Tsev Kev Nce Nqi thiab Kev Nqis Peev rau Cov Neeg Muab Kev Pabcuam Medi-Cal ​​ 

Medi-Cal Targeted Provider Rate nce thiab nqis peev​​ 

Assembly Bill (AB) 119 (Tshooj 13, Txoj Cai ntawm 2023) tau tso cai rau Lub Koom Haum Saib Xyuas Kev Tswj Xyuas (MCO) Tus Nqi Se txij thaum lub Plaub Hlis 1, 2023 txog Lub Kaum Ob Hlis 31, 2026. Raws li tsoom fwv pom zoo, MCO cov nyiaj tau los yuav raug siv los txhawb Medi-Cal qhov kev pab cuam suav nrog, tab sis tsis txwv rau, cov phiaj xwm tshiab nce tus nqi thiab lwm yam kev nqis peev uas nce kev nkag tau, zoo, thiab kev ncaj ncees rau Medi-Cal cov tswv cuab thiab txhawb nqa kev koom tes hauv Medi-Cal qhov kev pab cuam.​​   

Tswv yim 35​​ 

Cov neeg pov npav hauv California tau pom zoo Proposition 35 thaum lub Kaum Ib Hlis 5, 2024 Kev Xaiv Tsa General ua rau MCO Tax mus tas li, raws li tsoomfwv tau pom zoo txuas ntxiv, thiab muab cov nyiaj tau los rau cov phiaj xwm Medi-Cal uas tau teev tseg txij xyoo 2025.​​ 

Txoj Cai Lij Choj 35 ua rau tsis ua haujlwm rau cov neeg muab kev pab them nqi ntxiv thiab kev pab them nqi tas mus li rau cov menyuam yaus txog plaub xyoos tau tso cai los ntawm Senate Bill (SB) 159 (Tshooj 40, Txoj Cai ntawm 2024), uas yuav tau siv rau lub Ib Hlis 1, 2025 lossis tom qab ntawd. Txoj Cai Lij Choj 35 tsis cuam tshuam rau cov neeg muab kev pabcuam tus nqi nce ntxiv uas tau ua tiav Lub Ib Hlis 1, 2024.​​ 

Txoj Cai 35 xav kom DHCS los sab laj nrog pawg neeg tawm tswv yim, raug xaiv los ntawm Tus Thawj Kav Tebchaws thiab cov thawj coj tsim cai lij choj, ua ntej tshaj tawm lossis siv cov kev them nyiaj tshiab lossis kev hloov pauv rau cov neeg muab kev pabcuam uas twb muaj lawm uas txhawb nqa los ntawm MCO Tax. DHCS lub vev xaib yuav raug hloov kho thaum muaj ntaub ntawv ntxiv.​​  

Targeted Rate Increases Effective January 1, 2024​​ 

Ua raws li Txoj Cai Lij Choj Nyiaj Txiag xyoo 2023 thiab AB 118 (Tshooj 42, Txoj Cai ntawm 2023 ntxiv Welfare & Institutions Code Section 14105.201), DHCS tau siv Lub Hom Phiaj Tus Nqi nce ntxiv rau kev saib xyuas thawj zaug, obstetric, thiab tsis yog tshwj xeeb cov kev pabcuam kev puas siab puas ntsws siv tau rau cov hnub ua haujlwm rau lossis tom qab Lub Ib Hlis 1, 2024.​​ 

Cov kev nce nqi no siv rau cov neeg muab kev pab tsim nyog hauv Fee-For-Service delivery system, nrog rau cov chaw muab kev pab cuam uas tsim nyog tau cog lus nrog Medi-Cal cov kev pab them nqi kho mob. DHCS nce tus nqi, raws li tsim nyog, rau cov kev pab cuam tsis pub tsawg dua 87.5% ntawm Medicare tus nqi, suav nrog tshem tawm AB 97 tus kws kho mob txo cov nyiaj txo thiab suav nrog Cov Lus Qhia 56 ntxiv cov nyiaj them rau hauv tus nqi pib. DHCS suav qhov sib npaug nce rau cov kev pabcuam uas tsis muaj tus nqi tsim los ntawm Medicare. DHCS tau txais kev pom zoo los ntawm tsoomfwv ntawm 2024 lub hom phiaj nce tus nqi hauv Xeev Txoj Kev Hloov Kho (SPA) 23-0035.​​ 

DHCS developed the code list through a review of existing Medi-Cal policies and procedures, review of current utilization data by provider taxonomy, review of literature, review by DHCS’s staff medical consultants, and consultation with technical experts. DHCS reserves the right to modify the code list for purposes including, but not limited to, accounting for changes to coding and billing definitions, applying technical corrections or updates, and obtaining or maintaining any necessary federal approvals.​​ 

