DHCS Kev Ncaj Ncees-Involved Waiver Stakeholder Toolkit
Keeb kwm
Ntau tshaj 400,000 tus neeg laus thiab cov hluas raug tso tawm los ntawm California cov tsev loj cuj thiab kaw txhua xyoo. Txog tam sim no, vim yog tsoomfwv Medicaid txoj cai lij choj hu ua "kev cais tawm hauv neeg nyob hauv tsev," kev saib xyuas hauv tsev kho mob yog tib qho kev pabcuam uas tuaj yeem them los ntawm Medicaid rau cov tib neeg uas suav tias yog "tus neeg raug kaw hauv tsev kho mob pej xeem." Paub txog lub sijhawm los txhim kho kev txuas ntxiv ntawm kev pabcuam kev noj qab haus huv rau cov tib neeg muaj kev ncaj ncees, California tab tom siv Medicaid 1115 ua qauv qhia zam los muab cov phiaj xwm Medi-Cal rau cov tub ntxhais hluas thiab cov neeg laus hauv tsev loj cuj hauv xeev, tsev kaw neeg hauv nroog, thiab cov chaw kho cov tub ntxhais hluas mus txog 90 hnub ua ntej tso tawm. California yog thawj lub xeev tau pom zoo los muab cov kev pabcuam no. Medi-Cal txoj kev ncaj ncees-sib koom nrog yuav txo qhov tsis sib xws hauv kev saib xyuas, txhim kho cov txiaj ntsig kev noj qab haus huv, thiab tiv thaiv kev tsis tsim nyog nkag mus rau hauv tsev kho mob, tsev kho mob puas hlwb, tsev laus, thiab chaw kho mob xwm txheej ceev.
Txog Cov Khoom Siv no
Cov cuab yeej no suav nrog cov kev sib txuas lus sib txuas lus los pab koj tshaj tawm cov lus hais txog qhov kev pom zoo tshiab txog kev ncaj ncees, txhawb nqa California txoj kev hloov pauv dav dav ntawm Medi-Cal, thiab txhawb DHCS txoj kev cog lus rau kev noj qab haus huv zoo dua, muaj kev ncaj ncees rau txhua tus.
Additional information can be found on the DHCS Justice Involved webpage and the Justice-Involved Initiative Fact Sheet.
Kev sib txuas lus tswv cuab
Thaum txuas nrog cov tswv cuab thiab tsev neeg ntawm cov tib neeg muaj kev ncaj ncees, thov siv cov Tswv Cuab FAQ hauv qab no. Nws suav nrog kev xa xov meej txog cov txiaj ntsig pom tau zoo rau cov tswv cuab nrog rau cov ntaub ntawv hais txog yuav ua li cas qhov kev pib no cuam tshuam rau lub hom phiaj dav dav ntawm Medi-Cal kev hloov pauv.
Kev Sib Txuas Lus
Thaum koom nrog cov chaw muab kev pabcuam, thov xa mus rau Tus Muab Kev Pabcuam FAQ hauv qab no kom paub meej txog cov qauv tsim nyog, cov kev pabcuam muaj, thiab ntau dua.
Social Media Posts
Hauv qab no yog cov lus qhia txog kev tshaj xov xwm rau koj los qhia thoob plaws koj lub koom haum lub platform. Thov koj xav tias dawb los txiav txim rau koj lub koom haum lub suab. Peb kuj txhawb kom koj qhia thiab nthuav dav DHCS cov ntsiab lus hauv kev tshaj tawm hauv Facebook thiab Twitter thaum peb txhua tus ua haujlwm tshaj tawm cov lus.
Sample Ncej 1
Ntau tshaj 400,000 tus neeg laus thiab cov hluas raug tso tawm los ntawm California cov tsev loj cuj thiab kaw txhua xyoo. Medi-Cal txoj kev koom tes nrog kev ncaj ncees yav dhau los yuav ua rau cov neeg California tsom mus rau cov kev pabcuam kev noj qab haus huv ua ntej tso tawm los pab lawv rov nkag mus rau lawv cov zej zog muaj kev nyab xeeb.
Sample Ncej 2
Health disparities still exist among people who’ve been incarcerated. CA is the 1st state to provide Medi-Cal services in state prisons, county jails & youth correctional facilities pre-release to help Californians safely re-enter their communities.
Sample Post 3
Medi-Cal’s new justice-involved initiative will support a safe community re-entry for Californians who have been incarcerated. Medi-Cal is committed to health equity and improving health outcomes. Read more.
Sample Post 4
Justice-involved individuals are disproportionately people of color with complex health needs who often go without health coverage and care upon release. Medi-Cal’s pre-release services will set a new standard for equitable, person-centered care. Read more.
Kev Ncaj Ncees-Involved Waiver Approval Talking Points
- DHCS’ justice-involved initiative is part of CalAIM, a broad initiative to transform Medi-Cal.
- The state’s priority is to ensure all Californians have access to high-quality and timely care.
- Los ntawm CalAIM txoj kev pib, peb tab tom tsim tus qauv tshiab rau kev saib xyuas kev noj qab haus huv ntawm tib neeg thiab kev ncaj ncees, suav nrog rau cov neeg raug kaw tam sim no thiab yav dhau los.
- Cov neeg rov qab los hauv zej zog tom qab raug kaw muaj qhov xav tau kev noj qab haus huv ntawm lub cev thiab tus cwj pwm tseem ceeb thiab muaj kev pheej hmoo siab ntawm kev raug mob thiab kev tuag, tshwj xeeb tshaj yog nyob rau lub sijhawm pib tom qab tso tawm.
- Txoj kev koom tes nrog kev ncaj ncees ua kom muaj kev tiv thaiv txuas ntxiv los ntawm Medi-Cal kev tso npe tso npe ua ntej tso npe thiab muab cov kev pabcuam tseem ceeb los txhawb kev rov nkag mus tau zoo.
- Cov kev pab cuam tso tawm ua ntej yuav muab tso rau hauv kev tswj hwm kev saib xyuas thiab suav nrog kev sib tham ntawm lub cev thiab tus cwj pwm, kev kuaj mob thiab hluav taws xob, Kev Kho Mob Kho Mob (MAT), cov kev pabcuam hauv zej zog, thiab cov tshuaj noj thiab cov khoom siv kho mob ntev.
- Rau cov neeg tsim nyog, tus saib xyuas kev saib xyuas yuav raug xaiv, nyob rau hauv qhov chaw kho mob los yog hauv xov tooj, los tsim kev sib raug zoo nrog tus neeg, nkag siab txog lawv cov kev xav tau kev noj qab haus huv, koom tes nrog cov kev pabcuam tseem ceeb, thiab npaj cov phiaj xwm rau kev hloov pauv hauv zej zog, suav nrog kev txuas tus neeg mus rau tus saib xyuas kev saib xyuas hauv zej zog lawv tuaj yeem ua haujlwm nrog thaum lawv tso tawm.
