Tsev Cov Chaw Muab Kev Pabcuam & Cov Neeg Koom Tes Cov Lus Nug Feem Ntau Txog Kev Them Rov Qab Tshuaj Medi-Cal​​ 

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?​​ 

Cov nyiaj rov qab "Medi-Cal" yog cov kev pab cuam Medicaid rov qab ntawm tsoomfwv California. Medi-Cal yog California txoj kev pab cuam kev noj qab haus huv uas muab kev pab them nqi kho mob pub dawb lossis pheej yig rau cov neeg nyob hauv California uas ua tau raws li cov cai tsim nyog. Cov chaw tsim tshuaj yuav tsum tau them tus nqi rov qab rau txhua cov tshuaj kho mob sab nraud uas Lub Xeev txoj haujlwm Medi-Cal tau muab thiab them rau. Kev them nqi rau cov nyiaj rov qab los ntawm tshuaj tau pib lub Ib Hlis Ntuj hnub tim 1, 1991 thiab txuas ntxiv mus txog hnub no.​​ 

Cov nyiaj rov qab "Medi-Cal ntxiv" yog dab tsi?​​ 

Cov nyiaj rov qab "Medi-Cal ntxiv" yog cov nyiaj rov qab ntxiv uas cov chaw tsim tshuaj tau pom zoo them rau lub xeev. Cov nyiaj rov qab ntxiv yog raws li kev siv tib yam li qhov kev pab cuam txo nqi ntawm tsoomfwv. Cov chaw tsim tshuaj uas tau pom zoo them cov nyiaj rov qab ntxiv tau suav nrog rau hauv Daim Ntawv Teev Tshuaj Cog Lus ntawm Lub Xeev (CDL). Feem ntau, cov khoom no tsis tas yuav tsum tau kev tso cai ua ntej. Lub Chaw Haujlwm Cog Lus Tshuaj ntawm Lub Tsev Muag Tshuaj muaj lub luag haujlwm los tswj hwm qhov kev pab cuam thiab kev sib tham txog cov ntawv cog lus. Yuav tsum tau them cov nyiaj rov qab ntxiv rau txhua qhov kev pab cuam hauv tsoomfwv tshwj tsis yog siv los ntawm cov koom haum tswj kev saib xyuas (MCOs). Cov nyiaj rov qab ntxiv tau yog ib feem ntawm California txoj kev pab cuam nyiaj rov qab txij li xyoo 1991 los. Ua ntej xyoo 1997, cov nyiaj rov qab ntxiv tau suav ua feem pua ntawm Tus Nqi Nruab Nrab ntawm Chaw Tsim Khoom (AMP) rau txhua yam tshuaj uas them. Txawm li cas los xij txij li xyoo 1997, cov ntawv cog lus tau sib tham txog cov tshuaj tshwj xeeb. Tam sim no California muaj ob hom ntawv cog lus ntxiv: Net Cost thiab AMP. Cov ntawv cog lus ntxiv muaj feem cuam tshuam rau txhua qhov kev pab cuam txo nqi tshwj tsis yog cov koom haum tswj hwm kev saib xyuas (MCO) uas tau tsim nyog tau txais kev txo nqi hauv xyoo 2010.​​ 

Puas yog cov nyiaj rov qab ntxiv yuav raug them cov paj laum?​​ 

Yes. Section 14105.33 of the Welfare & Institutions Code was amended in 1997 allowing state supplemental contracts to include interest and penalty provisions. Contracts include the following:​​ 

  • 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.​​ 
  • 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. Pib txij lub quarterthib 4 xyoo 2001, DHCS tau pib xa cov ntawv them nqi ntxiv rau cov neeg sau daim ntawv. Ua ntej lub Kaum Hli Ntuj xyoo 2001, cov neeg sau daim ntawv lo rau daim ntawv pov hwm tau raug qhia kom suav cov nyiaj rov qab ntxiv los ntawm kev 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:​​ 

