Medi-Cal Rx: Hloov Medi-Cal Pharmacy Services los ntawm Managed Care mus rau Nqi-Rau-Service Cov Lus Nug nquag​​ 

Version 16.0​​ 

Lub yim hli ntuj 31, 2023​​ 

The following Frequently Asked Questions (FAQs) document provides additional guidance and clarification to Medi-Cal beneficiaries, providers, plan partners, and other interested parties regarding the transition of Medi-Cal’s pharmacy benefit (collectively referred to as “Medi-Cal Rx”). As the Department of Health Care Services (DHCS) receives additional questions, this document will be updated as indicated by the version number and date on the title page.​​  

For information regarding Medi-Cal Rx, please visit DHCS’ dedicated Medi-Cal Rx Transition website. In addition, general questions regarding Medi-Cal Rx may also be submitted to DHCS via email at medi-cal.pharmacybenefits@dhcs.ca.gov.​​ 

Cov Lus Qhia​​ 

Cov ntaub ntawv dav dav​​ 
Cov ntaub ntawv yuav khoom​​ 
Hloov ntaub ntawv​​ 
Cov ntaub ntawv pub, Electronic Access, & Lwm yam kev pab kho mob​​ 
Muab Kev Tshaj Tawm, Kev Kawm, & Kev cob qhia​​ 
Cov neeg tau txais txiaj ntsig Kev Pabcuam Cov Neeg Siv Khoom & Cov Kev Pabcuam ntsig txog​​ 
Kev tsim nyog tau txais txiaj ntsig, sib faib cov nqi, thiab lwm yam lus nug ntsig txog kev noj qab haus huv​​ 
Medi-Cal Fee-For-Service Reimbursement Methodology​​ 
Kev txiav txim siab txog txoj cai​​ 
Kev Tso Cai Ua Ntej / Siv Kev Tswj Xyuas​​ 
340B Federal Drug Discount Program​​ 
Medi-Cal Rx Kev Tsis Txaus Siab / Kev Tsis Txaus Siab Kev daws teeb meem & Cov txheej txheem thov rov hais dua​​ 
Kev cuam tshuam txog nyiaj txiag / kev soj ntsuam​​ 
Lwm yam / Lwm Cov Ntaub Ntawv​​ 

Cov ntaub ntawv dav dav​​ 

1. Vim li cas Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) thiaj hloov chaw muag tshuaj Medi-Cal tau txais txiaj ntsig los ntawm kev tswj hwm kev saib xyuas Medi-Cal mus rau kev them nqi rau kev pabcuam?​​ 

DHCS tau hloov cov kev pabcuam tshuaj Medi-Cal los ntawm lub kaw lus xa khoom kho mob Medi-Cal mus rau lub kaw lus xa khoom them nqi rau Medi-Cal vim yog Tus Thawj Kav Xeev Gavin Newsom lub Ib Hlis 7, 2019 Daim Ntawv Txiav Txim N-01-19, rau lub hom phiaj ntawm kev ua tiav kev txuag nqi rau kev yuav tshuaj uas lub xeev ua, los ua kom cov txiaj ntsig tshuaj thoob plaws lub xeev rau txhua tus tswv cuab Medi-Cal, thiab kom nce kev nkag mus rau tag nrho los ntawm kev tso cai rau cov tswv cuab kom tau txais cov kev pabcuam tshuaj los ntawm lub network tshuaj them nqi rau kev pabcuam dav dua. Ntxiv mus, qhov kev hloov kho tus qauv no yog ib kauj ruam tseem ceeb rau kev vam meej ntawm California Advancing and Innovating Medi-Cal (CalAIM) cov kev pib uas DHCS tau tshaj tawm. Yog xav paub ntxiv txog CalAIM, mus saib lub vev xaib DHCS.​​ 

2. Medi-Cal Rx yog dab tsi?​​ 

Medi-Cal Rx yog lub npe uas Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tau muab rau cov txiaj ntsig thiab cov kev pabcuam ntawm cov khw muag tshuaj uas tau tswj hwm los ntawm lub kaw lus them nqi rau kev pabcuam los ntawm Magellan Medicaid Administration, LLC (MMA) thaum Lub Sijhawm Ua Haujlwm Tag Nrho (AOO).​​  

3. Puas yog tag nrho Medi-Cal Rx Assumption of Operations (AOO) sawv cev li cas?​​ 

Medi-Cal Rx AOO sawv cev rau hnub uas Magellan Medicaid Administration, LLC (MMA) tau lees txais lub luag haujlwm ua haujlwm rau txhua qhov kev pabcuam tswjfwm uas tseem tshuav uas tsim nyog los txhawb Medi-Cal Rx, suav nrog tab sis tsis txwv rau kev tswj hwm cov lus thov, kev tso cai ua ntej (PA) thiab kev tswj hwm kev siv (UM), cov kev pabcuam txhawb nqa tus neeg muab kev pabcuam thiab cov tswv cuab, thiab lwm yam kev pabcuam pabcuam thiab kev tshaj tawm. Medi-Cal Rx tag nrho AOO, raws li tau piav qhia hauv cov lus nug # 23-25, tau tshwm sim rau lub Ib Hlis 1, 2022. Yog xav paub ntxiv, thov saib cov lus nug # 28-30.​​ 

4. Dab tsi yog qhov zoo ntawm kev hloov pauv Medi-Cal cov kev pab cuam hauv khw muag tshuaj los ntawm kev tswj hwm kev saib xyuas mus rau tus nqi-rau-kev pabcuam?​​ 

Kev hloov chaw muag tshuaj los ntawm Medi-Cal tswj kev saib xyuas mus rau tus nqi-rau-kev pabcuam yuav, thiab lwm yam:​​ 

• Ua raws li Medi-Cal lub tsev muag tshuaj tau txais txiaj ntsig thoob plaws lub xeev, nyob rau hauv ib qho kev xa khoom.​​ 
• Improve access to pharmacy services with a pharmacy network that includes the vast majority of the state’s pharmacies and is generally more expansive than individual Medi-Cal Managed Care Plan (MCP) pharmacy networks.​​ 
• Siv cov txheej txheem kev tswj hwm kev siv (UM) thoob plaws lub xeev rau txhua cov tshuaj kho mob sab nraud, raws li tsim nyog.​​ 
• Txhawb kom California muaj peev xwm sib tham txog cov nyiaj rov qab los ntawm cov tshuaj ntxiv rau lub xeev nrog cov chaw tsim tshuaj ua qhov kev pab cuam Medicaid loj tshaj plaws uas muaj ntau dua 15 lab tus tswv cuab.​​ 

5. Puas yog DHCS yuav tsum tau nrhiav kev pom zoo los ntawm tsoomfwv los siv Medi-Cal Rx?​​ 

Yog lawm. DHCS tau thov tsoomfwv pom zoo los ntawm Lub Chaw Pabcuam Medicare thiab Medicaid (CMS) txhawm rau hloov pauv cov txiaj ntsig ntawm lub tsev muag tshuaj los ntawm kev tswj hwm tus menyuam mus rau tus nqi-rau-kev pabcuam los ntawm CalAIM Tshooj 1915(b) wavier daim ntawv thov. Daim ntawv thov zam no cuam tshuam txog kev tshem tawm cov txiaj ntsig ntawm lub tsev muag tshuaj uas raug them los ntawm lub tsev muag tshuaj ntawm lub tsev muag tshuaj daim ntawv thov suav nrog cov tshuaj them rau cov neeg mob sab nraud thiab cov kws kho mob siv tshuaj, raws li tau piav qhia hauv Medi-Cal Rx Txhua Daim Ntawv Npaj (APL20-020), pib lub Ib Hlis 1, 2022.​​ 

6. Dab tsi Medi-Cal Managed Care Plans (MCPs) yog dab tsi thiab tsis cuam tshuam los ntawm Medi-Cal Rx?​​ 

Txhua lub Medi-Cal MCPs, suav nrog AIDS Healthcare Foundation, raug cuam tshuam. Medi-Cal Rx tsis siv rau Cov phiaj xwm Programs of All-Inclusive Care for the Elderly (PACE), Senior Care Action Network (SCAN), lossis Major Risk Medical Insurance Program (MRMIP).​​ 

7. Will Medi-Cal Rx apply to California Children’s Services (CCS) and the Genetically Handicapped Persons Program (GHPP)? If yes, will Medi-Cal Rx change CCS, and how does it intend to address CCS-unique issues?​​ 

Medi-Cal Rx siv tau rau ob qho tib si CCS thiab GHPP. Txij li thaum Medi-Cal Rx puv nkaus Assumption of Operations (AOO), txhua qhov kev thov rau kev tso cai ua ntej (PAs) (yav tas los hu ua Service Authorization Requests lossis Treatment Authorization Requests, feem) - rau ob lub nroog ywj pheej thiab cov nroog uas vam khom, thiab CCS-xwb, GHPP-xwb, thiab CCS/GHPP Medi-Cal cov tswv cuab - ua tiav los ntawm Medi-Cal Rx rau cov txiaj ntsig tshuaj uas raug them rau cov kev thov tshuaj.​​ 

Raws li tau hais tseg hauv lo lus nug #24 hauv qab no, DHCS tswj hwm txhua qhov kev them nqi tshuaj thiab lub luag haujlwm txoj cai nrog rau teeb tsa txhua qhov kev ntsuas ntsig txog kev txiav txim siab PA. Tsis tas li ntawd xwb, vim pom tias cov pej xeem CCS/GHPP xav tau kev kho mob tshwj xeeb, DHCS tseem niaj hnub ua haujlwm nrog CCS Advisory Group thiab lwm cov neeg tseem ceeb hauv qhov chaw no.​​ 

8. Dab tsi yuav tsis hloov raws li ib feem ntawm Medi-Cal Rx?​​ 

Medi-Cal Rx tsis tau hloov cov hauv qab no:​​ 

• The scope of the existing Medi-Cal pharmacy benefit.​​ 
• Kev muab cov kev pabcuam hauv tsev muag tshuaj raws li ib feem ntawm cov qauv sau nqi / tag nrho suav nrog hauv ib qho chaw kho mob lossis Lub Sijhawm Ntev (LTC) (suav nrog Cov Kws Pabcuam Saib Xyuas Neeg Mob [SNFs] thiab lwm yam Kev Pabcuam Nruab Nrab [ICFs]), tsis hais txog kev xa khoom.​​ 
• Medi-Cal uas twb muaj lawm cov chaw muag tshuaj uas tswj xyuas kev kho mob carve-outs (piv txwv li, ntshav yam, tshuaj tiv thaiv kab mob HIV/AIDS, tshuaj tiv thaiv kev puas hlwb, lossis tshuaj siv los kho cov teeb meem siv yeeb tshuaj).​​ 
• Txhua qhov kev pabcuam hauv tsev muag tshuaj uas raug nqi raws li kev khomob thiab / lossis kev thov hauv tsev tsis yog kev thov tshuaj.​​ 
• Txoj Kev Ncaj Ncees Hauv Xeev (SFH), raws li tau hais tseg hauv California txoj cai lij choj uas siv tau.​​ 

9. Medi-Cal Rx cuam tshuam li cas rau kev them nyiaj ntawm cov tshuaj uas tau muab rau hauv qhov chaw kho mob hauv tsev lossis mus sij hawm ntev (LTC)?​​ 

Raws li tau hais hauv lo lus nug #8, yog tias muaj tshuaj uas muab ua ib feem ntawm tus nqi sib koom ua ke rau cov kev pabcuam uas muab los ntawm LTC/Skilled Nursing Facility (SNF), ces nws yuav tseem yog lub luag haujlwm ntawm Medi-Cal Managed Care Plan (MCP). Txwv tsis pub, yog tias cov tshuaj uas kws kho mob sau ntawv kom yuav tsis yog ib feem ntawm tus nqi sib koom ua ke rau cov kev pabcuam uas LTC/SNF muab, thiab hloov chaw raug them tus nqi rau kev pabcuam, ces lub luag haujlwm nyiaj txiag rau cov tshuaj ntawd yog txiav txim siab los ntawm hom kev thov uas lawv raug them. Yog tias cov tshuaj raug muab los ntawm lub tsev muag tshuaj thiab raug them nqi rau ntawm daim ntawv thov tshuaj, ces lawv raug txiav tawm thiab them los ntawm Medi-Cal Rx. Yog tias cov tshuaj yog muab los ntawm LTC/SNF thiab them nqi rau kev thov kho mob/tsev kho mob, MCP yog tus muaj lub luag haujlwm, lossis California Medicaid Management Information System (CA-MMIS) Fiscal Intermediary, yog tias tus tswv cuab raug them nqi-rau-kev pabcuam.​​ 

10. What pharmacy benefits will be “carved out” of Medi-Cal managed care due to Medi-Cal Rx?​​ 

Medi-Cal Rx tau txais lub luag haujlwm los ntawm Medi-Cal Managed Care Plans (MCPs) rau kev tswj hwm cov hauv qab no thaum lub tsev muag tshuaj them nqi rau ntawm daim ntawv thov tsev muag tshuaj:​​ 

• Cov Tshuaj Kho Mob Sab Nraud, suav nrog qee yam Tshuaj Kho Mob (PADs)​​ 
• Cov khoom siv kho mob tshwj xeeb​​ 
• Khoom noj khoom haus Enteral​​ 

Cov tshuaj muaj nyob rau hauv cov kev pab cuam uas tsis yog capitated rau MCPs (piv txwv li, ntshav yam, tshuaj HIV/AIDS, antipsychotics, los yog tshuaj siv los kho cov teeb meem siv yeeb tshuaj) nyob twj ywm uncapitated (carved) tsis hais hom kev thov (uas yog, khw muag tshuaj los yog daim ntawv thov kho mob). Cov ntaub ntawv kho mob rau cov chav kawm ntawm cov tshuaj no yuav tsum tau xa mus ntxiv raws li kev thov them nqi rau kev pabcuam rau Medi-Cal Fiscal Intermediary (FI). Cov kws kho mob tau ceeb toom tias cov tshuaj tsis tau teev nyob rau hauv lub tsev muag tshuaj Daim Ntawv Cog Lus Tshuaj (CDL) thiab tswj hwm los ntawm
tus kws kho mob uas tsis yog kws kho mob yuav tsum tau them nqi raws li cov ntaub ntawv kho mob los ntawm tus kws kho mob thiab tsis raug them los ntawm lub tsev muag tshuaj.​​ 

Cov kev ntxiv tshiab rau daim ntawv teev cov tshuaj uas tsis suav nrog cov tshuaj feem ntau siv sijhawm tsawg kawg 60 hnub ua ntej cov ntawv thov tuaj yeem them tau zoo. Cov chaw muab kev pab raug thov kom tuav lawv cov ntaub ntawv thov kom txog thaum lub kaw lus npaj txhij txais lawv.​​  

Yog xav paub ntxiv, thov saib daim ntawv qhia txog Medi-Cal Scope ntawm DHCS uas nyob rau ntawm lub vev xaib ntawm DHCS. Daim ntawv no muab cov ntsiab lus ntxiv thiab cov ntaub ntawv ntsig txog DHCS txoj kev siv Medi-Cal managed care mus rau kev faib tshuaj raws li kev pabcuam. Nws kuj muab cov npe ntawm cov txiaj ntsig ntawm Medi-Cal, uas yog tsis raug cais tawm (uas yog, cov txiaj ntsig ntawm cov tshuaj uas raug them rau cov kev thov kho mob thiab cov tsev kho mob) lossis raug cais tawm (uas yog, txhua qhov txiaj ntsig ntawm cov tshuaj uas raug them rau cov kev thov tshuaj).​​ 