- Raws li kev pib, cov tsev kaw neeg hauv nroog, cov chaw kho cov hluas hauv nroog, thiab cov tsev loj cuj hauv xeev yuav:
- Xyuas kom txhua tus neeg tsim nyog tau txais kev tso npe hauv Medi-Cal ua ntej tso tawm.
- Muab cov phiaj xwm Medi-Cal kev saib xyuas kev noj qab haus huv rau cov tub ntxhais hluas thiab cov neeg laus tsim nyog nyob rau hauv 90 hnub ua ntej tso tawm los npaj lawv rov qab mus rau zej zog thiab txo qis kev saib xyuas. Cov neeg laus uas tsim nyog muaj xws li cov neeg uas muaj kev puas siab puas ntsws los yog xav tias muaj kev kuaj mob, kev siv tshuaj yeeb tshuaj lossis kev kuaj mob uas xav tias muaj, kev kho mob ntev, mob hlwb raug mob, kev txawj ntse lossis kev loj hlob tsis taus, lossis cev xeeb tub lossis tom qab yug menyuam. Tag nrho cov tub ntxhais hluas raug kaw hauv qhov chaw kho cov tub ntxhais hluas muaj cai tsim nyog yam tsis muaj cov txheej txheem kho mob.
- Provide “warm handoffs” to health care providers to ensure that individuals who require behavioral and other health care services, medications, and other medical supplies (e.g., a wheelchair) have what they need upon re-entry.
- Ua haujlwm nrog cov thawj coj saib xyuas hauv zej zog kom muaj kev sib koom tes saib xyuas hauv zej zog rau cov tib neeg thaum rov nkag mus, suav nrog los ntawm Kev Tswj Xyuas Kev Kho Mob Zoo.
- Ua hauj lwm nrog cov thawj coj saib xyuas hauv zej zog kom muaj kev txhawb nqa hauv zej zog (xws li, kev txhawb nqa vaj tse lossis kev txhawb nqa zaub mov) muaj nyob rau thaum rov nkag yog tias muaj los ntawm lawv txoj kev npaj saib xyuas.
FAQ Cov Tswv Cuab (Cov Lus Tseem Ceeb Rau Cov Tswv Cuab / Tsev Neeg ntawm JI Cov Neeg)
1. Thaum twg JI cov tib neeg tuaj yeem nkag mus rau cov kev pabcuam?
- DHCS expects correctional facilities to launch pre-release services between October 1, 2024 through April 2026.
- Thaum lawv lub chaw muab kev pab tso tawm ua ntej, cov tub ntxhais hluas thiab cov neeg laus tsim nyog nyob hauv tsev kaw neeg, cov chaw kho cov tub ntxhais hluas, lossis cov tsev loj cuj tuaj yeem pib tau txais cov kev pabcuam Medi-Cal 90 hnub ua ntej lawv yuav tso tawm hnub. Txhua tus neeg raug kaw tau tsim nyog tau txais kev pabcuam ua ntej tso tawm, yog tias lawv ua tau raws li lwm cov qauv, suav nrog cov neeg raug kaw rau lub sijhawm luv
2. Cov neeg tsim nyog tau txais kev tso npe hauv Medi-Cal li cas?
- Lub tsev kaw neeg hauv nroog, cov chaw kho cov tub ntxhais hluas, cov tsev loj cuj, thiab cov chaw raug xaiv yog lub luag haujlwm los txheeb xyuas cov tib neeg muaj peev xwm tsim nyog tau txais Medi-Cal, pab lawv nrog daim ntawv thov, thiab xa daim ntawv thov mus rau Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv Hauv Nroog (SSDs).
3. Leej twg tsim nyog tau txais kev pab cuam ua ntej tso tawm?
- All individuals incarcerated in a youth correctional facility are eligible; no clinical criteria are required.
- Cov neeg laus uas tsim nyog muaj xws li cov neeg uas muaj kev kuaj mob hlwb, kev siv tshuaj tsis zoo, mob ntev lossis mob hnyav, mob hlwb raug mob, kev txawj ntse lossis kev loj hlob tsis taus, HIV / AIDS, lossis cev xeeb tub lossis tom qab yug menyuam.
4. Cov neeg JI tuaj yeem xav tias yuav tshwm sim li cas thaum lub sijhawm 90-hnub tso tawm ua ntej? Yuav muab kev pab dab tsi?
- Rau cov neeg tsim nyog tau txais kev pabcuam ua ntej tso tawm, tus thawj saib xyuas kev saib xyuas yuav raug xaiv los tsim kev sib raug zoo nrog tus neeg, nkag siab txog lawv cov kev xav tau kev noj qab haus huv, koom tes nrog cov kev pabcuam uas xav tau, thiab npaj rau kev hloov hauv zej zog. Qhov no suav nrog kev txuas tus neeg mus rau tus saib xyuas kev saib xyuas hauv zej zog (piv txwv li, ECM tus kws kho mob) uas lawv tuaj yeem ua haujlwm nrog thaum lawv tso tawm.
- Cov kws kho mob yuav ua kom cov tib neeg uas xav tau kev coj cwj pwm thiab lwm yam kev pab kho mob, tshuaj thiab lwm yam khoom siv kho mob (xws li lub rooj zaum muaj log) muaj qhov lawv xav tau thaum rov nkag los kom lawv tuaj yeem tau txais kev saib xyuas ntxiv uas lawv xav tau tom qab lawv tso tawm.
- Cov tswv cuab kuj tuaj yeem tsim nyog rau kev tso npe tso npe tom qab tso tawm hauv Kev Tswj Xyuas Kev Kho Mob thiab Kev Txhawb Zej Zog, suav nrog kev txhawb nqa vaj tse thiab zaub mov, los pab lawv tsim kev ruaj ntseg thaum lawv rov qab mus rau hauv zej zog.
- ECM cov neeg saib xyuas tuaj yeem ntsib Medi-Cal cov tswv cuab hauv xov tooj ua ntej lawv tso tawm los tsim kom muaj kev sib raug zoo thiab txhawb nqa lawv rov qab mus rau hauv zej zog.
- List of Pre-Release Services
- Kev tswj xyuas;
- Cov kev pab cuam sab laj txog kev noj qab haus huv thiab kev coj tus cwj pwm;
- Laboratory/radiology;
- Cov kev pabcuam kev noj qab haus huv hauv zej zog;
- Medications, consistent with the full scope of covered outpatient drugs under Medi-Cal state plans, and medication administration; and
- Tshuaj Pab Kho Mob (MAT).