  • Txoj Cai Kev Noj Qab Haus Huv thiab Cov Tsev Kawm Ntawv (W&I) Tshooj 14105. Muaj cov ntaub ntawv hais txog Medi-Cal Drug Rebate Program.​​ 
  • Senate Bill 391, 1997 Amended W & I Code 14105.33. Authorized the State to charge interest and a penalty for late state supplemental rebate payments. (Effective date 10/1/97)​​ 

Yog xav nkag mus rau W & I Code, mus saib lub vev xaib California Legislative Information, thiab xaiv lub pob uas muaj lub npe hu ua "California Law," ces xaiv Welfare and Institutions Code. Tom ntej no nkag mus rau ib ntu, xaiv lub pob "Enter" los tshawb nrhiav.​​ 

Hom kev pab cuam twg koom nrog hauv Department of Health Care Services Drug Rebate Program?​​ 

California invoices drug manufacturers for all federal Medicaid programs, including those incorporated by waiver. In addition, manufacturers receive supplemental invoices if they have entered into a contract with the State. Programs for which rebates are due include: Medi-Cal (FFS, COHS, Managed Care Organizations (MCOs)), CCS/Healthy Families, GHPP, Blood Factors, FPACT and BCCTP. Separate invoices are mailed for pharmacy, PADs and compound claims for many of the programs.​​ 

"FPACT" yog dab tsi?​​ 

Kev Npaj Tsev Neeg, Kev Nkag Mus, Kev Saib Xyuas, thiab Kev Kho Mob (FPACT) yog ib qho kev pab cuam ntawm Lub Xeev xwb txog rau lub Kaum Ob Hlis 1, 1999 thaum CMS tau pom zoo rau California txoj kev zam 1115. Yog li ntawd, qhov kev pab cuam tau tsim nyog rau Title XIX nyiaj pab. Txij li thaum 4Q1999, lub Xeev tau pib sau nqi rau cov nyiaj rov qab. Tom qab tau txais kev pom zoo ntawm daim ntawv tso cai, qhov kev pab cuam FPACT kuj tsim nyog tau txais cov nyiaj rov qab ntxiv. Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv tau xa daim Ntawv Hloov Kho Txoj Kev Npaj Hauv Xeev (SPA) los hloov qhov kev zam FPACT tam sim no mus rau hauv Txoj Kev Npaj Hauv Xeev Medi-Cal. Daim SPA tau txais kev pom zoo rau lub Peb Hlis 24, 2011 los ntawm CMS. Raws li CMS tau pom zoo, SPA tau hloov daim ntawv tso cai FPACT mus rau hauv Txoj Kev Npaj ntawm Lub Xeev nrog hnub pib siv rov qab rau lub Xya Hli 1, 2010. Cov ntaub ntawv ntxiv muaj nyob rau ntawm nplooj ntawv web ntawm FPACT program.​​ 

"Tshuaj uas kws kho mob muab (PAD)" yog dab tsi?​​ 

Cov tshuaj uas kws kho mob muab rau yog cov tshuaj uas tus neeg mob sab nraud them uas tau muab lossis muab rau tus neeg tau txais, thiab tus neeg muab kev pab uas tsis yog lub tsev muag tshuaj them nqi. Cov chaw muab kev pab no suav nrog, tab sis tsis txwv rau, cov chaw ua haujlwm kws kho mob, cov chaw kho mob thiab cov tsev kho mob. Cov tshuaj kho mob sab nraud uas them nqi yog txhais dav dav tias yog cov tshuaj uas tsuas yog muab tau raws li daim ntawv sau tshuaj xwb, thiab tau txais kev pom zoo rau kev nyab xeeb thiab kev ua haujlwm zoo ua cov tshuaj uas tau sau tshuaj raws li Txoj Cai Khoom Noj, Tshuaj thiab Tshuaj Pleev Xim ntawm Tsoom Fwv Tebchaws. Cov tshuaj uas kws kho mob muab rau suav nrog cov tshuaj txhaj thiab cov tshuaj uas tsis txhaj.​​ 

