Tus kws kho mob uas tsis yog kws kho mob kws kho mob ntxiv qhov kev pab nyiaj rov qab
PNPP Program Overview
Tus Kws Kho Mob Tsis Muaj Tus Kws Kho Mob Tus Kws Kho Mob Ntxiv Qhov Kev Pab Them Nyiaj Rov Qab (PNPP) yog Certified Public Expenditure (CPE) program, uas muab nyiaj rov qab ntxiv rau cov tsev kho mob uas tsim nyog tau txais los ntawm tsoomfwv lossis tsoomfwv cov koom haum, uas lawv koom nrog, rau cov nqi kho mob tsis tau them nqi kho mob thiab Cov kws kho mob tsis yog kws kho mob cov kev pabcuam rau cov neeg tau txais txiaj ntsig Medicaid.
California State Plan Amendment (SPA) No. 05-023, pib lub Xya hli ntuj 1, 2005, thiab tau pom zoo los ntawm Centers for Medicare & Medicaid Services (CMS) nyob rau lub Kaum Ob Hlis 21, 2007, piav qhia txog cov txheej txheem them rov qab ntxiv rau tus kws kho mob thiab cov kws kho mob uas tsis yog kws kho mob. cov nqi tshaj lij.
SPA 16-020, pib lub Xya hli ntuj 1, 2016, thiab tau pom zoo los ntawm CMS thaum lub Kaum Ob Hlis Ntuj 6, 2016, tau hloov kho State Plan hom lus kom muaj kev cuam tshuam cov npe tam sim no ntawm Cov Neeg Koom Tes Hauv Tsev Kho Mob (DPH) thiab suav rau kev hloov pauv lub npe tsev kho mob yav tom ntej.
SPA 24-0026, effective April 1, 2024, and approved by CMS on December 16, 2024, supersedes SPAs 05-023 and 16-020 with technical edits to the supplemental payment methodology for the cost of governmental outpatient hospitals’ professional services.
State Plan Attachment 4.19-B, nplooj 52-63 (SPAs 05-023, 16-020, thiab 24-0026) qhia txog cov kev xav tau ntawm kev them nyiaj rov qab, DPHs tsim nyog, thiab cov txheej txheem them rov qab. Lub Xeev Lub Hom Phiaj tso cai rau Lub Sijhawm Kawm Ua Haujlwm Npaj Ua Haujlwm, uas piav qhia txog lub sijhawm kawm txheej txheem hauv kev nthuav dav ntxiv.
Kev tshawb fawb sij hawm yuav tsum tau suav rau 100% ntawm cov kws kho mob lub sijhawm ntawm cov kws kho mob hauv qab no hauv cov chaw hauv qab no suav nrog txog li 4 tus nqi sib cais:
- University of California (UC) kev teeb tsa (tus kws kho mob)
- Kev teeb tsa UC (cov kws kho mob tsis yog kws kho mob)
- Kev teeb tsa tsis yog UC (cov kws kho mob tsis yog kws kho mob)
- Kev teeb tsa tsis yog UC (Medicare pom zoo tshawb xyuas tus kws kho mob lub sijhawm)
PNPP Txoj Haujlwm Pabcuam Kev Tsim Nyog
The physician and non-physician practitioner costs are limited to professional costs incurred by the DPHs listed in Appendix 1 of Attachment 4.19-A of the State Plan, including any successor or differently named hospital, as applicable, and their affiliated government physician practice groups (i.e., practice group that is owned and operated by the same government entity that owns and operates the hospital). These professional costs are reported on the DPHs’ Medi-Cal 2552 cost report and, in the case of the UC hospitals, the UC School of Medicine physician/non-physician practitioner cost report as approved by CMS.
Kev them nyiaj rov qab PNPP
PNPP cov nyiaj pab ntxiv yog kwv yees qhov sib txawv ntawm Kev Them Nqi rau Kev Pabcuam (FFS) thiab cov nqi Medicaid tso cai muaj feem xyuam rau cov kws kho mob lossis cov kws kho mob tsis yog kws kho mob cov kev pabcuam tsim nyog rau Tsoom Fwv Nyiaj Txiag Koom Tes (FFP). Kev them nyiaj ntxiv rau PNPP yog ua txhua xyoo raws li tau piav qhia hauv Lub Xeev Txoj Haujlwm Txuas Ntxiv 4.19-B, nplooj 52-63 (SPAs 05-023, 16-020, thiab 24-0026) thiab Lub Sijhawm Kawm Ua Haujlwm Npaj Ua Haujlwm.
Yuav tiv tauj peb li cas
Yog tias koj muaj lus nug ntxiv, xa cov lus nug rau: PNPP@dhcs.ca.gov
Txuas
California State Plan Attachment 4.19-B, nplooj 52-63 (SPAs 05-023, 16-020, thiab 24-0026)