11. DHCS yuav ua li cas thiaj li tau txais kev pab them nqi kho mob rau cov ntshav qab zib, uas suav nrog cov ntawv xeem, lancets, glucometers, tswj kev daws teeb meem, thiab cov cuab yeej lancing, tom qab Medi-Cal Rx tag nrho Assumption of Operations (AOO)?​​ 

Cov ntawv kuaj ntshav qab zib (rau cov zis, cov piam thaj hauv cov ntshav, thiab cov ketones) thiab cov cai ntawm cov koob txhaj tshuaj tsis tau hloov pauv raws li Medi-Cal Rx thiab raug rau cov npe ntawm cov khoom lag luam cog lus thiab cov qauv uas tam sim no luam tawm hauv ntu Khoom Siv Kho Mob ntawm Phau Ntawv Qhia Txog Tus Muab Kev Pabcuam Medi-Cal.​​  

Cov ntaub ntawv no muaj nyob rau hauv Medi-Cal Rx Tus Kws Kho Mob Phau Ntawv Qhia thiab ntawm Medi-Cal Rx Web Portal.​​ 

Cov Glucometers, Control Solutions, thiab Lancing Devices tshwj xeeb yog cov txiaj ntsig kho mob uas tau them los ntawm Medi-Cal Rx, siv tau txij lub Ib Hlis 1, 2022, thiab tsuas yog siv tau rau cov khoom lag luam ntawm Daim Ntawv Teev Npe Tshiab ntawm Cov Tshuab Ntsuas Qab Zib Ntshav (Glucometers), Control Solutions, thiab Lancing Devices (muaj nyob rau ntawm Medi-Cal Rx Web Portal) rau kev txiav txim siab txog kev them nqi ntawm Medi-Cal R ua txiaj ntsig ntawm lub tsev muag tshuaj. Cov khoom siv tau hauv pawg no uas tsis nyob hauv daim ntawv teev npe no suav tias tsis tsim nyog rau kev txiav txim siab them nqi los ntawm Medi-Cal Rx ua qhov txiaj ntsig ntawm kev muag tshuaj.​​ 

Cov khoom lag luam uas tsis tau cog lus tsis pom nyob rau hauv Daim Ntawv Teev Kev Saib Xyuas Tus Kheej Cov Ntshav Qab Zib (Glucometers), Cov Txheej Txheem Tswjhwm, thiab Lancing Devices raug them rov qab los ntawm Medi-Cal Managed Care Plans (MCPs) lossis tus nqi-rau-kev pabcuam Kev Pabcuam Nyiaj Txiag (FI) raws li HCPCS-billed Durable Medical Equip. Kev txwv kom muaj nuj nqis tseem tsis hloov.​​ 

12. Tam sim no DHCS tab tom saib xyuas kev them nqi ntawm cov tshuab xa tshuaj insulin sab nraud pov tseg (Omnipod thiab V-Go) li cas thiab qhov ntawd puas tau hloov pauv txij li Medi-Cal Rx tag nrho Assumption of Operations (AOO)?​​ 

Cov Khoom Siv Xa Tshuaj Insulin Siv Ib Zaug Xwb (DIDDs) yog cov txiaj ntsig kho mob uas tau them los ntawm Medi-Cal Rx, siv tau txij lub Ib Hlis 1, 2022, thiab tsuas yog siv rau cov khoom lag luam ntawm Daim Ntawv Teev Cov Khoom Siv Xa Tshuaj Insulin Siv Ib Zaug Xwb uas tau them rau ntawm Medi-Cal Rx Web Portal. Cov khoom no tau txheeb xyuas tias yog "Ib Feem" ntawm daim ntawv Medi-Cal Rx Scope; yog li ntawd, txhua qhov kev thov DIDD uas tau them rau ntawm daim ntawv thov tshuaj yuav tsum xa mus rau Medi-Cal Rx, thiab cov kev thov kho mob uas tau them los ntawm HCPCS yuav tsum xa mus rau Medi-Cal Managed Care Plans (MCPs) lossis tus nqi-rau-kev pabcuam Fiscal Intermediary (FI). Cov ntawv thov uas NDC tau xa tom qab hloov mus rau Medi-Cal Rx rau cov khoom uas tsis pom nyob rau hauv daim ntawv teev npe no yuav raug tsis lees paub.​​ 

DIDDs xav tau kev tso cai ua ntej (PA) rau kev them nyiaj rov qab thiab cov txheej txheem tshwj xeeb raug siv. DIDDs suav nrog hauv txoj cai hloov pauv. Rau cov ntawv thov uas tau them dhau los ua cov txiaj ntsig kho mob tau sau rau hauv daim ntawv CMS-1500 , cov kws kho mob yuav tsum suav nrog PA ua ntej xa nrog daim ntawv thov nyiaj pab kho mob thiab sau ntawv pov thawj rau kev kho mob txuas ntxiv thaum lawv xa cov chaw muag tshuaj rau cov khoom thov kom ntseeg tau tias cov kev pab them nqi kho mob tau ua tiav.​​ 

13. DHCS yuav ua li cas los tswj kev them nqi ntawm Cov Khoom Siv Ntsuas Qab Zib Txuas Ntxiv (CGMs), lwm yam khoom siv kho mob ruaj khov (DME), cov khoom siv DME thiab cov khoom siv kho mob pov tseg, tom qab Medi-Cal Rx tag nrho Assumption of Operations (AOO)?​​ 

Cov Txheej Txheem Kho Mob CGM tau dhau los ua qhov txiaj ntsig kho mob uas tau them los ntawm lub tsev muag tshuaj los ntawm Medi-Cal Rx, pib siv rau lub Ib Hlis 1, 2022. Cov khoom no tau txheeb xyuas tias yog "Ib feem" ntawm daim ntawv Medi-Cal Rx Scope. Yog li ntawd, daim ntawv thov CGM yuav tsum xa mus rau Medi-Cal Rx. Cov Txheej Txheem CGM suav nrog rau hauv Txoj Cai Hloov Pauv Medi-Cal Rx. Rau cov kev thov uas tau them ua ntej ua cov nyiaj pab kho mob uas tau sau rau ntawm daim ntawv CMS-1500 , cov ntaub ntawv ntawm cov kev thov kho mob uas tau them tsis ntev los no, thiab cov lus piav qhia txog kev txuas ntxiv kho mob, yuav tsum muaj rau cov khoom thov kom ntseeg tau tias cov kev cai them nqi tau ua tiav.​​ 

 Kev them nqi tsuas yog rau cov khoom lag luam nyob rau hauv Daim Ntawv Teev Npe ntawm Cov Txheej Txheem Saib Xyuas Qab Zib Txuas Ntxiv (CGM) uas tau them nqi thiab yuav tsum tau kev tso cai ua ntej (PA) rau kev them rov qab. Cov qauv kev pov hwm tshwj xeeb tseem siv tau. Saib daim ntawv teev cov txheej txheem saib xyuas qabzib tas mus li (CGM) uas them thiab phau ntawv qhia Medi-Cal Rx Provider hauv Medi-Cal Rx Web Portal kom paub cov ntaub ntawv tshwj xeeb.​​ 

Rau Tus Nqi-rau-Service (FFS) Medi-Cal cov neeg tau txais txiaj ntsig, pib lub Kaum Hlis 1, 2022, cov lus thov uas tau them dhau los ua cov txiaj ntsig kho mob tau sau rau hauv daim ntawv CMS 1500 los ntawm HCPCS code yuav tsum raug xa mus raws li lub tsev muag tshuaj thov rau Medi-Cal Rx. Cov HCPCS cov lej no yuav tsis lees paub cov ntaub ntawv kho mob uas xa nrog hnub ua haujlwm tom qab Lub Kaum Ob Hlis 1, 2022.​​ 

Nco tseg: Cov twj tso kua tshuaj insulin sib raug rau qee cov khoom siv CGM tseem yuav nyob twj ywm DME cov nqi them raws li cov txiaj ntsig kho mob tau them rau ntawm CMS 1500 daim ntawv ntawm HCPCS code. Xa mus rau ntu DME ntawm Medi-Cal phau ntawv qhia chaw muag tshuaj ntawm Medi-Cal Cov Chaw Pabcuam lub vev xaib rau kev pab them nqi thiab cov ntaub ntawv them nqi ntawm DME insulin twj thiab khoom siv.​​ 

Medi-Cal Managed Care members should contact their individual Medi-Cal Managed Care Plan (MCP) as MCPs may determine their own CGM coverage policy, criteria, and reimbursement. CGM is a partially carved-out medical supply; therefore, MCPs can determine if they will continue to provide the benefit themselves or through Medi-Cal Rx. Managed care CGM coverage policies are available on the individual MCP’s website for provider and member clarification.​​ 

14. DHCS yuav ua li cas thiaj li yuav tau txais kev pab them nqi kho mob lwm yam kev pab cuam tam sim no lossis yav tas los them raws li daim ntawv thov kho mob, los ntawm HCPCS code thiab hauv daim ntawv CMS-1500, tom qab Medi-Cal Rx tag nrho Assumption of operations (AOO)?​​ 

Tshwj tsis yog tias tau sau tseg lwm yam rau ntawm Daim Ntawv Qhia Txog Medi-Cal Rx Scope, txhua yam khoom siv kho mob ruaj khov (DME) thiab cov khoom siv DME tseem yuav txuas ntxiv mus, tsis hloov pauv, thiab them rov qab tau raws li HCPCS-them nyiaj DME los ntawm tus neeg nruab nrab nyiaj txiag (FI) uas them tus nqi rau kev pabcuam, ntawm kev thov kho mob.​​ 

Sterile Syringes with Needles (non-insulin), a disposable medical supplies item currently billed via HCPCS code on a CMS-1500 form, will become a pharmacy-billed medical supply benefit through Medi-Cal Rx, effective January 1, 2022, restricted to products on the newly created List of Covered Sterile Syringes with Needles (non-insulin), which can be found on the Medi-Cal Rx Web Portal. NDC‑billed claims submitted after transitioning to Medi-Cal Rx for products not found on this list will be denied. These products are identified as “Partial” on the Medi‑Cal Rx Scope document; therefore, claims billed on a pharmacy claim must be submitted to Medi-Cal Rx, and claims billed as HCPCS-billed medical claims must be submitted to either Medi-Cal Managed Care Plans (MCPs) or the fee-for-service Fiscal Intermediary. Restrictions will remain unchanged: 200 syringes every 30 days without prior authorization.​​ 

Cov Ntawv Qhia Txog Cawv, yog cov khoom siv kho mob siv ib zaug xwb, yog cov nyiaj pab kho mob uas tau them los ntawm Medi-Cal Rx. Cov khoom no tau txheeb xyuas tias yog "Ib Feem" ntawm daim ntawv Medi-Cal Rx Scope; yog li ntawd, cov ntawv thov uas tau them rau daim ntawv thov tshuaj yuav tsum xa mus rau Medi-Cal Rx, thiab cov ntawv thov uas tau them raws li HCPCS-them cov ntawv thov kho mob yuav tsum xa mus rau Medi-Cal MCPs lossis FI them tus nqi rau kev pabcuam. Cov pas nrig cawv tsis suav nrog hauv pawg no thiab tsis yog cov txiaj ntsig Medi-Cal Rx. Cov pas ntsuas cawv yuav txuas ntxiv them rov qab raws li cov khoom siv kho mob uas HCPCS them los ntawm
tus nqi-rau-kev pabcuam FI.​​ 

15. Puas yog Medi-Cal Rx suav nrog cov nyiaj pab hauv tsev muag tshuaj uas tau them rau kev kho mob thiab/lossis kev thov hauv tsev?​​ 

Tsis yog, txij li thaum Medi-Cal Rx tag nrho Assumption of Operations (AOO), cov kev pabcuam tshuaj Medi-Cal uas tau them rau kev kho mob lossis kev thov los ntawm lub tsev muag tshuaj, lossis lwm tus neeg muab kev pabcuam, txuas ntxiv raug them los ntawm Medi-Cal Managed Care Plans (MCPs) lossis rau California Medicaid Management Information System (CA-MMIS) Fiscal Intermediary, rau cov tswv cuab Medi-Cal MCP lossis cov tswv cuab them nqi rau kev pabcuam, zoo li lawv tau ua ua ntej Medi-Cal Rx tag nrho AOO. Txawm li cas los xij, cov tshuaj uas "txiav tawm" ntawm lub kaw lus tswj kev saib xyuas (piv txwv li, cov tshuaj ntshav, cov tshuaj HIV/AIDS, cov tshuaj tiv thaiv kev puas siab puas ntsws, lossis cov tshuaj siv los kho kev siv tshuaj yeeb dej cawv) yuav raug them rau CA-MMIS rau ob qho tib si tus nqi-rau-kev pabcuam thiab cov tswv cuab MCP.​​ 

16. Cov tshuaj tiv thaiv COVID-19 puas yog "txiav tawm" ntawm Cov Phiaj Xwm Kev Kho Mob Tswj (MCPs)?​​ 

Raws li txoj kev uas Medicare siv los ntawm Medicare Advantage Plans, Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) txiav cov tshuaj tiv thaiv COVID-19 los ntawm Medi-Cal MCPs thiab them rov qab rau cov neeg muab kev pabcuam raws li txoj cai them nqi rau kev thov kho mob thiab tshuaj. Txoj kev no ua rau kev tswj hwm qhov kev pab cuam yooj yim dua, tshem tawm cov teeb meem nrog
cov nyiaj them rov qab sab nraud ntawm lub network, thiab ua kom cov nqi txhaj tshuaj sib xws rau cov neeg muab kev pab txawm tias yog lub kaw lus xa khoom li cas los xij.​​  

17. Medi-Cal yuav them nyiaj rov qab li cas rau kev tswj hwm cov tshuaj tiv thaiv COVID-19?​​ 

Medi-Cal them rov qab rau tus nqi txhaj tshuaj tiv thaiv COVID-19 ntawm tus nqi Medicare uas tso cai rau txhua qhov kev thov (kev kho mob, kev kho mob sab nraud, thiab tshuaj) raws li tus naj npawb ntawm cov koob tshuaj uas xav tau. Vim tias tsoomfwv tebchaws them rau cov tshuaj tiv thaiv thawj zaug, tsis muaj kev them rov qab rau cov neeg muab kev pabcuam Medi-Cal rau cov tshuaj tiv thaiv COVID-19 nws tus kheej. Txawm li cas los xij, tus nqi ntawm cov tshuaj tiv thaiv kab mob yuav raug them rov qab thaum cov tshuaj tiv thaiv COVID-19 tau muag hauv lub caij nplooj zeeg xyoo 2023. Yog xav paub ntxiv txog tshuaj tiv thaiv COVID-19, mus saib https://covid19.ca.gov/ thiab nplooj ntawv web ntawm Department of Health Care Services' (DHCS) COVID-19 Response.​​  

18. Where can I find DHCS’ guidance and coverage/reimbursement policy relative to the COVID-19 vaccine?​​ 

Mus saib ntu COVID-19 Vaccines, OTC Antigen Test Kits, thiab Therapeutics: Coverage and Reimbursements ntawm Medi-Cal Rx Provider Manual rau DHCS txoj cai thiab cov lus qhia txog kev them rov qab rau cov tshuaj tiv thaiv COVID-19.​​ 