- Cov tib neeg uas tsim nyog yuav tau txais kev pab them nqi kho mob sab nraud thiab cov cuab yeej siv kho mob ntev (DME) hauv tes thaum tso tawm, ua raws li kev pom zoo hauv lub xeev txoj cai tswjfwm thiab txoj cai.
- Cov thawj coj saib xyuas ua ntej tso tawm yuav yog lub luag haujlwm rau:
- Tsim kom muaj kev ntseeg siab, kev sib raug zoo nrog cov tswv cuab;
- Ua qhov kev ntsuas xav tau, raws li qhov tsim nyog, thaum lawv thawj zaug ntsib nrog tus neeg;
- Teem sijhawm thiab sib koom cov kev pabcuam kev sib tham, yog tias tsim nyog;
- Kev sib koom ua ke tshuaj ua ntej tso tawm suav nrog MAT;
- Developing a transitional care plan (i.e., discharge plan);
Sharing the final transitional care plan with community-based providers (electronically, if possible); - Coordinating post-release DME medication, including MAT;
Coordinating with the individual’s post-release providers, including specialty behavioral health providers or other community-based providers on an as-needed basis; - Qhia tawm cov ntaub ntawv tseem ceeb thiab kev npaj khomob hloov pauv nrog kev txhawb nqa tom qab tso tawm thiab cov kws kho mob (xws li tus thawj saib xyuas kev tso tawm tom qab tso tawm, MCP) los txhawb kev sib koom tes saib xyuas; thiab,
- Conducting a warm handoff with the individual’s post-release care manager (e.g., ECM provider) if different than the pre-release care manager.
5. Cov tswv cuab tuaj yeem mus qhov twg kom paub ntau ntxiv thiab teb rau lawv cov lus nug?
FAQ (Cov lus tseem ceeb rau cov neeg muab kev pabcuam)
1. Cov kev coj cwj pwm thiab kev noj qab haus huv ntawm lub cev yog dab tsi rau cov kev pab cuam ua ntej tso tawm rau cov tib neeg uas muaj kev ncaj ncees?
- Cov neeg laus:
- Kev puas siab puas ntsws, txhais tau tias paub tseeb lossis xav tias kev kuaj mob puas hlwb raws li cov txheej txheem teev tseg;
- Kev siv tshuaj tsis zoo, txhais tau tias yog kev kuaj pom tseeb lossis xav tias muaj kev kuaj mob raws li cov txheej txheem teev tseg;
- Cov mob ntev lossis qhov mob tseem ceeb, txhais tau tias yog kev kuaj pom tseeb lossis xav tias muaj kev kuaj mob raws li cov txheej txheem teev tseg;
- Kev tsis taus kev txawj ntse lossis kev loj hlob (I/DD), txhais tau tias yog kev xiam oob qhab uas pib ua ntej tus neeg muaj hnub nyoog 18 xyoo thiab xav tias yuav txuas ntxiv mus tsis tau thiab nthuav tawm qhov kev tsis taus loj heev;
- Kev raug mob ntawm lub hlwb lossis lwm yam mob, qhov uas tus mob tau ua rau muaj kev nkag siab zoo, kev coj cwj pwm, thiab / lossis kev ua haujlwm tsis zoo;
- Kev kuaj pom zoo lossis kev kuaj pom tus kab mob human immunodeficiency virus (HIV) lossis kis tau tus kab mob immunodeficiency (AIDS); los yog
- Tam sim no cev xeeb tub lossis hauv 12 lub hlis tom qab yug menyuam.
- Youth:
- All youth under 21 and former foster youth between 18-26 years of age do not need to demonstrate a health care need to qualify for pre-release services.
2. What pre-release services will healthcare providers be responsible for providing? What services will correctional facilities be responsible for facilitating
- Kev saib xyuas kev sib koom tes thiab txuas cov tib neeg nrog kev saib xyuas lawv xav tau;
- Cov kev pab cuam sab laj txog kev noj qab haus huv thiab kev coj tus cwj pwm;
- Laboratory/Radioology;
- Cov Kev Pabcuam Kev Noj Qab Haus Huv Hauv Zej Zog;
- Cov tshuaj, ua raws li tag nrho cov peev txheej ntawm cov tshuaj tiv thaiv tus neeg mob sab nraud raws li Medi-Cal State Plans, thiab kev tswj hwm tshuaj; thiab
- Tshuaj Pab Kho Mob (MAT);
- Muab cov neeg tsim nyog tau txais kev pab them nqi kho mob sab nraud thiab Cov Khoom Siv Kho Mob Ntev (DME), kom ntseeg tau tias lawv muaj cov kev txhawb nqa no thaum tso tawm, ua raws li kev pom zoo hauv lub xeev txoj cai tswjfwm thiab txoj cai.
3. Cov neeg saib xyuas kev tso tawm ua ntej yuav muaj lub luag haujlwm rau dab tsi?
- Tsim kom muaj kev ntseeg siab, kev sib raug zoo nrog cov tswv cuab;
- Ua ib qho kev ntsuas xav tau siv DHCS-muab template thaum lawv thawj zaug ntsib nrog tus neeg;
- Teem sijhawm thiab sib koom cov kev pabcuam kev sib tham, yog tias tsim nyog;
- Kev sib koom ua ke tshuaj ua ntej tso tawm, suav nrog MAT;
- Tsim ib txoj kev npaj khomob hloov pauv (piv txwv li, phiaj xwm tso tawm);
- Sib koom cov phiaj xwm kev saib xyuas kev hloov pauv zaum kawg nrog cov kws kho mob hauv zej zog (electronically, yog tias ua tau);
- Kev sib koom tes tom qab tso tshuaj DME, suav nrog MAT;
- Coordinating with the individual’s post-release providers, including specialty behavioral health providers or other community-based providers on an as-needed basis;
- Qhia tawm cov ntaub ntawv tseem ceeb thiab kev npaj khomob hloov pauv nrog kev txhawb nqa tom qab tso tawm thiab cov kws kho mob (xws li tus thawj saib xyuas kev tso tawm tom qab tso tawm, MCP) los txhawb kev sib koom tes saib xyuas; thiab,
- Conducting a warm handoff with the individual’s post-release care manager (e.g., ECM provider) if different than the pre-release care manager.
4. Qhov kev pib no yuav nce kev nkag mus rau MAT li cas?
- To increase access to MAT in carceral settings and improve the standard of care in delivering these services to justice-involved populations, the provision of MAT will be a required pre-release service.
- DHCS will work with correctional facilities to build off their current progress in providing MAT and provide technical assistance to CDCR, jails, and youth correctional facilities to ensure all facilities are able to provide MAT.
5. Cov neeg tsim nyog tau txais kev tso npe hauv Medi-Cal li cas?
- County jails, youth correctional facilities, prisons, and designated entities (DHCS/MCED’s preferred term for application assisters) such as county offices will be responsible for identifying individuals potentially eligible for Medi-Cal, assisting them with the application, and submitting the application with County Social Services Departments.
