Tsev Cov Chaw Muab Kev Pabcuam & Cov Neeg Koom Tes Kev Pab Cuam Them Nqi Rau Kev Pov Hwm Zoo ntawm Tsev Kho Mob​​ 

Tsev Kho Mob Tus Nqi Them Nqi Kho Mob​​ 

HQAF Program Overview​​ 

Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv ntawm California (DHCS) tau siv nws thawj qhov kev pab cuam Them Nqi Zoo rau Tsev Kho Mob (HQAF) hauv xyoo 2010. Qhov kev pab cuam no muab nyiaj pab rau cov tsev kho mob hauv California uas pab cov neeg mob Medi-Cal thiab cov neeg mob uas tsis muaj kev pov hwm kho mob. Cov nyiaj tau los ntawm HQAF kuj muab nyiaj rau kev pab them nqi kho mob rau menyuam yaus, them nyiaj ncaj qha rau cov tsev kho mob pej xeem, thiab them rov qab rau DHCS rau cov nqi ncaj qha ntawm kev tswj hwm qhov kev pab cuam. Qhov kev pab cuam no tau ua tiav zoo heev, muab ntau txhiab lab daus las rau cov tsev kho mob hauv California. Qhov kev pab cuam no tau ua mus tas li los ntawm kev pom zoo ntawm Proposition 52 thaum lub Kaum Ib Hlis 2016.​​ 

HQAF Program Kev Tsim Nyog​​ 

Rau lub tsev kho mob ntiag tug kom tsim nyog tau txais kev them nyiaj ntxiv cov cai hauv qab no yuav tsum tau ua raws, raws li tau teev tseg hauv Welfare and Institutions (W&I) Code §14169.51 subdivision (ap):​​ 

  • Muaj ntawv tso cai raws li subdivision (a) ntawm Tshooj 1250 ntawm Txoj Cai Kev Noj Qab Haus Huv thiab Kev Nyab Xeeb.​​ 
  • Yog nyob rau hauv Charitable Research Hospital cov phooj ywg, raws li tau teev tseg nyob rau hauv 1991 Tsev Kho Mob Peer Grouping Report luam tawm los ntawm lub tuam tsev, los yog tsis raug xaiv los ua ib lub tsev kho mob tshwj xeeb nyob rau hauv lub tsev kho mob cov ntaub ntawv nyuam qhuav tshaj tawm Office of Statewide Health Planning and Development Annual Financial Disclosure Report, raws li thawj hnub ntawm lub sijhawm ua haujlwm.​​ 
  • Tsis ua raws li Medicare cov txheej txheem los muab cais ua lub tsev kho mob mus sij hawm ntev.​​ 
  • Yog lub tsev kho mob uas tsis yog pej xeem, tsev kho mob uas tsis yog pej xeem hloov dua siab tshiab, lossis lub tsev kho mob hloov dua siab tshiab raws li cov ntsiab lus tau teev tseg hauv kab lus (26) txog (28), suav nrog, feem, ntawm subdivision (a) ntawm Tshooj §14105.98.​​ 
  • Tsis yog tsev kho mob pej xeem uas tsis tau teem caij lossis tsev kho mob pej xeem uas tau teem caij.​​ 

HQAF Fee Collections​​ 

Lub tuam tsev tau ntsuas tus nqi ntawm qee lub tsev kho mob hnyav uas yuav tsum tau siv, feem ntau, raws li tsoomfwv tsis yog tsoomfwv cov nyiaj pabcuam Medi-Cal ntxiv rau cov tsev kho mob tsim nyog rau cov kev pabcuam neeg mob hauv tsev thiab sab nraud. Cov nyiaj khaws cia tau muab tso rau hauv lub tsev kho mob cov nyiaj tau los ntawm cov nyiaj tau los.​​ 

HQAF Program Funding Calculations​​ 

Kev suav nyiaj txiag tau ua tiav los ntawm tus qauv nqi tsev kho mob. Tus qauv nqi tsev kho mob suav cov nqi thiab cov nyiaj them rau txhua lub tsev kho mob uas koom nrog los ntawm kev siv txhua lub tsev kho mob cov ntaub ntawv txhua hnub los txiav txim siab txog kev siv Medicaid tus nqi, tsoomfwv cov nyiaj them qis tshaj, thiab ntau lwm yam ntaub ntawv.​​ 