For additional information about COVID-19, visit https://covid19.ca.gov/ and DHCS’ COVID-19 Response web page.​​  

19. Cov Kev Kuaj Antigen Uas Siv Tau Ntawm Tus Kheej Uas Tsis Tas Yuav Muaj Tshuaj Kho Mob Puas Yog "txiav tawm" ntawm Cov Phiaj Xwm Kev Kho Mob Tswj (MCPs)?​​ 

Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) qhov kev pab them nqi ntawm COVID-19 OTC Self-Administered Antigen Tests ua ib qho txiaj ntsig los ntawm kev them nqi los ntawm Medi-Cal Rx tau pib siv rau lub Ob Hlis Ntuj hnub tim 1, 2022, raws li cov lus pom zoo tam sim no ntawm Chaw Tswj thiab Tiv Thaiv Kab Mob (CDC). Muaj kev txwv txog qhov ntau thiab cov qauv tshwj xeeb rau kev them nqi khoom. Yog xav paub ntxiv, mus saib Medi-Cal Rx Provider Portal ntawm Medi-Cal Rx Web Portal thiab saib Covered Emergency Use of Authorization (EUA) COVID-19 Antigen Tests. daim ntawv teev npe nyob rau ntawm nplooj ntawv Forms & Information , lossis mus saib ntu Over-the-Counter (OTC)COVID-19 Antigen Test Kits ntawm Medi-Cal Rx Provider Manual.​​ 

Cov ntaub ntawv yuav khoom​​ 

20. Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv tau muab Medi-Cal Rx li cas?​​ 

DHCS tau tso tawm Daim Ntawv Thov Kev Pom Zoo (RFP) #19-96125 rau lub Yim Hli 22, 2019, los nrhiav tus neeg cog lus kev pabcuam kev tswj hwm los tswj hwm cov kev pabcuam tshuaj Medi-Cal rau, thaum lub sijhawm ntawd, ntau dua 13.5 lab tus tswv cuab Medi-Cal. Thaum Lub Kaum Ob Hlis 13, 2019, DHCS tau muab daim ntawv cog lus rau Magellan Medicaid Administration, LLC (MMA) los muab cov kev pabcuam kev tswjfwm raws li DHCS tau hais, uas suav nrog tab sis tsis txwv rau kev tswj hwm cov lus thov, kev tso cai ua ntej (PA) thiab kev tswj hwm kev siv (UM), kev tswj hwm cov nyiaj rov qab los ntawm cov tshuaj hauv tsev muag tshuaj, cov kev pabcuam txhawb nqa tus neeg muab kev pabcuam thiab cov tswv cuab, thiab lwm yam kev pabcuam pabcuam thiab kev tshaj tawm los txhawb kev tswj hwm ntawm Medi-Cal cov txiaj ntsig tshuaj.​​ 

21. Medi-Cal Rx lub sijhawm yuav khoom yog dab tsi?​​ 

Lub sijhawm ncua sij hawm rau Medi-Cal Rx kev siv zog ntsig txog kev yuav khoom yog raws li hauv qab no:​​  

• Lub Xya Hli 22, 2019: Daim Ntawv Thov Kev Pab Txog Kev Kho Mob Medi-Cal Rx (RFP) #19-96125 tau tso tawm rau ob lub lis piam rau pej xeem tawm tswv yim.​​ 
• Lub Yim Hli 22, 2019: Daim Ntawv Thov Medi-Cal Rx zaum kawg #19-96125 tau tso tawm.​​ 
• Lub Yim Hli 29, 2019: Cov lus nug zaum kawg ntawm Medi-Cal Rx RFP #19-96125 vim yog Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS).​​ 
• Cuaj Hlis 17, 2019: Cov lus teb rau cov lus nug ntsig txog Daim Ntawv Thov Kev Pab Nyiaj Txiag Medi-Cal Rx RFP zaum kawg #19-96125 thiab cov ntawv ntxiv tau muab tso tawm.​​ 
• Lub Kaum Hli Ntuj hnub tim 1, 2019: Txhua daim ntawv thov Medi-Cal Rx RFP #19-96125 yuav tsum xa tuaj.​​ 
• Kaum Ib Hlis 7, 2019: Daim Ntawv Ceeb Toom Txog Lub Hom Phiaj Rau Kev Muab Khoom Plig tau muab tso rau hauv lub vev xaib DHCS.​​ 
• Lub Kaum Ob Hlis Ntuj hnub tim 13, 2019: DHCS tau muab daim ntawv cog lus rau Magellan Medicaid Administration, LLC (MMA).​​ 
• Lub Kaum Ob Hlis Ntuj hnub tim 20, 2019: Hnub uas Daim Ntawv Cog Lus Siv Tau.​​ 
• Lub Ib Hlis 1, 2022: Kev Txais Yuav Kev Ua Haujlwm Tag Nrho (AOO) ntawm Medi-Cal Rx tau tshwm sim.​​ 

22. Leej twg yog Medi-Cal Rx tus neeg cog lus xaiv los ntawm txoj kev yuav khoom?​​ 

Tus Neeg Cog Lus Medi-Cal Rx uas raug xaiv los tswj hwm cov kev pabcuam tshuaj Medi-Cal uas them tus nqi yog Magellan Medicaid Administration, LLC (MMA).​​ 

23. Cov Kev Npaj Kho Mob Medi-Cal Managed Care Plans (MCPs) yuav ua lub luag haujlwm thiab lub luag haujlwm dab tsi thaum Medi-Cal Rx pib ua haujlwm tag nrho (AOO)?​​ 

Medi-Cal MCPs yuav muaj lub luag haujlwm rau cov haujlwm suav nrog, tab sis tsis txwv rau, cov hauv qab no:​​ 

• Saib xyuas thiab tswj txhua yam haujlwm tsim nyog rau kev sib koom tes saib xyuas cov tswv cuab Medi-Cal thiab lwm yam haujlwm cuam tshuam, raws li cov luag haujlwm cog lus.​​ 
• Muab kev saib xyuas thiab kev tswj hwm ntawm txhua qhov chaw kho mob ntawm chaw muag tshuaj, suav nrog kev muab kab mob thiab kev tswj hwm tshuaj.​​ 
• Kev ua haujlwm thiab kev them nyiaj ntawm tag nrho cov kev pabcuam hauv lub tsev muag tshuaj uas tau them nyiaj rau kev kho mob thiab tsev kho mob.​​ 
• Koom nrog cov rooj sib tham uas cuam tshuam nrog Medi-Cal Ntiaj Teb Kev Tshuaj Xyuas Tshuaj Siv Tshuaj (DUR) Pawg Thawj Coj thiab Lwm Lub Tsev Haujlwm Saib Xyuas Kev Kho Mob (DHCS)-cov rooj sib tham pawg kws muag tshuaj.​​ 
• Kev koom tes txuas ntxiv thiab tsis tu ncua hauv kev txiav txim tom qab kev txiav txim siab DUR cov haujlwm xws li Retrospective DUR (RetroDUR) (raws li qhov tsim nyog rau kev sib koom tes saib xyuas), cov kev kawm, thiab xa daim ntawv tshaj tawm DUR txhua xyoo.​​ 

24. What roles and responsibilities will DHCS maintain upon Medi-Cal Rx’s full Assumption of Operations?​​ 

DHCS yuav yog lub luag haujlwm rau cov haujlwm suav nrog, tab sis tsis txwv rau, cov hauv qab no:​​ 

• Tsim, siv, thiab tswj txhua txoj cai ntawm Medi-Cal lub tsev muag tshuaj, suav nrog, tab sis tsis txwv rau:​​ 
  • Kev pab tshuaj​​ 
  • Lub xeev cov tshuaj ntxiv nyiaj rov qab​​ 
  • Kev tso cai ua ntej (PA) / tswj kev siv (UM)​​ 
• Kev sib tham ntawm, thiab kev cog lus rau, lub xeev cov nyiaj rov qab tshuaj ntxiv.​​ 
• Tshuaj xyuas thiab tshaj tawm cov kev txiav txim siab zaum kawg txog txhua qhov kev tsis kam lees PA rau cov txiaj ntsig Medi-Cal Rx, suav nrog cov rau California Children's Services (CCS) program / Genetically Handicapped Persons Program (GHPP).​​ 
• Muab kev saib xyuas ntawm, thiab kev txhawb nqa rau, Lub Xeev Lub Rooj Sib Hais Ncaj Ncees (SFH) txheej txheem.​​ 
• Tsim kom muaj cov txheej txheem them rov qab rau Medi-Cal Rx tshuaj, ua raws li cov cai ntawm lub xeev thiab tsoomfwv.​​ 
• Tsim thiab tswj hwm Medi-Cal lub chaw muag tshuaj network.​​ 
• Saib xyuas Medi-Cal Ntiaj Teb Tshuaj Siv Tshuaj Ntsuam Xyuas (DUR) Pawg Neeg Saib Xyuas thiab lwm pab pawg kws muag tshuaj, koom tes nrog Magellan Medicaid Administration, LLC (MMA).​​ 
• Daim ntawv cog lus tswj thiab saib xyuas / saib xyuas ntawm MMA.​​ 

25. What roles and responsibilities will the Medi-Cal Rx Contractor assume upon Medi-Cal Rx’s full Assumption of Operations?​​ 

Magellan Medicaid Administration, LLC (MMA) yuav yog tus saib xyuas cov haujlwm suav nrog, tab sis tsis txwv rau, cov hauv qab no:​​  

• Muab Chaw Pabcuam Neeg Siv Khoom Medi-Cal Rx (CSC) uas muaj 24 teev hauv ib hnub, 7 hnub hauv ib lub lim tiam, 365 hnub hauv ib xyoos, tsis suav cov hnub so uas tau pom zoo, lossis tshwj tsis yog tias Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tau hais kom ua lwm yam, los txhawb txhua tus neeg muab kev pabcuam thiab cov tswv cuab hu xov tooj, nrog rau muab kev ncav tes, kev cob qhia, thiab cov ntaub ntawv qhia.​​ 
• Muab Medi-Cal Managed Care Plan (MCP) ncaj qha rau kev sib koom tes nrog kev saib xyuas thiab teeb meem kho mob.​​ 
• Providing real-time access into MMA’s electronic environment via a secure portal to all Medi-Cal providers (prescribers and pharmacies) and MCPs, Mental Health Plans, and Substance Use Disorder Plans.​​ 
• Muab cov ntaub ntawv thov kev tswj hwm, kev ua haujlwm, thiab kev them nyiaj ua haujlwm rau txhua qhov kev pabcuam hauv khw muag tshuaj uas tau them rau hauv daim ntawv thov tshuaj.​​ 
• Saib xyuas kev sib koom tes ntawm cov txiaj ntsig (COB) nrog rau lwm qhov kev pab them nqi kho mob, suav nrog Medicare.​​ 
• Muab kev tswj kev siv (UM) cov haujlwm, suav nrog kev ua kom ntseeg tau tias kev tso cai ua ntej ntawm lub tsev muag tshuaj (PA) tshwm sim hauv 24 teev, suav nrog California Children's Services (CCS) program / Genetically Handicapped Persons Program (GHPP).
  Lus Cim: Txhua qhov kev tsis lees paub PA ntawm lub tsev muag tshuaj yuav xav tau DHCS los tshuaj xyuas ua ntej kev txiav txim siab zaum kawg.​​ 
• Muab Cov Kev Pabcuam Yav Tom Ntej thiab Kev Siv Tshuaj Rov Qab (DUR).​​ 
• Muab cov ntaub ntawv pub (tsawg kawg txhua hnub) rau Medi-Cal MCPs los txhawb lawv lub luag haujlwm ntawm kev koom tes saib xyuas cov tswv cuab, ua raws li kev kho mob ntawm chaw muag tshuaj, thiab kev tswj kab mob thiab tshuaj.​​ 
• Providing drug rebate administration services that are compliant with federal and state laws and adhere to DHCS’ policies and direction.​​ 

Nruab nrab ntawm Lub Ib Hlis 1, 2021, thiab Medi-Cal Rx qhov Kev Txais Yuav Haujlwm (AOO) tag nrho rau Lub Ib Hlis 1, 2022, DHCS - koom tes nrog MMA - tau muab ntau yam Kev Txhawb Nqa thiab Kev Pabcuam Hloov Chaw Medi-Cal Rx (TSS), raws li tau piav qhia ntau ntxiv hauv qab no hauv cov lus nug #30 thiab #31.​​ 

26. Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv ua li cas thiaj li xyuas kom meej tias Tus Neeg Cog Lus Medi-Cal Rx tsis siv cov ntaub ntawv ntawm tus neeg mob, suav nrog cov ntaub ntawv sau tshuaj, rau lwm lub hom phiaj dua li cov kev pabcuam kev tswj hwm Medi-Cal Rx?​​ 

Cov kev cai rau kev siv cov ntaub ntawv tswv cuab Medi-Cal kom raug tau piav qhia meej thiab ntxaws ntxaws, hauv Medi-Cal Rx Request for Proposal (RFP) #19-96125, uas dhau los ua ib feem ntawm cov lus cog tseg kawg. Ntxiv rau qhov ntawd, Magellan Medicaid Administration, LLC (MMA) yuav tsum ua raws li txhua yam uas twb muaj lawm hauv xeev thiab tsoomfwv qib siab xav tau nrog rau DHCS cov cai ntsig txog cov ntaub ntawv rhiab heev thiab kev ceev ntiag tug.​​ 

27. Kuv tuaj yeem nrhiav tau cov ntaub ntawv ntau ntxiv txog Medi-Cal Rx Thov Kev Pom Zoo #19-96125?​​ 

Yog xav paub ntxiv txog Medi-Cal Rx Thov Kev Pom Zoo #19-96125, thov mus saib hauv FI$Cal/Cal eProcure lub vev xaib. Cov ntawv thov zaum kawg yuav dhau los ntawm Lub Kaum Hli 1, 2019 thaum 4 teev tsaus ntuj PDT. Cov txheej txheem kev yuav khoom tam sim no raug kaw.​​ 

Hloov ntaub ntawv​​ 

28. Thaum twg Medi-Cal Rx tag nrho Assumption of Operations (AOO) yuav tshwm sim?​​ 

Medi-Cal Rx tag nrho AOO, raws li tau piav qhia hauv cov lus nug # 23-25, suav nrog kev tswj hwm cov lus thov thiab kev txiav txim siab ua ntej kev tso cai, yuav tshwm sim rau Lub Ib Hlis 1, 2022.​​  

29. Vim li cas hnub Go-Live uas tau npaj tseg rau lub Plaub Hlis 1, 2021 rau Medi-Cal Rx qhov kev xav tau tag nrho ntawm kev ua haujlwm thiaj li raug ncua?​​ 

Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tau ncua hnub Go-Live uas tau npaj tseg rau lub Plaub Hlis 1, 2021, rau Medi-Cal Rx vim yog qhov xav tau los tshuaj xyuas cov txheej txheem tiv thaiv kev tsis sib haum xeeb tshiab uas Magellan Medicaid Administration, LLC (MMA), tus neeg muag khoom cog lus ntawm qhov project.​​ 

