Cov lus nug nquag nug txog Medi-Cal Cov Nyiaj Them Nqi Tshuaj
Cov Lus Nug
Cov nyiaj rov qab "Medi-Cal" yog dab tsi?
"Medi-Cal" cov nyiaj rov qab yog California cov kev pabcuam Medicaid cov nyiaj rov qab los ntawm tsoomfwv. Medi-Cal yog California qhov kev pab cuam noj qab haus huv uas muab kev pab them nqi kho mob dawb lossis nqi qis rau cov neeg nyob hauv California uas muaj raws li qhov yuav tsum tau muaj. Cov tuam txhab tshuaj yuav tsum tau them tus nqi rov qab rau txhua yam tshuaj kho mob sab nraud uas tau muab thiab them los ntawm Lub Xeev qhov kev pab cuam Medi-Cal. Kev xa nyiaj rov qab rau cov tshuaj siv tshuaj pib thaum Lub Ib Hlis 1, 1991 thiab tseem niaj hnub no
"Medi-Cal supplemental" rebates yog dab tsi?
"Medi-Cal supplemental" rebates yog cov rebates ntxiv cov tuam txhab tshuaj tau pom zoo them lub xeev. Cov nyiaj rov qab ntxiv yog raws li kev siv tib yam li tsoomfwv cov nyiaj rov qab. Cov tuam txhab tshuaj uas tau pom zoo them nyiaj rov qab ntxiv yog suav nrog hauv Xeev Daim Ntawv Cog Lus Tshuaj (CDL). Feem ntau, cov khoom no tsis raug tso cai ua ntej. Lub Pharmacy Benefit's Drug Contracting Branch yog lub luag haujlwm los tswj cov kev pab cuam thiab sib tham txog cov ntawv cog lus. Kev them nyiaj rov qab ntxiv yog xav tau rau txhua qhov kev pabcuam tseemfwv tshwj tsis yog kev siv los ntawm cov koomhaum pabcuam (MCOs). Cov nyiaj rov qab ntxiv tau yog ib feem ntawm California qhov kev them nyiaj rov qab txij li xyoo 1991. Ua ntej xyoo 1997, cov nyiaj rov qab ntxiv tau suav tias yog feem pua ntawm Tus Nqi Nruab Nrab Chaw Tsim Tshuaj (AMP) ntawm txhua cov tshuaj them. Txawm li cas los xij txij li xyoo 1997, cov ntawv cog lus tau sib tham txog cov tshuaj tshwj xeeb. California tam sim no muaj ob hom kev cog lus ntxiv: Tus Nqi Net thiab AMP. Cov ntawv cog lus ntxiv hais txog txhua qhov kev them nyiaj rov qab tshwj tsis yog rau cov koom haum saib xyuas kev tswj hwm (MCO) uas tau txais nyiaj rov qab tsim nyog hauv xyoo 2010.
Puas yog cov nyiaj rov qab ntxiv yuav raug them cov paj laum?
Yog lawm. Tshooj 14105.33 ntawm Welfare & Institutions Code tau hloov kho hauv 1997 tso cai rau lub xeev cov ntawv cog lus ntxiv nrog rau cov paj laum thiab kev nplua. Cov ntawv cog lus suav nrog cov hauv qab no:
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Yog tias tsis tau txais cov nyiaj them ntxiv tsis pub dhau 38 hnub txij li hnub xa ntawv xa tuaj, cov paj laum suav ntawm CMS tus nqi (Lub Limtiam Federal Treasury-bill rate) yuav dhau.
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Yog tias tsis tau txais kev them nyiaj ntxiv tsis pub dhau 69 hnub txij li hnub xa ntawv xa tuaj, yuav raug nplua nyiaj paj ntawm 10 feem pua cov ntsiab lus ntxiv rau CMS tus paj laum. Cov paj laum thiab 10% raug nplua txuas ntxiv mus kom txog rau thaum hnub kawg ntawm kev them nyiaj.
Kuv puas tau txais ib daim ntawv them nqi cais rau cov nyiaj rov qab ntxiv?
Yog lawm. Pib txij lub quarterthib 4 xyoo 2001, DHCS pib xa cov ntawv sau cais cov ntawv sau nyiaj ntxiv. Ua ntej lub Kaum Hlis 2001, cov ntawv sau tau qhia kom suav cov nyiaj rov qab ntxiv uas siv lawv daim ntawv them nqi Medi-Cal.
