LEA Program Glossary of Terms
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O | P | Q | R | S | T | U | V | W | X | Y | Z |
A
Daim Ntawv Qhia Txhua Xyoo - Txhua tus LEA uas tau sau npe rau hauv LEA Medi-Cal Billing Option yuav tsum xa "Daim Ntawv Qhia Txhua Xyoo" mus rau Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv txhua xyoo. Daim ntawv tshaj tawm muaj cov ntaub ntawv hais txog kev them rov qab rau LEA Medi-Cal, cov nuj nqis rov ua lag luam, qhov tseem ceeb ntawm kev pabcuam rov ua lag luam, kev lees paub cov nyiaj sib phim ntawm lub xeev, thiab kev cog lus tias yuav rov ua lag luam.
C
Cal-SAFE (Kev Kawm Rau Tsev Neeg Rau Cov Neeg Kawm Ntawv Hauv California) - Qhov kev pab cuam Cal-SAFE no yog tsim los kom muaj kev pabcuam txhawb nqa rau cov menyuam kawm ntawv uas xav tau kev pab/niam txiv kom txhim kho kev kawm thiab kev txawj ua niam txiv thiab muab kev pab cuam saib xyuas/kev loj hlob zoo rau lawv cov menyuam. Qhov kev pab cuam hauv tsev kawm ntawv uas muaj ntau yam, txuas ntxiv mus, thiab txuas nrog zej zog no hloov qhov Kev Pab Cuam Rau Cov Menyuam Yaus Uas Muaj Hnub Nyoog Xeeb Tub (PMP), Kev Pab Cuam Rau Cov Niam Txiv Thiab Kev Loj Hlob Me Nyuam Mos Thaum Kawm Ntawv (SAPID), thiab Kev Pab Cuam Rau Cov Tub Ntxhais Xeeb Tub Thiab Cov Tub Ntxhais Haus Mis (PALS).
CalWORKs (California Work Opportunity and Responsibility to Kids) - Qhov kev pab cuam CalWORKs muab kev pab ib ntus hauv daim ntawv ntawm cov nyiaj ntsuab thiab cov kev pabcuam rau cov tsev neeg txom nyem uas muaj cov menyuam yaus. Qhov kev pab cuam no muaj xws li kev hloov kho kev noj qab haus huv thiab cov kev pabcuam uas tsim los txhawb kom cov neeg tau txais kev pab tsim nyog thiab nrhiav cov haujlwm uas yuav ua rau cov tsev neeg muaj peev xwm txhawb nqa lawv tus kheej. Tshwj tsis yog tias zam, txhua tus neeg tau txais kev pab yuav tsum koom nrog CalWORKs Welfare-to-Work program ua ib qho tseem ceeb ntawm kev tsim nyog.
CCN (Claim Control Number) – Tus lej uas muab rau txhua daim ntawv thov uas nkag mus rau California Medicaid Management Information System. CCN muaj hnub Julian qhia hnub tim tau txais daim ntawv thov.
CCS (California Children's Services) - Qhov kev pab cuam CCS muab kev pab kho mob rau cov menyuam yaus uas tsim nyog uas muaj qee yam kev txwv lub cev thiab tej yam mob lossis kab mob ntev. CCS them rau cov kev pabcuam kws kho mob, kev saib xyuas hauv tsev kho mob thiab kev phais mob, kev kho lub cev thiab kev ua haujlwm, kev kuaj mob hauv chaw kuaj mob, duab X-ray, cov khoom siv pob txha, cov khoom siv kho mob, thiab kev tswj hwm cov ntaub ntawv kho mob. Cov nyiaj se ntawm lub xeev, lub nroog, thiab tsoomfwv teb chaws tau txais nyiaj los ntawm cov nyiaj no, nrog rau qee cov nqi uas cov niam txiv them.