Thaum Lub Ib Hlis 2021, Centene Corporation tshaj tawm tias nws npaj yuav Magellan. Centene ua haujlwm - los ntawm cov tuam txhab me - Managed Care Plans (MCPs) thiab cov khw muag tshuaj uas koom nrog Medi-Cal. Qhov kev lag luam no yog qhov tsis tau xav txog thiab xav tau sijhawm ntxiv rau kev tshawb nrhiav cov txheej txheem tiv thaiv kev tsis sib haum xeeb kom ntseeg tau tias muaj cov firewalls uas tau txais kev pom zoo ntawm cov koom haum lag luam los tiv thaiv cov ntaub ntawv thov tshuaj ntawm txhua tus tswv cuab Medi-Cal, thiab los tiv thaiv lwm cov ntaub ntawv ntiag tug.​​ 

Medi-Cal Rx tseem yog qhov tseem ceeb tshaj plaws rau Lub Xeev California ua ib qho cuab yeej los ua kom cov txiaj ntsig ntawm Medi-Cal hauv lub xeev muaj tus qauv hauv ib txoj kev xa khoom. Medi-Cal Rx siv cov txheej txheem kev tswj hwm kev siv (UM) thoob plaws lub xeev rau txhua cov tshuaj kho mob sab nraud, ua kom muaj kev paub zoo rau txhua tus tswv cuab thiab cov kws kho mob Medi-Cal. Medi-Cal Rx kuj tseem ua kom California muaj peev xwm sib tham txog cov nyiaj rov qab rau cov tshuaj ntxiv ntawm lub xeev nrog cov chaw tsim tshuaj, pab txo cov nqi tshuaj.​​ 

30. Puas yog Medi-Cal Rx siv txoj hauv kev "theem ib" rau kev hloov pauv cov kev pabcuam?​​ 

Tsis yog, kev siv tag nrho ntawm Medi-Cal Rx tau tshwm sim rau lub Ib Hlis 1, 2022. Txawm li cas los xij, ntawm Lub Ib Hlis 1, 2021, thiab Medi-Cal Rx tag nrho Assumption of Operations (AOO), Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS), koom tes nrog Magellan Medicaid Administration, LLC (MMA), tau muab ntau yam Medi-Cal Rx Transitional Supports and Services (TSS), suav nrog tab sis tsis txwv rau:​​ 

• Tso cai rau cov neeg muab kev pab Medi-Cal, Cov Phiaj Xwm Kev Kho Mob Tswj (MCPs), thiab lwm cov neeg txaus siab sau npe rau Medi-Cal Rx secure portals thiab koom nrog cov kev cob qhia uas ua kom nkag siab zoo dua txog qhov project thiab txhawb kev npaj ua haujlwm rau cov neeg muab kev pab thiab MCPs.​​ 
• Tau sawv thiab txhawb nqa Medi-Cal Rx Customer Service Center (CSC) kom cov kws tshaj lij ntawm CSC teb thiab teb cov lus nug los ntawm cov tswv cuab Medi-Cal, cov chaw muab kev pab, MCPs, thiab lwm cov neeg koom nrog, uas tej zaum yuav ua rau muaj kev tsis meej pem thiab lwm yam teeb meem thaum muaj kev siv Medi-Cal Rx tag nrho. Txawm hais tias cov kws tshaj lij CSC tsis tau muab cov kev pabcuam tag nrho ua ntej AOO, lawv tab tom nrhiav
  Medi-Cal Rx tag nrho AOO. Lawv muaj peev xwm muab cov TSS tseem ceeb, suav nrog kev ncav tes mus rau cov neeg muab kev pab, nrog rau kev pab tshwj xeeb thiab cov ntaub ntawv tseem ceeb, piv rau cov cuab yeej thiab kev ua haujlwm ntawm Medi-Cal Rx.​​ 
• Muab sijhawm ntxiv rau MCPs los sib tham thiab tsim kev sib raug zoo nrog cov neeg ua haujlwm kho mob Medi-Cal Rx, uas tau pab MMA tsim cov ntaub ntawv MCP kom raug thiab tiav kom ntseeg tau tias cov kev xav tau ntawm cov pej xeem uas txhua MCP tau txais kev pab txuas ntxiv mus.​​ 
• Tau tso cai rau DHCS thiab MMA kom nthuav tawm ntxiv Medi-Cal Rx lub vev xaib thiab ruaj ntseg cov haujlwm portal thiab cov cuab yeej ua ntej Medi-Cal Rx tag nrho AOO, suav nrog, tab sis tsis txwv rau, Medi-Cal Rx Pharmacy Locator cuab yeej,
  Phau Ntawv Qhia Txog Tus Muab Kev Pabcuam Medi-Cal Rx, Medi-Cal Rx Daim Ntawv Teev Tshuaj (CDL), thiab lwm yam ntaub ntawv txoj cai thiab kev pab cuam.​​ 

Tom qab Medi-Cal Rx tag nrho AOO, MMA tau lees txais lub luag haujlwm rau txhua qhov kev pabcuam kev tswj hwm uas tseem tshuav uas tsim nyog los txhawb Medi-Cal Rx, suav nrog, tab sis tsis txwv rau, cov hauv qab no:​​ 

• Txuas CSC cov sij hawm mus rau 24 teev hauv ib hnub, 7 hnub hauv ib lub lis piam, 365 hnub hauv ib xyoos, tsis suav nrog cov hnub caiv pom zoo, lossis tshwj tsis yog hais los ntawm DHCS, los txhawb txhua tus neeg muab kev pabcuam thiab cov tswvcuab hu, nrog rau kev tshaj tawm, kev cob qhia, thiab cov ntaub ntawv qhia.​​ 
• Kev lees paub kev tswj hwm, kev tso cai ua ntej (PA) thiab kev tswj hwm kev siv (UM), cov kev pabcuam thiab cov tswvcuab txhawb nqa, thiab lwm yam kev pabcuam ntxiv thiab tshaj tawm.​​  

Yog xav paub ntxiv, thov mus saib cov lus nug #23-25.​​ 

31. DHCS ua li cas thiaj li ua kom paub tseeb tias kev paub thiab kev paub txog Medi-Cal Managed Care Plans (MCPs), thiab lwm cov neeg koom tes, raug siv rau hauv cov txheej txheem hloov pauv kom ua tiav kev txuas ntxiv ntawm cov kev pabcuam?​​ 

DHCS tau koom tes nrog cov neeg sab nraud hauv ntau txoj hauv kev thiab los ntawm ntau txoj hauv kev los xyuas kom meej tias kev paub thiab kev paub dhau los ua kom Medi-Cal Rx ua tiav. DHCS npaj siab yuav txuas ntxiv cov hom kev sib koom tes no thiab cog lus tias yuav ua haujlwm nrog nws cov neeg koom tes sab nraud, suav nrog Medi-Cal MCPs, cov nroog, cov chaw muab kev pabcuam, cov neeg txhawb nqa cov neeg siv khoom, thiab cov neeg tau txais txiaj ntsig, kom ntseeg tau tias muaj kev hloov pauv thiab ua tiav. Piv txwv li, DHCS tau tsim ib lub koom haum Medi-Cal MCP Workgroup thiab Medi-Cal Rx Advisory Workgroup uas muaj ntau tus neeg sawv cev ntawm cov neeg sawv cev uas tau ntsib tsis tu ncua los tham txog ntau yam teeb meem, txheeb xyuas cov kev coj ua zoo tshaj plaws, thiab muab cov kev daws teeb meem thiab cov tswv yim los txhawb DHCS cov kev siv zog.​​ 

Mus rau tom ntej, DHCS tseem yuav txuas ntxiv mus tshawb nrhiav cov hauv kev los txhim kho thiab txhim kho cov neeg koom nrog kev koom tes thiab kev txhawb nqa thoob plaws Medi-Cal, uas yuav suav nrog cov phiaj xwm Medi-Cal Rx pawg neeg ua haujlwm cov rooj sib tham thiab kev sib tham los sib koom tes ntawm cov kev coj ua zoo tshaj plaws thiab cov tswv yim ua kom tau raws li cov kev xav tau ntawm txhua tus neeg muaj kev cuam tshuam.​​ 

32. Cov ntaub ntawv hais txog kev hloov pauv ntawm Medi-Cal Rx thiab lwm yam kev hloov pauv yuav raug xa mus li cas?​​ 

DHCS yuav koom tes nrog MMA kom ntseeg tau tias txhua tus neeg txaus siab (xws li, tab sis tsis txwv rau, Medi-Cal MCPs, Cov Kev Pab Cuam Rau Kev Puas Hlwb, Cov Kev Npaj Siv Tshuaj, cov neeg muab kev pab, thiab cov neeg tau txais txiaj ntsig) raug ceeb toom txog kev hloov pauv thiab lwm yam kev hloov pauv.​​ 

Kev sib txuas lus yuav raug tshaj tawm los ntawm ntau txoj hauv kev suav nrog, tab sis tsis txwv rau, cov hauv qab no:​​ 

• Medi-Cal Rx Web Portal tshiab tau tsim tawm thaum Lub Rau Hli 2020 thiab ua lub platform los qhia thiab sib txuas lus muaj peev xwm, cov ntaub ntawv, thiab kev hloov pauv rau cov neeg nyiam. Cov ntsiab lus kev kawm thiab cov lus nug nquag raug tshaj tawm thiab hloov kho tsis tu ncua.​​ 
• Pib txij lub Rau Hli 2020, Medi-Cal Rx Subscription Service (MCRxSS) tau tsim muaj los ntawm Medi-Cal Rx Web Portal kom tso cai rau cov neeg txaus siab sau npe thiab tau txais Medi-Cal Rx hloov tshiab los ntawm email.​​ 
• Txij thaum Lub Yim Hli 2020 mus ntxiv, cov neeg txaus siab tuaj yeem pom cov ntawv xov xwm hais txog kev hloov pauv ntawm Medi-Cal Rx Web Portal.​​ 
• Muaj cov kev cob qhia thiab cov ntaub ntawv qhia kev kawm rau Medi-Cal cov kws kho mob thiab MCPs muaj los ntawm Medi-Cal Rx lub vev xaib tshiab. MCPs thiab cov kws kho mob muaj peev xwm sau npe rau kev cob qhia thiab kev kawm cov xwm txheej txij li lub Cuaj Hli 2020.​​ 
• Cov ntawv ceeb toom rau cov neeg tau txais txiaj ntsig Medi-Cal nyob rau hauv ob qho tib si MCPs thiab them nqi-rau-kev pabcuam xa tuaj rau lossis txog Lub Kaum Hli 1, 2020, Kaum Ib Hlis 1, 2020, thiab Lub Kaum Ob Hlis 15, 2020. Cov ntawv ceeb toom rau cov neeg tau txais txiaj ntsig Medi-Cal kuj tau xa tuaj pib thaum lub Peb Hlis 2021 kom qhia lawv txog kev ncua mus rau Medi-Cal Rx tag nrho Assumption of Operations (AOO). Cov ntawv ceeb toom ntxiv rau cov neeg tau txais txiaj ntsig Medi-Cal tau xa tuaj rau lossis txog lub Kaum Ib Hlis 1, 2021, tshaj tawm AOO thaum Lub Ib Hlis 1, 2022.​​ 
• Medi-Cal MCP Medi-Cal Rx Kev Tshaj Tawm Kev Tshaj Tawm, ua los ntawm kev sib tw hu xovtooj sab nraud lossis lwm yam kev sib txuas lus, raws li kev pom zoo los ntawm DHCS, rau cov tswvcuab rau npe.​​ 
• Hloov tshiab rau Medi-Cal Managed Care Plan Cov Tswv Cuab Phau Ntawv Qhia (Cov Ntaub Ntawv Pov Thawj), nrog rau cov ntaub ntawv qhia rau lwm lub koom haum cuam tshuam.​​ 
• Kev hloov kho tshiab rau Medi-Cal Phau Ntawv Qhia Txog Tus Kws Kho Mob, nrog rau cov kev taw qhia tshiab thiab cov ntaub ntawv luam tawm los ntawm MMA, raws li DHCS qhia.​​ 
• Hloov kho rau Medi-Cal MCP cov ntawv cog lus, raws li xav tau, txhawm rau cuam tshuam txog kev hloov pauv ntawm lub tsev muag tshuaj tau txais txiaj ntsig los ntawm kev tswj hwm kev saib xyuas mus rau tus nqi-rau-kev pabcuam.​​ 
• Tsim ib daim ntawv tshiab Medi-Cal Rx Txhua Daim Ntawv Npaj rau MCPs, thiab lwm cov ntawv ceeb toom muaj feem xyuam rau cov chaw muab kev pabcuam hauv nroog thiab lwm tus neeg koom tes tseem ceeb hauv lub nroog.​​ 
• Tsim ib Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv tshiab Txhua Daim Ntawv Npaj, txheeb ze rau Medi-Cal Rx, rau Medi-Cal MCPs uas muab kev taw qhia los ntawm kev tswj hwm, kev ua raws, thiab kev xa ntawv xa mus.​​ 
• Hloov tshiab rau Medi-Cal MCP tus nqi.​​ 
• Regular updates via existing stakeholder processes and workgroups, including but not limited to DHCS’ bimonthly Stakeholder Communication Update, Medi‑Cal Rx Public Forum, Medi-Cal Global Drug Use Review Board, Medi-Cal Pharmacy Directors’ Meeting, Stakeholder Advisory Committee, California Children’s Services Advisory Committee, etc.​​ 

33. DHCS yuav ua li cas kom cov neeg tau txais txiaj ntsig Medi-Cal hloov mus rau Medi-Cal Rx tsis muaj kev cuam tshuam hauv lawv txoj kev saib xyuas thiab/lossis tsis muaj peev xwm nkag mus rau cov tshuaj uas tsim nyog?​​ 

Txhawm rau pab cov neeg tau txais txiaj ntsig Medi-Cal, cov kws kho mob (cov kws sau ntawv thiab cov khw muag tshuaj), thiab Cov Phiaj Xwm Kev Kho Mob Tswj (MCPs) nrog Medi-Cal Rx tag nrho Assumption of Operations (AOO), DHCS yuav muab ntau yam Medi-Cal Rx Transitional Supports and Services (TSS) ntawm Lub Ib Hlis 1, 2021, mus txog Medi-Cal Rx tag nrho AOO rau Lub Ib Hlis 1, 2022, raws li tau piav qhia ntxiv hauv lo lus nug #30 saum toj no thiab tau tsim thiab yuav siv txoj cai hloov pauv ntau yam tshuaj. Txoj cai hloov chaw muag tshuaj yuav siv cov tswv yim xws li "ua kom loj hlob" cov kev thov kev tso cai ua ntej (PA) uas tau pom zoo ua ntej dhau lub sijhawm teev tseg, tsis pub tshaj ib (1) xyoo tag nrho txij li hnub sau daim ntawv yuav tshuaj, tshwj tsis yog tias cov tshuaj suav nrog hauv daim ntawv teev cov kev zam uas tso cai rau kev ncua sijhawm / ntau xyoo PA txog li tsib (5) xyoos rau qee pawg tshuaj / pawg. Lub sijhawm hloov pauv kuj suav nrog lub sijhawm 180 hnub uas DHCS yuav tsis xav tau PA rau cov ntawv sau tshuaj uas twb muaj lawm yam tsis tau pom zoo PA los ntawm lawv cov Medi-Cal MCPs, rau cov tshuaj uas tsis nyob hauv Medi-Cal Daim Ntawv Teev Tshuaj (CDL), lossis lwm yam uas muaj cov kev cai PA raws li Medi-Cal Rx. Txoj cai no tsis siv rau cov ntawv sau tshuaj tshiab lossis cov tshuaj uas tsis muaj cov kev cai PA raws li Medi-Cal Rx. Thaum lub sijhawm hloov pauv no, Magellan yuav muab cov lus qhia, kev tshaj tawm thiab kev ncav cuag kom yooj yim hloov mus rau Medi-Cal Rx. Lub sijhawm hloov pauv tshuaj no yuav ua rau muaj kev hloov pauv zoo thiab muaj txiaj ntsig, kom ntseeg tau tias cov neeg tau txais Medi-Cal tsis ntsib kev cuam tshuam hauv lawv txoj kev nkag mus rau cov tshuaj kho mob uas tsim nyog thaum tseem ua raws li txhua txoj cai lij choj hauv xeev thiab tsoomfwv uas cuam tshuam nrog kev pab cuam tshuaj Medi-Cal. DHCS Txoj Cai Hloov Chaw Muag Tshuaj muaj nyob rau ntawm nplooj ntawv web Medi-Cal Rx Transition.​​ 