Tsoom Fwv Teb Chaws thiab Lub Xeev Txoj Cai Lij Choj Hais Txog Qhov Kev Pab Them Nqi Tshuaj Hauv Xeev California / Tsoom Fwv Teb Chaws Txoj Cai Li Cas?
Tsoom Fwv Teb Chaws Txoj Cai:
Social Security Act Section 1927 [42 USC 1396r-8] (a)
Tsoom Fwv Teb Chaws txoj cai lij choj hais txog Medicaid (Medi-Cal hauv California) Txoj Kev Pab Them Nqi Tshuaj. Mus saib lub vev xaib Social Security kom paub ntau ntxiv.
Xeev Txoj Cai:
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Welfare and Institutions (W&I) Code Section 14105. Muaj cov ntaub ntawv hais txog Medi-Cal Cov Nyiaj Them Nqi Tshuaj Kho Mob.
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Senate Bill 391, 1997 Hloov Kho W & I Code 14105.33. Tso cai rau Lub Xeev kom them cov paj laum thiab nplua rau cov nyiaj them rov qab rau lub xeev lig. (Nyob rau hnub tim 10/1/97)
Txhawm rau nkag mus rau W & I Code, mus saib hauv California Cov Ntaub Ntawv Kev Cai Lij Choj lub vev xaib, thiab xaiv lub pob uas sau tias " California Law,” ces xaiv Welfare and Institutions Code. Tom ntej no nkag mus rau ib ntu, xaiv "Enter" khawm los tshawb.
Hom kev pab cuam twg koom nrog hauv Department of Health Care Services Drug Rebate Program?
California xa cov tuam txhab muag tshuaj rau tag nrho tsoom fwv cov kev pab cuam Medicaid, suav nrog cov koom nrog los ntawm kev zam. Tsis tas li ntawd, cov tuam txhab lag luam tau txais cov ntawv xa nyiaj ntxiv yog tias lawv tau nkag mus rau hauv daim ntawv cog lus nrog Lub Xeev .
Cov kev pab cuam uas yuav tau them rov qab muaj xws li: Medi-Cal (FFS, COHS, Managed Care Organizations (MCOs)), CCS/Healthy Families, GHPP, Blood Factors, FPACT thiab BCCTP. Cov ntawv xa nyiaj sib cais raug xa mus rau lub tsev muag tshuaj, PADs thiab cov ntawv thov sib txuas rau ntau qhov haujlwm.
"FPACT" yog dab tsi?
Family Planning, Access, Care, and Treatment (FPACT) yog ib lub xeev nkaus xwb txoj haujlwm kom txog rau thaum lub Kaum Ob Hlis 1, 1999 thaum CMS pom zoo rau California qhov kev zam 1115. Yog li ntawd, qhov kev zov me nyuam tau tsim nyog rau Title XIX nyiaj txiag. Siv tau 4Q1999, Lub Xeev tau pib them nyiaj rov qab. Nrog rau kev pom zoo ntawm qhov kev zam, FPACT qhov kev pab cuam kuj tau tsim nyog tau txais cov nyiaj rov qab ntxiv. Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv tau xa daim State Plan Amendment (SPA) los hloov FPACT kev zam tam sim no mus rau hauv Medi-Cal State Plan. SPA tau pom zoo rau lub Peb Hlis 24, 2011 los ntawm CMS. Raws li kev pom zoo los ntawm CMS, SPA tau hloov pauv FPACT kev zam rau hauv Lub Xeev Txoj Kev Npaj nrog rau hnub rov pib pib lub Xya Hli 1, 2010. Cov ntaub ntawv ntxiv muaj nyob rau ntawm FPACT qhov webpage.
"Physician Administered Drug (PAD)" yog dab tsi?