- County jails, youth correctional facilities, and designated entities should submit Medi-Cal applications at intake or as close to intake as possible. Prisons will start this process, at an appropriate time closer to the release date.
6. Cov kws kho mob tuaj yeem mus qhov twg kom paub ntau ntxiv thiab cov lus teb rau lawv cov lus nug?
- Medi-Cal CalAIM Fact Sheet
- Medi-Cal Kev Ncaj Ncees Involved Web Page
- Contact DHCS with any questions or comments about the CalAIM Justice- Involved initiative at CalAIMJusticeAdvisoryGroup@dhcs.ca.gov.
Cov txiaj ntsig ntawm Kev Pab Kho Mob Sab Nraud thiab Medi-Cal Rx FAQ
DHCS Pharmacy Benefits Division (PBD) has prepared the following Questions and Answers (Q&A) based upon stakeholder feedback received during meetings and via email. The intent is to provide additional support for correctional facilities and pharmacies as they prepare for implementation of the Justice-Involved (JI) Reentry Initiative. This information is specific to Medi-Cal outpatient pharmacy benefits administered under Medi-Cal Rx. For information about medical and durable medical equipment benefits covered by Medi-Cal, please refer to Justice-Involved (JI) Pre-Release Services.
Rau lub hom phiaj ntawm kev sib txuas lus uas yuav txawv ntawm DHCS cov peev txheej, cov ntsiab lus hauv qab no tau siv rau daim ntawv no:
Individual: Use of the term “individual” applies to the incarcerated individual who is JI-eligible 90-days prior to release and receiving, or eligible to receive outpatient pharmacy benefits covered by Medi-Cal. This term is used synonymously with “patient” when the individual is receiving pharmacy services.
Member: Use of the term “member” refers to the individual enrolled in Medi-Cal. While incarcerated, they may be referred to as a patient or JI-eligible individual. Once released, they are referred to as a Medi-Cal member.
Rau Kev Tsim Nyog, xa mus rau Cov Lus Nug 1-2.
Rau Kev Them Nqi, xa mus rau Cov Lus Nug 3-20.
Rau Kev Tso Cai Ua Ntej, xa mus rau Cov Lus Nug 21-23.
For Policy, refer to Questions 24-25.
1. Yog tias tus neeg tau txais kev pab kho mob Medi-Cal JI, tus neeg ntawd puas tau txais kev pab kho mob ntawm Medi-Cal Rx?
- Yog lawm, yog tias tus neeg tau txais kev pab kho mob Medi-Cal JI, lawv yuav tau txais kev pab (Medi-Cal Rx) JI lub tsev muag tshuaj. Lub DHCS Medi-Cal Eligibility Division (MCED) muab cov ntaub ntawv tsim nyog rau Medi-Cal Rx rau cov chaw muag tshuaj thiab rau CA-MMIS rau kev thov kho mob.
2. Puas yog Daim Ntawv Teev Npe Npe thiab JI muaj hnub nyoog tib yam rau Medi-Cal thiab Medi-Cal Rx?
- Yog lawm, tib tus Neeg Sau Npe (tus tswv cuab) ID thiab JI cov cai pab cov hnub siv tau raug siv los ntawm Medi-Cal thiab Medi-Cal Rx. Lub DHCS Medi-Cal Eligibility Division (MCED) muab cov ntaub ntawv tsim nyog rau Medi-Cal Rx rau cov chaw muag tshuaj thiab rau CA-MMIS rau kev thov kho mob.
3. Puas yog peb yuav tsum tau them cov nqi tso tawm ua ntej thiab tso tshuaj tawm ntawm ib qho chaw lossis ib qho NPI?
- Billing for pre-release and discharge medications does not need to be from a single site/NPI. If different sites will be submitting pharmacy claims to Medi-Cal Rx, each site will need to submit a Medi-Cal provider enrollment application to DHCS Provider Enrollment Division (PED) via PAVE – Provider Application and Validation for Enrollment.
4. Thaum thawj (xa ntawv xaj) lub tsev muag tshuaj them nqi Medi-Cal Rx rau 90-hnub ua ntej tso tshuaj thiab tus neeg tau txais kev tso tawm ntxov (xws li hnub 67), lub khw muag tshuaj hauv zej zog yuav ua li cas thiaj li them tau Medi-Cal rau cov tshuaj, vim tias cov tshuaj ntxiv yuav raug xaj sai dhau? Hauv qhov xwm txheej no, lub khw muag tshuaj hauv zej zog puas yuav muab cov tshuaj tso tawm ua ntej tso tawm? Dab tsi yog qhov hloov kho uas lub tsev muag tshuaj yuav tsum siv rau thaum tso tshuaj? Nrog tus hloov kho, Medi-Cal Rx puas yuav pom zoo rau cov tshuaj tso tawm ntxov?
Rau feem ntau cov tshuaj / cov khoom lag luam, lub khw muag tshuaj hauv zej zog tuaj yeem hla qhov kev thov. Cov tsev muag tshuaj thov uas raug tsis lees paub rau Medi-Cal Rx Kev Tshuaj Xyuas Tshuaj Siv Tshuaj (DUR) yuav tau txais NCPDP Reject Code 88 (DUR Reject Error) nrog rau cov lus ntxiv qhia txog qhov laj thawj tshwj xeeb (thaum ntxov, koob tshuaj ntau, thiab lwm yam). DUR-hais txog lub tsev muag tshuaj thov kev tsis lees paub / tsis lees paub tuaj yeem daws tau los ntawm lub chaw muag tshuaj muag (POS) lossis los ntawm kev thov hauv web uas xa los ntawm Medi-Cal Rx Provider Portal. Txhawm rau daws qhov kev thov hauv tsev muag tshuaj, xa mus rau:
- NCPDP Reject Code 88 DUR Reference Guide
- Daim Ntawv Ntxiv A: Tsis lees paub Code 88 DUR: Cov Cai Pabcuam Kev Ua Haujlwm
Yog xav paub ntxiv txog Medi-Cal Rx DUR qhov kev pab cuam, xa mus rau cov peev txheej hauv qab no:
- Medi-Cal Rx Phau Ntawv Qhia; xa mus rau Tshooj Tshuaj Xyuas Kev Siv Tshuaj (DUR) (tam sim no ntu 16.0)
- Medi-Cal Providers | Drug Use Review; select “Alert Criteria” link (from left-hand navigation)
Yog tias qhov kev thov raug tsis lees paub rau cov lej ntxiv lossis lwm cov lej tsis lees txais NCPDP, lub tsev muag tshuaj hauv zej zog yuav muab kev pabcuam thaum muaj xwm txheej ceev. Mus saib Phau Ntawv Qhia Txog Kev Muab Tshuaj Medi-Cal Rx, ntu Kev Sau Tshuaj Thaum Muaj Xwm Ceev (tam sim no ntu 15.7) kom paub ntxiv.
