Kev Hloov Kho Dav Dav ntawm Cov Haujlwm Tswj Xyuas Medi-Cal hauv Tsev Kawm Ntawv (SMAA)
Lub Sijhawm Kawg Rau Kev Ncua Sijhawm
Tam sim no tsuas yog hnub kawg rau kev ncua sijhawm rau qhov kev pab cuam SMAA yog lub Plaub Hlis 30, 2014. Nov yog hnub kawg rau cov neeg thov kev pab xa cov ntaub ntawv pov thawj Reasonableness Test Criteria (RTC) rau cov nqi uas tau them rau ntawm CMS 64 rau lub quarter xaus rau lub Kaum Ob Hlis 2011. Txij li hnub hloov tshiab no, tsis muaj hnub kawg rau cov txheej txheem RTC, lossis cov txheej txheem ncua sijhawm.
Kev Xaiv Rau Cov Cheeb Tsam Uas Yuav Tsum Tau Nyiaj Rau Lub Xeev
Rau cov koog tsev kawm ntawv uas yuav tshuav nyiaj rau Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) vim yog kev siv Cov Qauv Ntsuas Kev Tsim Nyog (RTC) rau cov nqi them rov qab, DHCS tau tsim ib txoj kev uas yuav tso cai rau cov koog tsev kawm ntawv kom tsis txhob muaj daim ntawv tso cai los them cov nuj nqis ntawd. Cov txheej txheem yuav tsum tau kom txhua lub chaw thov nyiaj siv RTC rau txhua daim ntawv them nqi pib nrog lub quarter xaus rau lub Cuaj Hlis 2010 thiab txuas mus txog rau lub sijhawm ua haujlwm xaus rau lub Rau Hli 2013. Cov LEC/LGAs yuav xa cov ntawv them nqi no mus rau DHCS ua ib pob es tsis yog xa ib daim zuj zus. Yog tias qhov kev xa pob khoom no ua rau muaj qhov nyiaj tshuav zoo rau chav thov, DHCS mam li rho tawm cov nyiaj uas tshuav rau lub xeev thiab muab daim tshev rau LECs/LGAs rau qhov nyiaj tshuav ntawm tag nrho cov nyiaj thov rau lub sijhawm ncua sijhawm. Txawm li cas los xij, yog tias qhov kev xa pob khoom no ua rau muaj tus nqi tshuav tsis zoo rau chav thov nyiaj, chav thov nyiaj ntawd yuav tsum xa daim tshev rau DHCS rau tus nqi tshuav.
Cov txheej txheem no tsis cuam tshuam rau lub Plaub Hlis 30, 2014 hnub kawg rau cov ntawv them nqi uas tau them rau ntawm CMS 64 rau lub quarter xaus rau lub Kaum Ob Hlis 2011. Cov ntaub ntawv RTC rau cov ntawv xa tawm "thawj daim ntawv them nqi ncua" yuav tsum xa tuaj rau lub Plaub Hlis 30, 2014 hnub kawg. Cov chaw thov nyiaj tuaj yeem xa cov ntaub ntawv RTC rau cov ntawv them nqi thawj zaug no ib tus zuj zus lossis ua ib feem ntawm pob khoom piav qhia saum toj no. Txawm li cas los xij, txawm tias cov ntaub ntawv RTC raug xa ib leeg lossis ua ib feem ntawm pob khoom piav qhia saum toj no, nws tseem yuav tsum ua raws li lub Plaub Hlis 30, 2014 hnub kawg. Yog tias cov ntaub ntawv RTC rau cov ntawv them nqi qub no raug xa ib leeg zuj zus, cov chaw thov nyiaj yuav muaj sijhawm ntxiv los xa cov ntaub ntawv RTC rau lawv cov ntawv them nqi uas tseem tshuav.
RTC thiab Cov Ntawv Them Nqi Nruab Nrab
Rau cov nqi them nruab nrab uas suav tias yog ib feem ntawm cov nqi them ncua thawj zaug (cov uas tau them rau lub Kaum Ob Hlis 2011 CMS 64), cov txheej txheem RTC tsis tas yuav tsum tau hloov kho cov nqi them uas siv los xam cov nqi them nruab nrab. Piv txwv li, yog tias daim ntawv them nqi nruab nrab ntawm peb lub hlis thib plaub yog tsim los ntawm peb lub hlis ib, ob thiab peb, ces tsuas yog yuav tsum tau kho dua daim ntawv them nqi ntawm peb lub hlis thib plaub xwb. Cov chav kawm ib, ob thiab peb tsis tas yuav tsum tau hloov kho.
