Cov Lus Qhia Txog Kev Sau Npe (Kev Them Nyiaj Rau Cov Neeg Ua Haujlwm COVID-19 Hauv Tsev Kho Mob thiab Chaw Saib Xyuas Neeg Mob)
Cov Chaw Pabcuam Kev Pabcuam (CEs), Cov Chaw Pabcuam Kev Pabcuam (CSEs), thiab Pawg Kws Khomob (PGEs) yog txhua tus yuav tsum tau sau npe nrog Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) txhawm rau koom nrog hauv Tsev Kho Mob thiab Chaw Pabcuam Kws Kho Mob COVID-19 Cov Neeg Ua Haujlwm Retention Payments (WRP). Thaum sau npe, CEs, CSEs, thiab PGEs yuav raug pom zoo los thov cov nyiaj tuav pov hwm sawv cev ntawm cov neeg ua haujlwm tsim nyog.
Kev taw qhia dav dav:
- Kev tso npe qhib rau lub Kaum Hlis 21, 2022, thiab kaw rau lub Kaum Ob Hlis 23, 2022. CEs, CSEs, thiab PGEs raug txhawb kom ua tiav kev sau npe ntxov kom tsis txhob ncua kev pom zoo.
- Ib qhov txuas mus rau daim ntawv sau npe yuav muaj nyob rau ntawm Lub Tsev Kho Mob thiab Lub Chaw Pabcuam Saib Xyuas Neeg Mob Zoo COVID-19 Cov Neeg Ua Haujlwm Retention Payments lub vev xaib thaum Lub Kaum Hli 21.
- Txhua lub koom haum yuav tsum ua kom tiav thiab xa Daim Ntawv Foos STD 204, Tus Neeg Them Cov Ntaub Ntawv Cov Ntaub Ntawv thaum lub sijhawm sau npe, txawm tias ib tus twb tau ua ntaub ntawv nrog Lub Xeev California lawm.
- Yog tias koj yog ib feem ntawm lub network loj, kab ke kev noj qab haus huv, lossis pab pawg kho mob, koj tuaj yeem sau npe siv cov ntaub ntawv los ntawm koj qhov chaw loj tshaj plaws / lub koom haum (nrog cov neeg ua haujlwm coob tshaj plaws) thiab sau npe ib zaug.
- Cov Chaw Ua Haujlwm Pabcuam Kev Pabcuam (saib cov ntsiab lus hauv qab no) yuav raug hais kom xa cov ntawv theej hluav taws xob ntawm koj daim ntawv cog lus Kev Pabcuam uas tau kos npe nrog Cov Chaw Pabcuam / Cov Chaw Tsim Nyog hauv Word (doc, docx) lossis PDF hom. Lub kaw lus lees txais ib daim ntawv ua ke nrog cov ntaub ntawv siab tshaj plaws ntawm 16 MB.
Tsuas yog cov kws kho mob ywj pheej, cov neeg ua haujlwm yuav tsum tsis txhob thov ncaj qha. Cov chaw tsim nyog, chaw ua haujlwm, thiab pab pawg kws kho mob yog lub luag haujlwm los thov cov nyiaj khaws cia rau lawv cov neeg ua haujlwm tsim nyog thiab cov kws kho mob.
Nyob ntawm hom chaw, muaj kwv yees li 15 yam khoom yuav tsum ua kom tiav ntawm daim ntawv sau npe. Thov saib Daim Ntawv Ntxiv rau cov ntaub ntawv xav tau.
Kwv yees lub sijhawm ua tiav yog 15 feeb.
- Hauv 10 hnub ua haujlwm ntawm kev sau npe, cov CEs, CSEs, PGEs thiab Cov Kws Kho Mob Ywj Pheej tau sau npe tiav lawm koj yuav tau txais email lees paub nrog qhov txuas mus rau daim ntawv thov. Yog tias koj tsis tau txais email lees paub thiab/lossis qhov txuas mus rau daim ntawv thov hauv lub sijhawm no, thov xa email rau DHCS ntawm wrp@dhcs.ca.gov thiab suav nrog "Qhov Txuas Daim Ntawv Thov uas Ploj Lawm" rau hauv kab ntawv kawm.