CHDP (Kev Noj Qab Haus Huv thiab Kev Tiv Thaiv Kev Tsis Taus Rau Menyuam) - Qhov kev pab cuam CHDP muab cov kev pab cuam tiv thaiv kev noj qab haus huv tsis tu ncua rau cov menyuam yaus hauv California uas tsim nyog tau txais Medi-Cal lossis nrog tsev neeg cov nyiaj tau los sib npaug lossis tsawg dua 200% ntawm cov qauv nyiaj tau los ntawm tsoomfwv. CHDP muab kev ntsuam xyuas kev noj qab haus huv tsis tu ncua; cov menyuam yaus uas muaj teeb meem raug xa mus kuaj mob thiab kho mob.
Child Find – Through the Individuals with Disabilities Education Act of 1997 (IDEA), all children with disabilities residing in the state who are in need of special education and related services must be identified and evaluated to determine if services are required.
CIF (Daim Ntawv Nug Txog Kev Thov Nyiaj) - Daim ntawv no yog siv tom qab xa daim ntawv thov nyiaj los thov ib qho ntawm cov hauv qab no: kev hloov kho rau qhov kev thov nyiaj uas tau them tsawg lossis them ntau dhau, kev rov xav txog qhov kev thov nyiaj uas tsis tau lees paub; lossis tus neeg taug qab qhov kev thov nyiaj uas tau xa ua ntej uas tsis muaj ntaub ntawv them nyiaj lossis tsis lees paub.
CMS (Centers for Medicare & Medicaid Services) - Yav tas los hu ua Health Care Financing Administration (HCFA), CMS yog lub koom haum tsoomfwv uas saib xyuas Medicare, Medicaid, State Children's Health Insurance Program (SCHIP), thiab ntau lwm yam kev pab cuam ntsig txog kev noj qab haus huv.
CRCS (Daim Ntawv Teev Nyiaj Rov Qab thiab Kev Sib Piv) - Txhua tus LEA uas tau sau npe rau hauv LEA Medi-Cal Billing Option yuav tsum xa daim ntawv CRCS mus rau Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv. Cov chaw muab kev pab cuam LEA yuav tsum tau lees paub txhua xyoo tias cov nyiaj pej xeem siv rau cov kev pabcuam LEA tsim nyog rau kev koom tes nyiaj txiag ntawm tsoomfwv. Daim CRCS yuav raug siv los piv rau txhua tus LEA cov nqi tiag tiag rau cov kev pabcuam LEA rau cov nyiaj them rov qab Medi-Cal ntawm LEA.
D
DHCS (Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv) - Lub koom haum hauv xeev uas muaj lub luag haujlwm tswj hwm qhov kev pab cuam Medicaid rau Tsoom Fwv Tebchaws.
Diagnosis Codes – All Medi-Cal claims require a diagnosis code. The approved codes may be found in the ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification), a statistical classification system that arranges diseases and injuries into groups according to established criteria.
E
EDS (Cov Txheej Txheem Ntaub Ntawv Hluav Taws Xob) - EDS yog Medi-Cal Fiscal Intermediary uas muaj lub luag haujlwm rau kev ua cov ntaub ntawv thov uas cov neeg muab kev pabcuam Medi-Cal xa los ntawm daim ntawv cog lus nrog Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS). EDS kuj muab ntau yam kev pabcuam txhawb nqa rau cov kws kho mob Medi-Cal.
EPC (Kev Kho Kev Them Nyiaj Yuam Kev) - Cov txheej txheem siv los kho cov kev pabcuam lossis cov lus thov tshwj xeeb uas tau txiav txim siab tias tau them ntau dhau lossis them tsawg dhau. Cov txheej txheem EPC ua rau daim ntawv thov thawj zaug tsis muaj txiaj ntsig, tshwm sim ua qhov tsis zoo ntawm cov lus qhia txog kev xa nyiaj ntawm tus neeg muab kev pabcuam ua raws li kab ntawv thov tshiab uas qhia tus nqi kho.