Tus kws kho mob muab tshuaj yog ib yam tshuaj uas them rau tus neeg mob sab nraud yog muab los yog muab rau tus neeg txais, thiab them nqi los ntawm tus kws kho mob uas tsis yog lub tsev muag tshuaj. Cov kws kho mob xws li, tab sis tsis txwv rau, cov chaw kho mob, chaw kho mob thiab tsev kho mob. Cov tshuaj them rau tus neeg mob sab nraud tau txhais dav dav tias yog cov tshuaj uas yuav muab tau raws li daim ntawv xaj nkaus xwb, thiab tau txais kev pom zoo rau kev nyab xeeb thiab kev ua tau zoo raws li cov tshuaj noj raws li Tsoom Fwv Teb Chaws Khoom Noj, Tshuaj thiab Tshuaj pleev ib ce. Cov tshuaj uas kws kho mob muab tshuaj muaj xws li tshuaj txhaj thiab tsis txhaj tshuaj
"HCPCS" yog dab tsi?
Txoj Kev Kho Mob Cov Txheej Txheem Txheej Txheem Txheej Txheem (HCPCS) yog lub teb chaws, cov qauv coding zoo ib yam tsim los ntawm Lub Chaw rau Medicare & Medicaid Services (CMS) los ua qauv txheej txheem coding uas siv los ua cov txheej txheem Medicare thiab Medicaid (Medi-Cal) thov raws lub teb chaws.
Tus Kws Kho Mob Tus Thawj Saib Xyuas Tshuaj thov kom muaj HCPCS code txhawm rau txheeb xyuas tus txheej txheem thiab txiav txim siab tus nqi them rov qab rau tus kws kho mob. Tsis tas li ntawd, tag nrho cov Kws Kho Mob Tswj Tshuaj (PAD) cov lus thov yuav tsum suav nrog National Drug Code (NDC) yog li cov chaw tsim tshuaj yuav raug xa mus rau cov nyiaj rov qab. DHCS tseem xav kom cov neeg thov uas tau sau nrog 340B yuav cov tshuaj kom suav nrog "UD" hloov kho, uas tshem tawm qhov kev thov los ntawm cov chaw tsim tshuaj hauv daim ntawv xa nyiaj rov qab tshuaj.
"FPACT HCPCS" yog dab tsi?
FPACT HCPCS yog Family Planning Access Care and Treatment (FPACT) Tus Kws Kho Mob Tswj Tshuaj (PAD) thov. Cov no yog cov lus thov los ntawm cov chaw muab tshuaj uas tsis yog tsev muag tshuaj. Feem ntau qhov kev thov raug xa los ntawm lub tsev kho mob, tab sis tsis tas li. Daim ntawv thov yuav tsum muaj HCPCS code, NDC thiab tus hloov kho "UD" yog tias sau nrog 340B yuav tshuaj.
"COHS" yog dab tsi?
County Organized Health Systems (COHS) yog ib lub koom haum tsis muaj txiaj ntsig, muaj kev ywj pheej rau pej xeem uas tau cog lus nrog Lub Xeev los tswj hwm cov txiaj ntsig Medi-Cal los ntawm cov kws kho mob hauv zos thiab / lossis Cov Koom Haum Saib Xyuas Kev Noj Qab Haus Huv. COHS tau yog ib feem ntawm Medi-Cal qhov kev pab cuam txij li CMS tau pom zoo thawj COHS txoj kev npaj rau xyoo 1983. COHS tau yog ib feem ntawm qhov kev them nyiaj rov qab txij li xyoo 1991 thiab tau sau npe sib cais txij li lub quarter thib plaub xyoo 2001.
Muaj pes tsawg COHS?
Muaj rau COHS txoj kev npaj them rau 22 lub nroog.
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"CalOPTIMA" - Lub Nroog Orange
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"Central California Alliance for Health" - Santa Cruz, Monterey thiab Merced counties
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"Kev Npaj Noj Qab Haus Huv ntawm San Mateo" - Lub Nroog San Mateo
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"Partnership Health Plan" - Napa, Solano, Yolo, Sonoma, Marin, Mendocino, Del Norte, Humboldt, Lake, Lassen, Modoc, Shasta, Siskiyou thiab Trinity counties.
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"CenCal" - Lub nroog Santa Barbara thiab San Luis Obispo
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"Gold Coast Health Plan" -- Ventura County
"CCS/GHPP" yog dab tsi?