34. DHCS puas yuav tsim kho Medi-Cal Rx txoj kev hloov pauv, thiab, yog tias muaj, cov phiaj xwm yuav suav nrog dab tsi?​​ 

Yog, raws li cov kev cai uas tau teev tseg hauv Daim Ntawv Thov rau Cov Lus Qhia #19-96125, Daim Ntawv Qhia A, Daim Ntawv Ntxiv I - Scope of Work - Takeover, Magellan Medicaid Administration, LLC (MMA) thiab DHCS yuav tsim ib txoj hauv kev/kev npaj hloov pauv chaw muag tshuaj Medi-Cal Rx kom suav nrog, tsawg kawg, cov txheej txheem rau:​​ 

• Muab kev ceeb toom txaus thiab yooj yim rau Medi-Cal cov khw muag tshuaj thiab cov kws kho mob kom ua txhua yam tsim nyog los ua kom haum rau Medi-Cal Rx Tus Neeg Ua Haujlwm tshiab, Medi-Cal Daim Ntawv Cog Lus Tshuaj (CDL), thiab cov txheej txheem cuam tshuam.​​ 
• Muab cov ntawv ceeb toom tsim nyog thiab cov ntaub ntawv muaj feem cuam tshuam los ntawm DHCS thiab Medi-Cal Managed Care Plans (MCPs) rau cov neeg tau txais txiaj ntsig Medi-Cal txog kev hloov pauv.​​ 
• Muab kev taw qhia rau kev tau txais kev tso cai ua ntej (PA) rau cov tshuaj uas tau muab thaum lub sijhawm hloov pauv los ntawm kev tso cai rau cov tshuaj uas tau muab thiab them nqi rau cov tshuaj uas tau pib ua ntej Medi-Cal Rx tag nrho Assumption of Operations [AOO] yam tsis tau muaj PA uas tau pom zoo ua ntej. Txawm li cas los xij, cov kev cai ntawm Kev Tshuaj Xyuas Kev Siv Tshuaj (DUR) rau kev nyab xeeb ntawm cov tshuaj tseem yuav siv tau.​​ 
• Lub tsev muag tshuaj, tus kws kho mob, thiab cov neeg tau txais kev pab, suav nrog kev ua kom cov tog neeg cuam tshuam tau txais kev ceeb toom tsim nyog ntawm, thiab cov ntaub ntawv ntxiv ntsig txog, Medi-Cal Rx lub sijhawm hloov pauv ntawm lub tsev muag tshuaj thiab cov txheej txheem cuam tshuam.​​ 

35. DHCS yuav siv cov tswv yim dab tsi hauv Medi-Cal Rx txoj kev hloov pauv los ua kom muaj kev hloov pauv mus rau Medi-Cal Rx kom muaj txiaj ntsig zoo rau cov neeg tau txais txiaj ntsig?​​ 

Txhawm rau pab cov neeg tau txais txiaj ntsig Medi-Cal nrog kev hloov pauv Medi-Cal Rx tag nrho, DHCS yuav muab ntau yam Kev Txhawb Nqa thiab Kev Pabcuam Hloov Pauv Medi-Cal Rx (TSS) ntawm Lub Ib Hlis 1, 2021, mus txog Medi-Cal Rx Assumption of Operations (AOO) tag nrho rau Lub Ib Hlis 1, 2022, raws li tau piav qhia ntxiv hauv lo lus nug #30 saum toj no. Ntxiv rau, DHCS txoj cai hloov pauv chaw muag tshuaj, raws li tau piav qhia hauv lo lus nug #33 saum toj no, thiab qhia ntxiv hauv qhov txuas hauv qab no, yuav siv cov tswv yim xws li cov hauv qab no:​​ 

• “Grandfathering” previously approved prior authorizations (PAs) through their stated duration, not to exceed one (1) full year from the date the prescription was written, unless the drug is included in the list of exceptions allowing for extended/multi-year PAs up to five (5) years for certain drug classes/categories, as articulated in the policy.​​ 

For more information, please review DHCS’ Pharmacy Transition Policy on the Medi-Cal Transition webpage.​​ 

36. Puas yog Medi-Cal Managed Care Plans (MCPs) yuav tsum txiav thiab/lossis tsis muaj kev tso cai ua ntej (PAs) uas raug txiav txim thiab pom zoo los ntawm Medi-Cal MCP rau lossis ua ntej Medi-Cal Rx tag nrho Assumption of Operations (AOO)?​​ 

Tsis yog, Medi-Cal MCPs yuav tsum tsis txhob tso tseg thiab/lossis tsis muaj PAs li no thiab yuav tsum zoo ib yam li tsis muaj kev tso cai cia li yuav tas ib hnub ua ntej Medi-Cal Rx puv AOO. Ob lub DHCS thiab Medi-Cal MCPs yuav tsum ua cov kauj ruam tsim nyog los xyuas kom cov neeg tau txais txiaj ntsig Medi-Cal txuas ntxiv tau txais cov txiaj ntsig thiab cov kev pab cuam kho mob uas tsim nyog rau lub tsev muag tshuaj thaum hloov mus rau Medi-Cal Rx.​​ 

Cov ntaub ntawv pub, Electronic Access, & Lwm yam kev pab kho mob​​ 

37. Puas yog Medi-Cal Rx muab cov ntaub ntawv muag tshuaj thiab kev siv hluav taws xob tsim nyog rau Medi-Cal cov kws kho mob, Medi-Cal Managed Care Plans (MCPs), thiab lwm lub koom haum los txhawb kev sib koom tes saib xyuas?​​ 

Yog lawm, Medi-Cal Rx yuav muab cov ntaub ntawv pub (tsawg kawg txhua hnub) rau Medi-Cal MCPs los txhawb lawv lub luag haujlwm ntawm kev koom tes saib xyuas cov neeg tau txais txiaj ntsig, ua raws li kev kho mob ntawm chaw muag tshuaj, thiab kev tswj kab mob thiab tshuaj. DHCS tseem tab tom tshawb nrhiav cov kev xaiv thiab cov lus pom zoo uas cuam tshuam rau cov ntaub ntawv pub rau Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv thiab Kev Siv Tshuaj Tsis Zoo thiab yuav koom nrog cov neeg muaj feem tseem ceeb hauv qhov chaw no. Ib qho kev daws teeb meem uas pom zoo yuav raug muab coj los siv tom qab Medi-Cal Rx tag nrho Assumption of Operations.​​ 

Tsis tas li ntawd, Medi-Cal Rx yuav muab kev nkag mus rau hauv lub sijhawm tiag tiag rau hauv MMA qhov chaw hluav taws xob los ntawm lub portal ruaj ntseg rau txhua tus kws kho mob Medi-Cal (cov kws kho mob thiab cov khw muag tshuaj) thiab Medi-Cal MCPs, Mental Health and Substance Use Disorder Plans, thiab ntxiv cov koom haum raws li DHCS.​​ 

38. Medi-Cal Rx yuav muab kev pab cuam kho mob thiab kev saib xyuas dab tsi ntxiv rau Medi-Cal Managed Care Plans (MCPs)?​​ 

MMA yuav muab kev pab cuam kho mob thiab kev saib xyuas ntxiv rau Medi-Cal MCPs kom ua tau raws li lawv cov kev cog lus cog lus ntsig txog kev saib xyuas cov neeg tau txais txiaj ntsig Medi-Cal, kev ua raws li kev noj tshuaj, thiab lwm yam kev lav phib xaub, los ntawm:​​ 

• Providing a dedicated Medi-Cal MCP clinical liaison team to interface with the Medi-Cal MCPs, other MMA staff, and MMA’s portal/environment to assist with and resolve clinical pharmacy-related issues for Medi-Cal Rx, including those involving prior authorization, as directed by DHCS.​​ 
• Tuav cov neeg ua haujlwm kom txaus ntawm Medi-Cal MCP kev sib tham hauv chaw kho mob kom paub meej tias qib kev nkag mus tau raug tswj xyuas rau Medi-Cal MCPs.​​ 
• Muab kev nkag mus rau Medi-Cal MCP cov neeg sib txuas lus hauv tsev kho mob los ntawm Medi-Cal Rx lub tshuab teb lus sib xyaw ua ke los pab thiab daws cov teeb meem ntsig txog tshuaj hauv tsev kho mob.​​ 

For more information, please see the Medi-Cal Rx MCP Clinical Liaison Policy and the Medi-Cal Rx Website and Pharmacy Portal Policy.​​ 

Muab Kev Tshaj Tawm, Kev Kawm, & Kev cob qhia​​ 

39. Hom kev nthuav qhia twg, kev kawm, thiab kev cob qhia, nrog rau cov kev txhawb nqa uas muaj feem xyuam, yog DHCS muab thiab/los yog npaj ua rau Medi-Cal Rx?​​ 

DHCS, koom tes nrog MMA, tau mob siab rau muab Medi-Cal tus neeg muab kev pab txhawb nqa cov neeg siv khoom, suav nrog tab sis tsis txwv rau cov hauv qab no:​​ 

• Lub Chaw Pabcuam Cov Neeg Siv Khoom (CSC) los txhawb txhua tus neeg muab kev pabcuam hu, nees nkaum plaub (24) teev hauv ib hnub, xya (7) hnub hauv ib asthiv, peb puas rau caum-tsib (365) hnub hauv ib xyoos, tsis suav cov hnub so pom zoo, lossis tshwj tsis yog tias DHCS tau qhia lwm yam.​​ 
• Kev nthuav qhia, kev cob qhia, thiab cov ntaub ntawv qhia rau Medi-Cal cov kws kho mob, Medi-Cal Managed Care Plans (MCPs), thiab lwm qhov chaw.​​ 
• Cov kev pabcuam hauv Web los txhawb kev sib txuas lus thiab cov cuab yeej rau Medi-Cal Rx.​​ 
• Real-time access into MMA’s electronic environment via a secure portal.​​ 
• Lwm cov kev pabcuam thiab kev txhawb nqa los ua kom muaj kev hloov pauv tau zoo thiab muaj txiaj ntsig (xws li Medi-Cal Rx cov kev pabcuam hloov pauv hloov pauv thiab cov kev pabcuam (TSS) thiab 180-hnub lub sijhawm hloov pauv lub tsev muag tshuaj).​​ 

Tsis tas li ntawd, MMA's Medi-Cal Rx CSC Cov Neeg Sawv Cev yuav ua sawv cev ntawm DHCS los xa thiab muab cov kev txawj ntse / kev txhawb nqa txog Medi-Cal Rx cov ntaub ntawv thiab cov ntaub ntawv cob qhia rau cov kws kho mob (cov kws kho mob thiab cov khw muag tshuaj) cov chaw muag tshuaj, thiab cov koom tes npaj, hauv ntau qhov chaw. Yog xav paub ntxiv, thov mus saib Daim Ntawv Thov Kev Pom Zoo #19-96125 Exhibit A, Attachment II – Scope of Work – Operations – Education and Outreach.​​ 

Additional information about provider outreach, education, and training, including schedules and sign-up information, is and will be made available on DHCS’ dedicated Medi-Cal Rx Web Portal. In addition, providers and all other interested parties are encouraged to sign up for the Medi-Cal Rx Subscription Service (MCRxSS) to receive news and updates related to Medi-Cal Rx.​​ 

Kev Pabcuam Rau Cov Tswv Cuab & Kev Txhawb Nqa Lwm Yam​​ 

39. Yam dab tsi ntawm Medi-Cal cov neeg tau txais kev pabcuam thiab cov kev txhawb nqa muaj feem cuam tshuam yog DHCS muab thiab/los yog npaj ua rau Medi-Cal Rx?​​ 

DHCS, koom tes nrog Magellan Medicaid Administration, LLC (MMA), tau mob siab rau muab cov tswv cuab cov neeg siv khoom thiab kev txhawb nqa, suav nrog tab sis tsis txwv rau cov hauv qab no:​​ 

• Lub Chaw Pabcuam Neeg Siv Khoom Medi-Cal Rx (CSC) txhawb nqa txhua tus tswv cuab hu xov tooj, 24 teev hauv ib hnub, 7 hnub hauv ib lub lim tiam, 365 hnub hauv ib xyoos, tsis suav cov hnub so uas tau pom zoo, lossis tshwj tsis yog DHCS hais lwm yam.​​ 
• Cov ntaub ntawv qhia txog Medi-Cal Rx los ntawm ntau txoj kev sib txawv, suav nrog tab sis tsis txwv rau cov ntawv ceeb toom tsim nyog los ntawm U.S. Mail thiab cov kev pabcuam hauv web (piv txwv li, cov vev xaib sab nraud los txhawb kev sib txuas lus thiab cov cuab yeej rau Medi-Cal Rx).​​ 
• Cov cuab yeej nrhiav chaw muag tshuaj Medi-Cal Rx (PLT) muaj nyob rau ntawm
  Medi-Cal Rx Web Portal thiab suav nrog txhua lub tsev muag tshuaj uas tsim nyog rau Medi-Cal Rx.​​ 
• Ib qho kev sib tham sib lub suab teb (IVR) system los muab:​​ 
  • Cov ntaub ntawv kaw tseg​​ 
  • Kev xaiv kev pabcuam tus kheej​​ 
  • Muaj peev xwm thov rov qab los ntawm kev pabcuam cov neeg siv khoom, xws li kev hu xovtooj rov qab lossis cov ntaub ntawv muab los ntawm kev xa ntawv lossis email.​​ 

Ntxiv rau, MMA cov Neeg Sawv Cev Pabcuam Neeg Siv Khoom (CSRs) ua haujlwm sawv cev rau DHCS los xa thiab muab kev txawj ntse / kev txhawb nqa txog cov ntaub ntawv
-Cal Rx thiab cov ntaub ntawv cuam tshuam rau cov tswv cuab Medi-Cal, hauv ntau qhov chaw. Yog xav paub ntxiv, mus saib Daim Ntawv Thov Kev Pom Zoo (RFP)
#19-96125 Daim Ntawv Qhia A, Daim Ntawv Ntxiv II - Qhov Ua Haujlwm - Kev Ua Haujlwm - Kev Kawm thiab Kev Nthuav Qhia.​​ 

Kev Tsim Nyog Rau Cov Tswv Cuab, Kev Sib Koom Tus Nqi, & Lwm Cov Lus Nug Txog Kev Noj Qab Haus Huv​​ 

40. Relative to the transition to Medi-Cal Rx, what happens to the claims if a beneficiary’s eligibility is in “on-hold” status and is waiting for the county to adjust the beneficiary’s eligibility?​​ 