Hauv qhov xwm txheej no, nws xav tias thaum tso cov tshuaj uas tau muab xa mus / hauv kev thauj mus los (twb tau them nqi) los ntawm lub tsev muag tshuaj xa ntawv yuav raug xa rov qab thiab lub tsev muag tshuaj xa ntawv yuav thim rov qab cov ntaub ntawv cuam tshuam.
5. Thaum lub tsev muag tshuaj tau txais daim ntawv thov NCPDP Reject Code 88 nrog DUR yuam kev code ntawm ER: Overutilization (Early Refill) rau cov tshuaj tso tawm, lub tsev muag tshuaj nkag tau dab tsi thaum xa rov qab daim ntawv thov kom ua tiav qhov override?
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Qhov kev txiav txim siab rau Medi-Cal Rx them los yog tsis them yog nyob ntawm cov lus teb los ntawm lub tsev muag tshuaj ntawm qhov kev thov rov qab xa tuaj rau hauv daim teb #440-E5 Cov Cai Pabcuam Kev Ua Haujlwm thiab #441-E6 Cov Txheej Txheem Kev Pabcuam.
6. Hauv qhov chaw kho mob sab nraud, cov khw muag tshuaj muaj cov software uas tso cai rau lawv sau nqi thiab xa cov ntaub ntawv mus rau Medi-Cal Rx (siv lub kaw lus muag muag). Puas yog lub vev xaib thiab batch txoj hauv kev xa mus rau cov tsev muag tshuaj thov kom peb muaj cov software sab nraud los xa cov ntawv thov lossis tseem tuaj yeem ua tiav yam tsis muaj software?
- Batch- thiab cov ntaub ntawv xa mus rau lub tsev muag tshuaj yuav tsum ua raws li NCPDP hom ntawv; xa mus rau Medi-Cal Rx NCPDP Daim Ntawv Qhia Txog Tus Neeg Them Nyiaj.
- Txhawm rau xa daim ntawv thov tsev muag tshuaj los ntawm batch kuj tseem yuav kom lub tsev muag tshuaj kom tau txais software thiab / lossis kev pabcuam los npaj thiab xa cov ntawv thov hauv NCPDP hom.
- Txhawm rau xa daim ntawv thov tsev muag tshuaj hauv lub vev xaib, lub tsev muag tshuaj yog siv Medi-Cal Rx Web Claims Submission tool txhawm rau nkag mus rau cov ntaub ntawv tsim nyog thiab xa lawv daim ntawv thov tsev muag tshuaj; Qhov no muaj nyob ntawm Medi-Cal Rx ruaj ntseg Tus Muab Kev Pabcuam Portal.
- To access the Medi-Cal Rx secured Provider Portal, once the provider’s application has been approved by DHCS Provider Enrollment Division (PED), the pharmacy provider wishing to access the Medi-Cal Rx Secured Provider Portal can assign a designated staff member to complete registration via the User Administration Console (UAC) application (the UAC is a registration tool that controls and manages the user’s access to the Medi-Cal Rx secured portal).
- Nyob rau hauv Medi-Cal Rx Tus Kws Kho Mob Phau Ntawv Qhia, xa mus rau cov lus hauv qab no kom paub ntau ntxiv:
- Tus Muab Kev Ruaj Ntseg Portal (Nqe 3.6.1.2)
- Web Claims Submission/Direct Data nkag (section 3.6.1.2.1)
- Cov ntawv thov (section 4.0) thiab ntu ntu
- Yog xav paub ntxiv txog daim ntawv thov tsev muag tshuaj hauv lub vev xaib, xa mus rau:
- Rau kev cob qhia ntxiv, cov lus qhia, thiab cov ntaub ntawv xa mus rau:
- Medi-Cal Rx | Kev Kawm & Kev Tshaj Tawm, Medi-Cal Rx Kev cob qhia los ntawm kev taw qhia sab laug
- Medi-Cal Rx Providers | Forms and Information, Reference Materials, Billing Tips & Payer Sheets, Covered Products Lists, Prior Authorization (PA), Provider Manual, and Welcome Packet from left-hand navigation
7. Can we utilize paper claims (Pharmacy Claim Form 30 – 1) for billing Medication Upon Release (30-day supply)?
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Yes. Pharmacy Claim Form (30-1), Section 19.2.1.1 in the Provider Manual, provides completion instructions for this form.
8. Thaum daim ntawv thov raug txiav txim, puas yog hnub yug (DOB) siv los ua ib feem ntawm kev lees paub cov tswv cuab? Yog tias BIC lossis CIN raug lees paub, tab sis DOB tsis haum rau Medi-Cal Rx cov tswvcuab cov ntsiab lus, qhov kev thov puas yuav raug lees paub?
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Ntxiv rau CIN/BIC, thawj/lub xeem thiab hnub yug raug siv los ua pov thawj tus tswvcuab. Yog tias thawj/lub xeem thiab/lossis hnub yug tsis phim DHCS/Medi-Cal Rx cov ntaub ntawv, NCPDP Reject 52 (Non-Matched Cardholder ID) yog muab rau hauv cov lus teb, nrog rau cov lus ntxiv los txheeb xyuas qhov tsis sib xws. Yog xav paub ntxiv, xa mus rau Daim Ntawv Ceeb Toom Kev Ceeb Toom ntawm Cov Chaw Kho Mob Medi-Cal | Cov ntaub ntawv thiab cov ntaub ntawv.
9. Koj puas tuaj yeem hais meej yog tias cov ntawv xaj uas tau muab thaum lub sijhawm nyob hauv tsev kaw neeg raug them nqi los ntawm Medi-Cal Rx lossis yog Medi-Cal Rx txwv tsis pub tso tshuaj / cov khoom xaj?
- Cov tshuaj uas tau muab xa mus rau lub sijhawm 90-hnub JI ua ntej tso tawm thiab cov uas tau muab rau hauv tes thaum lub sijhawm tso tawm, yuav tsum tau them rau Medi-Cal. Xa mus rau Txoj Cai thiab Phau Ntawv Qhia Kev Ua Haujlwm rau hom kev faib khoom twg yog them rau Medi-Cal Rx ntawm lub tsev muag tshuaj thov rau CA-MMIS ntawm daim ntawv thov kho mob.
10. Lub tsev muag tshuaj yuav thov li cas rau ib tus neeg ib zaug ntawm cov tshuaj? Qhov ntawd puas yog ib qho kev faib tawm lossis kev tswj hwm?
