Medi-Cal Kev Nkag Mus Nkag Siab thiab Cov Txheej Txheem rau Cov Chaw Kho Mob uas tuav Daim Ntawv Kho Mob Kho Kho Kho Kho Kho Kho Kho Kho Kho Kho Kho Mob (CLIA) Daim Ntawv Pom Zoo
Cov lus nug nquag nug los ntawm Cov Neeg Koom Tes Hauv Lub Rooj Sib Hais rau Lub Rau Hli 10, 2025
Hauv qab no yog cov lus teb rau feem ntau ntawm cov lus nug uas Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tau txais thaum lub rooj sib hais ntawm cov koom nrog rau lub Rau Hli 10th. Yog tias koj tsis pom cov lus teb rau koj cov lus nug, thov xa email mus rau qhov chaw nyob email uas tsim nyog tau teev tseg hauv qab no:
Kev tso npe rau tus kws kho mob
1. Lub sijhawm ua haujlwm ntawm daim ntawv thov tshuaj tshiab yog dab tsi?
2. Puas yog ib lub chaw muag tshuaj uas muaj npe tam sim no yuav tsum tau xa daim ntawv thov ntxiv rau daim nqi rau CLIA qhov kev xeem zam?
Yog lawm, tam sim no cov chaw muab tshuaj rau npe tuaj yeem xa daim ntawv thov ntxiv nrog ib daim qauv siv tau ntawm lawv daim ntawv pov thawj CLIA thiab daim ntawv pov thawj tam sim no ntawm California Clinical Laboratory Registration. CLIA Certificate of Waiver thiab Certificate of California Clinical Laboratory Registration service address yuav tsum phim qhov chaw nyob ntawm qhov chaw tshiab lossis rau npe.
3. Puas yog daim ntawv tshaj tawm no tsuas yog siv rau cov chaw muab tshuaj lossis nws puas suav nrog cov tsev kho mob uas muaj cov chaw muag tshuaj hauv tsev uas muaj daim ntawv tso cai CLIA?
Cov ntawv tshaj tawm no siv rau txhua lub tsev muag tshuaj uas tuav daim ntawv pov thawj CLIA ntawm Kev Zam Txim thiab npaj siab yuav sau Medi-Cal rau cov kev pabcuam hauv chaw kuaj mob raws li nws tus lej chaw muag tshuaj yuav tsum ua raws li cov lus qhia hauv tsab ntawv tshaj tawm. Qhov no suav nrog cov khw muag tshuaj uas ua haujlwm ua cov chav sib txawv hauv ib lub chaw kho mob uas muaj ntawv tso cai.
4. Peb tseem tsis tau lees paub tias CLIA zam tsis tau; Nws yuav siv sij hawm ntev npaum li cas thiaj tau lees paub raws li CLIA waived Pharmacy?
5. Hais txog CLIA Certificate of Waiver, peb tuav daim ntawv pov thawj siv tau, tab sis peb tsis xyaum ua ib lub chaw kuaj mob ntxiv lawm txij li tus kab mob COVID-19 tau ploj mus lawm. Peb puas yuav tsum tso npe rau hauv qhov kev pab cuam Medi-Cal?
Tsis yog, tsis tas yuav tso npe kawm yog tias koj tsis ua CLIA-tso xeem. Cov ntawv xov xwm qhia meej tias yuav pib lub Yim Hli Ntuj 1, 2025, cov chaw muag tshuaj uas tuav daim ntawv pov thawj CLIA siv tau thiab daim ntawv pov thawj tam sim no ntawm California Clinical Laboratory Registration tej zaum yuav tau them nqi rau CLIA-tso cov kev xeem nyob rau hauv tus kws muag tshuaj qhov kev coj ua. Txawm li cas los xij, yog tias koj lub tsev muag tshuaj tsis ua qhov kev sim no lawm, kev tso npe hauv Medi-Cal rau lub hom phiaj no tsis tsim nyog.
6. Peb muaj CLIA zam raws li kev kuaj sim; puas muaj dabtsi rau peb ua ntawm no?
Tsis yog, yog tias koj twb tau cuv npe ua chav kuaj, koj tsis tas yuav xa daim ntawv thov ntxiv. Yog tias koj tsis yog ib lub chaw muag tshuaj, cov kev cai tshwj xeeb rau npe yuav tsis siv. Cov ntawv tshaj tawm tsuas yog siv rau cov chaw muab tshuaj nrog CLIA Daim Ntawv Pov Thawj Kev Zam. Yog tias koj lub chaw kuaj mob tsis ua haujlwm raws li lub chaw muab tshuaj, koj yuav tsis raug rau cov txheej txheem sau npe Medi-Cal tshwj xeeb uas suav nrog hauv daim ntawv tshaj tawm no.