Cov neeg muab kev pab tsim nyog​​ 

Cov txheej txheem txheej txheem teev tseg raws li Kev Kho Mob Hauv Tsev Kawm Ntawv / General tau thov kom them rov qab ntawm tus nqi nce ntxiv yog tias qhov kev pabcuam raug them nqi siv Daim Ntawv Pov Hwm Kev Noj Qab Haus Huv (CMS-1500) thiab muab los ntawm ib tus kws kho mob uas tsim nyog rau hauv cov pawg kws kho mob hauv qab no:​​ 

Cov Kws Kho Mob

Neeg Pab Kws Kho Mob
Cov Kws Kho Mob Saib Xyuas Neeg Mob
cph0} Cov Kws Kho Mob Podiatrists
Cov Kws Pab Yug Me Nyuam Uas Muaj Ntawv Pov Thawj {cph0} Cov Kws Pab Yug Me Nyuam Uas Muaj Ntawv Tso Cai
cph0} Cov Kws Muab Kev Pab Doula
Cov Kws Kho Mob Hlwb
Cov Kws Pab Tswv Yim Kho Mob Uas Muaj Ntawv Tso Cai
Cov Neeg Ua Haujlwm Pabcuam Zej Zog Hauv Tsev Neeg Uas Muaj Ntawv Tso Cai
Cov Kws Kho Mob Sib Yuav Thiab Tsev Neeg​​ 

Lwm tus kws kho mob yuav tau them rov qab rau ntawm tus nqi Medi-Cal uas twb muaj lawm rau cov txheej txheem cov cai uas tau txheeb xyuas tias yog Kev Pabcuam Hauv Tsev / Kev Kho Mob.​​ 

Cov txheej txheem txheej txheem txheeb xyuas raws li Obstetric thiab Non-Specialty Mental Health Services tau thov kom them rov qab ntawm tus nqi nce ntxiv rau txhua tus kws kho mob uas tsim nyog.​​ 

Thov saib cov ntawv sau tseg ntawm Medi-Cal Lub Hom Phiaj Tus Muab Kev Pab Them Nqi Tshaj Tawm rau cov ntaub ntawv ntxiv hais txog kev sau nqi thiab kev txwv kev tsim nyog.​​ 

Rate Information​​  

Raws li txoj cai ntawm Txoj Cai 35, CY 2024 Cov Nqi Them Nqi Them Nqi tseem siv tau kom txog thaum muaj kev ceeb toom ntxiv.​​ 

Hu rau DHCS​​ 

Thov xa cov lus nug txog kev them nqi thiab kev them nqi ntawm Tus Nqi Tshaj Lij Tshaj Tawm rau Medi-Cal Lub Chaw Pabcuam Xov Tooj. Rau cov lus nug ntsig txog kev them nqi thiab kev them nyiaj los ntawm Medi-Cal cov kev pab them nqi kho mob, thov hu rau cov kev pab them nqi kho mob uas siv tau.​​ 

Legislation & Resources​​ 

Tus Nqi Muab Kev Pabcuam Uas Tau Targeted Nce APL 25-012 (Hloov Tag Nrho Cov Ntawv Qhia Txog Kev Npaj 24-007,10-014 thiab 10-003)
Daim Ntawv Teev Se MCO (Lub Xya Hli 3, 2024 hloov los ntawm Prop 35)
SB 159
Tus Nqi Muab Kev Pabcuam Uas Tau Targeted Nce APL 24-007
Lub Xya Hli 17, 2024 Cov Ntaub Ntawv Nthuav Qhia (hloov los ntawm APL 24-007)
Daim Ntawv Teev Npe Lub Koom Haum Saib Xyuas Kev Tswj Xyuas (Lub Ib Hlis 19, 2024 hloov los ntawm Prop 35)
Daim Ntawv Qhia Txog Nyiaj Txiag ntawm Lub Koom Haum Saib Xyuas Kev Tswj Xyuas (Lub Ib Hlis 19, 2024 hloov los ntawm Prop 35)
Daim Ntawv Pom Zoo Tso Tseg Se ntawm Lub Koom Haum Saib Xyuas Kev Tswj Xyuas thiab Daim Ntawv Qhia Ntxiv
SPA 23-0035
AB 118
AB 119
MCO Txoj Kev Npaj Siv Nyiaj Se & Kev Nqis Peev
Cov Lus Nug Feem Ntau Txog Kev Nce Tus Nqi Muab Kev Pabcuam (FAQs)
California Cov Lus Nug Txog Se Rau Lub Koom Haum Saib Xyuas Kev Tswj Xyuas (Plaub Hlis Ntuj Xyoo 2025)​​