EPSDT (Kev Tshuaj Xyuas Thaum Ntxov thiab Ib Txwm, Kev Kuaj Mob, thiab Kev Kho Mob) - Cov kev pabcuam EPSDT yog Medicaid txoj kev pabcuam kev noj qab haus huv rau menyuam yaus uas muaj kev tiv thaiv thiab ua tiav rau cov tib neeg hnub nyoog qis dua 21 xyoos. Qhov kev pab cuam EPSDT muaj ob qho kev txhawb nqa, kev ua haujlwm: (1) xyuas kom muaj thiab nkag tau cov peev txheej kev kho mob uas xav tau thiab (2) pab cov neeg tsim nyog Medicaid thiab lawv niam lawv txiv lossis cov neeg saib xyuas siv cov peev txheej no tau zoo. Hauv California, qhov kev pab cuam Child Health and Disability Prevention (CHDP) muab cov kev pab cuam kev noj qab haus huv tiv thaiv tsis tu ncua rau cov menyuam yaus tsim nyog tau txais Medi-Cal raws li qhov kev pab cuam EPSDT.
F
FFP (Kev Koom Tes Nyiaj Txiag ntawm Tsoom Fwv Tebchaws) - Cov xeev yuav tsum ua raws li qee qhov kev cai ntawm tsoomfwv kom koom nrog hauv qhov kev pab cuam Medicaid. Cov xeev uas ua tau raws li cov cai no tau txais nyiaj txiag los ntawm tsoomfwv hauv daim ntawv ntawm FFP rau txhua qhov kev siv nyiaj Medicaid.
FFS (Fee-for-Service) – The traditional method of billing for health services under which a health care provider charges separately for each patient encounter or service rendered.
FMAP (Federal Medical Assistance Percentage) - Feem pua ntawm tsoom fwv teb chaws cov nuj nqis uas lub xeev siv rau Medicaid. Daim FMAP raug txiav txim siab txhua xyoo rau txhua lub xeev.
H
HCPCS (Healthcare Common Procedure Coding System) - HCPCS yog ib lub teb chaws, ib qho qauv coding uas tau tsim los ntawm Centers for Medicare & Medicaid Services (CMS) los ua kom cov txheej txheem coding uas siv los them nqi rau Medicare thiab Medicaid cov kev pabcuam thoob teb chaws. Txhua qhov kev thov Medi-Cal xav tau cov lej kev pabcuam HCPCS.
Healthy Families – The Healthy Families Program offers low cost insurance for children and teens up to age 19. It provides health, dental, and vision coverage for children who meet the program rules and do not qualify for Medi-Cal. Health Families contracts with selected insurance plans, and program members pay low monthly premiums.
Kev Pib Noj Qab Haus Huv - Qhov kev pab cuam Pib Noj Qab Haus Huv yog ib qho kev pib ua haujlwm ntawm lub xeev uas muab kev sib txuas rau cov tub ntxhais kawm thiab lawv tsev neeg mus rau cov peev txheej hauv zej zog los ntawm cov chaw pabcuam tsev neeg hauv tsev kawm ntawv.
HMO (Lub Koom Haum Saib Xyuas Kev Noj Qab Haus Huv) - Ib lub koom haum uas lav ris lub luag haujlwm los muab kev kho mob rau cov tswv cuab rau kev them nyiaj tsis tu ncua yam tsis hais txog qhov ntau npaum li cas ntawm cov kev pabcuam tiag tiag uas tau muab rau tus neeg sau npe. Lub HMO muaj lub luag haujlwm los muab feem ntau cov kev pabcuam kev noj qab haus huv thiab kev kho mob uas cov tib neeg lossis tsev neeg xav tau, thiab cov kev pabcuam no tau teev tseg hauv daim ntawv cog lus ntawm HMO thiab cov neeg koom nrog.
Kuv
IDEA (Individuals with Disabilities Education Act) - Txoj cai lij choj hauv tebchaws uas yuam kom txhua tus menyuam yaus uas muaj kev tsis taus muaj kev kawm ntawv pej xeem dawb (FAPE) uas suav nrog kev kawm tshwj xeeb thiab lwm yam kev pabcuam kom tau raws li lawv cov kev xav tau tshwj xeeb. Tshooj B ntawm IDEA muab kev pab nyiaj pub dawb rau cov koom haum kev kawm hauv xeev rau kev kawm ntawm cov menyuam yaus uas muaj kev tsis taus, hnub nyoog peb txog 21 xyoos. Ntu C ntawm IDEA muab nyiaj txiag rau cov koom haum ua thawj coj hauv xeev los pab muab cov kev pabcuam cuam tshuam thaum ntxov rau cov menyuam mos thiab cov menyuam yaus uas muaj kev tsis taus, hnub nyoog yug los txog ob xyoos.