"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 are Family Planning Access Care and Treatment (FPACT) Physician Administered Drug (PAD) claims. These are claims from non-pharmacy providers. Usually the claim is submitted by a clinic, but not always. The claim requires a HCPCS code, the NDC and a “UD” modifier if filled with a 340B purchased drug.​​ 

What is a “COHS”?​​ 

Lub Koom Haum Saib Xyuas Kev Noj Qab Haus Huv Hauv Lub Nroog (COHS) yog ib lub koom haum pej xeem uas tsis yog rau kev khwv nyiaj, ywj pheej uas cog lus nrog Lub Xeev los tswj hwm cov txiaj ntsig Medi-Cal los ntawm cov neeg muab kev pabcuam hauv zos thiab/lossis Cov Koom Haum Saib Xyuas Kev Noj Qab Haus Huv. COHS tau yog ib feem ntawm qhov kev pab cuam Medi-Cal txij li thaum CMS tau pom zoo thawj txoj kev npaj COHS hauv xyoo 1983. COHS tau yog ib feem ntawm qhov kev pab cuam them rov qab txij li xyoo 1991 thiab tau txais daim ntawv them nqi 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.​​ 

  1. “CalOPTIMA” – Orange County​​ 
  2. “Central California Alliance for Health” - Santa Cruz, Monterey thiab Merced counties​​ 
  3. “Health Plan of San Mateo” – San Mateo County​​ 
  4. "Partnership Health Plan" - Napa, Solano, Yolo, Sonoma, Marin, Mendocino, Del Norte, Humboldt, Lake, Lassen, Modoc, Shasta, Siskiyou thiab Trinity counties.​​ 
  5. "CenCal" - Lub nroog Santa Barbara thiab San Luis Obispo​​ 
  6. “Txoj Kev Npaj Kho Mob Hauv Gold Coast” — Ventura County​​ 

"CCS/GHPP" yog dab tsi?​​ 

California Children’s Services (CCS) yog ib qho kev pab cuam uas kho cov menyuam yaus uas muaj qee yam kev txwv lub cev thiab tej yam mob lossis kab mob ntev. Qhov Kev Pab Cuam Rau Cov Neeg Muaj Kev Tsis Taus caj ces (GHPP) yog ib qho kev pab cuam kev noj qab haus huv rau cov neeg laus uas muaj qee yam kab mob caj ces. CMS tau pom zoo rau qhov kev zam tsis pub siv Medicaid program, uas siv tau rau lub Cuaj Hlis 01, 2005, uas tso cai rau Lub Xeev xa daim ntawv them nqi rau cov chaw tsim 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.​​ 

Cov "Cov Yam Ntshav" yog dab tsi?​​ 

Blood Factors or Factor 8 is an essential blood-clotting protein, also known as anti-hemophilic factor (AHF). DHCS invoices drug manufacturers on separate invoices for drugs that are used to treat blood factor diseases. Providers of AHF drugs are reimbursed at their acquisition cost plus 20 percent.​​ 

BCCTP yog dab tsi?​​ 

Breast Cancer and Cervical Treatment Program (BCCTP) provides cancer treatment for eligible low-income California residents who are screened by Cancer Detection Program: Every Woman Counts (CDP:EWC) or Family Planning Access Care and Treatment (FPACT) programs and found to be in need of treatment for breast and/or cervical cancer. Assembly bill (AB) 430, (Chapter 171, Statutes of 2001) provided the State with statutory authority to implement the optional federal Breast and Cervical Cancer and Treatment Act of 2000. California’s SPA was approved by the federal government with an effective date of January 1, 2000. Drug manufacturers have been required to pay rebates since the program was included in California’s Medicaid State Plan. Visit the BCCTP webpage for more information.​​ 