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Yuav pib ua cov txheej txheem sau npe, koj yuav tsum tau lees txais cov Lus Qhia Txog Kev Tshaj Tawm thiab Kev Ceev Ntiag Tug hauv qab no ua ntej txuas ntxiv mus:
- Kev Tshaj Tawm Cov Ntaub Ntawv Tus Kheej. Yuav kom paub tseeb tias koj yog leej twg thiab koj tsim nyog koom nrog WRP, tej zaum yuav tsum tau qhia cov ntaub ntawv uas koj muab rau cov koom haum hauv xeev/tsoomfwv lossis cov neeg muag khoom sab nraud. Txawm hais tias koj xaiv ua tiav cov txheej txheem sau npe thiab thov, yog tias koj ua tsis tiav tag nrho cov txheej txheem, koj yuav tsis paub txiav txim siab tsim nyog thiab them nyiaj rau cov neeg uas koj tsis tsim nyog koom nrog.
Daim Ntawv Ceeb Toom Txog Kev Ceev Ntaub Ntiag Tug, Civ. Code Seem 1798.17: Cov ntaub ntawv ntiag tug uas tau sau rau ntawm daim ntawv no thiab nrog rau yog zais cia, raws li Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) Daim Ntawv Ceeb Toom Txog Kev Ua Haujlwm Txog Kev Ceev Ntaub Ntiag Tug uas tuaj yeem pom ntawm no: https://www.dhcs.ca.gov/formsandpubs/laws/priv/Documents/Notice-of-Privacy-Practices-English.pdf. DHCS xav tau cov ntaub ntawv los tswj hwm WRP. DHCS yuav tsis siv lossis qhia cov ntaub ntawv rau lwm lub hom phiaj tsuas yog koj tso cai lossis raws li txoj cai tso cai. Koj yuav tsum muab tag nrho cov ntaub ntawv thov rau ntawm daim ntawv no. Yog tias koj tsis muab tag nrho cov ntaub ntawv thov, peb yuav tsis tuaj yeem txiav txim siab seb koj puas tsim nyog tau txais kev them nyiaj. Feem ntau, tus neeg (cov) uas cov ntaub ntawv no cuam tshuam nrog muaj cai nkag mus rau nws. DHCS tau tso cai los sau cov ntaub ntawv no raws li Labor Code Seem 1492. Daim ntawv ceeb toom txog kev ceev ntaub ntawv no yog xav tau los ntawm California Civil Code Seem 1798.17.
Kuv nkag siab thiab pom zoo tias txhua cov ntaub ntawv muab rau ntawm WRP - Covered Entity thiab Covered Services Employer's Registration Form yuav raug muab qhia rau lwm tus.
- Kev Tshaj Tawm Cov Ntaub Ntawv Tus Kheej. Yuav kom paub tseeb tias koj yog leej twg thiab koj tsim nyog koom nrog WRP, tej zaum yuav tsum tau qhia cov ntaub ntawv uas koj muab rau cov koom haum hauv xeev/tsoomfwv lossis cov neeg muag khoom sab nraud. Txawm hais tias koj xaiv ua tiav cov txheej txheem sau npe thiab thov, yog tias koj ua tsis tiav tag nrho cov txheej txheem, koj yuav tsis paub txiav txim siab tsim nyog thiab them nyiaj rau cov neeg uas koj tsis tsim nyog koom nrog.
- Yuav kom ua tiav qhov kev sau npe, koj yuav raug nug kom paub meej tias cov ntaub ntawv koj tau nkag mus thiab pom zoo rau daim ntawv pov thawj los ntawm kev sau koj lub npe thiab lub xeem thiab koj lub npe hauv lub koom haum, thiab tom qab ntawd nyem lub pob ua tiav. Yog koj teb tau zoo ces yuav muab cov lus qhia ntxiv rau koj. Lus Cim: Tus neeg pov thawj uas tau tso cai yuav tsum yog tus tswv ib leeg, tus khub, tus thawj coj ntawm lub tuam txhab, lossis tus neeg sawv cev ntawm lub koom haum / lub koom haum uas muaj cai los khi tus neeg thov raws li txoj cai.
- "Kuv tshaj tawm raws li kev rau txim ntawm kev dag raws li txoj cai ntawm Lub Xeev California tias cov ntaub ntawv saum toj no hauv daim ntawv no thiab cov ntaub ntawv txuas ntxiv yog qhov tseeb, raug, thiab tiav raws li kuv paub thiab ntseeg zoo tshaj plaws. Kuv tau tso cai xa cov ntaub ntawv no rau tus neeg thov. Kuv nkag siab tias los ntawm kev ntaus lub npe thiab lub xeem hauv lub thawv hauv qab no suav tias yog kuv kos npe hluav taws xob. "
- Tom qab kev tso npe tso npe, CEs, CSEs, thiab PGEs yuav tau txais email los ntawm DHCS lees paub tias lawv cov ntawv sau npe tau txais lossis xav tau cov ntaub ntawv ntxiv.