The “on-hold” status pertains to the beneficiary’s Medi-Cal Managed Care Plan eligibility status and there is no change to this process under Medi-Cal Rx. Medi‑Cal Rx will be evaluating the Health Care Plan (HCP) status in the Medi-Cal Eligibility Data System (MEDS) to determine an active versus inactive status and proceed accordingly.​​ 

41. Relative to Medi-Cal Rx, what happens if the beneficiary has moved and the county has not updated the beneficiary’s eligibility?​​ 

There is no change to Medi-Cal’s overarching eligibility processes as a result of the transition to Medi-Cal Rx. Medi-Cal Rx will be evaluating the Health Care Plan (HCP) status in the Medi-Cal Eligibility Data System (MEDS) to determine an active versus inactive status and proceed accordingly.​​ 

42. Are there any changes to Medi-Cal’s Share of Cost (SOC) policy where self-pay and spend-down have to occur before the Medi-Cal benefits?​​ 

Medi-Cal’s overarching SOC policy is not changing, and associated processes and policies would remain unchanged under Medi-Cal Rx.​​ 

43. Thaum twg cov neeg tau txais txiaj ntsig Medi-Cal muaj Lwm Qhov Kev Pabcuam Kev Noj Qab Haus Huv (OHC), qhov kev pab them nqi kho mob thiab cov nyiaj pab twg yog qhov tseem ceeb?​​ 

Medi-Cal’s overarching OHC policy is not changing and, in most instances, Medi‑Cal is the payer of last resort.​​ 

44. Medi-Cal Rx puas yuav cuam tshuam rau Medi-Cal cov neeg tau txais txiaj ntsig uas muaj Medi-Cal thiab Medicare (Part D)?​​ 

Tsis yog. Medi-Cal Rx tsis cuam tshuam lossis hloov lwm yam kev pab them nqi tshuaj rau Medi-Cal cov neeg tau txais txiaj ntsig uas muaj Medi-Cal thiab Medicare (Part D). Medi-Cal tej zaum yuav them cov txiaj ntsig tshuaj noj uas Medicare (Part D) tsis tuaj yeem, yog li Medi-Cal cov neeg tau txais txiaj ntsig yuav tsum tau tham nrog lawv cov kws kho mob.​​ 

Medi-Cal Fee-For-Service Reimbursement Methodology​​ 

45. Rau Medi-Cal cov khw muag tshuaj, Medi-Cal tus nqi them-rau-kev pab cuam lub tsev muag tshuaj li cas yog txoj kev them rov qab, thiab dab tsi yog cov khoom?​​ 

DHCS utilizes drug reimbursement methodologies as defined in state law and the Medi-Cal State Plan. Medi-Cal fee-for-service pharmacy reimbursement is the lower of the drug’s ingredient cost plus a professional dispensing fee or pharmacy’s usual and customary charge to the public.​​ 

1. Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) suav cov nqi tshuaj muaj nqis raws li qhov qis tshaj ntawm:​​ 
   • Tus Nqi Them Nqi Them Nqi Hauv Tebchaws (NADAC) ntawm cov tshuaj, lossis thaum tsis muaj NADAC, Tus Nqi Muag Khoom Muag Khoom Muag (WAC) + 0%, lossis​​ 
   • Federal Upper Limit (FUL), los yog​​ 
   • Tus Nqi Tshaj Lij Tshaj Lij Tshaj Lij Tshaj Lij Tshaj Lij (MAIC).​​ 
2.  Tus nqi them tus kws tshaj lij (ob-tiered raws li tag nrho Medicaid thiab tsis yog Medicaid txhua xyoo lub tsev muag tshuaj thov ntim [uas yog, cov tshuaj muab tshuaj]):​​ 
   • > los yog = 90,000 thov ib xyoos: $10.05​​ 

For 340B claims, reimbursement is covered entity’s actual drug acquisition cost plus the appropriate professional dispensing fee.​​ 

For more information on the Departments MAIC program, view the Maximum Allowable Ingredient Cost (MAIC) Program Frequently Asked Questions.​​ 

46. Does the Department of Health Care Services (DHCS) reimburse specialty pharmacies for medication management services provided to patients identified as “high-risk” for compliance, adherence, or medication misuse concerns?​​ 

DHCS has established the Medication Therapy Management (MTM) program as authorized in Welfare and Institutions Code (W&I Code) Section 14132.969 as part of pharmacist services to support, ensure continued access, and reimburse specialty pharmacies for the services which they offer. Part of this is establishing and maintaining a list of covered specialty drug categories, eligibility criteria, and conditions for which MTM pharmacist services will be reimbursed. DHCS contracts with any willing Medi-Cal enrolled pharmacy providers, as authorized in W&I Code, Section 14105.3, to provide MTM pharmacist services to Medi-Cal members for covered specialty drug categories and to patients that meet the eligibility criteria in the contracts. For additional details, see DHCS’ web page Update on Medication Therapy Management Pharmacy Services.[NI1]​​  

 [NI1]The last question # 48 in V15 has been deleted in this version​​ 

Kev txiav txim siab txog txoj cai​​ 

47. What is Medi-Cal’s Contract Drugs List (CDL)?​​ 

The Department of Health Care Services (DHCS) maintains the CDL, which is DHCS’ list of covered drugs and includes drugs for which there is a current state supplemental drug rebate agreement in place. Generally, under the existing Medi-Cal fee-for-service pharmacy benefit, if a drug is listed on the CDL, then it does not require an approved prior authorization (PA) for coverage. Alternatively, if a drug is not listed on the CDL, then it would require an approved PA for coverage. Note that even if a drug is listed on the CDL, it may still require an approved PA for coverage; however, if a certain drug on the CDL requires an approved PA, then DHCS’ policy would clearly articulate that requirement.​​ 

View the CDLs on the Contract Drugs List page on the Medi-Cal Rx Web Portal.​​ 

48. How will Medi-Cal Rx affect Medi-Cal’s Contract Drugs List (CDL), and does DHCS take anything else into consideration for its Medi-Cal drug coverage policies?​​ 

Medi-Cal RxCDL replaced the previous DHCS-approved Medi-Cal CDL as the list of covered drugs. In addition, DHCS’ pharmacy drug coverage policies take into consideration:​​ 

• Tag nrho US Food and Drug Administration (FDA)-pom zoo cov tshuaj tiv thaiv kab mob sab nraud, raws li tau hais los ntawm Lub Chaw rau Medicare & Medicaid Services (CMS), raug rau kev kho mob.​​ 
• DHCS’ business rules that detail requirements for the covered outpatient drugs and non-drug products, and limitations of coverage, which include aid code, program, and/or date-specific coverage.​​ 
• 
  View the CDLs on the Contract Drugs List page on the Medi-Cal Rx Web Portal.
  ​​ 

49. Will Medi-Cal Rx consider local exceptions to Medi-Cal’s Contract Drugs List (CDL)?​​ 

Tsis yog. Medi-Cal Rx siv ib qho CDL, thoob plaws lub xeev, thiab Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS)-tau pom zoo los ua kom cov txiaj ntsig ntawm Medi-Cal hauv tsev muag tshuaj zoo ib yam. Saib cov CDLs ntawm nplooj ntawv Daim Ntawv Teev Tshuaj ntawm Medi-Cal Rx Web Portal.​​ 

50. DHCS ua li cas txiav txim siab ntxiv lossis tshem tawm cov tshuaj los ntawm Daim Ntawv Cog Lus Tshuaj (CDL)?​​ 

DHCS tuaj yeem ntxiv cov tshuaj rau Medi-Cal CDL raws li tau txais los ntawm (1) Ib qho kev thov rau Tus Neeg Siv Tshuaj Sab Nraud (IDP) los ntawm lub chaw tsim khoom, tus kws kho mob, thiab / lossis tus kws muag tshuaj, lossis (2) DHCS-initiated IDP tshuaj xyuas, yog tias tsim nyog. Thaum tau txais daim IDP lawm, DHCS ua qhov kev tshuaj xyuas dav dav ntawm qhov kev thov, suav nrog cov ntaub ntawv pov thawj, kev coj ua zoo tshaj plaws hauv kev lag luam, thiab cov qauv tshuaj xyuas hauv qab no, uas tau teev tseg hauv Welfare and Institutions Code Section 14105.39(c)(1) thiab (2):​​ 

• Kev nyab xeeb ntawm cov tshuaj​​ 
• Qhov ua tau zoo ntawm cov tshuaj​​ 
• Qhov tseem ceeb xav tau ntawm cov tshuaj​​ 
• Lub peev xwm rau kev siv tshuaj tsis raug​​ 
• Tus nqi ntawm cov tshuaj rau qhov kev pab cuam​​ 

In addition to conducting its own internal review, DHCS also consults with the Medi-Cal Drug Advisory Committee (Committee), as required by Welfare and Institutions Code Section 14105.4. The Committee is composed of members who are appointed by DHCS’ Director – including community physicians and pharmacists, faculty members from academic pharmacy institutions, and Medi-Cal beneficiaries – and assists DHCS by providing written recommendations to inform decision-making regarding adding and/or deleting, drug(s) from the Medi-Cal CDL. The Committee’s final response with detailed, drug-by-drug recommendations is due within 30 calendar days of DHCS requesting consultation, and takes into consideration the Welfare and Institutions Code Section 14105.39(c)(1) and (2) criteria, as well as additional information such as generic name, brand name, federal Food and Drug Administration (FDA)-approved indications, manufacturer, fiscal/cost impact, clinical criteria, etc.​​ 

DHCS then makes an informed and documented decision whether or not to add the drug to the Medi-Cal CDL based upon the Committee’s recommendations, state law requirements, and other relevant factors.​​ 

As DHCS moves closer to Medi-Cal Rx’s full Assumption of Operations on January 1, 2022, it is continuing its efforts to closely analyze variances and gaps between Medi-Cal Managed Care Plan (MCP) formularies and the Medi-Cal CDL. As a product of DHCS’ analysis, and in an effort to drive down the total number of required prior authorizations, numerous medications have been added to the Medi-Cal CDL since January 2020, and DHCS will continue this review on a monthly basis to add more medications to the Medi-Cal CDL.​​ 

51. Puas muaj cov kev cai lij choj hloov pauv cuam tshuam txog Medi-Cal Rx?​​ 

Yes, DHCS’ proposed Trailer Bill language was part of the Governor’s Fiscal Year 2020-21 budget, which made the following changes:​​ 

• Repealed the six-prescription (“6 Rx”) drug limit.​​ 
• Tshem tawm Medi-Cal tus nqi-rau-kev pab them nqi kho mob.​​ 
• Redefined “Best Price” for Medi-Cal drugs to allow for drug prices outside the United States to be considered for state supplemental drug rebate contracts.​​ 

52. Rau cov tshuaj uas xav tau kev tso cai ua ntej (PA), cov kws kho mob lossis cov kws kho mob puas yuav tsum tau xa daim ntawv PA txhua zaus muab tshuaj?​​ 

Tsis yog, PA tuaj yeem them rau ntau qhov kev xa tawm hauv lub sijhawm PA pom zoo.​​ 

53. Puas yog DHCS tau hloov txoj cai los tso cai rau ntau xyoo ua ntej kev tso cai (PA)?​​ 

Txhawm rau kom txo qhov kev nyuaj siab ntawm kev tswj hwm thaum ua kom muaj kev saib xyuas thiab kev nyab xeeb ntawm cov tshuaj rau cov tswv cuab, DHCS tau ua kom muaj kev ncua sijhawm / ntau xyoo PAs txog li tsib xyoos rau qee cov tshuaj kho mob siv rau cov mob ntev. Cov tshuaj uas tsim nyog tau txais kev tso cai txuas ntxiv mus. Saib daim ntawv ceeb toom txog Kev Tso Cai Ua Ntej Ntev Dua rau Cov Tshuaj Kho Mob kom paub ntxiv.​​ 

54. Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) puas yuav xav txog kev hloov pauv txoj cai kom tso cai rau kev txhim kho thiab/lossis nthuav dav kev ua haujlwm ntawm kev txiav txim siab tsis siv neeg?​​ 

Ua ib feem ntawm Medi-Cal Rx, DHCS txuas ntxiv txhim kho thiab/lossis nthuav cov haujlwm txiav txim siab tsis siv neeg (piv txwv li, kev pom zoo thiab kev them nyiaj tsis siv neeg) kom txo cov tshuaj uas muaj cov kev cai tso cai ua ntej (PA) uas xav tau kev tshuaj xyuas tes.​​ 

55. Medi-Cal Rx puas muaj cov kev pabcuam tswj hwm opioid?​​ 

Medi-Cal Rx muab cov kev pabcuam tswj hwm opioid raws li Txoj Cai Lij Choj 6 Kev Tiv Thaiv Kev Siv Tshuaj Yeeb Uas Txhawb Kev Rov Qab Zoo thiab Kev Kho Mob Opioid (SUPPORT) rau Cov Neeg Mob thiab Cov Zej Zog,​​ 

Txoj cai thiab cov txheej txheem ntawm kev muag tshuaj Medi-Cal, thiab cov lus qhia uas tsim nyog rau kev kho mob, raws li pov thawj. Txhawm rau txhawb kev pom tseeb thiab kev paub ntau ntxiv, Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tau qhia cov ntaub ntawv no rau sab nraud ntawm ntau qhov kev tshwm sim ntawm cov neeg koom nrog, suav nrog tab sis tsis txwv rau Medi-Cal Rx Managed Care Plan (MCP) pawg ua haujlwm thiab
Medi-Cal Rx Advisory pawg ua haujlwm. Yog xav paub ntxiv txog DHCS cov cai thiab cov txheej txheem tam sim no ntawm lub tsev muag tshuaj hauv qhov chaw no, mus saib cov ntaub ntawv siv los ua piv txwv .​​ 

Ntxiv rau qhov ntawd, ua ib feem ntawm Medi-Cal Rx, DHCS tau thov cov lus pom zoo ua ib feem ntawm Daim Ntawv Thov Kev Pom Zoo (RFP) los tshawb nrhiav ntxiv txog cov cuab yeej tswj kev siv tshuaj opioid uas zoo dua li qhov uas txoj cai lij choj hauv tebchaws xav tau. Txij no mus, DHCS yuav xav txog kev siv cov kev pabcuam tswj hwm opioid uas tau txhim kho uas tau pom zoo.​​  

56. Medi-Cal Rx puas yuav suav nrog qhov kev pab cuam hauv tsev muag tshuaj?​​ 

Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tsis tau siv qhov kev pab cuam kaw-hauv ua ib feem ntawm Medi-Cal Rx tag nrho Assumption of Operations (AOO) rau lub Ib Hlis 1, 2022, tab sis yuav soj ntsuam cov kev xaiv nrog Magellan Medicaid Administration, LLC (MMA) yav tom ntej. Ua ib feem ntawm Daim Ntawv Thov Kev Pab Them Nqi Kho Mob Medi-Cal (RFP) #19-96125, DHCS tau thov cov ntawv thov kom tshawb nrhiav cov kev xaiv ntxiv rau cov kev pab cuam kaw tsev muag tshuaj, suav nrog, tab sis tsis txwv rau, tej yam xws li: kev siv ntau lub tsev muag tshuaj, cov neeg sau tshuaj sib txawv, thiab tus lej ntawm cov tshuaj tswj. Ntxiv rau, DHCS paub tias kwv yees li 50 feem pua ntawm Medi-Cal Managed Care Plans (MCPs) siv cov kev pab cuam kaw hauv tsev muag tshuaj niaj hnub no, yog li los ntawm kev siv zog koom tes nrog cov neeg koom tes, DHCS yuav nrhiav kev kawm ntxiv thiab siv cov kev coj ua zoo tshaj plaws rau
Medi-Cal Rx.​​ 