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:​​ 

  • Tus Nqi Siv Tshuaj Hauv Tebchaws (NADAC), lossis Tus Nqi Muag Khoom Muag (WAC) + 0% yog tias tsis muaj NADAC,​​ 
  • Federal Upper Limit (FUL), los yog​​ 
  • 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 ib txwm muaj rau cov koom haum tswj kev saib xyuas (MCOs) los muab cov nyiaj rov qab tsawg lossis tsis muaj nyiaj rov qab rau ntawm daim ntawv thov. Daim Ntawv Ceeb Toom Txog Kev Them Rov Qab Tshuaj Medicaid ntawm CMS rau Cov Chaw Tsim Khoom Tshaj Tawm No. 84 hais txog qhov teeb meem ntawm kev them rov qab tsawg lossis tsis muaj nyiaj rov qab rau cov kev thov MCO. Raws li CMS, cov nyiaj rov qab tseem tshuav txawm tias daim ntawv them nqi MCO tsis qhia txog tus nqi them vim tias tus nqi tshuaj yog ib feem ntawm cov nyiaj them uas Lub Xeev tau them rau MCO. Yog li ntawd, tus nqi them rov qab yuav tsum tsis txhob siv los sib cav txog kev siv vim nws tsis muaj feem cuam tshuam rau cov chav nyob.​​ 

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 neeg sau daim ntawv lo uas muaj Daim Ntawv Cog Lus Rov Qab Tshuaj Ntxiv ntawm Xeev AMP nrog California thiaj li yuav tsum muab cov ntaub ntawv AMP. Daim ntawv cog lus yuav tsum tau xa cov ntaub ntawv AMP txhua peb lub hlis kom suav tau tus nqi rov qab them ib chav tsev (URA) rau lub hom phiaj ntawm daim ntawv them nqi. Cov ntaub ntawv AMP yuav tsum tau muab rau txhua NDC rau txhua peb lub hlis 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 xa mus rau California Department of Health Care Services (DHCS) tus neeg nruab nrab nyiaj txiag, Gainwell Technologies, LLC (Gainwell), tsis pub dhau 30 hnub tom qab xaus txhua peb lub hlis. Lub sijhawm kawg no zoo ib yam li CMS lub sijhawm kawg rau txoj haujlwm txo nqi tshuaj ntawm tsoomfwv.​​ 

Yog tias kuv tsis xa cov ntaub ntawv AMP raws sijhawm, yuav ua li cas?​​ 

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?​​ 

Cov ntaub ntawv AMP rau cov ntawv cog lus ntxiv raug xa mus rau Gainwell. Cov ntaub ntawv AMP yuav tsum tau xa tuaj tsis pub dhau 30 hnub tom qab xaus lub quarter. Thov hu rau Drug Rebate Branch ntawm drugrebatebranch@dhcs.ca.gov, kom tau cov lus qhia txog kev xa cov ntaub ntawv AMP.​​ 

Yuav ua li cas yog kuv AMP hloov?​​ 

Yog tias tus neeg sau daim ntawv lo AMP hloov pauv rau ib lub sijhawm raws li daim ntawv cog lus, tus neeg sau daim ntawv lo yuav tsum xa daim ntawv lo AMP uas hloov kho tshiab ntawd mus rau Gainwell. Cov ntaub ntawv AMP raug xa mus rau tib txoj kev li AMP thawj zaug tau xa mus. Thov hu rau Drug Rebate Branch ntawm drugrebatebranch@dhcs.ca.gov, kom tau cov lus qhia 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 xyuas cov nyiaj rov qab yuav tiv tauj tus neeg sau daim ntawv lo yog tias muaj teeb meem nrog cov ntaub ntawv AMP xa tuaj.​​ 

Yog tias kuv nrhiav tsis tau daim ntawv cog lus ntxiv ntawm kuv lub xeev, yuav ua li cas?​​ 

