Kev Thauj Mus Los Thaum Muaj Xwm Ceev Hauv Av Rau Cov Neeg Muab Kev Pabcuam Rau Pej Xeem Kev Pabcuam Hloov Chaw ntawm Tsoomfwv - Daim Ntawv Cai Lij Choj Sib Tham Xyoo 1705
Keeb kwm
Raws li tsab cai Assembly Bill (AB) 1705 (Tshooj 544, Txoj Cai ntawm 2019), Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tau tsim Cov Kev Pabcuam Pej Xeem Kev Pabcuam Kev Khomob Kub Ceev (PP-GEMT) txhawm rau muab cov nyiaj them rov qab ntau dua, los ntawm kev thov kev nce ntxiv, rau kev thauj mus los thaum muaj xwm txheej ceev (GEMT) uas tsis tsim nyog rau pej xeem. Qhov tsis yog tsoomfwv cov nyiaj tau los yuav raug siv los muab kev nce ntxiv rau cov nqi them nqi-rau-kev pabcuam (FFS) tus nqi sijhawm rau cov lej GEMT cuam tshuam thiab qhov kev ntsuas nce ntxiv uas yuav raug siv rau thawj tus nqi them rau kev cog lus Medi-Cal Plans.
PP-GEMT Ntxiv-On:
Qhov Kev Pabcuam PP-GEMT yuav muab kev nce ntxiv rau Medi-Cal FFS tus nqi sijhawm ntawm GEMT thauj cov nqi nrog cov txheej txheem hauv qab no:
| Txheej Txheem Cai | Cov txheej txheem Code piav qhia | CY 2024 Tus Nqi Them Nqi Them Nqi | CY 2024 Medi-Cal PP-GEMT IGT Ntxiv-On | CY 2024 Kev Them Nyiaj Tau Los |
|---|---|---|---|---|
| A0225 | Neonatal Emergency Transport | $ 179.92 | $ 1,049.98 | $ 1,229.90 |
| A0427 | ALS1-Kev kub ntxhov | $ 118.20 | $ 1,049.98 | $ 1,168.18 |
| A0429 | BLS-Kev kub ntxhov | $ 118.20 | $ 1,049.98 | $ 1,168.18 |
| A0433 | ALS 2 | $ 118.20 | $ 1,049.98 | $ 1,168.18 |
| A0434 | Kev Thauj Khoom Tshwj Xeeb | $ 118.20 | $ 1,049.98 | $ 1,168.18 |
- GEMT QAF Keeb Kwm CPT thiab Cov Nyiaj Them Rov Qab
- PP-GEMT Keeb Kwm CPT thiab Cov Nyiaj Them Rov Qab
DHCS yuav xam tus nqi ntxiv thoob plaws lub xeev raws li qhov sib txawv ntawm: (a) qhov nyiaj rov qab nruab nrab uas tau them raws li daim ntawv them nqi Medi-Cal FFS rau kev thauj mus los kho mob thaum muaj xwm txheej ceev, thiab (b) tus nqi nruab nrab uas cuam tshuam ncaj qha rau kev muab kev thauj mus los kho mob thaum muaj xwm txheej ceev ntawm Medi-Cal raws li qhov kev pab cuam Medi-Cal los ntawm tus neeg muab kev pab tsim nyog. Cov ntaub ntawv nqi nruab nrab yuav raug rho tawm los ntawm cov ntawv qhia txog tus nqi uas tau tshuaj xyuas tsis ntev los no ntawm cov neeg muab kev pabcuam tsim nyog uas muaj thaum lub sijhawm tsim tus nqi ntxiv. Qhov kev nce ntxiv no yuav tsum tau kev pom zoo los ntawm tsoomfwv Meskas txog Kev Hloov Kho Txoj Kev Npaj Hauv Xeev (SPA) los ntawm Lub Chaw rau Medicare thiab Medicaid Services (CMS). Yog xav saib daim ntawv ceeb toom rau pej xeem SPA tshiab tshaj plaws, thov mus saib: SPA Public Notices.
Yog xav paub ntxiv txog cov ntawv xa tuaj tshiab tshaj plaws ntawm SPA thov mus saib Pending 2025 SPAs (SPA 25-0002 Pending thiab SPA 25-0030 Pending).
Yog xav saib cov kev pom zoo SPA tshiab tshaj plaws, thov mus saib: Cov SPA uas tau pom zoo
Pib txij Lub Ib Hlis Ntuj Tim 1, 2023, cov chaw muab kev pabcuam pej xeem yuav tsis raug ntsuas tus Nqi Them Nqi Zoo (QAF) ntxiv lawm thiab yuav tsis tsim nyog tau txais cov khoom txuas ntxiv raws li GEMT QAF Program, tab sis yuav tsim nyog tau txais ib qho Kev them nyiaj rov qab ntxiv rau hauv PP-GEMT Program. Tsis tas li ntawd, cov neeg muab kev pabcuam GEMT pej xeem yuav tsis tsim nyog koom nrog GEMT Certified Public Expenditures Program.