Xaiv koj hom chaw:
Cov ntaub ntawv xav tau ntawm daim ntawv sau npe yog nyob ntawm hom chaw. Nco ntsoov xaiv hom chaw uas zoo tshaj plaws qhia txog koj lub koom haum. Yog tias koj muaj ntau tshaj ib lub koom haum uas tau piav qhia hauv qab no nrog tib lub Npe, Tus Naj Npawb Ua Se (TIN), lossis Tsoom Fwv Teb Chaws Tus Neeg Ua Haujlwm Tus Naj Npawb (FEIN), xaiv hom chaw nrog cov neeg ua haujlwm loj tshaj plaws.
Qualifying Facility – A health facility that is not a state facility and is a facility described in Labor Code section 1491(k)(1)-(7).
Physician Entity – Independent Physician or Physician Group. Any legal entity that contracts with a qualifying facility to provide physician services, including, but not limited to, professional medical corporations and individual physicians/sole proprietorships.
Tus Tswv Haujlwm Pabcuam Uas Tau Them - Txhua tus neeg lossis ib lub koom haum uas ntiav ncaj qha lossis tswj hwm cov nyiaj hli, sijhawm ua haujlwm, lossis cov xwm txheej ua haujlwm ntawm ib tus neeg; thiab muab cov kev pabcuam hauv chaw ua haujlwm, xws li kev pabcuam sau ntawv, kev noj haus, kev pabcuam ib puag ncig, kev ntxhua khaub ncaws, kev ruaj ntseg, kev tsim kho, kev tswj hwm chaw, kev tswjfwm, lossis cov neeg ua haujlwm them nqi los ntawm daim ntawv cog lus nrog lub chaw tsim nyog uas tus neeg lossis lub koom haum yog tus tswv haujlwm ntawm cov ntaub ntawv.
Lus txhais:
If your Entity Type is “Qualifying Facility”
Koj yuav tsum xaiv ib qho ntawm cov chaw hauv qab no:
| Hom chaw | Lub ntsiab lus |
|---|---|
| Mob Psychiatric Hospital | Raws li tau hais tseg hauv Txoj Cai Kev Noj Qab Haus Huv thiab Kev Nyab Xeeb Tshooj 1250(b). |
| General Acute Care Hospital | Raws li tau hais tseg hauv Txoj Cai Kev Noj Qab Haus Huv thiab Kev Nyab Xeeb Tshooj 1250(a). |
| Kev Pabcuam Saib Xyuas Neeg Mob | Raws li tau hais tseg hauv Txoj Cai Kev Noj Qab Haus Huv thiab Kev Nyab Xeeb Tshooj 1250(c). |
| Lwm Lub Tsev Kho Mob | Koom nrog, muaj, lossis tswj los ntawm ib tus neeg lossis lub koom haum uas muaj lossis ua haujlwm hauv tsev kho mob hnyav raws li tau hais tseg saum toj no, thiab ua haujlwm los ntawm lub koom haum tsis muaj txiaj ntsig uas tshawb fawb txog kev kho mob thiab muab kev saib xyuas kev noj qab haus huv rau cov neeg mob los ntawm ib pab pawg ntawm 40 lossis ntau tus kws kho mob thiab kws phais neeg, uas yog cov neeg ua haujlwm ywj pheej sawv cev tsis pub tsawg dua 10 lub rooj sib tham, thiab tsis muaj ntawv pov thawj tshwj xeeb Lub hauv paus puv sijhawm ntawm lub tsev kho mob, raws li tau teev tseg hauv Kev Noj Qab Haus Huv thiab Kev Nyab Xeeb Txoj Cai Tshooj 1206(l). |
Lwm Cov Lus Txhais
| lub sij hawm | Txhais |
|---|---|
| Tus neeg hu xov tooj (siv rau Lub Npe Hu, Hu rau email chaw nyob, thiab tus xov tooj hu) | Tus neeg uas yuav tiv tauj tau yuav tsum yog tus neeg uas DHCS yuav tiv tauj tau, yog tias xav tau, txog koj daim ntawv sau npe. Tus email chaw nyob yuav raug siv rau txhua qhov kev sib txuas lus ntawm DHCS txog koj qhov xwm txheej sau npe thiab cov kauj ruam tom ntej suav nrog daim ntawv thov. |
| NPI | Tus Neeg Muab Kev Pabcuam Hauv Tebchaws: tus lej cim 10 tus lej tshwj xeeb tshaj tawm rau cov kws kho mob hauv Tebchaws Meskas los ntawm Lub Chaw Pabcuam Medicare & Medicaid (CMS). |