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?​​ 

Txoj kev pab cuam txo nqi tshuaj tau hloov kho los ntawm Veterans Health Care Act of 1992 (VHCA). Raws li VHCA, Congress tau tsim qhov kev pab cuam 340B uas yog tswj hwm los ntawm tsoomfwv qib siab Health Resources and Services Administration (HRSA), Office of Pharmacy Affairs (OPA). Qhov kev pab cuam 340B yuav tsum tau kom cov chaw tsim tshuaj uas cov kev pab cuam Medicaid hauv xeev them rau kom nkag mus rau hauv daim ntawv cog lus nrog HRSA los muab cov luv nqi raws li txoj cai rau cov tshuaj rau "cov chaw uas tau them." Cov koom haum uas tau them nqi yuav tsum tau txheeb xyuas cov kev thov uas tus neeg tau txais txiaj ntsig Medicaid tau txais cov tshuaj 340B uas tau yuav. Lub Xeev tsis muaj cai tau txais cov nyiaj rov qab rau cov kev thov ntawd vim tias lub koom haum uas tau them rau twb tau txais cov luv nqi los ntawm lub chaw tsim tshuaj lawm. California lub tshuab them nqi rov qab yuav tshem tawm cov ntawv thov tshuaj thiab cov ntawv thov tshuaj uas tau muab los ntawm kws kho mob (PAD) uas suav nrog tus cim PHS/340B tsim nyog los ntawm daim ntawv them nqi ntawm lub tuam txhab tsim tshuaj. Cov ntaub ntawv hais txog qhov kev pab cuam 340B thiab cov chaw twg tsim nyog tuaj yeem pom ntawm nplooj ntawv web HRSA 340 B Drug Pricing Program.​​ 

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. Yuav kom ua raws li txoj cai lij choj hauv tebchaws, cov lus thov yuav tsum tau sau kom raug kom tiv thaiv "kev txo nqi ob zaug." Qhov no tshwm sim thaum lub chaw tsim tshuaj muab tus nqi luv nqi 340B rau tus kws kho mob thiab them tus nqi rov qab Medicaid. Yuav kom tiv thaiv tau "kev txo nqi ob zaug", cov neeg muab kev pabcuam yuav tsum muaj tus lej tsim nyog rau ntawm daim ntawv thov. Cov ntawv thov tshuaj uas kws kho mob tau muab yuav tsum muaj lub cim hloov kho "UD". Cov ntawv thov tshuaj yuav tsum muaj "08" hauv daim teb Kev Txiav Txim Siab Txog Tus Nqi. Ob qho tib si tus hloov kho "UD" thiab "08" qhia rau DHCS tias cov tshuaj 340B uas yuav tau siv rau qhov kev thov. Peb lub txheej txheem them rov qab yuav tshem tawm cov lus thov ntawm daim ntawv them rov qab ntawm cov chaw tsim tshuaj kom ntseeg tau tias cov chaw tsim tshuaj tsis raug rau "kev txo nqi ob zaug".​​ 

"EFT" yog dab tsi?​​ 

Kev xaiv them nyiaj los ntawm Electronic Fund Transfer (EFT) tso cai rau cov neeg siv uas tau sau npe them lawv cov nqi them rov qab tshuaj hauv hluav taws xob yam tsis tas yuav xa daim tshev ntawv ib txwm muaj. Qhov kev xaiv ua siab dawb no yuav tsum tau kom cov neeg koom nrog ua raws li ib hom ntawv tshwj xeeb thaum xa cov ntaub ntawv hluav taws xob. Thov hu rau Chaw Muab Nyiaj Rov Qab Tshuaj ntawm drugrebatebranch@dhcs.ca.gov, kom paub ntau ntxiv txog yuav sau npe rau EFT li cas.​​ 

What is “EIS”?​​ 

Lub Tshuab Hluav Taws Xob Sib Txuas Lus (EIS) tso cai rau cov chaw tsim tshuaj uas sau npe kom tau txais cov ntawv them nqi peb lub hlis tam sim no thiab rub tawm 10 xyoo ntawm cov ntaub ntawv thov raws li cov ntawv them nqi rov qab. Thov hu rau pab pawg Drug Rebate Branch Portal ntawm drugrebateportal@dhcs.ca.gov, kom paub ntxiv txog yuav ua li cas thiaj nkag tau rau hauv lub 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:​​ 

