Kev Pabcuam Midwifery hauv Medi-Cal
California tam sim no lees paub ob hom midwives: Certified Nurse Midwives (CNM) uas qee zaum hu ua Nurse Midwives (NMW) thiab Licensed Midwives (LM). Ob leeg LMs thiab CNMs tuaj yeem xyaum ua lawv tus kheej, lawv tsis tas yuav muaj kev saib xyuas tus kws kho mob thiab tsim nyog tau txais kev tso npe ua Medi-Cal cov kws kho mob nrog California Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS). CNMs thiab LMs uas tau cuv npe hauv Medi-Cal tuaj yeem muab Medi-Cal cov txiaj ntsig thiab cov kev pabcuam hauv lawv cov kev siv tau ntawm kev coj ua hauv ob qho tib si tus nqi-rau-kev pabcuam (FFS) thiab los ntawm cov kev npaj khomob (MCPs) hauv cov kev tswj xyuas kev pabcuam.
Nurse-Midwives (CNM)
- CNMs tau ntawv tso cai los ntawm Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv Hauv California (BRN) raws li Cov Neeg Saib Xyuas Kev Noj Qab Haus Huv (RNs) thiab tau txais daim ntawv pov thawj ntxiv los ntawm BRN los xyaum midwifery.
- CNM qhov kev coj ua hauv California tau txhais hauv Tshooj 2746.5 ntawm Txoj Cai Kev Lag Luam thiab Kev Ua Haujlwm. CNMs tsis xav kom tus kws kho mob saib xyuas los xyaum hauv California.
- Many Nurse Midwives maintain national board certification through the American Midwifery Certification Board (AMCB) those who maintain this certification are Certified Nurse-Midwives. Certification through AMCB is not required for practice in California.
Daim Ntawv Tso Cai Midwives (LM)
- LMs tau ntawv tso cai los ntawm California Medical Board.
- LM scope ntawm kev coj ua hauv California yog txhais hauv Tshooj 2507 ntawm Txoj Cai Kev Lag Luam thiab Kev Ua Haujlwm. LMs tsis xav kom tus kws kho mob saib xyuas los xyaum hauv California.
- Many LMs maintain national board certification through the North American Registry of Midwives (NARM) those who maintain this certification are Certified Professional Midwives (CPM). Certification through NARM is not required for practice in California.
Yuav Ua Li Cas Los Ua Tus Kws Pab Medi-Cal Midwife
The majority of California’s Medi-Cal pregnant enrollees are cared for through Managed Care Plans (MCP) a smaller number are cared for through fee for service (FFS). Midwives (CNMs and LMs) may enroll through the Provider Application and Validation for Enrollment (PAVE) portal to submit their Medi-Cal application to provide care for to people through both FFS and MCP.
Midwives (CNMs and LMs) interested in serving Medi-Cal managed care plan (MCP) members will also need to enter contracts with the member’s Medi-Cal MCP plan. LMs and CCNMs must contact the Medi-Cal MCP directly for instructions on how to become a Medi-Cal MCP network provider.
Medi-Cal Fee Rau Kev Pabcuam (FFS):
Enrollment in Medi-Cal through PAVE is all that is required to start taking Medi-Cal FFS. DHCS pays out directly at rates set by the State for care provided to individuals covered by FFS. Please see Current Medi-Cal Rates.
Medi-Cal Managed Care:
CNMs and LMs interested in providing services to Medi-Cal managed care members who receive care through Medi-Cal MCPs must first enroll with Medi-Cal through PAVE. After enrolling with PAVE they must contract directly with the MCPs. Only CNMs and LMs who entered into contracts with Medi-Cal MCPs will be able to receive reimbursement for services provided to MCP members. To view a list of Medi-Cal MCPs in your county, please visit DHCS’ Medi-Cal Managed Care Health Plan Directory website.
DHCS’ Provider Application and Validation for Enrollment (PAVE) portal
For more information about PAVE, please visit DHCS’ PAVE Provider Portal (ca.gov) website. You may also call the PAVE Help Desk at (866) 252-1949, and one of DHCS’ experts will be happy to assist you (available Monday – Friday, 8:00 am – 6:00 pm Pacific time, excluding state holidays).
