Certified Mastectomy Fitter Application
CMF cov neeg muab kev pabcuam ua haujlwm nyob rau hauv lub peev txheej ntawm lawv cov kev coj ua yuav tsum tau thov rau kev tso npe rau hauv Medi-Cal Fee-For-Service program ntawm PAVE (Kev Pabcuam Kev Thov thiab Kev Pabcuam rau Kev Sau Npe) raws li cov tib neeg, pab pawg neeg muab kev pabcuam, lossis cov chaw muab kev pabcuam, thiab yuav raug xaiv. tib hom kws kho mob xws li Prosthetists, raws li tau hais tseg hauv California Txoj Cai Tswjfwm Ntiag Tug (CCR), Title 22, Tshooj 51103.
Raws li Welfare & Institutions Code (W & I Code) Seem 14043.75(b), DHCS tau tsim cov ntawv thov tshwj xeeb thiab kev tso npe nkag rau cov kws kho mob CMF uas thov rau npe rau hauv qhov kev pab cuam Medi-Cal kom tau them rov qab rau cov kev pab cuam uas lawv muab rau cov neeg tau txais txiaj ntsig Medi-Cal. Thov siv cov ntawv xov xwm hu ua, “Medi-Cal Kev Nkag Mus Rau Npe thiab Cov Txheej Txheem rau Certified Mastectomy Fitters” yog xav paub ntxiv.
Daim ntawv pov thawj
Ua ntej ua ntawv thov rau Medi-Cal, ua ntej kos lub American Board rau Certification hauv Orthotics thiab Prosthetics kom ntseeg tau tias koj ua tau raws li qhov yuav tsum tau muaj ntawv pov thawj. Txhawm rau tso npe ua tus kws kho mob CMF hauv Tus Nqi-Rau-Service Medi-Cal, txhua tus kws kho mob mastectomy yuav tsum tau lees paub tam sim no nrog American Board rau Certification hauv Orthotics, Prosthetics & Pedorthics lossis Board of Certification/Accreditation.
Cov ntaub ntawv xav tau
Sau cov ntaub ntawv xav tau hauv qab no, raws li tsim nyog, thiab muab tso rau hauv daim ntawv thov ua tiav. Thov xyuas kom meej tias cov ntaub ntawv txuas nrog yog qhov tseeb.
- Daim ntawv pov thawj raws li Mastectomy Fitter los ntawm American Board for Certification in Orthotics, Prosthetics & Pedorthics los yog Board of Certification/Accreditation.
- Daim Ntawv Tso Cai Tsav Tsheb lossis daim npav qhia tawm hauv lub xeev (tso tawm nyob rau hauv 50 Tebchaws Meskas lossis Cheeb Tsam ntawm Columbia) ntawm tus kws kho mob, lossis tus neeg kos npe rau daim ntawv thov uas muaj txoj cai khi rau tus neeg thov lossis tus muab kev pabcuam. Daim ntawv kos npe yuav tsum yog tus muab kev pabcuam, tshwj tsis yog tus neeg muab kev pabcuam yog lub koomhaum. Yog tias tus kws kho mob yog ib lub tuam txhab thiab daim ntawv thov yuav raug kos npe los ntawm ib tus neeg uas tsis yog tus muab kev pabcuam, thov xa ib daim ntawv theej ntawm ntu ntawm lub tuam txhab txoj cai lij choj uas txheeb xyuas tus neeg kos npe txoj cai rau kev cai lij choj lub koom haum.
- Yog tias tsis siv tus lej social security, thov daim ntawv pov thawj Federal Employer Identification Number (FEIN) lossis Individual Taxpayer Identification Number (ITIN), los ntawm kev xa daim ntawv Internal Revenue Service (IRS) uas tau tsim tawm tam sim no. Cov ntaub ntawv uas siv tau tsuas yog muaj xws li Tsab Ntawv 147-C uas IRS tsim, Daim Ntawv 941 uas IRS tsim (Daim Ntawv Se Rov Qab Los Ntawm Tus Tswv Haujlwm Lub Peb Hlis), Daim Ntawv 8109-C (Daim Coupon Tso Nyiaj) uas IRS tsim, lossis Daim Ntawv SS-4 uas IRS tsim (tsuas yog Daim Ntawv Ceeb Toom Txog Kev Muab FEIN/ITIN rau xwb). Lus Cim: Lub npe raug cai ntawm tus neeg thov lossis tus neeg muab kev pabcuam hauv daim ntawv thov yuav tsum phim lub npe ntawm daim ntawv IRS tsim; thiab tus neeg thov/tus neeg muab kev pabcuam yuav tsum yog tus tswv lossis tus tub ceev xwm ntawm lub koom haum uas teev nyob rau hauv daim ntawv IRS. Yog xav paub ntxiv, thov mus saib
IRS los yog hu rau lawv ntawm (800) 829-4933. - Daim Ntawv Tso Cai Ua Lag Luam Hauv Zos, Daim Ntawv Pov Thawj Se, thiab Daim Ntawv Tso Cai rau txhua lub nroog thiab/lossis lub nroog uas ua lag luam. Lus Cim: Lub npe thiab chaw nyob ua lag luam ntawm tus neeg thov lossis tus neeg muab kev pab uas nyob rau hauv daim ntawv thov yuav tsum phim lub npe ua lag luam thiab chaw nyob ua lag luam uas nyob rau hauv txhua daim ntawv tso cai thiab daim ntawv tso cai hauv zos. Yog tias tsis tas yuav muaj daim ntawv tso cai ua lag luam, thov xa ib daim ntawv sau los ntawm koj lub nroog/lub nroog hauv zos uas qhia tias koj lub lag luam tsis tas yuav muaj daim ntawv tso cai lossis daim ntawv tso cai. Yog xav paub ntxiv, thov hu rau koj lub chaw ua haujlwm tso cai ua lag luam hauv nroog thiab/lossis mus saib lub vev xaib ntawm