IEP (Txoj Kev Npaj Kawm Ntawv Tus Kheej) - Ib daim ntawv cog lus raws li txoj cai uas cov kws tshaj lij hauv kev kawm tau sau, nrog rau cov lus qhia los ntawm niam txiv ntawm tus menyuam, rau cov tub ntxhais kawm uas tau txheeb xyuas tias muaj kev xiam oob qhab raws li cov cai ntawm IDEA. Daim ntawv cog lus no coj, sib koom tes, thiab sau cov ntaub ntawv qhia uas tau tsim tshwj xeeb los ua kom tau raws li tus tub ntxhais kawm cov kev xav tau tshwj xeeb.
IFSP (Txoj Kev Npaj Pabcuam Rau Tsev Neeg Tus Kheej) - Ib daim phiaj xwm sau tseg rau kev muab cov kev pabcuam pabcuam thaum ntxov rau tus menyuam uas tsim nyog raws li IDEA thiab tsev neeg ntawm tus menyuam. Daim IFSP ua rau tsev neeg thiab cov neeg muab kev pabcuam ua haujlwm ua ke ua tus khub sib npaug zos hauv kev txiav txim siab txog cov kev pabcuam thaum ntxov uas xav tau rau tus menyuam uas muaj kev tsis taus thiab tsev neeg.
L
LEA (Lub Chaw Haujlwm Saib Xyuas Kev Kawm Hauv Zos) - Lub koom haum tswj hwm ntawm txhua lub koog tsev kawm ntawv lossis lub koog tsev kawm ntawv qib siab hauv zej zog, Lub Chaw Haujlwm Saib Xyuas Kev Kawm Hauv Lub Nroog, lub tsev kawm ntawv tshwj xeeb hauv xeev, lub tsev kawm ntawv qib siab hauv California State University, lossis University of California.
LEA Kev Koom Tes - Ib pawg neeg ua haujlwm pabcuam tib neeg ntawm ntau lub koom haum (kev koom tes hauv zos) ntawm theem nroog lossis theem nroog me uas txiav txim siab txog kev rov nqis peev ntawm cov nyiaj uas muaj los ntawm LEA Medi-Cal Billing Option. Feem ntau, cov neeg sawv cev yuav suav nrog cov tsev kawm ntawv, cov koom haum pej xeem loj uas pab cov menyuam yaus thiab tsev neeg suav nrog kev noj qab haus huv, kev noj qab haus huv ntawm lub hlwb, kev pabcuam hauv zej zog thiab kev ncaj ncees rau cov menyuam yaus, cov tsev hais plaub, cov thawj coj hauv zej zog thiab kev lag luam, cov zej zog tawm tswv yim, cov niam txiv lossis cov neeg saib xyuas, thiab cov chaw muab kev nyab xeeb tam sim no thiab cov chaw muab kev kho mob ib txwm muaj.
Kev Xaiv Them Nqi Medi-Cal ntawm LEA - Ib qho kev pab cuam rau LEAs los them nqi rau Medi-Cal rau cov kev pabcuam kev noj qab haus huv thiab kev kho mob tshwj xeeb uas tau muab rau cov tub ntxhais kawm thiab lawv tsev neeg hauv tsev kawm ntawv. Cov kev pabcuam uas muab los ntawm qhov kev pab cuam no suav nrog kev ntsuam xyuas, kev kho mob, thiab Kev Tswj Xyuas Cov Neeg Mob Uas Tau Targeted.