Yog xav paub ntxiv txog GEMT QAF Program kaw, thov mus saib hauv GEMT QAF lub vev xaib: https://www.dhcs.ca.gov/provgovpart/Pages/GEMTQAF.aspx.
Yog tias koj muaj lus nug, thov hu rau GEMT QAF ntawm: GEMTQAF@dhcs.ca.gov.
Kev Tsim Nyog Tau Txais Nyiaj Rov Qab Los Ntawm Qhov Kev Pab Cuam
Cov kws kho mob tuaj yeem tsim nyog tau txais PP-GEMT add-on yog tias tus kws kho mob ua tau raws li tag nrho cov kev cai hauv qab no thaum lub sij hawm tag nrho ntawm Medi-Cal tswj xyuas kev saib xyuas lub sij hawm. Yog xav paub ntxiv txog kev tsim nyog, thov mus saib hauv Welfare and Institutions Code (WIC) seem 14105.945.
- Muab cov kev pabcuam GEMT uas tsis muaj daim ntawv cog lus rau cov neeg tau txais txiaj ntsig Medi-Cal.
- Tau cuv npe ua Medi-Cal tus kws kho mob rau lub sijhawm thov.
- Muaj lossis ua haujlwm los ntawm lub xeev, ib lub nroog, lub nroog, lub nroog thiab lub nroog, kev tiv thaiv hluav taws, cheeb tsam tshwj xeeb, cheeb tsam kev pabcuam hauv zej zog, cheeb tsam saib xyuas kev noj qab haus huv, lossis tsoomfwv tau lees paub txog haiv neeg Indian.
Tus nqi-rau-kev pabcuam kev xa khoom:
- Qhov kev pab ntxiv PP-GEMT yuav muab rau txhua qhov kev thauj mus los thaum cov neeg muab kev pabcuam tau txais nyiaj rov qab rau qhov kev thauj mus los pib los ntawm DHCS' Medi-Cal Fiscal Intermediary.
Managed care delivery system:
- Cov phiaj xwm kev saib xyuas uas tswj hwm (MCPs) yuav tsum tau them rov qab rau cov kev thov uas tsim nyog ntawm tus nqi FFS suav nrog txhua qhov "ntxiv rau tus nqi" FFS uas siv tau (piv txwv li, "Rogers Rates") raws li tau hais hauv lub rooj saum toj no.
Thov nco ntsoov: Kev tsim nyog tau txais kev them rov qab yog qhov sib txawv ntawm kev tsim nyog raws li lub koom haum nyiaj txiag, vim tias txhua lub koomhaum tseemfwv yuav tsim nyog tau txais kev pabcuam PP-GEMT Program los ntawm kev hloov pauv hauv tsoomfwv (IGT). Thov mus saib daim ntawv pov thawj IGT hauv qab no kom paub meej ntxiv.
* Daim ntawv teev npe no yog tus sawv cev ntawm cov koom haum uas tuaj yeem ua rau feem ntau ntawm Cov Neeg Muab Kev Pabcuam rau pej xeem, tab sis nws tsis suav nrog txhua tus thiab tej zaum yuav suav nrog qee Cov Chaw Pabcuam uas tsis yog, lossis tsis yog, muab kev pabcuam GEMT.
Yog li ntawd, daim ntawv teev npe no yog tsim los ua ib feem ntawm cov txheej txheem txheeb xyuas tus Muab Kev Pabcuam rau pej xeem kom ntseeg tau tias Cov Muab Kev Pabcuam tau txais nyiaj rov qab raws sijhawm ntawm PP-GEMT add-on. Daim ntawv teev npe no yuav tsum siv ua ib qho piv txwv tab sis yuav tsum tsis txhob hloov MCP cov P&Ps uas siv los xyuas kom meej tias cov Chaw Muab Kev Pabcuam rau pej xeem uas tsim nyog tau raug txheeb xyuas thiab them rov qab raws li qhov tsim nyog. Thaum kawg, nws yog MCP lub luag haujlwm los txheeb xyuas tus Muab Kev Pabcuam "xwm txheej pej xeem".