20% Kev txwv ntawm kev ua haujlwm / kev tswj hwm rau RTC
Qhov txwv 20% rau cov haujlwm ua haujlwm hauv chaw ua haujlwm thiab kev tswj hwm rau cov txheej txheem RTC tsis siv rau cov chaw thov uas cov neeg koom nrog tsuas yog los ntawm Pawg 3 thiab Pawg 4 ntawm daim ntawv teev npe Time Survey Participant Universe Authorized Positions (TSPUAP). Yog tias Daim Ntawv Qhia Txog Kev Ua Haujlwm ntawm Chav Thov Nyiaj rau ib daim ntawv them nqi tshwj xeeb tsis suav nrog cov neeg koom nrog los ntawm Pawg 1, 2 & 5 ntawm daim ntawv teev npe TSPUAP, ces qhov txwv 20% yuav tsis siv. Chav thov yuav tsum muab ib qho lus piav qhia rau ntawm daim ntawv pov thawj RTC uas qhia tias nws yog chav thov haujlwm ua haujlwm ua tus neeg ua haujlwm hauv chaw ua haujlwm/kev tswj hwm.
Ua raws li 20% txwv rau cov haujlwm Clerical / Administrative
Yog tias cov haujlwm uas tsis tau tso cai raug tshem tawm ntawm Lub Ntiaj Teb Koom Tes kom ua tau raws li 20% ntawm cov haujlwm ua haujlwm hauv chaw ua haujlwm/kev tswj hwm thiab feem pua ntawm Kev Tshawb Fawb Lub Sijhawm tseem siab dua cov feem pua ntawm kev ntsuas, nws raug tso cai hloov sijhawm los ntawm cov lej them tau mus rau cov lej tsis them tau (Code 1) kom ua tiav cov feem pua ntawm kev ntsuas. Yuav tsum muaj ib daim ntawv piav qhia txog qhov kev hloov pauv no rau ntawm daim ntawv pov thawj RTC.
Cov Kev Txwv ntawm Feem Pua ntawm Benchmark
Yog tias cov ntawv them nqi tsis ua tau raws li cov feem pua ntawm kev ntsuas tom qab tshem tawm cov haujlwm tsis raug cai, nws raug tso cai hloov lub sijhawm los ntawm cov lej them tau mus rau cov lej tsis them tau (Code 1) kom ua tiav cov feem pua ntawm kev ntsuas.
Cov Ntawv Them Nqi Uas Ua Raws Li RTC
Rau cov ntawv them nqi uas ua raws li txhua yam ntawm RTC suav nrog, hom haujlwm, qhov txwv 20% rau cov haujlwm ua haujlwm hauv chaw ua haujlwm/kev tswj hwm, feem pua ntawm cov lej ua haujlwm, thiab cov nqi ntawm tus muag khoom, tsuas yog cov ntaub ntawv uas yuav tsum xa mus rau DHCS yog daim ntawv theej ntawm daim ntawv pov thawj RTC, cov txiaj ntsig ntawm Kev Tshawb Fawb Lub Sijhawm, thiab daim ntawv ua haujlwm them nqi ntawm tus muag khoom. Tsis tas yuav xa daim ntawv theej ntxiv ntawm daim ntawv them nqi ncua. Yog li ntawd, ib pob khoom tiav RTC rau daim ntawv them nqi raws li RTC suav nrog daim ntawv pov thawj RTC uas tau kos npe, daim qauv ntawm tag nrho cov txiaj ntsig ntawm Kev Tshawb Fawb Lub Sijhawm, thiab daim ntawv ua haujlwm xam tus nqi ntawm tus muag khoom.
Siv Txoj Cai ntawm "Kev Koom Tes" ua ib qho Kev Piav Qhia rau Kev Koom Tes Cov Xib Fwb Kev Kawm Txuj Ci Hauv Lub Ntiaj Teb Koom Tes
Vim tias feem ntau, tab sis tsis yog txhua tus, cov tub ntxhais kawm tshwj xeeb uas tau muab tso rau hauv cov chav kawm ib txwm muaj, ib qho txheej txheem hu ua Kev Koom Tes, muaj tus Pab Qhia Ntawv nrog, siv Kev Koom Tes ua ib qho kev zam rau kev suav nrog Cov Xib Fwb Kev Kawm Dav Dav hauv Lub Ntiaj Teb Koom Tes tsis tas yuav ua raws li cov kev cai ntawm RTC. Yog tias tus tub ntxhais kawm tshwj xeeb muaj tus Pab Qhia Ntawv nrog, tus Pab Qhia Ntawv yuav tsim nyog rau Lub Ntiaj Teb Koom Tes thiab tsis yog tus Xib Fwb Kev Kawm Dav Dav tshwj tsis yog tias muaj xwm txheej tshwj xeeb. Cov piv txwv ntawm kev siv Kev Koom Tes ua ib qho kev zam rau kev suav nrog Cov Xib Fwb Kev Kawm Dav Dav ua ib feem ntawm Lub Ntiaj Teb Koom Tes yuav raug soj ntsuam ntawm ib rooj plaub rau ib rooj plaub thiab yuav tau txais kev tshuaj xyuas nruj heev.