California Children's Services (CCS) yog ib qho kev pab cuam uas kho cov me nyuam muaj qee yam kev txwv lub cev thiab mob ntev los yog kab mob. Genetically Handicapped Persons Program (GHPP) yog ib qho kev pab kho mob rau cov neeg laus uas muaj qee yam kab mob caj ces. CMS tau pom zoo rau Medicaid qhov kev zam, pib lub Cuaj Hlis 01, 2005, uas tso cai rau Lub Xeev tuaj yeem xa cov tuam txhab tshuaj rau cov nyiaj rov qab.
Qhov kev zam ntawm Medicaid los sau cov nyiaj them rov qab rau cov tshuaj rau lub xeev nkaus xwb CCS thiab GHPP siv tas sijhawm rau lub Kaum Ob Hlis 31, 2020. Vim tias tsis muaj kev txuas ntxiv ntawm tsoomfwv cov nyiaj pab rau CCS thiab GHPP cov pej xeem, DHCS tsis muaj txoj cai los sau nqi thiab sau nyiaj rov qab los ntawm tsoomfwv Medicaid rau cov kev pabcuam no. Raws li ntawm Q1 2021, CCS thiab GHPP invoices tau raug rho tawm los ntawm kev them nqi.
"Blood Factors" yog dab tsi?
Ntshav Factors lossis Factor 8 yog ib qho tseem ceeb ntawm cov ntshav txhaws protein, tseem hu ua anti-hemophilic factor (AHF). DHCS invoices cov tuam txhab tshuaj nyob rau hauv daim ntawv them nqi cais rau cov tshuaj uas siv los kho cov kab mob ntshav. Cov neeg muab tshuaj AHF raug them rov qab ntawm lawv cov nqi tau txais ntxiv rau 20 feem pua.
BCCTP yog dab tsi?
Qhov Kev Pabcuam Mob Cancer thiab Cervical Treatment Program (BCCTP) muab kev kho mob qog noj ntshav rau cov neeg nyob hauv California uas tau txais nyiaj tsawg uas tau txais kev kuaj mob los ntawm Kev Tshawb Fawb Txog Kev Kho Mob: Txhua Tus Poj Niam suav (CDP:EWC) lossis Family Planning Access Care and Treatment (FPACT) cov kev pab cuam thiab pom tias yog xav tau kev kho mob cancer mis thiab/los yog ncauj tsev menyuam. Assembly bill (AB) 430, (Tshooj 171, Statutes of 2001) tau muab lub Xeev txoj cai lij choj los ua raws li kev xaiv nom tswv lub mis thiab Cervical Cancer thiab Treatment Act of 2000. California's SPA tau pom zoo los ntawm tsoomfwv nrog rau hnub pib lub Ib Hlis 1, 2000. Cov tuam txhab tshuaj tau raug yuam kom them rov qab vim qhov kev zov me nyuam tau suav nrog hauv California Txoj Kev Npaj Kho Mob Medicaid. Mus ntsib BCCTP lub vev xaib kom paub ntau ntxiv.
California tus nqi them rov qab rau cov tsev muag tshuaj yog dab tsi?
Siv tau rau cov tsev muag tshuaj thov nrog cov hnub ua haujlwm rau lossis tom qab lub Plaub Hlis 1, 2017, Medi-Cal cov nyiaj them rov qab raws li qhov qis dua ntawm Tus Nqi Tshaj Lij Tshaj Lij (AAC) ntxiv rau cov nqi xa khoom, lossis cov nqi them raws li ib txwm muaj. AAC yog txiav txim siab raws li qhov qis tshaj ntawm:
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Tus Nqi Siv Tshuaj Hauv Tebchaws (NADAC), lossis Tus Nqi Muag Khoom Muag (WAC) + 0% yog tias tsis muaj NADAC,
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Federal Upper Limit (FUL), los yog
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Tus Nqi Tshaj Lij Tshaj Lij Tshaj Tawm (MAIC).
California cov hnub ntau tshaj plaws yog dab tsi thaum muab tshuaj?
California muaj 100-hnub cov khoom siv ntau tshaj plaws rau cov tshuaj feem ntau. Qhov no txawv ntawm ntau lwm lub xeev uas muaj ntau tshaj 30-hnub khoom. Nws yog ib qho tseem ceeb uas yuav tsum tau siv 100-hnub qhov khoom siab tshaj plaws los txiav txim siab thaum sib cav txog kev siv.