LEC (Local Education Consortium) - Ib lub LEA uas koom tes nrog Medi-Cal Administrative Activities (MAA) rau ib qho ntawm 11 thaj chaw pabcuam ntawm California County Superintendents Educational Services Association (CCSESA). Cov LEAs yuav tsum thov MAA los ntawm lawv cheeb tsam LEC lossis lawv lub koom haum kev noj qab haus huv hauv zos lossis lub nroog (tseem hu ua Lub Koom Haum Tsoomfwv Hauv Zos lossis LGA). >
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MAA (Cov Haujlwm Tswjfwm Medi-Cal) - Ib qho kev pab cuam rau LEAs uas yuav tau txais nyiaj rov qab rau cov haujlwm ua haujlwm ntawm cov neeg ua haujlwm uas tsim nyog rau kev tswj hwm qhov kev pab cuam Medi-Cal kom zoo thiab ua haujlwm tau zoo. Tus nqi them rov qab yog raws li txoj kev npaj ua haujlwm thiab kev tshawb fawb tsis tu ncua. Qhov kev pab cuam MAA yog sib cais ntawm LEA Medi-Cal Billing Option.
Managed Care – A health care delivery system that provides services within a defined network of health care providers who are given the responsibility to manage and provide quality, cost-effective health care. Managed care plans, which may include but are not limited to Health Maintenance Organizations (HMOs), typically receive a prepaid rate for each member enrolled in the plan.
Sib phim - Feem ntawm tus nqi ntawm kev muab kev pabcuam LEA Medi-Cal uas tsoomfwv tebchaws tsis tau them rov qab. Hauv LEA Medi-Cal Billing Option, cov koog tsev kawm ntawv tsuas yog tau txais feem ntawm tsoomfwv qib siab ntawm tus nqi them rov qab xwb. Thaum lawv sau npe thiab hauv txhua daim ntawv qhia txhua xyoo tom qab ntawd, LEAs lees paub tias lawv yuav them tus nqi sib npaug rau feem ntawm tsoomfwv rau cov kev pabcuam LEA.
Medicaid – A federal program established in 1965 under Title XIX of the Social Security Act and jointly funded by the Federal and State governments. Medicaid provides health care coverage for low-income families; aged, blind, and disabled persons; and individuals whose income and resources are insufficient to meet the costs of necessary medical services. Medi-Cal is California’s Medicaid program and is administered by the Department of Health Care Services (DHCS).
Kev Sib Tw Cov Ntaub Ntawv Txog Kev Tsim Nyog Tau Txais Medi-Cal - Ib qho txheej txheem uas tau tsim los rau LEAs kom tau txais kev txheeb xyuas qhov tsim nyog tau txais Medi-Cal rau cov tub ntxhais kawm uas tau sau npe.
Medicare – A federal program, established in 1965 under Title XVIII of the Social Security Act. Medicare provides health care coverage for people age 65 or older, some people under age 65 with disabilities, and people with End-Stage Renal Disease (ESRD), which is permanent kidney failure requiring dialysis or a kidney transplant.
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NPI (Tus Neeg Qhia Txog Tus Muab Kev Pabcuam Hauv Tebchaws) - Tus lej cim tus neeg muab kev pabcuam 10-tus lej tshwj xeeb hauv tebchaws uas ua raws li Txoj Cai Kev Pov Hwm Kev Noj Qab Haus Huv thiab Kev Lav Ris (HIPAA).
O
OIG (Chaw Ua Haujlwm Saib Xyuas Kev Noj Qab Haus Huv) - Lub OIG tiv thaiv kev ncaj ncees ntawm cov kev pab cuam uas US Department of Health and Human Services (HHS) tswj hwm, nrog rau kev noj qab haus huv thiab kev noj qab haus huv ntawm cov neeg tau txais txiaj ntsig ntawm cov kev pab cuam no. HHS muab nyiaj pab rau cov kev pabcuam tseem ceeb rau tib neeg hauv ntau dua 300 qhov kev pab cuam, suav nrog Medicare thiab Medicaid. Lub OIG cov dej num raug ua tiav los ntawm kev sib koom tes thoob plaws lub tebchaws ntawm kev tshuaj xyuas thiab kev tshawb nrhiav ntawm HHS cov kev pab cuam.