  • Hnub tim cov khoom raug tshem tawm ntawm lub chaw muag tshuaj; los yog​​ 
  • 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. Tshooj 2501 ntawm Txoj Cai Saib Xyuas Kev Noj Qab Haus Huv Pheej Yig (ACA) uas tau hloov kho tshooj 1927(b)(1)(A) ntawm Txoj Cai Kev Ruaj Ntseg Hauv Zej Zog yuav tsum kom cov chaw tsim khoom "muab nyiaj rov qab ... suav nrog (rau) cov tshuaj no uas tau muab rau cov tib neeg uas tau sau npe nrog Medicaid MCO yog tias lub koom haum muaj lub luag haujlwm rau kev them nqi ntawm cov tshuaj no." Txawm hais tias ntu 1927(b)(1)(A) ntawm Tsab Cai hais txog kev them nyiaj raws li txoj kev npaj ntawm lub xeev, cov lus cai lij choj uas tau hloov kho tsis txwv tsis pub muab cov nyiaj rov qab ntxiv rau cov chaw tsim khoom rau cov tshuaj uas MCO tau siv rau. Thaum muab tshuaj rau tus neeg tau txais txiaj ntsig Medicaid raws li kev npaj kho mob, lub xeev tau them nyiaj rau MCO rau cov tshuaj. Txawm hais tias cov nqe lus them nqi tau sib tham ua ib feem ntawm daim ntawv cog lus ntawm MCO thiab nws cov neeg muab kev pabcuam koom nrog los muab kev pab them nqi Medicaid li cas los xij, tus neeg tsim khoom muaj lub luag haujlwm them cov nyiaj rov qab rau cov tshuaj kho mob sab nraud uas tau muab rau cov neeg tau txais txiaj ntsig Medicaid uas tau sau npe rau hauv MCOs. DHCS tau pib sau cov nyiaj rov qab rau cov kev thov nrog hnub ua haujlwm ntawm lub Peb Hlis 23, 2010, hnub siv ACA.​​ 

Puas yog nws yuav tsum tau xa ROSI thiab/lossis PQAS nrog daim ntawv lo cov nyiaj them rov qab?​​ 

Yog. Lub Chaw rau Medicare & Medicaid Services (CMS) yuav tsum tau kom muaj Reconciliation of State Invoices (ROSI) thiab Prior Quarter Adjustment Statement (PQAS) nrog txhua qhov nyiaj 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 daim foos tau txais kev pom zoo los ntawm Lub Chaw Haujlwm Saib Xyuas Kev Tswj Xyuas hauv tebchaws thiab raug CMS yuam kom ua. Nws tseem yog qhov yuav tsum tau ua kom cov chaw tsim tshuaj suav nrog ROSI thiab / lossis PQAS rau txhua qhov nyiaj rov qab ntxiv uas tau them. Xa cov tshev, ROSI, PQAS thiab lwm cov ntaub ntawv txhawb nqa mus rau qhov chaw nyob DHC Accounting uas tau sau tseg rau ntawm koj cov ntawv qhia txog daim ntawv them nqi.​​ 

Department of Health Care Services
Accounting Section
Medi-Cal​​ 

Tshuaj Rebate Accounts Receivable
MS 1101​​ 

PO Box 997415​​ 

Sacramento, CA 95899-7415​​ 

Yuav kom ntseeg tau tias cov nyiaj them tau ua tiav raws li qhov tsim nyog, nws yog ib qho tsim nyog los sab laj nrog koj daim ntawv qhia txog tus account kom paub cov ntaub ntawv ntawm koj tus account. Yuav tsum tau them nyiaj sib cais rau ntau yam 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. California lub txheej txheem ua cov ntaub ntawv thov tau khaws cov ntaub ntawv tsim nyog los them rov qab cov tuam txhab tsim tshuaj rau cov nyiaj rov qab sib xyaw txij li Lub Kaum Hli 2003. Yuav kom ua raws li tsoomfwv cov cai, cov chaw tsim tshuaj yuav tau txais daim ntawv them nqi rau cov tshuaj sib xyaw hauv xyoo 2014. Kev them nqi yuav siv rov qab mus rau xyoo 2003 thaum lub kaw lus ua cov ntaub ntawv thov pib sau cov ntaub ntawv.​​ 

Rov qab mus rau Medi-Cal Drug Rebate ​​