Vim li cas Medi-Cal thiaj li them nyiaj rov qab rau qee tus kws kho mob ntawm tus nqi qis li ntawd?
Cov nyiaj rov qab los tsis yog qhov qhia tau zoo tshaj plaws ntawm pes tsawg units (cov ntsiav tshuaj, milligrams, vials, thiab lwm yam) ntawm cov tshuaj tau muab xa tawm vim qee tus kws kho mob tsis suav tag nrho cov ntaub ntawv.
Lwm cov ntaub ntawv Kev Pabcuam Kev Noj Qab Haus Huv lossis Third Party Liability (TPL) qee zaum tsis suav nrog hauv Medi-Cal thov. Nws yog ib txwm pom cov kws kho mob tau them rov qab tsuas yog rau cov nyiaj them ua ke (piv txwv li $5, $15, $30, thiab lwm yam) tsis muaj TPL cov ntaub ntawv. Vim li ntawd, feem ntau cov lus thov nrog cov nyiaj them rov qab qis yog qhov tseeb thiab cov chav nyob hauv cov nqi them rov qab kuj raug.
Nws yog ib qho tseem ceeb rau cov koom haum saib xyuas kev tswj hwm (MCOs) los muab cov nyiaj them rov qab qis lossis tsis muaj nyiaj rov qab rau ntawm daim ntawv thov. CMS's Medicaid Drug Rebate Program Notice for Manufacturer's Release No. 84 hais txog qhov teeb meem qis lossis tsis them nyiaj rov qab rau MCO cov ntaub ntawv. Raws li CMS, cov nyiaj them rov qab tau them rov qab txawm tias daim ntawv xa nyiaj MCO tsis qhia cov nqi them vim tias cov nqi tshuaj yog ib feem ntawm cov nyiaj them los ntawm Lub Xeev rau MCO. Yog li ntawd, cov nyiaj them rov qab yuav tsum tsis txhob siv rau kev sib cav txog kev siv vim nws tsis muaj kev sib raug zoo rau units.
Cov kev coj noj coj ua ib txwm tuaj yeem sib txawv thiab / lossis raug hla dhau?
Yog lawm. Daim Ntawv Thov Kev Tso Cai Kho Mob (TAR) tuaj yeem siv los hla cov kev coj noj coj ua ib txwm muaj (piv txwv li daim ntawv tshuaj ntau tshaj li rau 6 daim ntawv tshuaj nyob rau ib lub sij hawm rau ib tug neeg tau txais kev pab, ntau npaum li cas loj tshaj li ib txwm dispensing quantities, tshuaj tsis nyob rau hauv daim ntawv cog lus tshuaj, thiab lwm yam.)
Vim li cas kuv thiaj li yuav tsum xa Cov Ntaub Ntawv Nruab Nrab Tus Nqi (AMP) rau qee qhov NDCs?
Tsuas yog cov ntawv sau npe uas muaj AMP raws li Lub Xeev Daim Ntawv Pom Zoo Ntxiv Tshuaj Rov Qab Nrog California yuav tsum tau muab cov ntaub ntawv AMP. Daim ntawv cog lus xav kom AMP cov ntaub ntawv xa mus rau peb lub hlis twg yog li tus nqi them rov qab (URA) tuaj yeem suav tau rau cov hom phiaj hauv nqe lus. AMP cov ntaub ntawv yuav tsum tau muab rau txhua NDC rau txhua lub hlis twg raws li cov lus cog tseg.
Thaum twg yog Tus Neeg Tsim Khoom Nruab Nrab Tus Nqi (AMP) cov ntaub ntawv them nqi hauv California?
Cov ntaub ntawv AMP rau txhua NDC yuav tsum raug xa mus rau California Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) kev pabcuam nyiaj txiag, Gainwell Technologies, LLC (Gainwell), tsis pub dhau 30 hnub tom qab xaus ntawm txhua lub hlis twg. Lub sijhawm kawg no yog tib yam li CMS lub sijhawm kawg rau tsoomfwv cov nyiaj rov qab siv tshuaj.
Yuav ua li cas yog tias kuv tsis tig rau hauv AMP cov ntaub ntawv raws sijhawm?