OMB Circular A-87 (Office of Management and Budget) – A codified Federal Executive Branch regulation that provides mechanisms and guidelines for state and local governments for accounting for costs when administering federal programs.
P
PPA (Daim Ntawv Cog Lus Koom Tes Nrog Cov Kws Muab Kev Pab) - Daim Ntawv Cog Lus Koom Tes Nrog Cov Kws Muab Kev Pab (PPA) yog daim ntawv cog lus uas cov Chaw Haujlwm Kev Kawm Hauv Zos uas tsim nyog sau npe los koom nrog LEA Medi-Cal Billing Option.
R
RAD (Remittance Advice Details) – A report listing provider claims that have been paid for a particular payment period. The RAD is used by providers to reconcile their records with claims that have been paid, denied or suspended.
S
SNF (Safety Net Financing Division) - SNFD tswj hwm cov nyiaj them ntxiv raws li "Choj Mus Rau Kev Hloov Kho" Tshooj 1115 Medicaid Waiver thiab Medicaid State Plan. Lub Chaw Them Nqi Ntxiv ntawm Medi-Cal (MSPS) ua cov txheej txheem thiab saib xyuas kev them nyiaj rau cov tsev kho mob thiab lwm hom kev muab kev pab cuam rau ntau yam kev pab cuam ntxiv thiab tswj hwm qhov kev pab cuam Nqi Xyuas Zoo ntawm Tsev Kho Mob (QAF). Pawg Neeg Saib Xyuas Kev Ua Qauv thiab Kev Kho Mob Tsis Muaj Kev Pov Hwm (HUDSS) soj ntsuam cov nqi thiab cov nqi kho mob pej xeem uas tau teev tseg thiab saib xyuas California txoj kev zam txim tag nrho. Pawg Neeg Txheeb Xyuas Kev Kuaj Mob (DRG) saib xyuas kev siv txoj kev them rov qab ntawm tsev kho mob thiab tswj hwm Subacute Care Program. Lub Chaw Haujlwm Saib Xyuas Kev Thov Nyiaj Txiag, Lub Chaw Pabcuam Hauv Zos, thiab Lub Tsev Kawm Ntawv muab kev them rov qab rau tsoomfwv rau cov nroog thiab cov koog tsev kawm ntawv rau cov haujlwm kev tswjfwm, kev tswj hwm cov ntaub ntawv raug tsom, thiab qee yam kev pabcuam kho mob uas tsim nyog rau tsev kawm ntawv. Lub Chaw Pab Nyiaj Txiag Rau Tsev Kho Mob Sib Koom Ua Ke Thiab Lub Chaw Pab Nyiaj Rov Qab Rau Tsev Kho Mob Uas Tsis Yog Daim Ntawv Cog Lus (DSH) them rov qab rau cov tsev kho mob uas tsim nyog rau cov nqi kho mob uas tsis tau them rau cov kev pabcuam hauv tsev kho mob thiab them rov qab cov nyiaj them ntau dhau rau cov kev pabcuam hauv tsev kho mob uas muab los ntawm cov tsev kho mob uas tsis yog daim ntawv cog lus.
SCHIP (Lub Xeev Txoj Haujlwm Pov Hwm Kev Noj Qab Haus Huv Rau Menyuam Yaus) - Ib qho kev pab cuam hauv tsoomfwv tebchaws, zoo ib yam li Medicaid, tau tsim muaj xyoo 1997 raws li Lub Npe XXI ntawm Txoj Cai Kev Ruaj Ntseg Hauv Zej Zog. SCHIP muab kev pov hwm kho mob rau cov menyuam yaus uas lawv tsev neeg khwv tau nyiaj ntau dhau los tsim nyog rau Medicaid, tab sis tsis muaj nyiaj txaus los yuav kev pov hwm kho mob ntiag tug. California txoj kev pab cuam hu ua Healthy Families Program thiab yog tswj hwm los ntawm Managed Risk Medical Insurance Board (MRMIB).
