hospice Attestation Form for a dual-eligible Medicare/Medi-Cal member for which the hospice provider is only submitting room & board claims to DHCS or a Medi-Cal MCP for payment?
Yes. A valid hospice Attestation Form must be submitted and on file in order for DHCS or a Medi-Cal MCP to reimburse hospice providers for room and board claims.
Yog tias tus neeg ntawd tsis muaj Medi-Cal thaum nkag mus tab sis tau txais kev pom zoo rov qab los, yuav ua li cas?
Hospice providers are responsible for verifying Medi-Cal member eligibility prior to rendering and billing for hospice services. Additionally, hospice providers can contact the DHCS Hospice Clerk for further assistance at MCHospiceClerk@dhcs.ca.gov. Hospice providers will need to provide proof of retroactive eligibility and submit the Attestation Form within five (5) days of the Medi-Cal member’s election date.
Cov kws kho mob hospice yuav ceeb toom rau DHCS li cas txog tus tswv cuab Medi-Cal uas raug tshem tawm cov kev pabcuam hospice?
Cov kws kho mob Hospice yuav tsum xa daim ntawv ceeb toom txog kev rho tawm rau cov tswv cuab Medi-Cal FFS xwb los ntawm email ncaj qha rau DHCS Hospice Clerk ntawm MCHospiceClerk@dhcs.ca.gov. Rau cov tswv cuab ntawm Medi-Cal managed care, cov kws kho mob hospice yuav tsum xa cov ntaub ntawv ntawd ncaj qha mus rau tus tswv cuab ntawm Medi-Cal uas MCP tau muab rau. Thov nco ntsoov tias qhov no yog cov txheej txheem tam sim no.
Cov chaw muab kev pab cuam hospice puas yuav tsum ceeb toom rau DHCS txog kev tso tawm thiab/lossis kev hloov chaw?
Yog. Cov neeg muab kev pab tu neeg mob yuav tsum ceeb toom rau DHCS rau cov tswv cuab Medi-Cal FFS, lossis Medi-Cal MCP uas tau muab rau cov tswv cuab Medi-Cal managed care, txog txhua qhov kev tso tawm thiab/lossis kev hloov chaw nrog rau qhov laj thawj rau kev tso tawm thiab/lossis kev hloov chaw (piv txwv li, kev tuag lossis tsiv tawm ntawm thaj chaw pabcuam, thiab lwm yam).
What if the Medi-Cal member revokes and later returns to hospice, do hospice providers need to submit a new hospice Attestation Form?
Yes, a new hospice Attestation Form must be submitted and on file if the Medi-Cal member revokes hospice but then later returns to hospice.
What if the Medi-Cal member transfers from another hospice, do hospice providers need to submit a new hospice Attestation Form?
Yes, a new hospice Attestation Form must be submitted and on file if the Medi-Cal member transfers from one hospice provider to another.
Yog tias tus tswv cuab Medi-Cal tsis kuaj pom tias muaj mob hnyav thaum nkag mus kho mob, yuav ua li cas?
A physician’s certification of terminal illness is required before the hospice provider submits the hospice Attestation Form.
Puas siv tau tus lej kuaj mob placeholder?
Tsis yog. Yuav tsum muaj tus lej kuaj mob uas siv tau thiab daim ntawv pov thawj los ntawm kws kho mob tias muaj mob hnyav.