Cov ntawv sau npe yuav tsum paub tias yog tias lawv tsis xa lawv cov ntaub ntawv rau ob lub quarter sib law liag, lawv daim ntawv cog lus California Ntxiv AMP tuaj yeem raug txiav lossis tsis txuas ntxiv thaum daim ntawv cog lus tam sim no tas sijhawm. Yog tsis muaj daim ntawv cog lus ua haujlwm, DHCS tuaj yeem ua rau daim ntawv lo cov tshuaj muaj los ntawm kev tso cai ua ntej.
Kuv yuav xa cov ntaub ntawv AMP li cas?
AMP cov ntaub ntawv rau cov ntawv cog lus ntxiv raug xa mus rau Gainwell. AMP cov ntaub ntawv yuav tsum tau them tsis pub dhau 30 hnub tom qab lub quarter kawg. Thov hu rau Drug Rebate Branch ntawm drugrebatebranch@dhcs.ca.gov, yog xav paub ntxiv txog kev xa cov ntaub ntawv AMP.
Yuav ua li cas yog kuv AMP hloov?
Yog tias tus sau npe AMP hloov pauv rau lub sijhawm raws li daim ntawv cog lus, tus neeg sau npe yuav tsum xa AMP hloov tshiab rau Gainwell. Cov ntaub ntawv AMP raug xa mus rau tib yam li thawj AMP raug xa mus. Thov hu rau Drug Rebate Branch ntawm drugrebatebranch@dhcs.ca.gov, yog xav paub ntxiv txog kev xa cov ntaub ntawv AMP.
Kuv yuav paub li cas yog tias kuv cov ntaub ntawv AMP raug xa tsis raug (piv txwv li format, tsis muaj ntaub ntawv, thiab lwm yam)?
Gainwell lossis tus kws tshuaj ntsuam xyuas nyiaj rov qab tshuaj yuav tiv tauj lub npe yog tias muaj teeb meem nrog cov ntaub ntawv AMP xa.
Yuav ua li cas yog tias kuv nrhiav tsis tau ib daim qauv ntawm kuv lub xeev daim ntawv cog lus ntxiv?
Hu rau koj tus kws tshuaj ntsuam xyuas nyiaj rov qab los ntawm DHCS lossis kom koj tus neeg sawv cev hauv tsoomfwv hu rau Lub Tsev Haujlwm Saib Xyuas Tshuaj Kho Mob.
Dab tsi tsim nyog rau Tus Muab Kev Pabcuam Kev Noj Qab Haus Huv (PHS) hauv California thiab tsim nyog rau 340B tus nqi?
Qhov kev pab them nqi kho mob tau raug kho los ntawm Veterans Health Care Act of 1992 (VHCA). Raws li VHCA, Congress tsim 340B qhov kev pab cuam uas yog tswj hwm los ntawm tsoom fwv teb chaws Health Resources and Services Administration (HRSA), Office of Pharmacy Affairs (OPA). Qhov kev pab cuam 340B xav kom cov tuam txhab muag tshuaj uas tau them los ntawm lub xeev Medicaid cov kev pab cuam kom nkag mus rau hauv kev pom zoo nrog HRSA los muab cov cai txo nqi ntawm cov tshuaj rau "cov koom haum them nqi". Cov koom haum tau txais kev pab yuav tsum txheeb xyuas cov lus thov uas tus neeg txais txiaj ntsig Medicaid tau txais 340B yuav tshuaj. Lub Xeev tsis muaj cai tau txais cov nyiaj rov qab rau cov ntawv thov vim tias lub koom haum them nyiaj twb tau txais luv nqi los ntawm cov chaw tsim tshuaj. California txoj kev them nyiaj rov qab yuav tshem tawm cov tsev muag tshuaj thiab Tus Kws Kho Mob Tswj Tshuaj (PAD) cov lus thov uas suav nrog tus lej PHS/340B uas tsim nyog los ntawm cov chaw tsim tshuaj daim ntawv xa nyiaj. Cov ntaub ntawv hais txog 340B qhov kev pab cuam thiab cov koom haum twg tsim nyog tuaj yeem nrhiav tau ntawm HRSA 340 B Drug Pricing Program lub vev xaib.
Tus kws kho mob puas yuav tsum txheeb xyuas qhov kev thov uas cov neeg tau txais txiaj ntsig Medi-Cal tau txais 340B yuav tshuaj?
Yog lawm.