Yog tias muaj cov Chaw Muab Kev Pabcuam rau pej xeem uas tsis suav nrog hauv Daim Ntawv Ntxiv no, lossis muaj Cov Chaw Muab Kev Pabcuam hauv Daim Ntawv Ntxiv no uas tsis yog Cov Chaw Muab Kev Pabcuam rau pej xeem lawm, thov qhia cov ntawd rau AB1705@dhcs.ca.gov los ntawm kev xa lub npe ntawm Tus Muab Kev Pabcuam, Tus Neeg Muab Kev Pabcuam Hauv Tebchaws, thiab cov ntaub ntawv tiv tauj (yog paub).
Xyoo 2026 Lub Sijhawm Ntsuas Daim Ntawv Them Nqi thiab Hnub Kawg Ua Haujlwm:
Daim Ntawv Qhia Txog CY 2026 #1
| Invoicing Component | Hnub Kawg |
|---|---|
| Invoice Packets xa | Tuesday, Kaum Ob Hlis Ntuj 2, 2025 |
| IGT Daim Ntawv Pov Thawj Yuav Tsum Tau | Hnub Friday, Lub Ib Hlis 2, 2026 |
| Them Nqi | Hnub Friday, Lub Ib Hlis 15, 2026 |
Daim Ntawv Qhia Txog CY 2026 #2
| Invoicing Component | Hnub Kawg |
| Invoice Packets xa | Tuesday, Peb Hlis 3, 2026 |
| IGT Daim Ntawv Pov Thawj Yuav Tsum Tau | Friday, Plaub Hlis Ntuj 3, 2026 |
| Them Nqi | Friday, Plaub Hlis Ntuj 17, 2026 |
| Kev Sib Tham Txog Kev Sib Haum Xeeb ntawm CY 2024 FFS #1 | Jan – Jun 2024 (Date of Service) |
| CY 2025 MC Kev Sib Haum Xeeb #1 | TBD |
Daim Ntawv Them Nqi CY 2026 #3
| Invoici ng Cov | Hnub Kawg |
|---|---|
| Invoice Packets xa | Tuesday, June 2, 2026 |
| IGT Daim Ntawv Pov Thawj Yuav Tsum Tau | Hnub Friday, Lub Xya Hli 3, 2026 |
| Them Nqi | Hnub Friday, Lub Xya Hli 17, 2026 |
Daim Ntawv Them Nqi CY 2026 #4
| Invoicing Component | Hnub Kawg |
|---|---|
| Invoice Packets xa | Tuesday, Cuaj hlis 1, 2026 |
| IGT Daim Ntawv Pov Thawj Yuav Tsum Tau | Friday, Kaum Hli Ntuj 2, 2026 |
| Them Nqi | Friday, Kaum Hli Ntuj 16, 2026 |
| Kev Sib Tham Txog Kev Sib Haum Xeeb ntawm CY 2024 FFS #2 | Lub Xya Hli - Lub Kaum Ob Hlis 2024 (Hnub Ua Haujlwm) |
| CY 2025 MC Kev Sib Haum Xeeb #2 | TBD |
* Daim ntawv pov thawj IGT raug xa tawm 45 hnub ua ntej hnub kawg sau.
* Cov ntawv pov thawj IGT yuav tsum xa tuaj ob lub lis piam ua ntej hnub kawg rau kev sau nyiaj.
IGT tsis txaus:
Yog tias DHCS txiav txim siab tias qhov kev xav tau ntawm cov nyiaj pab dawb tsis txaus los txhawb kev ua tiav ntawm Txoj Haujlwm, Txoj Haujlwm yuav xaus. Qhov Kev Pabcuam PP-GEMT yuav tsum tsis ua haujlwm nyob rau thawj hnub ntawm Medi-Cal tswj kev saib xyuas lub sijhawm pib los yog tom qab hnub uas tau txiav txim siab. Cov neeg muab kev pabcuam pej xeem yuav rov qab mus rau cov nyiaj them rov qab raws li cov kev pabcuam uas twb muaj lawm.
Daim ntawv:
PP-GEMT Muab Kev Pabcuam
Hu rau DHCS:
Txhawm rau koom nrog AB1705 ListServe, xa cov lus nug lossis cov lus pom, lossis rau hauv lub koom haum uas koom nrog cov peev nyiaj, thov xa email rau DHCS PP-GEMT Program inbox: AB1705@dhcs.ca.gov.
Txoj cai:
PP-GEMT Program Txhua Daim Ntawv Npaj
- MCPs tau txais PP-GEMT Kev Qhia Ib ntus hais txog kev them nyiaj rau lub Kaum Ob Hlis 30, 2022. MCPs tau qhia kom tshaj tawm PP-GEMT add-on pib txij lub Ib Hlis 1, 2024, thaum lawv tos tag nrho Daim Ntawv Npaj Ua Haujlwm (APL).
- Kev taw qhia ib ntus