Tshooj 504 Kev Pabcuam - Tshooj 504 ntawm Txoj Cai Kho Dua Tshiab xyoo 1973 yuav tsum tau kom cov koog tsev kawm ntawv muab lossis them rau qee yam kev pabcuam kom cov menyuam xiam oob qhab nkag tau rau kev kawm. Cov kev pabcuam no tau piav qhia nyob rau hauv Txoj Kev Npaj Pabcuam Kev Noj Qab Haus Huv Tus Kheej (IHSP) lossis Txoj Kev Npaj 504.
Lub Chaw Haujlwm Ib Leeg Hauv Xeev - Lub chaw haujlwm hauv xeev uas muaj lub luag haujlwm tswj hwm qhov kev pab cuam Medicaid. Hauv California, lub koom haum hauv xeev yog Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) thiab qhov kev pab cuam Medicaid hu ua Medi-Cal.
SSI (Cov Nyiaj Tau Los Ntxiv ntawm Kev Ruaj Ntseg) - Ib qho kev pab nyiaj txiag hauv tsoomfwv rau cov neeg laus, dig muag lossis xiam oob qhab uas muaj nyiaj tsawg uas tau tsim los ntawm Title XVI ntawm Social Security Act. Cov xeev yuav siv cov kev txwv ntawm cov nyiaj tau los ntawm SSI los tsim kom muaj cai tau txais Medicaid.
State Plan – A written plan between a State and the Federal Government that outlines Medicaid eligibility standards, provider requirements, payment methods, and health benefit packages. A Medicaid State Plan is submitted by each State and approved by the Centers for Medicare & Medicaid Services (CMS).
SPA (Kev Hloov Kho Txoj Kev Npaj ntawm Lub Xeev) - Cov xeev tuaj yeem xa cov kev hloov kho rau lawv cov phiaj xwm Medicaid hauv Xeev kom hloov cov qauv kev tsim nyog, cov kev cai ntawm cov neeg muab kev pab, cov txheej txheem them nyiaj, lossis cov pob khoom pab kev noj qab haus huv. Cov kev hloov kho raug tshuaj xyuas thiab ua tiav raws li cov sijhawm tshwj xeeb ntawm txoj cai los ntawm Lub Chaw Haujlwm Hauv Cheeb Tsam ntawm Chaw Haujlwm rau Medicare & Medicaid (CMS) nrog kev sab laj thiab kev tshuaj xyuas los ntawm Chaw Haujlwm Hauv Nruab Nrab ntawm CMS, yog tias tsim nyog.
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TANF (Kev Pab Ib Ntus Rau Cov Tsev Neeg Xav Tau Kev Pab) - Ib qho kev pab nyiaj txiag hauv xeev rau cov tsev neeg uas muaj nyiaj tsawg. TANF hloov qhov kev pab cuam qub hu ua Kev Pab rau Tsev Neeg uas Muaj Menyuam Nyob Nrog (AFDC). CalWORKs yog lub npe ntawm California txoj kev pab cuam TANF.
TCM (Kev Tswj Xyuas Cov Neeg Mob Uas Tau Targeted) - LEA Medi-Cal cov kev pabcuam TCM pab cov menyuam yaus tsim nyog thiab cov tswv cuab hauv tsev neeg tsim nyog kom tau txais kev pabcuam kho mob, kev sib raug zoo, kev kawm thiab lwm yam thaum TCM raug them los ntawm tus tub ntxhais kawm IEP lossis IFSP. Cov khoom ntawm TCM suav nrog: Txheeb xyuas cov kev xav tau, Tsim ib txoj kev npaj, Txuas & kev sab laj kev sib koom tes, Nkag mus rau cov kev pabcuam sab nraud ntawm lub tsev kawm ntawv, Pab nrog kev kub ntxhov, thiab Tshuaj Xyuas Kev Nce Qib.
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UB 04 – Daim ntawv no yog siv los xa cov ntawv thov rau cov kev pabcuam Medi-Cal rau cov neeg mob sab nraud, suav nrog cov kev pabcuam LEA Medi-Cal Billing Option.