57. Kuv tuaj yeem nrhiav Medi-Cal Rx Txhua Daim Ntawv Npaj Rau Medi-Cal Managed Care Plans (MCPs) uas muab kev taw qhia los ntawm txoj cai thiab kev pom zoo?​​ 

DHCS’ new Medi-Cal All Plan Letter APL 20-020 for Medi-Cal MCPs can be found on DHCS’ website.​​ 

58. Kuv tuaj yeem nrhiav Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv Txhua Tus Daim Ntawv Npaj, txheeb ze rau Medi-Cal Rx, rau Medi-Cal Managed Care Plans (MCPs) uas muab kev taw qhia los ntawm kev tswj hwm, kev ua raws, thiab kev xa mus?​​ 

The DMHC All Plan Letter APL 20-035 relative to Medi-Cal Rx is available on the Department of Managed Health Care’s website.​​ 

59. Where can I find the Informational Notice (IN) for the California Children’s Services (CCS) program and the Genetically Handicapped Persons Program (GHPP) relative to Medi-Cal Rx?​​ 

Daim ntawv IN 20-03 rau CCS thiab GHPP cov kev pab cuam piv rau Medi-Cal Rx muaj nyob rau ntawm lub vev xaib DHCS.​​ 

60. Kuv tuaj yeem nrhiav Daim Ntawv Ceeb Toom Txog Tus Cwj Pwm Kev Noj Qab Haus Huv (BHIN) qhov twg uas muab cov lus qhia ntsig txog Medi-Cal Rx rau kev noj qab haus huv hauv lub nroog thiab Kev Siv Tshuaj Yeeb (SUD)?​​ 

Tus BHIN uas muab cov lus qhia txog Medi-Cal Rx rau kev noj qab haus huv ntawm lub hlwb thiab kev pabcuam kev siv tshuaj yeeb tam sim no tseem tab tom tsim thiab, thaum ua tiav, peb yuav muaj nyob rau ntawm nplooj ntawv Ceeb Toom Txog Kev Noj Qab Haus Huv ntawm DHCS lub vev xaib.​​  

Kev Tso Cai Ua Ntej / Siv Kev Tswj Xyuas​​ 

61. Raws li Medi-Cal Rx, kev thov kev tso cai ua ntej (PA) yuav raug tshuaj xyuas thiab txiav txim li cas?​​ 

DHCS shall, in collaboration with MMA, process PA requests and provide a response to the submitting provider within 24 hours of receiving a PA request, pursuant to Welfare and Institutions Code Section 14133.37. A more detailed process document is posted on DHCS’ Medi-Cal Rx Transition website. ​​ 

62. Cov Kev Npaj Kho Mob Tswj Xyuas Medi-Cal (MCPs) puas raug tso cai cog lus nrog Tus Neeg Cog Lus Rx Medi-Cal kom ua qhov kev tso cai ua ntej (PA)?​​ 

Tsis tau. Txij li thaum Medi-Cal MCPs yuav tsis raug cog lus rau lub tsev muag tshuaj Medi-Cal cov txiaj ntsig ntxiv lawm tom qab Medi-Cal Rx tag nrho Assumption of Operations rau Lub Ib Hlis Ntuj 1, 2022, tag nrho cov kev txiav txim siab PA thiab cov txheej txheem cuam tshuam yuav raug xa los ntawm MMA, ua raws li cov lus cog tseg thiab ntawm DHCS cov kev taw qhia.​​ 

340B Federal Drug Discount Program​​ 

63. Tsoom Fwv Teb Chaws 340B Program yog dab tsi?​​ 

Tshooj 340B ntawm Txoj Cai Pabcuam Kev Noj Qab Haus Huv Hauv Pej Xeem (Title 42 United States Code Section 256b) tsim kom muaj tsoomfwv txoj haujlwm hu ua 340B Drug Pricing Program (340B Program), uas tau tsim nyob rau xyoo 1992 tom qab tau txais kev pom zoo ntawm Medicaid Drug Rebate Program. Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv thiab Kev Pabcuam, ib lub koomhaum nyob hauv Tebchaws Meskas Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv thiab Tib Neeg, tswj hwm thiab tswj cov haujlwm los ntawm nws Lub Chaw Haujlwm Saib Xyuas Tshuaj.​​ 

The 340B Program requires drug manufacturers to offer drugs to certain hospitals and other healthcare providers (covered entities) at a greatly reduced price. By selling drugs at lower prices, participating drug manufacturers are not required to pay Medicaid drug rebates on drugs purchased through the 340B Program and provided to a Medicaid beneficiary (better known as the provision against “duplicate discounts”).​​ 

64. Leej twg siv 340B Program?​​ 

Tshooj 340B (a) (4) ntawm Txoj Cai Kev Pabcuam Kev Noj Qab Haus Huv Pej Xeem (Title 42 United States Code Tshooj 256b) qhia meej tias cov chaw uas tau them nqi twg tsim nyog koom nrog hauv 340B Program. Cov no suav nrog cov tsev kho mob uas tsim nyog, cov neeg tau txais nyiaj pab los ntawm tsoomfwv los ntawm Health Resources and Services Administration (HRSA), Centers for Disease Control and Prevention (CDC), Department of Health and Human Services’ Office of Population Affairs, thiab Indian Health Service. Cov chaw uas tsim nyog tau txais kev pab them nqi yog txhais nyob rau hauv txoj cai lij choj thiab suav nrog cov chaw kho mob thiab cov chaw zoo li HRSA txhawb nqa, Ryan White cov chaw kho mob thiab cov kev pab cuam State AIDS Drug Assistance, Medicare/Medicaid Disproportionate Share Hospitals (DSH), cov tsev kho mob menyuam yaus, thiab lwm cov chaw muab kev pab cuam kev nyab xeeb.​​ 

When registering as a covered entity with HRSA, a covered entity may choose not to dispense 340B purchased drugs to Medicaid members or to dispense 340B purchased drugs to Medicaid members. HRSA maintains a file of covered entities that indicates whether the entity dispenses 340B purchased drugs to Medicaid patients. Although covered entities can purchase 340B drugs for all eligible patients, state Medicaid programs may only collect rebates on drugs purchased outside of the 340B Program. Additional details are available on HRSA’s 340B Drug Pricing Program website.​​ 

65. Dab tsi yog qhov kev sib cuam tshuam ntawm peb daim ntawv thov tshuaj noj thiab 340B Program?​​ 

Cov tshuaj uas yuav raws li tus nqi 340B thiab muab rau cov neeg sau npe Medicaid raug tshem tawm ntawm kev sau nyiaj rov qab los ntawm tsoomfwv thiab xeev. Qhov kev zam no tiv thaiv cov chaw tsim tshuaj los ntawm kev muab cov luv nqi rov qab rau cov tshuaj uas yuav los ntawm 340B Program.​​ 

Thaum Lub Kaum Hli Ntuj xyoo 2009, California tau tsim ib txoj cai uas twb muaj lawm uas yuav tsum tau kom cov koom haum uas muaj 340B them tsuas yog muab cov khoom muag 340B rau cov tswv cuab Medi-Cal xwb, thiab them tus nqi tiag tiag (AAC) rau cov tshuaj ntawd thaum muab los ntawm Medi-Cal tus nqi them rau kev pabcuam, raws li Welfare and Institutions Code (W&I Code), Tshooj 14105.46. Qhov yuav tsum tau them tus nqi tiag tiag ntawm 340B tsuas yog siv rau qhov kev xa khoom them tus nqi rau kev pabcuam xwb.​​ 

Hauv txoj kev tswj xyuas kev noj qab haus huv, 340B cov tshuaj uas muab rau cov tswv cuab Medi-Cal tsis raug raws li Medi-Cal tus nqi-rau-kev pabcuam-cov nqi them nqi. Qhov no tso cai rau cov koom haum tau txais kev pab thiab Medi-Cal Managed Care Plans (MCPs) thiab/los yog Cov Kws Pab Tswv Yim Kho Mob (PBMs) sib tham sib tham txog kev them nyiaj rov qab uas ua rau cov nyiaj them rov qab ntau dua rau 340B qhov chaw nyob hauv lub chaw tswj xyuas kev noj qab haus huv thaum piv rau cov koom haum li cas los yog yuav tau them nyiaj rov qab rau Medi-for-service system. Cov nyiaj tau los no tsis tau muab faib rau lub xeev, thiab tsis yog cov nyiaj tau los ntawm lub xeev.​​ 

Medi-Cal Rx tso cai rau kom muaj kev sib haum xeeb ntawm txoj cai thiab txhim kho kev saib xyuas ntawm kev thov rau cov tshuaj uas tau muab xa tawm thiab them nqi los ntawm 340B Program.​​ 

66. Medi-Cal Rx puas txwv tsis pub tus kws kho mob txuas ntxiv ua tus neeg mob 340B?​​ 

Tsis yog. Tsis tas li ntawd, qhov kev thov yuav tsis hloov lossis tshem tawm 340B Program hauv California.​​ 

67. Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) daws cov teeb meem uas tau hais txog qhov cuam tshuam ntawm Medi-Cal Rx rau kev tswj hwm ntawm 340B Program li cas?​​ 

DHCS lees paub lub luag haujlwm tseem ceeb ntawm peb cov chaw muab kev nyab xeeb thiab cov haujlwm tseem ceeb uas lawv ua rau cov neeg tau txais txiaj ntsig Medi-Cal. DHCS tau ua haujlwm thiab txuas ntxiv ua haujlwm sib koom tes thiab koom nrog kev sib tham nrog ntau tus neeg txaus siab thiab cov neeg koom nrog sawv cev ntawm cov chaw kho mob thiab pab pawg kom nkag siab zoo txog qhov cuam tshuam ntawm kev siv Medi-Cal Rx ntawm lawv qhov Kev Pabcuam 340B thiab lwm yam txheej txheem, nrog rau kev sib tham ntxiv txog cov kev xaiv rau kev txo qis.​​ 

68. DHCS yuav faib li cas thiab/los yog ua kom muaj cov nyiaj pab ntxiv rau cov tsev kho mob 340B uas tsis yog tsev kho mob?​​ 

DHCS tau hu ib pab pawg neeg koom tes los tsim cov txheej txheem rau kev faib cov nyiaj pab ntxiv rau cov tsev kho mob tsis yog tsev kho mob 340B hauv zej zog. Cov ntsiab lus ntawm pawg neeg ua haujlwm suav nrog cov qauv tsim nyog tau txais kev them nyiaj ntxiv, tag nrho cov nyiaj hauv pas dej ua ke muaj nyob rau hauv ib lub xyoo nyiaj txiag, thiab cov txheej txheem rau kev faib cov nyiaj hauv pas dej ntawm cov tsev kho mob tsis tsim nyog 340B hauv zej zog nrog rau lub sijhawm, zaus, thiab cov nyiaj tau los ntawm cov nyiaj tau los ntxiv. Lub Xeev Txoj Kev Hloov Kho (SPA) tau pom zoo. Tsis tas li ntawd, tsab ntawv ceeb toom tau tshaj tawm thaum Lub Rau Hli 28, 2023, hais tias DHCS yuav them nyiaj ntxiv rau qhov tsim nyog tsis yog tsev kho mob 340B cov chaw kho mob hauv zej zog rau hnub ua haujlwm txij Lub Xya Hli 1, 2023 txog Lub Kaum Ob Hlis 31, 2023, raws li cov cai ntawm Assembly Bill 80.​​ 

Medi-Cal Rx Kev Tsis Txaus Siab / Kev Tsis Txaus Siab Kev daws teeb meem & Cov txheej txheem thov rov hais dua​​ 

69. Cov txheej txheem daws teeb meem kev tsis txaus siab thiab kev tsis txaus siab dab tsi yuav Medi-Cal cov neeg tau txais txiaj ntsig yuav tsum tau daws cov teeb meem nyiaj pab hauv khw muag tshuaj?​​ 

In partnership with MMA, DHCS is committed to implementing and overseeing an effective Medi-Cal Rx complaint and grievances process to ensure appropriate triaging, referral, and/or disposition. Specific requirements are outlined in Request for Proposal #19-96125, Exhibit A, Attachment II – Scope of Work Operations – Complaints and Grievances Resolution. In addition, DHCS’ Medi-Cal Rx Complaints and Grievances Policy is posted on DHCS’ Med-Cal Rx Transition webpage.​​ 

70. Cov kev tsis txaus siab thiab kev tsis txaus siab ntawm lub tsev muag tshuaj twg yuav raug daws los ntawm Medi-Cal Rx?​​ 

Txhua qhov kev tsis txaus siab thiab kev tsis txaus siab ntsig txog lub tsev muag tshuaj rau cov kev pabcuam Medi-Cal Rx uas tau muab tom qab Medi-Cal Rx pib ua haujlwm tag nrho rau lub Ib Hlis 1, 2022, yuav raug daws los ntawm Medi-Cal Rx's Customer Service Center rau kev xaiv, kev tshawb fawb, thiab kev daws teeb meem. Yog xav paub ntxiv, thov mus saib DHCS txoj cai lij choj txog kev tsis txaus siab thiab kev tsis txaus siab txog Medi-Cal Rx.​​ 

71. Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tau ua li cas los daws cov lus tsis txaus siab thiab kev tsis txaus siab uas tshwm sim rau cov kev pabcuam ntsig txog tshuaj uas muab los ntawm Medi-Cal Managed Care Plans (MCPs) rau lossis ua ntej Medi-Cal Rx full Assumption of Operations (AOO)?​​ 

Pharmacy-related complaints and grievances for services rendered or requested on or before Medi-Cal Rx full AOO on January 1, 2022, by a Medi-Cal MCP, which are for services the MCP was at risk for, must be fully adjudicated by the Medi-Cal MCP in accordance with DHCS’ All Plan Letter 17-006 and any subsequent versions.​​ 

Cov kev tsis txaus siab thiab kev tsis txaus siab ntawm cov chaw muag tshuaj tau txais tom qab Medi-Cal Rx tag nrho AOO los ntawm Medi-Cal Rx Lub Chaw Pabcuam Cov Neeg Siv Khoom (CSC) rau cov kev pabcuam los ntawm Medi-Cal MCP rau lossis ua ntej Medi-Cal Rx tag nrho AOO yuav raug xa los ntawm Medi-Cal Rx CSC mus rau Medi-Cal MCP kom tsim nyog.​​ 

Medi-Cal Rx CSC yuav qhia rau Medi-Cal MCP cov tswv cuab tias lawv yuav tsum hu rau lawv MCP rau cov kev tsis txaus siab thiab kev tsis txaus siab ntawm lub tsev muag tshuaj.​​ 

Txoj cai ntawm Medi-Cal MCP cov tswv cuab xa cov lus tsis txaus siab thiab kev tsis txaus siab rau lawv Medi-Cal MCPs rau cov kev pab cuam hauv khw muag tshuaj uas tau muab rau lossis ua ntej Medi-Cal Rx tag nrho AOO tsis cuam tshuam los ntawm Medi-Cal Rx.​​ 

72. Puas yog Medi-Cal Rx muaj txoj hauv kev los qhia cov ntaub ntawv hais txog kev tsis txaus siab thiab kev tsis txaus siab nrog tus neeg tau txais txiaj ntsig Managed Care Plan (MCP)?​​ 