| Facility License Number | Tus lej 9 tus lej raug muab los ntawm California Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (CDPH). |
| California Medical License Number | Tus lej txheeb xyuas uas cuam tshuam nrog daim ntawv tso cai ua haujlwm uas tso cai rau tus neeg siv tshuaj raws cai raws li tau tshaj tawm los ntawm Medical Board of California. |
| Lag luam daim ntawv tso cai Number | Tus lej cim uas cuam tshuam nrog daim ntawv tso cai uas tso cai rau koj ua lag luam. |
| TIN/FEIN | Tus Naj Npawb Se (Tax Identification Number) lossis Tsoom Fwv Teb Chaws Tus Neeg Ua Hauj Lwm Tus Naj Npawb: tus lej tseem ceeb uas tshwm sim hauv koj daim ntawv W-9. |
| Hom Lub Koom Haum Tus Neeg Tau Txais Nyiaj (raws li tau txhais los ntawm Lub Xeev California - Lub Tsev Haujlwm Saib Xyuas Nyiaj Txiag) | Tus Tswv Cuab Ib Leeg/Tus Neeg: Tus Kheej lossis Tus Tswv Cuab Ib Leeg lossis Tus Muab Nyiaj (Kev Nyob Ruaj Khov Tau) Kev Ntseeg Siab tsis suav nrog cov hom phiaj se hauv tsoomfwv. Lub Tuam Txhab LLC Ib Leeg Tswv Cuab - yog tus tswv ntawm ib tus neeg: Lub Tuam Txhab Muaj Lub Luag Haujlwm Txwv (LLC) yog tus tswv ntawm ib tus neeg thiab tsis suav nrog rau cov hom phiaj them se ntawm tsoomfwv. Kev Koom Tes: Kev Koom Tes lossis Kev Koom Tes Muaj Lub Luag Haujlwm Txwv (LLP), thiab LLCs raug suav hais tias yog Kev Koom Tes. Vaj Tse Los Yog Kev Ntseeg Siab: Vaj Tse Los Yog Kev Ntseeg Siab (tsis suav nrog Kev Ntseeg Siab ntawm Tus Neeg Muab Nyiaj uas tsis quav ntsej). Lub Tuam Txhab - Kev Kho Mob: Lub Tuam Txhab uas yog ib lub tuam txhab kho mob (piv txwv li, kev kho mob thiab kev pabcuam kev noj qab haus huv, kev saib xyuas kws kho mob, kev saib xyuas menyuam yaus, kev kho hniav, thiab lwm yam) lossis LLC uas yuav raug them se zoo li lub tuam txhab thiab yog ib lub tuam txhab kho mob. Lub Tuam Txhab - Raws Cai: Lub tuam txhab uas raug cai (piv txwv li, cov kev pabcuam ntawm cov kws lij choj, cov neeg txiav txim plaub ntug, cov neeg sau ntawv pov thawj uas cuam tshuam txog kev cai lij choj lossis kev cai lij choj, thiab lwm yam), lossis LLC uas yuav raug them se zoo li lub tuam txhab thiab raug cai. Lub Tuam Txhab - Tsis Muaj Kev Zam: Lub Tuam Txhab uas tsim nyog rau qhov xwm txheej Tsis Muaj Kev Zam, suav nrog 501 (c) 3 thiab cov tuam txhab tsis muaj txiaj ntsig hauv tebchaws. Lub Tuam Txhab - Txhua Lwm Tus: Lub tuam txhab uas tsis ua raws li cov cai ntawm lwm hom tuam txhab teev saum toj no, lossis LLC uas yuav tsum tau them se raws li lub tuam txhab thiab tsis ua raws li lwm hom tuam txhab teev saum toj no. |
| Tus neeg txais nyiaj nyob hauv Status | Neeg Nyob Hauv California: Tsim Nyog Ua Lag Luam Hauv California Los Sis Muaj Chaw Ua Lag Luam Mus Ib Txhis Hauv California. California Cov Neeg Tsis Nyob Hauv: Koj raug suav hais tias yog cov neeg tsis nyob hauv yog tias koj qhov chaw ua lag luam tas mus li nyob sab nraum California. Cov nyiaj them rau cov neeg tsis nyob hauv xeev rau cov kev pabcuam yuav raug txiav se ntawm lub xeev. |
Yog xav paub ntxiv, thov mus saib hauv Tsev Kho Mob thiab Cov Kws Kho Mob Kws Kho Mob COVID-19 Cov Neeg Ua Haujlwm Retention Payments lub vev xaib thiab tshuaj xyuas cov lus nug uas nquag nug (FAQs) thiab cov ntsiab lus ntawm cov ntsiab lus.