Federally Qualified Health Centers (FQHC)
1. Qhov no puas suav nrog cov chaw kho mob (FQHC) uas muaj daim ntawv tso cai muag tshuaj rau lub tsev kho mob thiab nrog daim ntawv pov thawj CLIA, lossis lub chaw yuav tsum yog lub tsev muag tshuaj tshwj xeeb?
Cov kev cai rau npe kawm uas tau teev tseg hauv tsab ntawv tshaj tawm no siv tshwj xeeb rau cov chaw muab tshuaj. Cov ntawv xov xwm qhia txog cov txheej txheem rau cov chaw muag tshuaj uas tuav daim ntawv pov thawj CLIA ntawm Kev Zam, tsis yog FQHC's. Yog tias lub chaw kho mob FQHC npaj siab yuav sau nqi rau CLIA-tso kev xeem, lawv twb muaj peev xwm sau npe thiab sau nqi rau cov kev pabcuam no thiab yuav tsis tas yuav nqis tes ua ntxiv raws li daim ntawv tshaj tawm kev cai tswjfwm no.
2. Dab tsi yog qhov yuav tsum tau tso npe kawm thiab them nqi rau FQHCs uas cov kws muag tshuaj yuav xav sau nqi rau CLIA waived labs rau cov chaw noj qab haus huv uas (a) muaj lub tsev muag tshuaj kos rau hauv lawv qhov Prospective Payment System (PPS) tus nqi thiab (b) muaj lub tsev muag tshuaj kos tawm ntawm lawv tus nqi PPS?
Cov kev xav tau nyob ntawm seb cov kev pabcuam hauv tsev muag tshuaj puas suav nrog FQHC tus nqi PPS:
Pharmacy Carved Into PPS Rate: Yog tias cov kev pabcuam hauv tsev muag tshuaj suav nrog PPS tus nqi, CLIA-tso kev kuaj sim los ntawm cov kws muag tshuaj yuav tsum raug them nqi raws li ib feem ntawm FQHC ntsib. Cais cov nqi them rau cov kev xeem no nyob rau hauv ib lub tsev muag tshuaj naj npawb yog tsis tso cai. FQHC yuav tsum muaj daim ntawv pov thawj CLIA ua haujlwm ntawm Kev Zam Txim rau qhov chaw pabcuam qhov chaw kuaj mob.
Pharmacy Carved Out of PPS Rate: Yog tias cov chaw muag tshuaj raug muab tshem tawm, lub tsev muag tshuaj yuav tsum tau cais rau npe ua ib lub chaw muag tshuaj Medi-Cal thiab muaj CLIA Daim Ntawv Pov Thawj Ua Haujlwm rau qhov chaw pabcuam. Nyob rau hauv rooj plaub no, lub tsev muag tshuaj tuaj yeem sau nqi Medi-Cal ncaj qha rau CLIA-tso cov kev kuaj sim raws li qhov kev coj ua thiab tag nrho cov kev cai them nqi.
Nyob rau hauv ob qho xwm txheej, CLIA-tso kev xeem yuav tsum ua raws li lub xeev thiab tseem fwv cov cai, suav nrog daim ntawv tso cai tsim nyog thiab kev coj ua rau cov kws muag tshuaj.
Cov txiaj ntsig 1. Cov kev xeem CLIA Waiver yog dab tsi uas tam sim no Cov Tsev Muag Tshuaj muaj peev xwm ua tau?
Raws li Kev Lag Luam thiab Kev Ua Haujlwm (B&P) Txoj Cai Tshooj 4052.4 (b)(1)(A), cov kev xeem CLIA-waived no yuav tsum kuaj xyuas lossis tshuaj xyuas rau SARS-CoV-2 (COVID-19) lossis lwm yam mob ua pa, mononucleosis, kis kab mob sib deev, strep caj pas, anemia, kab mob plawv, kab mob raum, mob raum, mob raum, mob ntshav qab zib mellitus. Kev siv yeeb tshuaj, lossis ntshav qab zib.
Tsis tas li ntawd, cov kws muag tshuaj raug tso cai ua lwm yam kev xeem CLIA-raug zam uas raug zam raws li cov cai tswj hwm los ntawm tsoomfwv Saib Xyuas Nyiaj Txiag Saib Xyuas Kev Noj Qab Haus Huv thiab tau pom zoo los ntawm California State Board of Pharmacy, koom nrog Pawg Saib Xyuas Kev Kho Mob ntawm California thiab CDPH, raws li tau hais hauv B&P Code Tshooj 4052.4 (b)(1)(B). Cov kev ntsuam xyuas uas cov kws muag tshuaj yuav ua tau yuav tsum tsis txhob siv cov khoom uas sau los ntawm qhov chaw mos swab, venipuncture, los yog sau cov kua dej seminal.
2. Cov kev pabcuam no puas suav nrog Medi-Cal Medi-Cal Managed Care Organizations (MCOs) thiab/lossis Cov Kws Kho Mob ywj pheej (IPAs)?