Medi-Cal MCPs will have complete access to individual records of beneficiaries enrolled in their plan via the Medi-Cal Rx Web Portal, including documentation of complaints and grievances. This information can be reviewed by the plan case manager on a case-by-case basis as needed. Further, relative to complaints and grievances external reporting, DHCS is exploring options and will leverage existing modalities relative to sharing this information publicly through various avenues such as DHCS’ website and Open Data Portal.​​ 

73. Cov txheej txheem thov rov hais dua li cas cov neeg tau txais txiaj ntsig Medi-Cal yuav tau daws cov teeb meem kev pab kho mob?​​ 

Appeals go through the State Fair Hearing process, which is administered through the California Department of Social Services. If Medi-Cal beneficiaries do not agree with a denial or change of Medi-Cal Rx services, they can ask for a State Fair Hearing. Fair Hearings can be requested online or by phone, fax, mail, or email. For more information about the State Hearing process, refer to the Notice of Action (NOA) that you received or visit DHCS’ Medi-Cal Fair Hearing website or the California Department of Social Services’ website. Medi-Cal beneficiaries may also call to ask for a State Fair Hearing toll-free at 1-800-952-5253 (TTY 1-800-952-8349). Please note that the number can be very busy so you may get a message to call back later.​​ 

74. Yog tias tus neeg tau txais txiaj ntsig Medi-Cal xav tau Lub Xeev Lub Rooj Sib Hais Ncaj Ncees, puas muaj sijhawm txwv?​​ 

Yog lawm, cov neeg tau txais txiaj ntsig Medi-Cal tsuas muaj 90 hnub los thov kom muaj lub rooj sib hais, ua raws li txoj cai hauv lub xeev.​​ 

75. Cov neeg tau txais txiaj ntsig Medi-Cal puas tseem tuaj yeem tau txais lawv cov kev kho mob thaum tseem tos lub Xeev Qhov Kev Txiav Txim Siab Ncaj Ncees?​​ 

Yog lawm. Txhawm rau txuas ntxiv tau txais Medi-Cal Rx cov kev pab cuam uas daim ntawv ceeb toom tsis lees yuav tsum nres thiab/lossis hloov, Medi-Cal cov neeg tau txais txiaj ntsig yuav tsum thov kom muaj Lub Rooj Sib Hais Hauv Lub Xeev tsis pub dhau kaum hnub txij hnub NOA, lossis ua ntej hnub, tsab ntawv ceeb toom hais tias koj qhov kev kho mob yuav nres lossis hloov, qhov twg yog tom qab.​​ 

Thaum thov Lub Xeev Lub Rooj Sib Hais Ncaj Ncees, Medi-Cal cov neeg tau txais txiaj ntsig yuav tsum tau qhia tias lawv xav kom tau txais Medi-Cal Rx cov kev pab cuam thaum lub rooj sib hais. Thov nco ntsoov tias nws tuaj yeem siv sijhawm ntev txog 90 hnub rau qhov kev txiav txim siab thiab qhov kev txiav txim zaum kawg raug xa mus rau tus neeg txais txiaj ntsig Medi-Cal.​​ 

76. Cov neeg tau txais txiaj ntsig Medi-Cal puas tuaj yeem thov kom muaj lub Rooj Sib Hais Ncaj Ncees hauv Xeev?​​ 

Yog lawm. Cov neeg tau txais txiaj ntsig Medi-Cal tuaj yeem thov kom muaj lub rooj sib hais nrawm los ntawm kev xa tsab ntawv los ntawm lawv tus kws kho mob piav qhia tias tos txog li 90 hnub tuaj yeem pheej hmoo rau lawv lub neej thiab / lossis kev noj qab haus huv. Cov neeg tau txais txiaj ntsig Medi-Cal yuav tsum xa tsab ntawv nrog rau lawv qhov kev thov rooj sib hais. Yog xav paub ntxiv txog cov txheej txheem Rooj Hais Plaub Hauv Xeev, thov mus saib hauv DHCS' Medi-Cal Fair Hearing lub website.​​ 

77. Rau kev thov rov hais dua ntawm Medi-Cal Rx qhov kev txiav txim siab los ntawm Medi-Cal tus kws kho mob thiab/lossis Managed Care Plan (MCP), DHCS puas yuav tsim ib qho txheej txheem rov hais dua Medi-Cal Rx sab nraud uas cov kws kho mob ywj pheej tshuaj xyuas cov kev txiav txim?​​ 

No, at this time, DHCS is not exploring creating a separate independent medical review process, akin to that currently overseen by the California Department of Managed Health Care, for Medi-Cal Rx. As a reminder, Medi-Cal Rx denials for pharmacy claims will not be made by Medi-Cal providers and/or MCPs; rather, they will initially be made by MMA and reviewed by DHCS for final determination. As mentioned elsewhere in this document, Medi-Cal providers can appeal Medi-Cal Rx denials consistent with the requirements outlined in Request for Proposal #19-96125, Exhibit A, Attachment II – Scope of Work Operations – Claims Administration, applicable state law requirements, and DHCS’ policies/procedures.​​ 

78. Qhov kev thov rov hais dua txog tsev muag tshuaj dab tsi yuav raug daws los ntawm Medi-Cal Rx?​​ 

Txhua qhov kev thov rov hais dua txog kev kho mob rau cov kev pabcuam Medi-Cal Rx uas tau muab tom qab Medi-Cal Rx tag nrho Assumption of Operations yuav raug daws los ntawm Medi-Cal Rx siv cov txheej txheem State Fair Hearing uas twb muaj lawm, uas tswj hwm los ntawm California Department of Social Services, raws li tau piav qhia hauv cov lus nug #73-76 saum toj no.​​ 

79. Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tau daws cov teeb meem ntawm cov neeg tau txais txiaj ntsig Medi-Cal Managed Care Plan (MCP) uas tshwm sim rau cov kev pabcuam ntsig txog tshuaj uas muab los ntawm Medi-Cal MCPs thaum lossis ua ntej Medi-Cal Rx full Assumption of Operations (AOO) li cas?​​ 

Medi-Cal MCPs yuav tsum daws tag nrho Medi-Cal MCP cov neeg tau txais kev thov rov hais dua uas tau tshwm sim los ntawm qhov kev txiav txim siab MCP cuam tshuam rau cov kev pab cuam hauv khw muag tshuaj uas MCP muaj kev pheej hmoo rau los yog ua ntej Medi-Cal Rx puv AOO. Txoj cai ntawm Medi-Cal MCP cov tswvcuab xa daim ntawv thov rov hais dua mus rau Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv, suav nrog tab sis tsis txwv rau txoj cai rau Independent Medical Review, rau cov kev pab cuam hauv khw muag tshuaj uas muab los ntawm Medi-Cal MCPs ua ntej lossis ua ntej Medi-Cal Rx tag nrho AOO, tsis cuam tshuam los ntawm Medi-Cal Rx.​​ 

Kev cuam tshuam txog nyiaj txiag / kev soj ntsuam​​ 

80. Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) puas tau ua tiav kev tshuaj xyuas nyiaj txiag ua ntej kev hloov pauv?​​ 

Yog. DHCS ua tiav kev tshuaj xyuas nyiaj txiag rau Medi-Cal Rx thiab qhia cov ntaub ntawv no rau pej xeem. DHCS kwv yees tias yuav muaj kwv yees li $ 309 lab Nyiaj Txiag Dav Dav (GF) hauv kev txuag txhua xyoo los ntawm xyoo 2023-24. DHCS suav nrog qhov kev kwv yees nyiaj txiag rau Medi-Cal Rx ua ib feem ntawm cov txheej txheem kwv yees Medi-Cal txhua ob xyoos, thiab yuav muab cov kev hloov kho tsim nyog, yog tias muaj, rau kev tshuaj xyuas nyiaj txiag ntawm qhov txuas ntxiv mus tom ntej.​​ 

81. Cov ntsiab lus ntawm peb qhov kev kwv yees $ 309 lab Nyiaj Txiag Dav Dav (GF) hauv kev txuag txhua xyoo los ntawm xyoo 2023-24 yog dab tsi?​​ 

Cov ntsiab lus ntawm kev kwv yees $ 309 lab GF khaws cia los ntawm 2023-24 suav nrog tab sis tsis txwv rau cov hauv qab no:​​ 

• Lub xeev ntxiv cov tshuaj ntxiv nyiaj rov qab los ntawm kev hloov pauv ntawm kev siv tshuaj los ntawm kev tswj hwm kev saib xyuas mus rau tus nqi-rau-kev pabcuam.​​ 
• Kev Siv Cov Nqi Tshaj Lij Tshaj Lij Tshaj Lij Tshaj Lij Tshaj Lij (MAICs) rau cov tshuaj uas muaj peb (3) lossis ntau dua cov kev xaiv sib npaug.​​ 
• Txo cov nqi cuam tshuam txog kev tswj hwm ntawm ntau lub chaw muag tshuaj cov nyiaj pab tswj xyuas siv los ntawm ntau yam Medi-Cal Managed Care Plans (MCPs).​​ 
• Medi-Cal tus nqi-rau-kev pabcuam them rov qab, uas suav nrog $10.05/$13.20 tus nqi xa khoom.​​ 
• Ib qho kev them nyiaj ntxiv tshiab rau cov tsev kho mob 340B uas tsis yog tsev kho mob, tau txais txiaj ntsig nrog Medi-Cal Rx tag nrho Assumption of Operations nyob rau lub Ib Hlis 1, 2022, tau suav nrog hauv 2021-22 pob nyiaj siv. Saib nqe lus nug #70 saum toj no yog xav paub ntxiv.​​ 

Raws li tau hais hauv lo lus nug #80 saum toj no, txhua qhov kev hloov kho rau Medi-Cal Rx kev kwv yees nyiaj txiag, suav nrog kev kwv yees kev txuag nyiaj, yuav raug hloov kho tshiab ua ib feem ntawm cov txheej txheem kwv yees Medi-Cal txhua ob xyoos.​​ 

Lwm yam / Lwm Cov Ntaub Ntawv​​ 

82. Puas yog Medi-Cal Rx muaj cov kev xaiv yuav tshuaj xa ntawv?​​ 

Muaj. Cov kev xaiv xaj khoom xa ntawv muaj nyob rau hauv Medi-Cal los ntawm Medi-Cal Rx. Yog tias lub tsev muag tshuaj yog ib lub chaw muab tshuaj Medi-Cal uas tau sau npe, lub tsev muag tshuaj yuav muab cov tshuaj rau ntawm qhov chaw lossis los ntawm kev xa ntawv. Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tau ua kom muaj kev txuas ntxiv ntawm kev xaiv kev pabcuam xa ntawv zoo rau cov kev pabcuam tshuaj Medi-Cal.​​ 

83. Puas yog Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) puas ua rau Medi-Cal cov chaw muag tshuaj ntxiv cov ntawv cog lus rov qab rau pej xeem?​​ 

Tsis yog. Ob lub xeev thiab tseemfwv txoj cai lij choj tiv thaiv kev tsis pub lwm tus paub ntawm cov ntawv cog lus them rov qab tshuaj ntxiv.​​ 

84. Tus Neeg Cog Lus Medi-Cal Rx puas yuav tsum tau cog lus nrog cov tsev muag tshuaj uas twb muaj lawm hauv cov tes hauj lwm tam sim no?​​ 

Tsis yog. Magellan Medicaid Administration, LLC (MMA) tsis tau cog lus nrog ib tus kws kho mob. Tag nrho cov kev ua ub no ntawm tus kws kho mob thiab kev saib xyuas ntawm Medi-Cal lub chaw muag tshuaj yog khaws cia los ntawm Lub Tsev Haujlwm Saib Xyuas Kev Kho Mob (DHCS).​​ 

84. Muaj pes tsawg lub tsev muag tshuaj uas tseem siv tau, uas tau txais daim ntawv tso cai los ntawm California uas tau sau npe rau hauv Medi-Cal fee-for-service?​​ 

Nyob rau lub Ib Hlis Ntuj xyoo 2023, Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) cov ntaub ntawv, 6,547 California cov chaw muag tshuaj muaj ntawv tso cai tau tso npe rau hauv Medi-Cal tus nqi-rau-kev pabcuam.​​ 

85. Medi-Cal puas koom nrog kev rau siab sau npe cov tsev muag tshuaj uas yog ib feem ntawm Managed Care Plan (MCP) network tab sis tsis tau sau npe rau hauv Medi-Cal fee-for-service?​​ 

Txij li thaum Medi-Cal Rx pib ua haujlwm tag nrho (AOO) rau lub Ib Hlis 1, 2022, Medi-Cal Rx siv Medi-Cal lub network ntawm cov chaw muag tshuaj thoob plaws lub xeev uas tau sau npe ua cov chaw muab kev pabcuam Medi-Cal. Cov tsev muag tshuaj uas tau sau npe rau Medi-Cal suav nrog feem ntau ntawm cov tsev muag tshuaj uas tau tso cai hauv California. Cov Medi-Cal MCPs tam sim no siv cov tsev muag tshuaj no thiab qee cov tsev muag tshuaj ntxiv uas tseem tsis tau rau npe ua cov chaw muab kev pab cuam Medi-Cal. Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tau tshuaj xyuas cov tes hauj lwm muag tshuaj MCP, txheeb xyuas qhov sib txawv uas cov khw muag tshuaj muab kev pabcuam hauv kev saib xyuas kev tswj hwm tab sis tsis tau sau npe rau hauv kev them nqi rau kev pabcuam, thiab tau xa cov ntawv ceeb toom rau cov khw muag tshuaj ceeb toom rau lawv tias lawv yuav tsum sau npe ua tus kws muab tshuaj Medi-Cal kom txuas ntxiv pabcuam cov pej xeem Medi-Cal los ntawm Medi-Cal Rx txij li AOO tag nrho.​​ 

86. Cov Kev Npaj Kho Mob Tswj Xyuas Medi-Cal (MCPs) thiab lwm lub koom haum yuav koom nrog cov rooj sib tham rau Pawg Neeg Saib Xyuas Kev Siv Tshuaj Thoob Ntiaj Teb ntawm Medi-Cal (DUR) thiab lwm pawg neeg saib xyuas tshuaj uas Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tsav los ntawm lub peev xwm twg?​​ 

Tam sim no thiab tsis tu ncua tom qab kev hloov pauv, DHCS cia siab tias nws cov Medi-Cal MCPs thiab lwm tus neeg txaus siab yuav koom nrog cov rooj sib tham uas cuam tshuam nrog Medi-Cal Global DUR Board thiab hauv lwm pawg kws muag tshuaj DHCS, raws li xav tau. Tsis tas li ntawd, DHCS tseem niaj hnub soj ntsuam thiab tshuaj xyuas seb yuav ua li cas thiaj li muaj txiaj ntsig zoo thiab koom tes nrog Medi-Cal MCPs thiab lwm lub koom haum hauv kev sib tham thiab kev txiav txim siab ntsig txog Medi-Cal txoj cai mus rau tom khw muag tshuaj.​​ 

87. Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) puas muaj kev pabcuam rau kev hloov tshiab thiab xov xwm ntsig txog Medi-Cal Rx?​​ 

Yog, nws hu ua Medi-Cal Rx Subscription Service (MCRxSS). Txhua tus neeg uas xav koom nrog peb raug txhawb kom sau npe rau MCRxSS kom tau txais xov xwm thiab cov kev hloov tshiab ntsig txog Medi-Cal Rx.​​