Txhawm rau ua raws li tsoomfwv txoj cai lij choj thov yuav tsum tau sau kom raug txhawm rau tiv thaiv "kev txo nqi sib npaug." Qhov no tshwm sim thaum lub chaw tsim tshuaj paus muab tus kws kho mob txo tus nqi 340B thiab them tus nqi kho mob Medicaid. Txhawm rau tiv thaiv "kev txo qis dua", cov kws kho mob yuav tsum suav nrog cov cai tsim nyog ntawm qhov kev thov. Tus Kws Kho Mob Kev Tswj Xyuas Tshuaj thov yuav tsum muaj qhov hloov kho "UD". Cov tsev muag tshuaj thov yuav tsum muaj "08" nyob rau hauv Kev Txiav Txim Tus Nqi. Ob qhov "UD" hloov kho thiab "08" qhia DHCS tias 340B yuav tshuaj tau siv rau qhov kev thov. Peb qhov kev them nyiaj rov qab tshem tawm cov lus thov los ntawm cov tuam txhab tshuaj lag luam rov qab cov nqi them nyiaj kom ntseeg tau tias cov chaw tsim tshuaj tsis raug rau "tus nqi luv dua".
"EFT" yog dab tsi?
Qhov kev xaiv them nyiaj hauv Electronic Fund Transfer (EFT) tso cai rau cov neeg siv sau npe them lawv cov ntawv xa nyiaj rov qab tshuaj hauv hluav taws xob yam tsis tas yuav xa daim ntawv txheeb xyuas ib txwm muaj. Qhov kev xaiv yeem xav kom cov neeg tuaj koom ua raws li ib hom ntawv tshwj xeeb thaum xa cov ntaub ntawv hluav taws xob. Thov hu rau Drug Rebate Branch ntawm drugrebatebrach@dhcs.ca.gov, yog xav paub ntxiv txog yuav ua li cas rau npe rau EFT.
"EIS" yog dab tsi?
Electronic Interface System (EIS) tso cai rau cov tuam txhab lag luam muag tshuaj kom khaws cov ntawv xa nyiaj hauv peb lub hlis twg tam sim no thiab rub tawm 10 xyoo ntawm cov ntaub ntawv thov raws li cov ntawv them rov qab. Thov hu rau Drug Rebate Branch Portal team ntawm drugrebateportal@dhcs.ca.gov, yog xav paub ntxiv txog kev nkag mus rau qhov system.
Qhib Kev Thov los ntawm EIS System
Tom qab txuag cov ntaub ntawv thov them nyiaj txuas, siv 7-Zip kom rho tawm cov ntaub ntawv mus rau hauv cov ntawv nyeem uas tuaj yeem hloov mus rau Excel cov ntaub ntawv.
Cov txheej txheem ceeb toom yog dab tsi yog tias daim ntawv lo muaj NDC uas raug txiav?
Cov ntawv sau npe yuav tsum tau tshaj tawm hnub xaus rau CMS THIAB Thawj Cov Ntaub Ntawv Lub Tuam Txhab (FDB) nyob rau hauv qhov xwm txheej NDC raug txiav los xyuas kom meej tias cov ntaub ntawv Medi-Cal muaj cov ntaub ntawv tam sim no.
CMS txhais hnub txiav tawm rau cov nyiaj rov qab raws li:
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Hnub tim cov khoom raug tshem tawm ntawm lub chaw muag tshuaj; los yog
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Hnub tim ntawm lub txee lub neej (hnub kawg nws tuaj yeem muab faib) ntawm cov khoom muag kawg
Cov tuam txhab tshuaj yuav tsum tau tshaj tawm cov ntaub ntawv tus nqi rau cov tshuaj raug txiav rau plaub lub quarter dhau los ntawm hnub txiav tawm.
Puas yog cov ntawv thov xa los ntawm cov koom haum saib xyuas kev tswj hwm yuav raug them rov qab?
Yog lawm.