HQAF Change of Ownership (CHOW) Process​​ 

Cov tsev kho mob ntiav uas tau hloov pauv tswv cuab (CHOW) yuav tsum ua kom tiav cov txheej txheem CHOW uas tau piav qhia hauv 5/13/16 CHOW Tus Muab Kev Pabcuam tsis pub dhau 30 hnub txij li hnub tsab ntawv los ntawm Lub Xeev muab Medi-Cal Certification rau tus tswv tshiab ntawm lub tsev kho mob. Cov tswv tshiab tuaj yeem xa Daim Ntawv Pom Zoo Txog Nyiaj Txiag, tso cai rau lub tsev kho mob txuas ntxiv kev koom tes hauv cov nqi thiab kev them nyiaj ntawm HQAF qhov kev pab cuam, lossis ua kom tiav Daim Ntawv Pov Thawj, los ntawm lub tsev kho mob suav tias yog "Lub Tsev Kho Mob Tshiab" thiab tshem tawm tam sim no. HQAF program period. Yog xav paub ntxiv, thov xa email rau HQAF@dhcs.ca.gov. Txhawm rau kom ua tiav raws sijhawm, thov email ua tiav CHOW pob rau HQAF@dhcs.ca.gov.​​ 

Tsev Kho Mob Quality Assurance Fee Program Models​​ 

HQAF VIII Tus Nqi & Tus Qauv Them Nyiaj (CY 2023 & 2024)​​ 

HQAF VII Fee & Payment Model (CY 2022)​​ 

Tus Qauv Them Nqi & Kev Them Nyiaj ntawm HQAF VI (SFY 2019-2022)​​ 

HQAF V Tus Nqi & Tus Qauv Them Nyiaj (SFY 2017-2019)​​ 

Cov Kev Pab Kho Mob Hauv Tsev Kho Mob Ntiag Tug - CY 2024​​ 

Cov Chaw Kho Mob Sab Nraud ntawm Tsev Kho Mob Ntiag Tug - CY 2024​​ 

Cov Chaw Kho Mob Ntiag Tug rau Cov Neeg Mob Hauv Tsev Kho Mob UPLs - CY 2023​​ 

Cov Chaw Kho Mob Sab Nraud ntawm Tsev Kho Mob Ntiag Tug - CY 2023​​ 

Cov Chaw Kho Mob Ntiag Tug rau Cov Neeg Mob Hauv Tsev Kho Mob UPLs - CY 2022​​ 

Cov Chaw Kho Mob Sab Nraud ntawm Tsev Kho Mob Ntiag Tug - CY 2022​​ 

Cov Tsev Kho Mob Ntiag Tug Cov Kev Pab Kho Mob Hauv Tsev Kho Mob - SFY 2017-18 & 2018-19​​ 

Cov Tsev Kho Mob Ntiag Tug Cov Kev Pab Kho Mob Sab Nraud - SFY 2017-18 & 2018-19​​ 

Tsev Kho Mob Ntiag Tug Cov Neeg Mob Hauv Tsev Kho Mob UPL - SFY 2016-17​​ 

Private Hospital Outpatient UPL – SFY 2016-17​​ 

(Yog tias koj xav tau daim ntawv theej ntawm HQAF Upper Payment Limit thiab/lossis Fee & Payment Models, thov email rau HQAF@dhcs.ca.gov)​​ 

Yuav tiv tauj peb li cas​​ 

Cov ntaub ntawv txog kev sau nqi thiab kev them nqi rau kev pabcuam nyob rau ntawm nplooj ntawv web ntawm Third Party Liability & Recovery Division.​​ 

Cov lus nug txog kev pab cuam yuav tsum raug xa mus rau HQAF@dhcs.ca.gov​​ 

Lub Xeev Txoj Kev Hloov Kho​​ 

Kev tshaj tawm​​ 

Tsoom Fwv Teb Chaws Yuav Tsum Tau​​ 

Txoj Cai Lij Choj​​