California State Association of Counties thiab nyem rau ntawm qhov txuas "California's Counties", thiab xaiv "Counties Web Sites." - Daim Ntawv Qhia Txog Lub Npe Lag Luam Cuav (FBNS) uas tau sau/muab luam tawm , uas lub nroog uas qhov chaw ua lag luam tseem ceeb nyob, yog tias siv lub npe lag luam cuav THIAB lub npe lag luam txawv ntawm lub npe raug cai ntawm koj daim ntawv thov. Piv txwv li, yog tias muaj ib lub koom haum, txhua lub npe uas tsis yog lub npe koom haum uas tau sau tseg nrog Tus Tuav Ntaub Ntawv ntawm Lub Xeev yuav tsum muaj FBNS. Lus Cim: Lub npe lag luam thiab chaw nyob ua lag luam ntawm tus neeg thov lossis tus neeg muab kev pabcuam rau ntawm daim ntawv thov, txhua daim ntawv tso cai ua lag luam hauv zos, thiab FBNS yuav tsum sib xws. Yuav kom paub txog lub koom haum hauv nroog uas siv tau cov npe lag luam cuav, thov mus saib lub vev xaib ntawm
California State Association of Counties thiab nyem rau ntawm qhov txuas "California's Counties", thiab xaiv "Counties Web Sites." - Daim Ntawv Tso Cai Muag Khoom uas tau muab los ntawm Pawg Neeg Saib Xyuas Kev Sib Luag ntawm Xeev California, yog tias siv tau. Lus Cim: Lub npe lag luam thiab chaw nyob ua lag luam ntawm tus neeg thov lossis tus neeg muab kev pabcuam uas nyob rau hauv daim ntawv thov yuav tsum phim lub npe lag luam thiab chaw nyob ua lag luam uas nyob rau hauv daim ntawv tso cai ntawm tus neeg muag khoom. Yog xav paub ntxiv, hu rau
Pawg Neeg Saib Xyuas Kev Sib Luag ntawm (916) 445-6362 lossis mus saib lawv lub vev xaib "Sales & Use Tax". - Ua tiav Daim Ntawv Pom Zoo Sib Koom Tes, yog tias koj lub lag luam yog kev koom tes. Kev ua haujlwm qeeb yuav raug zam los ntawm kev qhia seb lub koom haum puas yog General Partnership lossis Limited Partnership thiab tseem xa cov hauv qab no:
- a) Rau General Partnership, ib daim ntawv teev npe ntawm txhua tus neeg koom tes nrog feem pua ntawm cov tswv cuab lossis tswj cov paj laum rau txhua tus; los yog
- b) Rau Kev Koom Tes Ua Lag Luam Txwv, cov ntaub ntawv txheeb xyuas tus khub General thiab cov npe ntawm txhua tus neeg koom tes nrog feem pua ntawm cov tswv cuab lossis tswj kev txaus siab rau txhua tus.
- Yog xav paub ntxiv txog koj txoj kev koom tes, thov mus saib
Tus Tuav Ntaub Ntawv ntawm Lub Xeev California Business Portal thiab nias rau ntawm qhov txuas "California Business Search" lossis lwm qhov txuas uas tsim nyog.
- Yog tias koj lub lag luam yog ib lub koom haum, kev ncua sijhawm ua tiav yuav raug zam los ntawm kev muab daim ntawv theej ntawm Cov Lus Cog Tseg ntawm Lub Koom Haum los ntawm Tus Tuav Ntaub Ntawv ntawm Lub Xeev, thiab daim ntawv teev cov thawj coj thiab cov tub ceev xwm lub npe thiab lub npe, nrog rau feem pua ntawm kev muaj thiab kev tswj hwm rau txhua tus. Yog xav paub ntxiv txog koj lub koom haum, thov mus saib
Tus Tuav Ntaub Ntawv ntawm Lub Xeev California Business Portal thiab nias rau ntawm qhov txuas "California Business Search" lossis lwm qhov txuas uas tsim nyog. - Daim ntawv pov thawj ntawm Commercial Liability Insurance (kev lag luam, kev lag luam, lossis kev lav phib xaub, lossis kev tuav pov hwm hauv chaw ua haujlwm) hauv tus nqi tsis tsawg dua $ 100,000 rau ib daim ntawv thov thiab qhov tsawg kawg nkaus txhua xyoo ntawm $ 300,000. Kev lees paub lees paub yog pov thawj ntawm kev tuav pov hwm tus kheej, lossis daim ntawv pov thawj ntawm kev tuav pov hwm lossis daim ntawv tshaj tawm uas muab los ntawm lub tuam txhab pov hwm uas muaj lub npe ntawm lub tuam txhab pov hwm, lub npe thiab chaw nyob ua lag luam ntawm cov ntawv pov hwm, hnub siv tau, thiab kev txwv ntawm kev pov hwm. Nco tseg: Lub npe thiab chaw nyob ua lag luam, suav nrog tus lej suite yog tias tsim nyog, ntawm tus neeg thov lossis tus neeg muab kev pabcuam hauv daim ntawv thov yuav tsum ua raws nraim li tus neeg tuav pov hwm lub npe thiab chaw nyob ntawm daim ntawv pov thawj ntawm kev tuav pov hwm lossis daim ntawv tshaj tawm.