Tshooj 2501 ntawm Txoj Cai Saib Xyuas Nqis Nqis (ACA) tau hloov kho ntu 1927(b)(1)(A) ntawm Txoj Cai Xaus Saus xav kom cov tuam txhab lag luam "muab cov nyiaj them rov qab ... suav nrog (rau) cov tshuaj no tau muab xa mus rau cov tib neeg rau npe nrog Medicaid MCO yog tias lub koom haum muaj lub luag haujlwm rau kev pab them nqi ntawm cov tshuaj no." Thaum nqe 1927(b)(1)(A) ntawm Txoj Cai hais txog kev them nyiaj raws li lub xeev txoj kev npaj, cov lus hloov kho tsis txwv kev muab cov chaw tsim khoom ntxiv rov qab rau cov tshuaj nkaus xwb uas MCO tau them tus nqi. Thaum cov tshuaj tau muab xa mus rau Medicaid tau txais txiaj ntsig raws li kev tswj hwm kev saib xyuas, lub xeev tau them nyiaj rau MCO rau cov tshuaj. Txawm hais tias cov nqe lus them nqi sib tham raws li ib feem ntawm daim ntawv cog lus ntawm MCO thiab nws cov neeg muab kev koom tes los muab kev pab kho mob Medicaid, cov chaw tsim khoom muaj lub luag haujlwm rau kev them nyiaj rov qab rau cov neeg mob sab nraud uas tau muab xa mus rau Medicaid cov neeg tau txais txiaj ntsig hauv MCOs. DHCS tau pib sau cov nyiaj rov qab rau cov lus thov nrog rau hnub ua haujlwm ntawm Lub Peb Hlis 23, 2010, hnub ua haujlwm ntawm ACA.
Puas yog nws yuav tsum tau xa ROSI thiab/lossis PQAS nrog daim ntawv lo cov nyiaj them rov qab?
Yog lawm. Lub Chaw rau Medicare & Medicaid Services (CMS) xav kom Reconciliation of State Invoices (ROSI) thiab Cov Lus Qhia Ua Ntej Lub Plaub Hlis (PQAS) suav nrog txhua qhov kev them rov qab. Yog tsis muaj ROSI thiab/lossis PQAS, lub xeev yuav tsis muaj peev xwm tshaj tawm koj cov nyiaj them rov qab. Cov ntaub ntawv xav tau ntawm cov ntaub ntawv raug pom zoo los ntawm Tsoom Fwv Teb Chaws Chaw Tswj Xyuas thiab raug txib los ntawm CMS. Nws tseem yog qhov yuav tsum tau ua rau cov tuam txhab tshuaj suav nrog ROSI thiab / lossis PQAS rau cov nyiaj them rov qab ntxiv.
Xa cov tshev, ROSI, PQAS thiab lwm yam ntaub ntawv txhawb nqa mus rau DHC Kev Sau Npe Chaw nyob sau tseg rau ntawm koj Daim Ntawv Sau Npe Sau Npe.
Department of Health Care Services
Accounting Section
Medi-Cal
Tshuaj Rebate Accounts Receivable
MS 1101
PO Box 997415
Sacramento, CA 95899-7415
Txhawm rau kom ntseeg tau tias kev them nyiaj raug ua tiav, nws yuav tsum tau sab laj nrog koj Daim Ntawv Pov Thawj Ua Haujlwm rau cov ntaub ntawv nyiaj txiag. Kev them nyiaj cais yuav tsum muaj rau ntau qhov kev pab cuam.
Muaj pes tsawg tus neeg tau txais txiaj ntsig tau cuv npe hauv Medi-Cal tswj kev saib xyuas hauv California?
Rau cov ntaub ntawv saib xyuas kev tswj hwm, suav nrog cov ntaub ntawv sau npe, mus saib hauv Medi-Cal Managed Care webpage.
Kalifonias puas xav kom cov tuam txhab muag tshuaj them rov qab rau cov ntawv thov sib txuas?
Yog lawm. California cov txheej txheem kev thov nyiaj tau txais cov ntaub ntawv tsim nyog los them rov qab cov tuam txhab tshuaj rau cov nyiaj rov qab los txij lub Kaum Hli 2003. Txhawm rau kom ua raws li tsoomfwv cov cai, cov tuam txhab tshuaj yuav raug xa mus rau cov khoom sib txuas hauv xyoo 2014. Invoicing yuav rov qab mus rau xyoo 2003 thaum qhov kev thov ua haujlwm tau pib khaws cov ntaub ntawv.
Rov qab mus rau Medi-Cal Cov Nyiaj Them Nqi Tshuaj
