Tsev Cov Chaw Muab Kev Pabcuam & Cov Neeg Koom Tes Cov Kev Cai thiab Cov Txheej Txheem rau Kev Sau Npe Medi-Cal rau Cov Kws Muab Tshuaj uas Tuav Daim Ntawv Pov Thawj Tso Cai Kho Mob (CLIA)​​ 

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?​​ 

Lub xeev txoj cai lij choj feem ntau xav kom DHCS ua ib qho kev thov rau npe rau tus kws kho mob hauv 180 hnub. Yog tias daim ntawv thov raug xa rov qab mus rau tus kws kho mob kom kho, tus kws kho mob muaj 60 hnub los xa daim ntawv thov rov qab. DHCS yuav muaj 60 hnub ntxiv los tshuaj xyuas daim ntawv thov thaum nws tau xa rov qab. Yog tias daim ntawv thov raug xa mus rau kev tshuaj xyuas zoo, lub sijhawm tshuaj xyuas yuav raug ncua. Kev xa daim ntawv thov kom tiav thiab raug yuav txo DHCS lub sijhawm ua daim ntawv thov tag nrho.​​ 

2. Tus kws muag tshuaj uas tam sim no sau npe kawm ntawv puas yuav tsum xa daim ntawv thov ntxiv kom them nqi rau cov kev xeem CLIA uas tsis tau them?​​ 

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. Daim ntawv tshaj tawm no puas siv rau cov chaw muab tshuaj xwb lossis nws puas suav nrog cov tsev kho mob uas muaj cov chaw muab tshuaj hauv tsev kho mob nrog 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?​​ 

DHCS tsis ua cov txheej txheem rau kev sau npe lossis kev muab CLIA Daim Ntawv Pov Thawj Tso Cai. Yog xav tau kev qhia txog yuav ua li cas thiaj tau txais daim ntawv pov thawj CLIA Certificate of Waiver, thov mus saib lub vev xaib Centers for Medicare & Medicaid Services How to Apply for a CLIA Certificate, Including International Laboratories .​​ 

Tsis tas li ntawd xwb, yog xav paub ntxiv txog yuav ua li cas thiaj tau daim ntawv pov thawj ntawm California Clinical Laboratory Registration, thov mus saib nplooj ntawv web California Department of Public Health CLIA Certificate Information .​​ 

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 chaw muag tshuaj thiab muaj daim ntawv pov thawj CLIA, lossis qhov chaw ntawd puas 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. Cov kev cai rau kev sau npe thiab kev them nqi rau FQHCs uas cov kws muag tshuaj xav them rau CLIA zam kev kuaj mob rau cov chaw kho mob uas (a) muaj tshuaj txiav rau hauv lawv tus nqi Prospective Payment System (PPS) thiab (b) muaj tshuaj txiav tawm ntawm lawv tus nqi PPS yog dab tsi?​​ 

Cov kev cai nyob ntawm seb cov kev pabcuam tshuaj puas suav nrog hauv 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 uas cov khw muag tshuaj tam sim no muaj peev xwm ua tau yog dab tsi?​​ 

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. Qhov kev pab cuam no puas yuav suav nrog Medi-Cal Medi-Cal Managed Care Organizations (MCOs) thiab/lossis Independent Physician Associations (IPAs)?​​ 

Daim ntawv ceeb toom ntawm cov chaw muab kev pab no siv rau cov chaw muab kev pab uas sau npe thiab them nqi rau kev pabcuam (FFS) Medi-Cal rau kev kuaj mob uas tsis tas siv CLIA. Cov khw muag tshuaj uas xav sau npe thiab them nqi raws li FFS Medi-Cal yuav tsum ua raws li cov cai uas tau teev tseg hauv tsab ntawv xov xwm. Daim ntawv tshaj tawm no tsis siv rau cov neeg muab kev pab them nqi los ntawm MCOs lossis IPAs, uas tej zaum yuav muaj cov txheej txheem sau npe thiab them nqi sib cais.​​ 

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?​​ 

Yog xav paub txog cov nqi them rov qab Medi-Cal tshiab tshaj plaws rau cov kev kuaj mob CLIA-zam, cov neeg muab kev pab yuav tsum mus saib nplooj ntawv web Medi-Cal Rates lossis tiv tauj Medi-Cal Benefits Division ntawm Medi-Cal.Benefits@dhcs.ca.gov.​​ 

2. Qhov no puas yog FFS uas raug txiav tawm zoo ib yam li kev them nqi rau Medication Therapy Management (MTM)?​​ 

Raws li Daim Ntawv Xaj Haujlwm N-01-19, cov kev pabcuam tshuaj raug txiav tawm, yog li txhua tus kws muag tshuaj uas them nqi Medi-Cal rau cov kev pabcuam tshuaj tau sau npe rau hauv FFS Medi-Cal. Yog li ntawd, tsab ntawv xov xwm no yuav siv rau txhua tus kws muag tshuaj uas tau sau npe rau hauv FFS Medi-Cal, los ntawm kev xa daim ntawv thov tag nrho rau kev sau npe tshiab lossis los ntawm kev xa daim ntawv ntxiv yog tias tus kws muag tshuaj twb tau sau npe lawm. Cov chaw muab tshuaj yuav muaj peev xwm them nqi rau 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?​​ 

Raws li Daim Ntawv Txuas 4.19-B, Nplooj Ntawv 3d, DHCS tau tso cai los tsim lossis kho cov nqi rau cov kev pabcuam kuaj mob hauv chaw kuaj mob kom tsis pub tshaj 100 feem pua ntawm daim ntawv teev nqi kuaj mob hauv chaw kuaj mob hauv tebchaws Medicare thiab daim ntawv teev nqi kws kho mob hauv chaw kuaj ... Yog xav paub txog tus nqi tam sim no, thov mus saib daim ntawv teev nqi ntawm DHCS Clinical Laboratory and Laboratory Services (CLLS).​​ 

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?​​ 

Thov saib phau ntawv qhia txog Medi-Cal Pathology: Billing and Modifiers (path bil) Billing Manual kom paub ntxiv txog kev them nqi rau cov kev xeem CLIA uas tsis tau them.​​ 

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 tiv tauj leej twg yog tias muaj lus nug txog kev them nyiaj thiab kev nkag mus tsis sib xws uas tshwm sim los ntawm Assembly Bill (AB) 1114 kev hloov pauv lub luag haujlwm?​​ 

Yog muaj lus nug txog kev them nyiaj thiab kev nkag mus tsis sib xws raws li 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):​​