- Cov koob tshuaj ntawm tus kheej yuav raug them los ntawm lub tsev muag tshuaj thaum lub sijhawm ntawm txhua qhov muab tshuaj. Yog tias lub tsev muag tshuaj tau sau cov kev tswj hwm thiab sau nqi rov qab, cov ntawv thov yuav tsum raug xa mus rau tag nrho 90-hnub JI tso ua ntej nyob rau hauv qhov tsawg tshaj plaws cov ntaub ntawv ua tau raws li Medi-Cal Rx cov chaw muag tshuaj tswj kev siv cov kev tswj xyuas.
11. Puas yog cov chaw muag tshuaj kho tau tsim nyog rau tsoom fwv 340B Cov Nqi Them Nqi Tshuaj?
- While the JI Initiative is a Medi-Cal program, the 340B program is federally administered by the Health Resources and Services Administration (HRSA). Questions related to 340B eligibility, including whether a correctional facility can qualify as a Covered Entity fall under HRSA’s jurisdiction. HRSA can provide clarification on how JI program participants are managed under the 340B patient definition and what conditions must be met for 340B use in such context.
12. Yuav sau cov ntawv sau li cas thaum lub tsev kho mob siv cov qauv xa tawm / kev tswj hwm, thiab cov tshuaj / chaw muag tshuaj tsis yog ib tus neeg tshwj xeeb?
- Cov tshuaj / cov khoom lag luam raug xa mus rau CA-MMIS ntawm daim ntawv thov kho mob. Saib rau Txoj Cai thiab Kev Qhia Txog Kev Ua Haujlwm, Tshooj 8.6.
13. Yog tias muab tshuaj rau tus kws saib xyuas neeg mob muab rau tus neeg JI, nws puas yuav tsum tau them nqi thaum lub sijhawm muab tshuaj lossis thaum tswj hwm?
- If the pharmacy is submitting the pharmacy claim to Medi-Cal Rx, the medication/product should be billed for the time/date of dispense. If the correctional facility’s Electronic Health Record (EHR) is deriving and submitting the pharmacy claim to Medi-Cal Rx once the individual is released, the EHR-derived pharmacy claim (for a given medication/product) is to encompass the entire 90-day JI pre-release period for the administered prescription and submit the fewest claims possible under existing Medi-Cal Rx pharmacy benefit utilization management controls.
14. Yuav ua li cas yog thaum lub sij hawm tso tawm ua ntej cov tshuaj tsis kam los ntawm tus neeg? Cov tshuaj puas tuaj yeem sau nqi?
- Yog tias cov tshuaj / cov khoom lag luam (hauv tag nrho lossis ib nrab) raug xa rov qab rau hauv Tshuag, xa daim ntawv thov mus rau Medi-Cal Rx rau kev them nyiaj rov qab rau feem siv. Yog tias daim ntawv thov tsev muag tshuaj raug xa mus rau Medi-Cal Rx thaum lub sijhawm muab tshuaj rau cov tshuaj / cov khoom xa rov qab, daim ntawv thov tsev muag tshuaj yuav tsum tau thim rov qab, thiab yog tias tsim nyog, xa daim ntawv thov tsev muag tshuaj rau feem siv.
15. JI Txoj Cai thiab Kev Qhia Txog Kev Ua Haujlwm, 8.6 Kev Pab Kho Tshuaj Thaum Lub Sijhawm Tso Tawm Ua Ntej, hais tias cov tshuaj los ntawm cov fwj ntim khoom yuav tsum tau them nqi ntawm CA- MMIS (piv txwv li, cov tshuaj hauv tsev kho mob tau sau nqi siv J-codes) thiab cov tshuaj tshwj xeeb uas tus neeg mob tau them los ntawm Medi-Cal Rx. Peb tab tom siv Epic module tshiab uas yuav sau cov koob tshuaj raws li kev tswj hwm rau hauv ib qho kev thov 90-hnub uas raug them nqi thaum tso tawm rau cov uas muaj JI tsim nyog. Txij li thaum peb cov nqi them yog raws li kev tswj hwm tiag tiag thiab sau rau tsawg tshaj plaws hauv lub sijhawm 90-hnub, nws puas muaj teeb meem yog tias cov tshuaj hauv pem teb los ntawm lub raj mis ntau lossis los ntawm cov hnab ntim txhua hnub?
- DHCS nkag siab tias EPIC-cov tshuaj sau tseg yog nyob ntawm daim ntawv xaj xaj tshuaj xyuas los ntawm tus kws muag tshuaj thiab tswj hwm los ntawm kws saib xyuas neeg mob. Txawm hais tias cov tshuaj tau ntim li cas, tsuav yog nws tau muab los ntawm lub tsev muag tshuaj, txhua tus neeg mob cov tshuaj uas tau muab tshuaj yuav raug them rau Medi-Cal Rx hauv qhov tsawg tshaj plaws thov tau.
16. Ua ntej raug kaw, tus neeg tau txais lawv daim ntawv xaj thiab xav tau cov tshuaj tib yam / cov khoom no thaum lub sijhawm 90-hnub JI tso tawm ua ntej, tab sis lub tsev muag tshuaj tau thov tsis lees paub rau Kev Tshuaj Ntsuam Xyuas Kev Siv Tshuaj (DUR) vim li cas. Qhov no puas tuaj yeem daws tau yam tsis tas yuav hu rau Medi-Cal Rx Cov Neeg Siv Khoom?
- Cov tsev muag tshuaj thov uas raug tsis lees paub rau Medi-Cal Rx Kev Tshuaj Xyuas Tshuaj Siv Tshuaj (DUR) yuav tau txais NCPDP tsis lees paub tus lej 88 (DUR Reject Error) nrog rau cov lus ntxiv qhia txog qhov laj thawj tshwj xeeb (thaum ntxov, koob tshuaj ntau, thiab lwm yam). DUR-hais txog lub tsev muag tshuaj thov kev tsis lees paub / tsis lees paub tuaj yeem daws tau los ntawm lub chaw muag tshuaj (POS) lossis los ntawm kev thov hauv web uas xa los ntawm Medi-Cal Rx Provider Portal. Txhawm rau daws qhov kev thov hauv tsev muag tshuaj, xa mus rau:
- Yog xav paub ntxiv txog Medi-Cal Rx DUR qhov kev pab cuam, xa mus rau cov peev txheej hauv qab no
- Medi-Cal Rx Phau Ntawv Qhia; xa mus rau Tshooj Tshuaj Xyuas Kev Siv Tshuaj (DUR) (tam sim no ntu 16.0)
- Medi-Cal Providers | Drug Use Review; select “Alert Criteria” link (from left-hand navigation)
- Nco tseg: Txoj kev daws teeb meem no tseem tuaj yeem siv tau rau hauv qhov xwm txheej ntawm 90-hnub ua ntej tso cov ntawv sau tshuaj uas sib tshooj nrog thaum cov ntawv tso tawm.
