Public Freestanding Non-Hospital-Based Clinics Supplemental Reimbursement Program
PFNC Program Overview
Txoj Cai Lij Choj Txog Kev Noj Qab Haus Huv thiab Cov Tsev Kawm Ntawv hauv California (W&I) §14105.965, tau tsim tsa rau lub Yim Hli 2006, tau tso cai rau PFNC cov kev pab cuam them rov qab ntxiv. Qhov kev pab cuam no yog raws li Kev Siv Nyiaj Txiag Rau Pej Xeem (CPE) uas pub dawb no muab nyiaj ntxiv rau cov koom haum tsoomfwv uas tsim nyog uas muab cov kev pabcuam hauv tsev kho mob rau cov neeg tau txais txiaj ntsig Medi-Cal. Txoj Cai Lij Choj ntawm Tsoom Fwv Teb Chaws §433.51 yuav tsum tau tus neeg sawv cev uas tau tso cai ntawm lub koom haum pej xeem uas pab txhawb nqa daim ntawv pov thawj tias cov nuj nqis ntawm lub koom haum tsoomfwv ua tau raws li cov cai tsim nyog rau kev koom tes nyiaj txiag ntawm tsoomfwv (FFP). Lub Chaw rau Medicare thiab Medicaid Services (CMS) tau pom zoo rau Txoj Cai Hloov Kho Txoj Kev Npaj Hauv Xeev (SPA) 06-016 thaum Lub Yim Hli 8, 2012, tso cai rau tsoomfwv qib siab ntawm cov nyiaj them rov qab ntxiv raws li cov nqi tsis tau them rau Medi-Cal tus nqi-rau-kev pabcuam Public Freestanding Non-hospital-based Clinics. SPA 16-021 tau txais kev pom zoo los ntawm CMS rau lub Kaum Ob Hlis 6, 2016, uas ua qhov kev hloov kho tshiab los hloov kho cov qauv kev koom tes hauv tsev kho mob hauv cov nplooj ntawv Txoj Kev Npaj ntawm Lub Xeev; tshwj xeeb, cov uas tsim nyog los qhia txog cov tub ceev xwm hauv tsev kho mob uas tswj hwm cov tsev kho mob pej xeem uas tau xaiv tseg.
Kev tsim nyog tau txais PFNC Program
Yuav kom tsim nyog rau qhov kev pab cuam no, tus neeg muab kev pab cuam PFNC yuav tsum ua tau raws li cov cai hauv qab no, raws li tau teev tseg hauv W&I Code §14105.965:
- Muab kev pabcuam rau cov neeg tau txais txiaj ntsig Medi-Cal (ntxiv tau txhais hauv SPA 06-016),
- Tau cuv npe ua Medi-Cal tus kws kho mob rau lub sijhawm thov, thiab
- Yuav tsum yog tus tswv lossis ua haujlwm los ntawm ib lub koom haum tsoomfwv uas tsim nyog, suav nrog lub xeev, lub nroog, lub nroog thiab lub nroog, University of California, thaj chaw kho mob uas tau teeb tsa raws li Tshooj 1 ntawm Division 23 (pib nrog Tshooj 32000) ntawm Txoj Cai Kev Noj Qab Haus Huv thiab Kev Nyab Xeeb, lossis lub tsev kho mob uas tau piav qhia hauv Tshooj 101850 lossis 101852, et seq. ntawm Txoj Cai Kev Noj Qab Haus Huv thiab Kev Nyab Xeeb, raws li cov kev cai lij choj no tau siv txij li Lub Xya Hli 1, 2016 (raws li SPA 16-021).
- Effective July 1, 2008, payment rules for State-owned and operated clinics are governed by the provisions set forth in SPA 08-014; therefore, effective July 1, 2008, such clinics are not eligible to receive supplemental reimbursement under the PFNC Program.
Cov nqi uas tau thov raws li PFNC Program tsis tau thiab yuav tsis raug thov raws li lwm yam kev pab cuam kom tau txais FFP. Cov neeg muab kev pab tsis tuaj yeem thov cov nqi raws li PFNC Program rau txhua lub sijhawm uas lawv thov, tau thov, tau txais nyiaj rov qab thiab/lossis koom nrog cov kev pab cuam uas tau pom zoo los ntawm Lub Xeev California thiab/lossis CMS uas cov nqi no tau lossis yuav raug siv los tau txais FFP.
Cov kws kho mob tsim nyog uas xaiv los koom nrog PFNC Program yuav tsum ua raws li hauv qab no:
- Nkag mus rau hauv Daim Ntawv Pom Zoo Muab Kev Koom Tes (PPA) nrog Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS), thiab
- Pom zoo them rov qab rau DHCS rau nws cov nqi tswj hwm uas cuam tshuam nrog kev tswj hwm qhov kev pab cuam PFNC.
Kev them nyiaj rov qab PFNC
Cov chaw muab kev pabcuam PFNC uas tsim nyog koom nrog hauv qhov kev pab cuam no yuav tau txais cov nyiaj them rov qab ntxiv los ntawm kev ua kom tiav daim ntawv qhia txog tus nqi uas CMS pom zoo txhua xyoo. Cov nyiaj them rov qab ntxiv yog raws li kev thov FFP rau cov nuj nqis uas tau raug siv los ntawm cov neeg muab kev pabcuam pej xeem thiab ua tau raws li cov cai rau CPE. Tus nqi them rov qab ntxiv yog txiav txim siab los ntawm txoj kev uas CMS tau pom zoo hauv SPA 06-016.
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Yuav tiv tauj peb li cas
Ua ib lub koom haum pej xeem, yog tias koj xav koom nrog PFNC Program, lossis yog tias koj muaj lus nug ntxiv, xa cov lus nug mus rau: PublicClinics@dhcs.ca.gov.
Cov ntaub ntawv pov thawj
Cov lus nug nquag
- Email Koj Cov Lus Nug Ntawm Nov Peb caw koj xa cov lus nug ntxiv rau peb daim ntawv FAQ tam sim no.
Ntxiv Resources & Txuas
- CMS-PUB 15-1 CMS Provider Reimbursement Manual – Part 1
- OMB Daim Ntawv Qhia A-87 Chaw Haujlwm Saib Xyuas Kev Tswj Xyuas thiab Kev Siv Nyiaj Txiag (OMB) Cov Ntsiab Cai Txog Tus Nqi rau Tsoomfwv Xeev, Hauv Zos, thiab Cov Pab Pawg Neeg Isdias.