Medi-Cal Phau Ntawv Qhia
Medi-Cal coverage policy for both Medi-Cal FFS and managed care delivery systems as well as Medi-Cal FFS reimbursement policy can be found in the Medi-Cal Provider Manual. Medi-Cal covered benefits and services provided by CNMs and LMs within their respective scopes of practice can be found in several different sections of the Medi-Cal Provider Manual, including:
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- Cov kws kho mob tsis yog kws kho mob (NMP) Manual: This manual includes billing guidance for LM and CNMs and information about care covered by Medi-Cal. Additional Resources and information can be found in the following subsections of the the Medi-Cal provider manual:
Txhua Daim Ntawv Npaj (APL)
Medi-Cal tswj hwm kev saib xyuas sib txuas lus nrog Medi-Cal MCPs los ntawm APLs, uas qhia cov ntaub ntawv lossis txhais cov kev hloov pauv hauv txoj cai lossis cov txheej txheem ntawm tsoomfwv qib siab thiab / lossis lub xeev, thiab muab kev qhia rau cov neeg cog lus, yog tias tsim nyog siv cov kev hloov pauv no raws li kev ua haujlwm. Cov ntaub ntawv rau CNMs thiab LMs tuaj yeem pom hauv ntau qhov sib txawv APLs, suav nrog:
- APL 18-022: Kev Nkag Mus Rau Cov Chaw yug menyuam dawb thiab kev pabcuam Midwife
- APL 16-017: Kev Pab Certified Nurse Midwife thiab Alternative Birth Center Facility Services (Supersedes APL 15-017)
- APL 18-022: Kev Nkag Mus Rau Cov Chaw Kho Mob Tsis Muaj Hnub Nyoog thiab Kev Pab Cuam Rau Midwife (Supersedes APL 16-017)
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APL 24-003: Abortion Services
Kev cob qhia Medi-Cal
Medi-Cal Learning Portal muaj Medi-Cal cov chaw muab kev pab, suav nrog CNMs thiab LMs, thiab cov neeg sau nqi them nqi kawm ntawv tus kheej hauv online txog kev them nqi, cov cai, cov txheej txheem, kev pib tshiab, thiab kev hloov pauv rau Medi-Cal yav tom ntej.
- Cov neeg siv thawj zaug: Ua kom tiav daim ntawv teev npe ib zaug ntawm learn.medi-cal.ca.gov
- Returning users: Log in on learn.medi-cal.ca.gov to view or search the course catalog.
Cov hauv qab no yog cov kev qhia qhia rau CNM thiab LMs:
- Kev Them Nqi Them Nqi: Cov kev cob qhia no tsom mus rau Medi-Cal Cov Nqi Them Nqi Nqis nrog rau cov neeg tau txais kev pab tsim nyog, Kev Sib Koom Tus Nqi, Kev Thov Kev Tso Cai Kho Mob (TAR), CMS-1500 lossis UB-04 Kev Thov Ua tiav thiab Kev Thov Rov Qab.
- CPSP Cov Ntaub Ntawv Teev Npe Webinar: Cov qauv no yuav paub cov neeg koom nrog ntau yam kev pabcuam muaj rau cov neeg tau txais Medi-Cal cev xeeb tub uas tau cuv npe hauv CPSP txij hnub pib xeeb mus txog 60 hnub tom qab lub hli yug. Kev koom tes ntawm tus neeg txais kev pab thiab tus neeg muab kev pab yog yeem. Cov ntaub ntawv them nqi kuj raug them.
- Licensed Midwife Billing Webinar: This training provides an overview of Medi-Cal Fee-for-Service billing and claims instructions, as well as general program policy information for Licensed Midwives.
Cov peev txheej
Cov hauv qab no yog cov peev txheej ntxiv uas CNMs thiab LMs tuaj yeem pom muaj txiaj ntsig:
- Txoj kev yug me nyuam
- Stakeholder News Subscription
- Medi-Cal Chaw Pabcuam Portal
- California BRN (CNMs)
- Cov lus nug nquag nug rau CNMs
- MBC (LMs)
- California Department of Public Health CPSP: CNMs and LMs may enroll in Medi-Cal as direct/billing providers and apply as a Comprehensive Perinatal Services Program provider (CPSP).
- Hloov kho Medi-Cal Tsim Qhov Chaw Ua Lag Luam Yuav Tsum Tau Sau Npe Ua Lag Luam thiab cov txheej txheem rau cov kws kho mob muaj ntawv tso cai thiab tus kws saib xyuas neeg mob muaj ntawv pov thawj
- DHCS Daim Ntawv Tso Cai Midwife Application Information
Tiv tauj peb
Yog tias CNMs thiab LMs muaj lus nug ntxiv, lawv tuaj yeem tiv tauj DHCS rau kev pab ntxiv, raws li hauv qab no:
- For billing and claim submission questions, please contact DHCS’ Fiscal Intermediary via phone through the Telephone Service Center (TSC) at 1-800-541-5555. For faster access to TSC resources, refer to the TSC Main Menu Prompt Options Guide.
- For policy guidance, please send an email to Medi-Cal.Benefits@dhcs.ca.gov.