Tsev Cov Chaw Muab Kev Pabcuam & Cov Neeg Koom Tes Kev Pab Cuam Txog Kev Muag Tshuaj thiab Kev Pab Cuam Saib Xyuas Qhov Muag Kev Pab Cuam Txog Medi-Cal

Medi-Cal Rx

Txheej txheem cej luam

Thaum Lub Ib Hlis 7, 2019, Tus Thawj Kav Xeev Gavin Newsom tau tshaj tawm Daim Ntawv Txiav Txim N-01-19 kom ua tiav kev txuag nqi rau kev yuav tshuaj uas lub xeev ua. Ib feem tseem ceeb ntawm daim ntawv xaj yuav tsum tau kom DHCS hloov tag nrho cov kev pabcuam tshuaj Medi-Cal los ntawm kev tswj hwm kev saib xyuas (MC) mus rau kev them nqi rau kev pabcuam (FFS).

Kev hloov chaw muag tshuaj los ntawm MC mus rau FFS yuav, nrog rau 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 Medi-Cal beneficiary access to pharmacy services with a pharmacy network that includes approximately 94% of the state’s pharmacies.

Cov txiaj ntsig thiab cov kev pabcuam ntawm Medi-Cal uas DHCS tswj hwm hauv FFS txoj kev xa khoom yuav raug txheeb xyuas ua ke ua "Medi-Cal Rx".

Lwm yam kev hloov pauv uas tshwm sim los ntawm kev hloov mus rau FFS suav nrog:

Siv cov kev tswj xyuas kev siv thoob plaws hauv xeev rau txhua yam tshuaj kho mob sab nraud.
Txhawb kom California muaj peev xwm sib tham txog cov nyiaj rov qab rau cov tshuaj ntxiv ntawm lub xeev nrog cov chaw tsim tshuaj.

Cov khoom siv thiab cov ntaub ntawv siv

Cov hauv qab no yog cov peev txheej thiab cov ntaub ntawv siv rau cov neeg tau txais txiaj ntsig thiab cov neeg muab kev pabcuam hais txog Medi-Cal Rx cov kev pabcuam:

Kev Kho Mob Medi-Cal Rx thiab Kev Npaj Rov Qab Tso Cai Ua Ntej: Qhov no yog ib txoj hauv kev uas yuav rov qab kho cov kev kho mob thiab kev tso cai ua ntej, thiab kev tshem tawm Txoj Cai Hloov Pauv. Lub Rau Hli 2022 Medi-Cal Rx Rov Qab Siv Cov Kev Tso Cai Ua Ntej thiab Kev So Haujlwm ntawm Txoj Cai Hloov Pauv Theem I, thiab lub Kaum Ob Hlis 2022 Theem II, III, thiab IV. Lub Cuaj Hlis 2023 Advancing Medi-Cal Rx kev nthuav qhia. Yog xav paub ntxiv txog Medi-Cal RX Reinstatement, koj mus saib tau ntawm Medi-Cal Rx Portal/ Education and Outreach Webpage.
Txoj Kev Npaj Tiv Thaiv Kev Tsis Sib Haum Xeeb ntawm Medi-Cal Rx: Hloov Kho Tshiab Lub Yim Hli 29, 2022. Thaum Lub Xya Hli 27, 2021, DHCS tau txais Daim Ntawv Qhia Txog Kev Tiv Thaiv Kev Tsis Sib Haum Xeeb uas nws tus neeg muag khoom Medi-Cal Rx, MMA, ib lub tuam txhab me ntawm Magellan Health, Inc. (Magellan), xa tuaj kom txo tau kev tsis sib haum xeeb uas cuam tshuam nrog kev yuav Magellan los ntawm Centene Corporation.
Lub Vas Sab Hauv Internet Medi-Cal Rx: Pib txij lub Ib Hlis 1, 2021, lub vas sab hauv internet Medi-Cal Rx tshiab yuav yog qhov chaw mus saib tau cov portals pej xeem thiab cov portals Medi-Cal Rx uas ruaj ntseg. Txij li thaum Lub Ib Hlis 1, 2022, lub portal ruaj ntseg yuav muab kev nkag mus rau cov chaw muab tshuaj, cov neeg sau tshuaj thiab lawv cov neeg ua haujlwm rau Prior Authorization (PA) system; cov cuab yeej nrhiav tshuaj rau cov neeg tau txais txiaj ntsig; thiab kev xa cov ntawv thov hauv web thiab batch.
Cov Lus Nug Feem Ntau ntawm Medi-Cal Rx (FAQs): Hloov kho lub Plaub Hlis 18, 2023, daim ntawv no muab cov lus qhia ntxiv thiab kev piav qhia rau cov neeg tau txais txiaj ntsig Medi-Cal, cov kws kho mob, cov neeg koom tes hauv txoj kev npaj, thiab lwm cov neeg txaus siab rau COVID-19 hla lub txee (OTC) Kev Ntsuas Antigen Tus Kheej. Thaum DHCS tau txais cov lus nug ntxiv, daim ntawv no yuav raug hloov kho raws li qhia los ntawm tus lej version thiab hnub tim hauv qab.
Txoj Cai Hloov Chaw Muag Tshuaj Medi-Cal Rx: Hloov Kho Lub Plaub Hlis 7, 2021, daim ntawv no piav qhia txog DHCS txoj cai hloov chaw muag tshuaj ntau yam, suav nrog "kev ua kom loj hlob" cov PA uas tau pom zoo yav dhau los los ntawm kev saib xyuas kev tswj hwm thiab kev them nqi rau kev pabcuam, nrog rau lub sijhawm 180 hnub uas tsis muaj qhov yuav tsum tau ua PA rau cov tshuaj uas twb muaj lawm, uas tau pab txhawb kev hloov chaw muag tshuaj Medi-Cal Rx. Thaum lub sijhawm hloov pauv no, Magellan tau muab cov lus qhia, kev tshaj tawm thiab kev ncav cuag kom Medi-Cal Rx hloov pauv tau yooj yim.
Medi-Cal Rx PA/Kev Tswj Xyuas Kev Siv (UM) thiab Cov Txheej Txheem Thov Rov Qab: Hloov Kho Lub Kaum Ib Hlis 05, 2021 daim ntawv no piav qhia txog DHCS' FFS Medi-Cal PA/UM thiab cov txheej txheem thov rov qab, uas sib haum nrog thiab tsim cov txheej txheem thiab cov txheej txheem Medi-Cal FFS uas twb muaj lawm rau qhov kev pab cuam Medi-Cal dav dua. Qhov kev hloov tshiab no qhia txog hnub siv Medi-Cal Rx tshiab thiab muaj cov sijhawm teem sijhawm koom tes nrog cov neeg koom nrog Medi-Cal Fair Hearing uas tau hloov kho tshiab.
Cov Lus Tsis Txaus Siab thiab Kev Tsis Txaus Siab ntawm Medi-Cal Rx: Hloov kho lub Plaub Hlis 7, 2021, daim ntawv no piav qhia txog DHCS txoj cai lij choj txog kev tsis txaus siab thiab kev tsis txaus siab ntawm FFS Medi-Cal Rx, uas sib haum nrog thiab tsim cov txheej txheem thiab cov txheej txheem Medi-Cal FFS uas twb muaj lawm rau qhov kev pab cuam Medi-Cal, dav dua.
Medi-Cal Rx Website & Pharmacy Portal Policy:Updated July 19, 2023, this document offers information about DHCS’ dedicated Medi-Cal Rx website, which is now live and offers content available on a public platform that is accessible by all. Additionally, the Medi-Cal Rx website launched several different secure portals for the beneficiaries, providers (including physician prescribers and pharmacies), managed care plan (MCP) partners, and other entities as determined by DHCS, to ensure their access to the appropriate tools and resources for Medi-Cal Rx services that require access to protected health information.
Txoj Cai Sib Txuas Lus Hauv Kev Kho Mob Medi-Cal Rx MCP: Hloov Kho Lub Plaub Hlis 7, 2021, daim ntawv no piav qhia txog yuav ua li cas Medi-Cal Rx yuav muab pab pawg Sib Txuas Lus Hauv Kev Kho Mob (CL) tshwj xeeb los txhawb nqa Medi-Cal MCPs hauv lawv cov luag haujlwm hauv kev kho mob ntsig txog kev sib koom tes saib xyuas cov neeg tau txais txiaj ntsig, kev ua raws li kev noj tshuaj, thiab lwm yam lub luag haujlwm ntsig txog cov kev xav tau tshuaj. Cov Medi-Cal MCPs yuav tau txais kev nkag mus rau MCP CLs 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, raws li tau teev tseg hauv daim ntawv no.
Medi-Cal Rx Scope: Hloov kho lub Kaum Hli 1, 2024, daim ntawv no muab cov ntsiab lus ntxiv thiab cov ntaub ntawv ntsig txog Lub Chaw Haujlwm txoj kev siv ntawm Medi-Cal MC rau FFS lub tsev muag tshuaj, siv tau rau lub Ib Hlis 1, 2022. Nws kuj muab cov npe ntawm cov txiaj ntsig ntawm Medi-Cal, uas yog cov uas tsis raug cais tawm (piv txwv li, cov txiaj ntsig ntawm cov tshuaj uas raug them rau cov kev thov kho mob thiab cov tsev kho mob), piv rau cov uas raug cais tawm (piv txwv li, txhua qhov txiaj ntsig ntawm cov tshuaj uas raug them rau cov kev thov tshuaj).