17. Puas muaj nyob hauv tes, thaum tso cov ntawv sau npe hauv Medi-Cal JI lossis Medi-Cal tsis yog JI?
- The individual’s Medi-Cal aid code is not included on the pharmacy claim submission. During claim adjudication, Medi-Cal Rx performs member eligibility look-up based on date of service and the appropriate aid code is selected/determined. If the individual is Medi-Cal JI eligible on the day of release, then the Medi-Cal JI aid code is selected.
18. Yuav ua li cas yog txoj cai rau muab 30-hnub muab tshuaj rau cov tib neeg uas tau teem tseg thiab tso tawm ntau zaus hauv ib hlis? Tshwj xeeb, yuav tsum tau muab 30-hnub muab faib txhua lub sijhawm tus neeg raug tso tawm los ntawm kev saib xyuas, lossis puas muaj lub sijhawm teem sijhawm uas txiav txim siab seb lawv puas tsim nyog rau cov khoom siv tag nrho (piv txwv li, ib zaug hauv ib lub sijhawm)?
- Medi-Cal’s objective is to maintain continuity of care; see Section 8.8 of the P&O Guide. The quantity to dispense is at the clinician’s discretion to decide what is “medically appropriate” for their patient. If the medication regimen (dose, instructions, etc.) hasn’t changed between incarceration periods and if the patient confirms that they have a sufficient quantity at home, the provider can reasonably decide against supplying more medications in hand upon release.
19. Lub sijhawm tso cai rau xa cov tshuaj rov qab los ntawm JI lub tsev muag tshuaj yog dab tsi vim kev siv qeeb?
- Txhawm rau them nyiaj rov qab tag nrho, daim ntawv thov tsev muag tshuaj yuav tsum xa mus rau Medi-Cal Rx li ntawm 6 lub hlis tom qab lub hli ntawm hnub uas tau txais kev pab. Qhov kev xav tau no raug xa mus rau qhov txwv rau lub hlis them nqi.
- Cov tsev muag tshuaj thov uas tsis tau txais nyob rau hauv 6 lub hlis nqi txwv thiab tsis muaj kev pom zoo tshwj xeeb yuav raug them rov qab ntawm tus nqi txo lossis yuav raug tsis lees paub raws li hauv qab no:
- Cov kev thov tau txais thaum lub hli 7 txog rau 9th tom qab lub hli ntawm kev pabcuam yuav raug them rov qab ntawm 75 feem pua ntawm cov nqi them.
- Cov kev thov tau txais thaum lub hli 10 txog rau 12th tom qab lub hlis ntawm kev pabcuam yuav raug them rov qab ntawm 50 feem pua ntawm cov nqi them.
- Cov kev thov tau txais tom qab lub hli 12 tom qab lub hli ua haujlwm yuav raug tsis lees paub.
Nco tseg: Cov lus nug tshwj xeeb hauv nroog tuaj yeem xa mus rau DHCS ntawm CalAimjusticeadvisorygroup@dhcs.ca.gov.
20. Puas yog daim ntawv tso cai tso tawm uas tau ua tiav ua ntej / ntawm hnub tso tawm tuaj yeem them nqi raws li JI lub tsev muag tshuaj thov thaum lub sijhawm tso tawm, txawm tias nws raug khaws tom qab hnub tso tawm? Lub tsev muag tshuaj yuav ua li cas thiaj li paub tshem tawm qhov uas twb tau them nqi lawm?
- A minimum requirement of JI is for the individual to leave with a full supply of medications in hand upon release. Refer to Section 8.6 of the Policy and Operation Guide. If the date filled (i.e., date of service) is within the JI eligibility period, there should be no issue with the member obtaining their discharge medications any time within 15 days from the date of service. Pursuant to CCR, Title 22, Section 51172, if a prescription has not been received by the member or the member’s representative within 15 days of the fill date, the pharmacy must reverse the claim and refund the payment to DHCS.
21. Cov chaw kho yuav raug them li cas rau cov ntim tshuaj txhua hnub, tso tawm ua ntej?
- Cov khw muag tshuaj yuav raug them rov qab rau cov khoom siv thiab cov nqi xa tawm rau txhua daim ntawv xaj txawm tias lawv ntim li cas. Xa mus rau Tshooj 4.6 ntawm Medi-Cal Rx Tus Kws Kho Mob Phau Ntawv Qhia rau cov txheej txheem them rov qab.
22. For JI pharmacy claims, what value (‘1′ [Home] or ’15’ [Correctional Institution]) is appropriate for the 384-4X (Patient Residence) field for pre-release prescriptions? For upon release discharge prescriptions?
- The residence value (NCPDP 384-4X [Patient Residence] field) is not a required field on the pharmacy claim. If the provider opts to include this information, it should be reflective of the member’s residence at the time of dispensing. It would be appropriate to populate with ’15’ (Correctional Institution) for pre-release and upon release discharge prescriptions.
23. Puas yog JI Aid Code xav tau hauv Medi-Cal Rx NCPDP Daim Ntawv Them Nyiaj? Yog muaj, teb twg?
- The aid code is not a field submitted on the NCPDP pharmacy transactions (claim, prior authorization, or eligibility). The member’s eligibility and aid code (JI or non-JI) are validated and determined by Medi-Cal Rx based upon the date of service. Medi-Cal Rx uses DHCS Medi-Cal Eligibility Division (MCED)-provided information for the validation and determination.
24. Cov tshuaj X tau raug sau tseg raws li ob qhov kev txiav txim sib cais (kev txiav txim A thiab B) rau tus neeg saib xyuas JI uas muaj NDC 1 thiab NDC 2 tau muab faib raws li. Peb puas tuaj yeem muab cov nqi ntawm ob qho kev txiav txim rau hauv ib qho nqi (ua rau ib qho nqi nrog NDCs sib txawv), lossis peb puas tuaj yeem cais lawv ua ob tus nqi los ntawm NDC, uas tuaj yeem ua rau ob tus nqi xa khoom?
- Cov ntawv thov nyiaj sib cais yuav tsum raug xa mus rau txhua qhov kev txiav txim (cov ntawv sau tshuaj) thiab koom nrog NDC.
25. Peb faib qhov chaw nyob rau hauv ib qho chaw kho mob los muab kev pabcuam mob hlwb rau cov neeg mob. Puas yog cov tshuaj muab rau cov neeg mob JI nyob rau hauv 90 hnub ua ntej lub sijhawm tso tawm raug them rau Medi-Cal Rx?