Tsab ntawv xov xwm no siv tshwj xeeb rau cov kws kho mob sau npe thiab sau nqi-rau-kev pabcuam (FFS) Medi-Cal rau CLIA-tso kev xeem. Cov khw muag tshuaj nrhiav kev tso npe thiab sau nqi raws li FFS Medi-Cal yuav tsum ua raws li cov kev cai uas tau teev tseg hauv tsab ntawv tshaj tawm. Cov ntawv xov xwm tsis siv rau cov chaw muab kev them nqi los ntawm MCOs lossis IPAs, uas tej zaum yuav muaj cov txheej txheem sau npe thiab sau nqi.
Kev Them Nqi & Cov Nyiaj Them Rov Qab
1. Cov nyiaj them rov qab Medi-Cal yog dab tsi (cov nqi teem caij) rau cov kev xeem no?
2. Puas yog qhov no tau kos tawm FFS zoo ib yam li Kev Tswj Xyuas Tshuaj Kho Mob (MTM)?
Raws li Txoj Cai Tswjfwm N-01-19 cov chaw muag tshuaj raug muab tshem tawm, yog li txhua lub tsev muag tshuaj uas tau them nqi Medi-Cal rau cov chaw muag tshuaj tau tso npe rau hauv FFS Medi-Cal. Yog li ntawd, tsab ntawv tshaj tawm no yuav siv tau rau txhua lub tsev muag tshuaj uas tau tso npe rau hauv FFS Medi-Cal, los ntawm kev xa daim ntawv thov tag nrho rau kev cuv npe tshiab lossis xa daim foos ntxiv yog tias tus kws kho mob twb tau cuv npe lawm. Cov chaw muab tshuaj yuav tuaj yeem sau nqi FFS Medi-Cal rau cov kev pabcuam no.
Qhov no tsis zoo li MTM. MTM Pharmacy Services yuav tsum tau them nqi los ntawm Medi-Cal cov chaw muag tshuaj kho mob sab nraud thiab lub tsev muag tshuaj yuav tsum muaj daim ntawv cog lus ntxiv nrog DHCS los muab cov kev pabcuam MTM.
3. Koj puas tuaj yeem qhia meej tias lub sijhawm them nqi Medi-Cal tam sim no tau tsim kho li cas rau cov chaw muag tshuaj ua cov kev xeem CLIA-tso, thiab seb cov nqi puas cuam tshuam txog cov nqi ua haujlwm tiag tiag thiab lub sijhawm kho mob cuam tshuam nrog cov kev pabcuam no?
4. Koj puas tuaj yeem hais meej yog tias cov kev pabcuam them rov qab yog rau tus nqi ntawm kev xeem CLIA zam lossis nws puas suav nrog lub sijhawm rau kev soj ntsuam kuaj mob thiab/lossis kev kho lossis kev xa mus raws li cov txiaj ntsig?
5. Yuav kom paub meej, peb yuav muaj peev xwm them nqi kuaj rau txhua tus neeg mob tab sis tsis yog kev pabcuam thaum tus neeg mob muaj MCO raws li lawv txoj kev npaj khomob?
Cov khw muag tshuaj tuaj yeem sau nqi Medi-Cal rau CLIA-tso cov kev xeem tsuas yog rau cov neeg mob cuv npe hauv tus nqi-rau-kev pabcuam Medi-Cal. Yog tias tus neeg mob tau cuv npe hauv Medi-Cal MCO, kev them nyiaj rov qab rau CLIA-tso kev xeem yuav tsum ua raws li cov cai thiab cov txheej txheem ntawm cov phiaj xwm kho mob tshwj xeeb ntawd. MCOs tsim lawv tus kheej cov chaw muab kev pabcuam thiab cov nqi them nqi, thiab kev pab them nqi ntawm CLIA-tso kuaj yuav txawv.
Cov tsev muag tshuaj yuav tsum txheeb xyuas tus neeg mob txoj kev npaj rau npe kawm thiab hu rau MCO uas tsim nyog los txiav txim seb qhov nqi them rau CLIA-tso kuaj tau tso cai thiab nyob rau hauv cov xwm txheej twg.
6. Peb yuav tsum hu rau leej twg rau cov lus nug ntsig txog kev them nyiaj thiab kev tsis sib xws uas tshwm sim los ntawm Kev Sib Tham Bill (AB) 1114 hloov lub luag haujlwm?
Rau cov lus nug ntsig txog kev them nyiaj thiab kev tsis sib xws uas tshwm sim hauv AB 1114, thov hu rau:
- Pharmacy Benefits Division (rau Medi-Cal Rx thiab carve-out guidance):
- CA-MMIS Help Desk (rau qhov tsis lees paub qhov kev thov thiab cov lus nug txog kev them nqi):