Stakeholder Engagement

Raws li ib feem ntawm qhov kev hloov pauv no, DHCS tau cog lus los ua haujlwm nrog nws cov neeg koom nrog sab nraud (xws li tab sis tsis txwv rau, MCP, Lub Nroog, Cov Chaw Pabcuam, Cov Neeg Siv Khoom, thiab cov neeg tau txais txiaj ntsig) kom ntseeg tau tias muaj kev hloov pauv thiab ua tiav los ntawm cov hauv qab no:

Tshaj tawm tshaj tawm cov ntaub ntawv qhia tawm (xws li Daim Ntawv Thov Kev Pom Zoo, cov chaw muab kev pabcuam thiab cov ntawv ceeb toom tau txais txiaj ntsig, Txhua Daim Ntawv Npaj, thiab lwm yam) rau kev tawm tswv yim.
Ua kom MCPs, Lub Nroog, cov chaw muab kev pabcuam, cov neeg txhawb nqa cov neeg siv khoom, thiab cov neeg tau txais txiaj ntsig tau txais cov ntaub ntawv raug raws sijhawm thiab raug hais txog kev hloov pauv thiab cov haujlwm cuam tshuam nrog.
Muab cov xwm txheej hloov kho tshiab thiab sib sau cov lus tawm tswv yim los ntawm cov neeg koom nrog ntau yam DHCS-sponsored public conferences.

Nco tseg: Ntxiv nrog rau cov rooj sib tham nyob ib leeg, DHCS yuav tab tom nrhiav kom txhawb nqa cov rooj sib tham thiab pab pawg ua haujlwm (xws li Pawg neeg saib xyuas cov neeg koom nrog, pawg neeg saib xyuas cov neeg siv khoom sib koom ua haujlwm, Medi-Cal Tus Thawj Saib Xyuas Kev Kho Mob cov rooj sib tham) los muab cov xwm txheej hloov tshiab ntawm kev siv zog thiab cov dej num ntsig txog Medi-Cal Rx.

Rau cov tib neeg uas muaj kev tsis taus, Lub Tsev Haujlwm yuav muab cov cuab yeej pab xws li kev txhais lus kos npe, sau npe hauv lub sijhawm, cov neeg sau ntawv, kev nyeem ntawv lossis kev sau ntawv thiab hloov cov kev qhia lossis cov ntaub ntawv sib tham rau hauv Braille, luam ntawv loj, audiocassette, lossis computer disk. Txhawm rau thov cov kev pabcuam lossis cov ntawv luam ua lwm hom, thov hu lossis sau ntawv:

Lori Bradley, RPh
Department of Health Care Services
Pharmacy Benefits Division, MS 4604
Sacramento, CA 95814
Phone Number: (916) 552-9500
Email: medi-cal.pharmacybenefits@dhcs.ca.gov

Thov nco ntsoov, qhov ntau ntawm cov kev pab cuam muaj peev xwm yuav raug txwv yog tias kev thov tau txais tsawg dua kaum hnub ua haujlwm ua ntej lub rooj sib tham lossis kev tshwm sim.