- Yog lawm, cov tshuaj uas tau muab rau hauv qhov chaw kho mob puas siab puas ntsws ntawm lub chaw kho mob nyob rau hauv 90-hnub lub sijhawm tso tawm ua ntej yuav raug them rau Medi-Cal Rx yog tias tau them nqi raws li daim ntawv xaj tus neeg mob sab nraud. Cov no tseem tuaj yeem xa mus raws li kev thov kho mob rau CA-MMIS. Yog tias cov kev pab cuam puas siab puas ntsws yog ib feem ntawm kev nyob hauv tsev kho mob, lawv yuav raug suav hais tias yog ib feem ntawm cov txiaj ntsig ntawm tus neeg mob hauv tsev kho mob, thiab cov tshuaj yuav tsis raug txiav tawm ntawm daim ntawv thov Medi-Cal Rx. Yog xav paub ntxiv, mus saib Medi-Cal Inmate Program.
26. An opioid dispense, per Medi-Cal Rx restriction, is a 7-day supply for the first dispense, 30 tablets/capsules or 240 mL. How is “dosage unit” defined? Are we required to combine all medications into “as fewest claims as possible?” How do we reconcile the difference between these variations/intervals?
- New start opioid pharmacy claims will be restricted to a 7-day supply or a maximum quantity of 30 solid dosage units (each) or 240 mL for liquids – meaning the first opioid claim on this member’s profile is limited to a 7-day supply or 30 tablets/capsules. If this opioid order is a liquid, the initial claim is limited to 240 mL.
27. Puas tuaj yeem xa daim PA rov qab?
- Yog lawm, PA yuav tsum tau xa daim ntawv thov hnub rov qab ua haujlwm rau lub chaw kho kom tau txais Medi-Cal Rx cov nyiaj rov qab.
28. Yog tias PA raug xa los ntawm lwm tus kws kho mob rau tus neeg ua ntej raug kaw, PA puas tseem ua haujlwm? Lub chaw kho mob puas tuaj yeem pom cov PAs twg ua haujlwm?
- Cov ntawv tso cai ua ntej tau pom zoo los ntawm Medi-Cal Rx ua ntej raug kaw tseem siv tau rau lub sijhawm pom zoo. Qhov ntev ntawm kev tso cai ua ntej nws txawv nyob ntawm ntau yam thiab raug txiav txim thaum lub sijhawm tshuaj xyuas. Kev raug kaw tsis cuam tshuam rau cov xwm txheej ntawm kev tso cai ua ntej ntawm cov ntaub ntawv. Txij li cov ntawv tso cai ua ntej raug cuam tshuam nrog NPI ntawm tus neeg xa khoom qub, lawv tsis pom rau lwm NPIs. Cov kws kho mob thiab cov khw muag tshuaj tuaj yeem hu rau Medi-Cal Rx Call Center txhawm rau nug seb PA puas muaj ntaub ntawv rau tus tswv cuab (tom qab dhau qhov kev kuaj xyuas rau PHI).
29. For an individual that had Medi-Cal eligibility prior to custody and was undergoing opioid treatment, how do we define “new” or lookback period? When does the new start begin?
- Rau kev saib xyuas txuas ntxiv uas tsis tau them lub tsev muag tshuaj keeb kwm thov rau cov tshuaj hauv 90 hnub dhau los, yuav tsum tau xa daim ntawv tso cai ua ntej. Yog xav paub ntxiv, thov mus saib Medi-Cal Rx Tus Kws Kho Mob Phau Ntawv Qhia, Tshooj 15.1.3.
30. Yog tias lub chaw kho mob tso tawm ib tus neeg uas muaj cov tshuaj ntxiv hauv lawv cov tshuaj tam sim no, puas ua tau raws li cov tshuaj hauv tes?
- No, correctional facilities must ensure that individuals are released with a full supply of medications in hand upon release, as described in Section 8.8.A of the Policy and Operation Guide. “Full supply” is defined as the maximum amount that is medically appropriate and allowed by the Medi-Cal State Plan which under most circumstances is up to a 35 days’ supply for controlled substances and 100 days’ supply for other prescription drugs.
- If the individual’s remaining medication on their current prescription is not a “full supply,” the correctional facility must ensure that they are given a full supply upon release.
- Ntxiv nrog rau kev muab cov tshuaj nyob rau hauv tes thaum tso tawm, lub chaw kho mob yuav tsum xa ib daim ntawv tshuaj rau cov tshuaj uas nquag siv, cov mis, lossis cov khoom siv kho mob rau lub tsev muag tshuaj hauv zej zog raws li qhov tsim nyog thiab ua tau kom tus neeg tau txais kev nkag mus ntxiv.
31. Puas muaj cov tshuaj txhaj tshuaj ntev ntev? Yog tias ib tug neeg tau txais cov tshuaj txhaj tshuaj ntev ntev, puas yuav tsum tau txhaj tshuaj thaum lub sijhawm tso tawm?
- All medications and biological products utilized to treat substance use disorders (SUDs), including long-acting injectables (LAI), are included as pre-release services and continue to be available through the Medi-Cal pharmacy benefit without prior authorization. For individuals who received LAIs while incarcerated, prescriptions should be provided if clinically appropriate. For example, if it is not clinically appropriate to provide a script (e.g. monitoring is needed) then a visit with a provider to continue treatment must be scheduled prior to needing another injection.Outpatient Pharmacy Benefits and Medi-Cal Rx FAQ
The Department of Health Care Services (DHCS) Pharmacy Benefits Division (PBD) has prepared the following Questions and Answers (Q&A) based upon stakeholder feedback received during meetings and via email. The intent is to provide additional support for correctional facilities and pharmacies as they prepare for implementation of the Justice-Involved (JI) Reentry Initiative.
Daim Ntawv Teev Npe Rau Kev Nkag Mus Rau Kev Ncaj Ncees ntawm Kev Pib Rov Qab Mus Rau Medi-Cal Rx
Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tau tsim Daim Ntawv Teev Npe Npaj Txhij thiab Cov Khoom Siv Medi-Cal Rx los txhawb nqa Cov Chaw Kho Mob (CFs), cov khw muag tshuaj koom tes, thiab cov kws kho mob hauv kev npaj rau kev siv Txoj Haujlwm Rov Qab Nkag Mus Rau Kev Ncaj Ncees (JI). Daim ntawv no yog tsim los ua kom tiav koj qhov Kev Ntsuam Xyuas Kev Npaj Txhij Rov Qab Los Ntawm Kev Ncaj Ncees thiab suav nrog cov ntaub ntawv tshwj xeeb txog kev muab cov txiaj ntsig tshuaj kho mob sab nraud ntawm Medi-Cal. Yog xav paub ntxiv txog lwm cov kev pabcuam uas muab los ntawm JI Initiative, mus saib daim ntawv teev npe npaj rau kev nkag mus rau hauv tsev kho mob uas muaj kev koom tes ntawm Justice-Involved Reentry Initiative Medi-Cal.
Complete the step-by-step checklist that highlights areas critical for new JI Medi-Cal pharmacy benefit providers.