- Certificate of Professional Liability Insurance nyob rau hauv ib tug npaum li cas ntawm tsis tsawg tshaj li $100,000 ib daim ntawv thov thiab ib tug yam tsawg kawg nkaus txhua xyoo ntawm $300,000. Kev lees paub lees paub yog daim ntawv pov thawj ntawm kev tuav pov hwm lossis daim ntawv tshaj tawm uas muab los ntawm lub tuam txhab pov hwm uas muaj lub npe ntawm lub tuam txhab pov hwm, lub npe ntawm cov ntawv pov hwm, hnub siv tau, thiab kev txwv ntawm kev pov hwm. Nco tseg: Tus kws kho mob lub npe, raws li nws tshwm nyob rau hauv daim ntawv pov thawj mastectomy fitter, yuav tsum tau qhia nyob rau hauv kev txheeb xyuas ntawm kev pov hwm kev lav phib xaub.
- Certificate of Workers 'Compensation Insurance yog xav tau los ntawm California txoj cai lij choj, yog tias koj lub lag luam muaj ib lossis ntau tus neeg ua haujlwm. Kev lees paub lees paub yog pov thawj ntawm kev tuav pov hwm tus kheej, lossis daim ntawv pov thawj ntawm kev tuav pov hwm lossis daim ntawv tshaj tawm uas muab los ntawm lub tuam txhab pov hwm uas muaj lub npe ntawm lub tuam txhab pov hwm, lub npe thiab chaw nyob ua lag luam ntawm cov ntawv pov hwm, thiab hnub siv tau. Yog tias tsis muaj kev pov hwm them nyiaj rau Cov Neeg Ua Haujlwm, yuav tsum muaj lus piav qhia. Nco tseg: Lub npe thiab chaw nyob ua lag luam ntawm tus neeg thov lossis tus neeg muab kev pabcuam yuav tsum ua raws nraim li cov ntawv pov hwm lub npe thiab chaw nyob ntawm daim ntawv pov thawj ntawm kev pov hwm.
- Kos Npe Daim Ntawv Pom Zoo, yog tias thaj chaw lag luam tsis yog los ntawm tus neeg thov lossis tus muab kev pabcuam. Nco tseg: Lub npe thiab chaw nyob ua lag luam ntawm tus neeg thov lossis tus neeg muab kev pabcuam yuav tsum ua raws nraim li tus neeg xauj tsev lub npe thiab chaw nyob ntawm daim ntawv cog lus xauj tsev.
- Successor Liability with Joint and Several Liability Agreement (DHCS 6217), if applicable.
Cov ntawv
Txhua tus neeg thov CMF thov kev txiav txim siab rau npe rau hauv qhov kev pab cuam Medi-Cal yuav tsum ua kom tiav thiab xa lawv daim ntawv thov ntawm PAVE.
Nco tseg rau Board Certified Orthotist thiab Prosthetist Providers
Certified Prosthetists, uas tau cuv npe hauv Medi-Cal qhov kev pab cuam tam sim no tuaj yeem muab cov kev pabcuam CMF rau cov neeg tau txais kev pabcuam uas tsim nyog tau txais kev pabcuam thiab sau nqi DHCS rau hnub ua haujlwm rau lossis tomqab hnub tso npe.
Certified Orthotists, uas tau cuv npe hauv Medi-Cal Program thiab dhau los ua Pawg Thawj Coj tau lees paub tias yog Mastectomy Fitter thiab xav muab cov kev pabcuam no, tuaj yeem xa daim ntawv thov hloov pauv ntxiv ntawm PAVE los tshaj tawm lawv daim ntawv pov thawj tshiab thiab yuav tsum xa ib daim qauv ntawm lawv cov Mastectomy siv tau Fitter daim ntawv pov thawj.
CMF cov uas tau cuv npe hauv Medi-Cal qhov kev pab cuam, thiab yav tom ntej los ua Board Certified in Orthotics lossis Board Certified in Prosthetics thiab xav muab cov kev pabcuam no, tuaj yeem xa daim ntawv thov hloov pauv ntxiv ntawm PAVE los tshaj tawm cov ntawv pov thawj tshiab thiab xa ib daim qauv. ntawm nws.