Daim ntawv ntxiv: Cov ntaub ntawv xav tau
Cov ntaub ntawv hauv qab no yuav tsum muaj nyob rau hauv daim ntawv sau npe.
Rau Cov Chaw Uas Tau Them Nqi (Cov Chaw Tsim Nyog):
- Hom chaw
- Lub npe chaw ua haujlwm lossis lub lag luam / lub npe raug cai cuam tshuam nrog Tus Naj Npawb Tus Neeg Them Se (TIN) / Tsoom Fwv Teb Chaws Tus Zauv Npe (FEIN) (raws li nws tshwm sim hauv daim ntawv IRS W9)*
- Chaw nyob (raws li nws tshwm sim hauv IRS daim ntawv W9)*
- Daim ntawv tso cai tus naj npawb (CDPH muab 9 tus lej) *
- TIN los yog FEIN
- Hom neeg them nyiaj
- Tus neeg txais nyiaj nyob hauv xeev (California neeg nyob lossis California tsis nyob hauv)
- Lub npe hu (thawj thiab xeem)
- Hu rau email chaw nyob thiab xov tooj
- Kwv yees tus naj npawb ntawm cov neeg ua haujlwm tsim nyog
- National Provider Identification (NPI) tus lej
- Cov npe ntawm cov kev cog lus Covered Services Cov tswv hauj lwm muab cov kev pab cuam nyob rau hauv
- Cov npe ntawm cov kws kho mob koom nrog cov chaw muab kev pabcuam hauv chaw
- Ua tiav daim ntawv STD 204 (Payee Data Record).
- Tus Neeg Sau Npe thiab Lub Npe
* Cov teb no yuav cia li populate nrog cov ntaub ntawv preset hauv cov ntawv qhia zaub mov. Txhawm rau muab cov ntaub ntawv manually, xaiv thawj qhov kev xaiv hauv qhov poob.
Rau Cov Chaw Ua Haujlwm Pabcuam Uas Tau Them Nqi:
- Lub npe (thawj thiab xeem) lossis lag luam / npe raug cai cuam tshuam nrog TIN / FEIN (raws li nws tshwm hauv IRS daim ntawv W9)
- Chaw nyob (raws li nws tshwm sim ntawm IRS daim ntawv W9)
- TIN los yog FEIN
- Hom neeg them nyiaj
- Tus neeg txais nyiaj nyob hauv xeev (California neeg nyob lossis California tsis nyob hauv)
- Lub npe hu (thawj thiab xeem)
- Hu rau email chaw nyob thiab xov tooj
- Kwv yees tus naj npawb ntawm cov neeg ua haujlwm tsim nyog
- Cov npe ntawm cov chaw tsim nyog tau txais kev pab nyob rau ntawm qhov chaw (cov chaw kho mob uas koj tau cog lus nrog thiab ua tau raws li qhov yuav tsum tau hais hauv FAQs) thiab hom kev pabcuam muab rau ntawm qhov chaw nyob.
- Kev xa tawm digital ntawm feem cuam tshuam ntawm daim ntawv cog lus cog lus nrog Cov Koom Haum Pabcuam, suav nrog kev ua haujlwm thiab nplooj ntawv kos npe
- Ua tiav daim ntawv STD 204 (Payee Data Record).
- Tus kws kho mob lub npe thiab lub npe
Rau Cov Chaw Pab Pawg Kws Kho Mob (lossis Cov Kws Kho Mob Ywj Pheej):
- Tus kws kho mob lub npe (thawj thiab xeem) lossis lub lag luam / lub npe raug cai cuam tshuam nrog TIN / FEIN (raws li nws tshwm sim hauv IRS daim ntawv W9)
- Chaw nyob (raws li nws tshwm sim ntawm IRS daim ntawv W9)
- TIN los yog FEIN
- Hom neeg them nyiaj
- Tus neeg txais nyiaj nyob hauv xeev (California neeg nyob lossis California tsis nyob hauv)
- Lub npe hu (thawj thiab xeem)
- Hu rau email chaw nyob thiab xov tooj
- Kwv yees tus naj npawb ntawm cov neeg ua haujlwm tsim nyog
- NPI num
- Tus kws kho mob / tus lej ntawv tso cai kho mob (npe daim ntawv tso cai ua lag luam hauv California, yog tias tus kheej)
- Cov npe ntawm cov chaw tsim nyog uas tau muab kev pabcuam
- Ua tiav daim ntawv STD 204 (Payee Data Record).
- Tus kws kho mob lub npe thiab lub npe