Medi-Cal Rx Advisory Workg roup

The Medi-Cal Rx Advisory Workgroup will meet three times between August 2021 and January 1, 2022 Assumption of Operations to help facilitate and further inform DHCS’ ongoing Medi-Cal Rx implementation efforts. Each Medi-Cal Rx Advisory Workgroup meeting will be held in Sacramento for approximately four hours. The Medi-Cal Rx Advisory Workgroup membership will be limited to 30 members to ensure a productive discussion environment. The Medi-Cal Rx Advisory Workgroup to be comprised of organizations and entities such as hospitals, clinics, health plans, counties, pharmacies, tribal health programs, consumer advocates and others. During the meetings, DHCS will provide updates on the pharmacy transition and request the Medi-Cal Rx Advisory Workgroup provide dialogue and input key topics, such as:

Lub luag haujlwm thiab lub luag haujlwm ntawm DHCS, Medi-Cal Rx Tus Neeg Ua Haujlwm, thiab Medi-Cal Kev Npaj Kho Mob
DHCS’ implementation strategies, tools, and timelines, including but not limited to, provider education and outreach and beneficiary notifications
Medi-Cal txoj cai txhim kho lub tsev muag tshuaj, uas yuav suav nrog qhov kev nthuav tawm, kev tso cai ua ntej, thiab cov txheej txheem tswj kev siv
Kev hloov pauv rau pawg kws muag tshuaj Medi-Cal uas twb muaj lawm

Tom qab kev hloov pauv, Medi-Cal Rx Advisory Workgroup cov rooj sib tham yuav tsom mus rau kev sau cov ntaub ntawv, cov kev paub dhau los thiab / lossis cov lus tawm tswv yim los ntawm pawg neeg ua haujlwm los pab kho cov txheej txheem Medi-Cal Rx thiab cov cai tsis tu ncua. Cov rooj sib tham yuav qhib rau pej xeem, thiab cov lus tawm tswv yim ntawm tus kheej yuav raug lees txais rau 30 feeb kawg ntawm txhua lub rooj sib tham. Cov ntsiab lus ntxiv, suav nrog tab sis tsis txwv rau kev txheeb xyuas thiab chaw nres tsheb cov ntaub ntawv, yuav raug tshaj tawm nrog cov txheej txheem tsawg kawg 10 hnub ua ntej txhua lub rooj sib tham.

Medi-Cal Rx Advisory Workgroup Sau Npe

Medi-Cal Rx Advisory Workgroup teem caij ntsib

Medi-Cal Rx Public Forum

Pib txij Lub Xya Hli 2019 thiab txuas ntxiv mus thoob plaws xyoo 2020, DHCS tau tuav thiab tseem yuav tuav ib (1) teev Medi-Cal Rx Public Forums ntawm tus kheej thiab hauv webinar los muab cov xwm txheej hloov tshiab los pab xyuas kom cov neeg muaj feem cuam tshuam nrog lub zej zog. tshiab txog kev siv Medi-Cal Rx cov dej num thiab ncua sij hawm. Txhua lub rooj sib tham Medi-Cal Rx Public Forum cov hnub thiab sijhawm muaj nyob hauv qab no. Txhua lub koom haum thiab cov koom haum txaus siab, suav nrog tab sis tsis txwv rau, tsev kho mob, chaw kho mob, cov phiaj xwm kev noj qab haus huv, nroog, khw muag tshuaj, pab pawg neeg noj qab haus huv, thiab cov neeg tawm tswv yim, raug caw tuaj koom.

Medi-Cal Rx Lub Rooj Sib Tham Pej Xeem

DHCS yuav tso tawm cov ntaub ntawv ntxiv thiab cov ntawv ceeb toom los ntawm ntau daim ntawv teev cov neeg koom tes hauv DHCS. Ntxiv rau qhov ntawd, DHCS kuj tseem yuav tshaj tawm cov txheej txheem kawg tsawg kawg 10 hnub ua ntej txhua lub rooj sib tham.

Medi-Cal Rx: Archives

Tag nrho cov ntaub ntawv khaws cia los ntawm nplooj ntawv no.

Tiv tauj peb

Yog koj muaj lus nug txog Medi-Cal Rx, thov xa koj cov lus tawm tswv yim thiab cov lus nug mus rau medi-cal.pharmacybenefits@dhcs.ca.gov.

Medi-Cal Rx​​

Txheej txheem cej luam​​

Cov khoom siv thiab cov ntaub ntawv siv​​

Stakeholder Engagement​​

Medi-Cal Rx Advisory Workg roup​​

Medi-Cal Rx Advisory Workgroup teem caij ntsib​​

Medi-Cal Rx Public Forum​​

Medi-Cal Rx Lub Rooj Sib Tham Pej Xeem​​

Medi-Cal Rx: Archives​​

Tiv tauj peb​​