Cov ntaub ntawv thov Tus Kws Saib Xyuas Neeg Mob
Cov Tsev Kho Mob Midwives yuav tsum xa lawv tus kheej thiab/lossis cov ntawv thov pab pawg los ntawm PAVE (Kev Pabcuam Kev Pabcuam thiab Kev Pabcuam rau Kev Sau Npe). Yog tias koj tab tom xa ib daim ntawv thov pab pawg, thov xyuas kom koj xa tsawg kawg ob daim ntawv thov kev ua haujlwm hauv PAVE txhawm rau tsim koj pab pawg.
Yog tias koj tab tom tso npe ua ib tus neeg 'sawv ib leeg' tus kws kho mob lossis ua ib tug ‘clinic-based certified nurse midwife provider’
, koj yuav tsum xa koj daim ntawv thov ntawm PAVE.
In accordance with Welfare and Institutions (W&I) Code Section 14043.75(b), requirements for certified nurse midwife providers who apply for enrollment in the Medi-Cal program have been updated. For more information, please see the regulatory provider bulletin titled, “Updated Place of Business Enrollment Requirements and Procedures for Licensed Midwives and Certified Nurse Midwives” and the Questions and Answers document from the Stakeholder Hearing held on August 1, 2024. Additionally, please see instructions regarding how to submit an application on PAVE based on your entity type:
- Nurse Midwife Rendering Provider Application
- Daim Ntawv Thov Tus Kws Kho Mob Tus Kws Kho Mob Tus Kheej Tus Kheej
- Nurse Midwife Group Daim Ntawv Thov Kev Pab Them Nqi
Daim ntawv tso cai
Ua ntej thov rau Medi-Cal, ua ntej kos nrog California Pawg Neeg Saib Xyuas Kev Noj Qab Haus Huv uas tau sau npe kom paub tseeb tias koj ua tau raws li tag nrho cov cai ntawm daim ntawv tso cai.
Cov ntaub ntawv xav tau
Tom ntej no, sau cov ntaub ntawv xav tau hauv qab no, raws li tsim nyog, txhawm rau muab lawv tso rau hauv PAVE thaum koj ua tiav koj daim ntawv thov PAVE. Thov xyuas kom meej tias cov ntaub ntawv uas tau muab tso tawm yog pom tseeb.
1. California Registered Nurse License thiab California Nurse-Midwife Certificate; California Nurse-Midwife Furnishing Certificate yog muab tshuaj thiab khoom siv raws li B&P Code Tshooj 2746.51 thiab DEA Kev Sau Npe yog tias koj muab cov tshuaj tswj hwm.
2. Daim Ntawv Tso Cai Tsav Tsheb lossis daim npav qhia tawm hauv lub xeev (tso tawm hauv 50 Tebchaws Meskas lossis Cheeb Tsam ntawm Columbia) rau tus neeg thov.
3. Certificate of Professional Liability Insurance nyob rau hauv tus nqi ntawm tsis tsawg tshaj li $100,000 ib daim ntawv thov thiab ib tug tsawg kawg nkaus txhua xyoo tag nrho ntawm $300,000. Kev lees paub lees paub yog daim ntawv pov thawj ntawm kev tuav pov hwm lossis daim ntawv tshaj tawm uas muab los ntawm lub tuam txhab pov hwm uas muaj lub npe ntawm lub tuam txhab tuav pov hwm, lub npe ntawm cov ntawv pov hwm, hnub siv tau, thiab kev txwv ntawm kev pov hwm. Nco tseg: Tus kws kho mob lub npe, raws li pom nyob rau hauv California Daim Ntawv Tso Cai Saib Xyuas Neeg Mob thiab Daim Ntawv Pov Thawj Tus Kws Saib Xyuas Neeg Mob, yuav tsum tau qhia txog kev pov hwm kev pov hwm kev lav phib xaub.
4. For ‘individual stand alone enrollment‘: Federal Employer Identification Number (FEIN) verification, if a social security number is not used, by submitting a current Internal Revenue Service (IRS) generated document. The only acceptable documents include an IRS-generated Letter 147-C, IRS-generated Form 941 (Employer’s Quarterly Federal Tax Return), IRS-generated Form 8109-C (Deposit Coupon), or IRS-generated Form SS-4 (only the official Confirmation Notification of FEIN assignment). Note: The legal name of the applicant or provider on the application must exactly match the name on the IRS-generated document; and the applicant/provider must be an owner or officer of the entity listed on the IRS document. For further information, please visit the IRS or call them at (800) 829-4933.
5. For ‘individual stand alone enrollment’: Certificate of Commercial Liability Insurance (kev lag luam, kev lag luam, lossis kev lav phib xaub, lossis kev tuav pov hwm hauv chaw ua haujlwm) hauv tus nqi tsis pub tsawg dua $ 100,000 rau ib daim ntawv thov thiab qhov tsawg kawg ib xyoos ib zaug ntawm $ 300,000. Kev lees paub lees paub yog pov thawj ntawm kev tuav pov hwm tus kheej, lossis daim ntawv pov thawj ntawm kev tuav pov hwm lossis daim ntawv tshaj tawm uas muab los ntawm lub tuam txhab pov hwm uas muaj lub npe ntawm lub tuam txhab pov hwm, lub npe thiab chaw nyob ua lag luam ntawm cov ntawv pov hwm, hnub siv tau, thiab kev txwv ntawm kev pov hwm. Nco tseg: Lub npe thiab chaw nyob ua lag luam, suav nrog tus lej suite yog tias tsim nyog, ntawm tus neeg thov lossis tus neeg muab kev pabcuam hauv daim ntawv thov yuav tsum ua raws nraim li daim ntawv pov hwm lub npe thiab chaw nyob ntawm daim ntawv pov thawj ntawm kev tuav pov hwm lossis daim ntawv tshaj tawm.
6. For ‘individual stand alone enrollment’: Certificate of Workers’ Compensation Insurance is required by California law, if your business has one or more employees. Acceptable verification is either evidence of being self-insured, or a certificate of insurance or declaration sheet issued by the insurance company that contains the name of the insurance company, the name and business address of the insured, and effective dates. If no Workers’ Compensation insurance is required, an explanation must be provided. Note: The name and business address of the applicant or provider must match the insured’s name and address on the certificate of insurance.
7. For ‘individual stand alone enrollment’: Signed Lease Agreement, if business premises are not owned by the applicant or provider. Note: The name and business address of the applicant or provider must exactly match the lessee’s name and address on the lease agreement.
8. For ‘individual stand alone enrollment’: Local Business License, Tax Certificate, and Permit for any city and/or county where business activities are conducted. Note: The name and business address of the applicant or provider on the application must exactly match the business name and business address on all local licenses and permits. If a business license/permit is not required, please submit a written statement from your local city/county indicating that your business does not require any license or permit. For further information, please contact your city business license office and/or visit the California State Association of Counties and click on the “California’s Counties” link, and select “County Web Sites.”
9. For ‘individual stand alone enrollment’: Recorded/stamped Fictitious Business Name Statement (FBNS), issued by the county where the principal place of business is located, if using a fictitious business name AND the business name is different from the legal name on your application. For example, in the case of a corporation, any name other than the corporation name on record with the Secretary of State requires a FBNS. Note: The business name and business address of the applicant or provider on the application, all local business licenses/permits, and the FBNS must exactly match. To determine the applicable county agency where fictitious business names are filed, please visit the California State Association of Counties and click on the “California’s Counties” link, and select “County Web Sites.”
10. For ‘individual stand alone enrollmen t’: If your business is a corporation, processing delays may be avoided by attaching a copy of the filed Articles of Incorporation from the Secretary of State, and a list of directors’ and officers’ names and titles, with percent of ownership and control interest for each. To verify or change the name and/or status of your corporation or for further information, please visit the Secretary of State California Business Portal and click on the “California Business Search” link or other appropriate link.
11. For ‘individual stand alone enrollment’: If your business is a partnership, a fully executed Partnership Agreement. Processing delays may be avoided by indicating whether the entity is a General Partnership or Limited Partnership and also submitting the following:
a) Rau General Partnership, ib daim ntawv teev npe ntawm txhua tus neeg koom tes nrog feem pua ntawm cov tswv cuab lossis tswj cov paj laum rau txhua tus; los yog
b) Rau Kev Koom Tes Ua Lag Luam Txwv, cov ntaub ntawv txheeb xyuas tus khub General, thiab cov npe ntawm txhua tus neeg koom tes nrog feem pua ntawm cov tswv cuab lossis tswj kev txaus siab rau txhua tus.
To verify or change the name and/or status of your partnership or for further information, please visit the Secretary of State California Business Portal and click on the “California Business Search” link or other appropriate link.
12. For ‘individual stand alone enrollment’: Successor Liability with Joint and Several Liability Agreement (DHCS 6217), if applicable.