Txoj Haujlwm Saib Xyuas
Kev piav qhia
CCS qhov kev pab cuam muab kev kuaj mob thiab kev kho mob, kev tswj xyuas cov ntaub ntawv kho mob, thiab kev kho lub cev thiab kev ua haujlwm rau cov menyuam yaus hnub nyoog qis dua 21 xyoos nrog CCS-tsim nyog kho mob. Piv txwv ntawm CCS-kev tsim nyog muaj xws li, tab sis tsis txwv rau, cov mob ntev xws li cystic fibrosis, hemophilia, cerebral palsy, kab mob plawv, mob qog noj ntshav, kev raug mob, thiab cov kab mob sib kis uas tsim cov kab mob loj. CCS tseem muab cov kev kho mob kho mob uas xa hauv cov tsev kawm ntawv pej xeem.
Yuav kom tsim nyog rau qhov kev pab cuam CCS, tus menyuam yuav tsum muaj tus mob uas tsim nyog rau CCS, nyob hauv California thiab ua tau raws li qhov tsim nyog nyiaj txiag. Kev tsim nyog tau txais nyiaj txiag ntawm CCS tsis yog txwv rau cov tsev neeg uas khwv tau $40,000 lossis tsawg dua. Cov tsev neeg uas muaj cov nyiaj tau los tag nrho (AGI) ntawm $ 40,000 lossis tsawg dua yuav tsim nyog, tab sis cov neeg uas muaj cov nyiaj tau los ntau dua tseem yuav tsim nyog yog tias lawv cov menyuam cov nqi kho mob siab heev. Cov menyuam yaus uas tau sau npe rau hauv Medi-Cal tej zaum yuav tsim nyog tau txais CCS. Qhov Kev Pab Kho Mob tsis muaj qhov txwv rau cov nyiaj tau los thiab muaj rau txhua tus menyuam uas tsim nyog.
Qhov kev pab cuam CCS yog tswj hwm ua kev koom tes ntawm cov chaw haujlwm kev noj qab haus huv hauv nroog thiab California Department of Health Care Services (DHCS). Tam sim no, kwv yees li ntawm 70 feem pua ntawm cov menyuam yaus uas tsim nyog rau CCS kuj tsim nyog rau Medi-Cal. Qhov kev pab cuam Medi-Cal them rov qab rau lawv cov kev kho mob. Tus nqi saib xyuas rau lwm 30 feem pua ntawm cov menyuam yaus raug faib sib npaug ntawm CCS Only thiab CCS Healthy Families. Tus nqi kho mob rau CCS Xwb yog tau txais nyiaj sib npaug ntawm Lub Xeev thiab cov nroog. Tus nqi kho mob rau CCS Healthy Families tau txais nyiaj los ntawm 65 feem pua ntawm tsoomfwv Title XXI, 17.5 feem pua ntawm lub xeev, thiab 17.5 feem pua ntawm cov nyiaj hauv nroog.
Ntxiv rau qhov ntawd, Cov Cai Kev Pov Hwm Tshooj 12693.62, 12693.64 thiab 12693.66, uas cuam tshuam txog California's Healthy Families Program, qhia tias cov kev pabcuam uas tau tso cai los ntawm CCS program los kho tus neeg sau npe ntawm Healthy Families plan tus mob uas tsim nyog tau txais CCS raug tshem tawm ntawm lub luag haujlwm ntawm txoj kev npaj. Lub luag haujlwm ntawm txoj kev npaj kho mob uas koom nrog rau kev muab txhua yam kev kho mob uas tsim nyog thiab kev tswj hwm cov ntaub ntawv hloov pauv thaum lub sijhawm uas qhov kev tsim nyog ntawm CCS raug txiav txim siab los ntawm qhov kev pab cuam CCS rau tus neeg sau npe rau txoj kev npaj. Lub phiaj xwm kev noj qab haus huv tseem muaj lub luag haujlwm los muab kev kho mob thawj zaug thiab kev tiv thaiv uas tsis muaj feem cuam tshuam nrog tus mob uas tsim nyog rau CCS rau tus neeg siv phiaj xwm tsuav yog lawv nyob hauv qhov kev pab cuam Healthy Families. Txoj kev npaj kho mob tseem yuav muaj lub luag haujlwm rau cov menyuam yaus uas raug xa mus tab sis tsis tau txiav txim siab tias yuav tsim nyog rau qhov kev pab cuam CCS.
Legislative Authority
Ua kom muaj kev cai lij choj ntawm CCS txoj haujlwm
Txoj Cai Kev Noj Qab Haus Huv thiab Kev Nyab Xeeb, Tshooj 123800 et seq. yog txoj cai lij choj uas ua rau muaj kev pab cuam CCS. Lub hom phiaj tseem ceeb ntawm txoj cai lij choj ntawm CCS qhov kev pab cuam yog los muab cov kev pabcuam kho mob tsim nyog rau cov menyuam yaus uas muaj cov mob tsim nyog rau CCS uas lawv niam txiv tsis tuaj yeem them rau cov kev pabcuam no, tag nrho lossis ib feem. Txoj cai lij choj kuj tseem yuav tsum tau kom DHCS thiab lub nroog CCS txoj haujlwm nrhiav cov menyuam yaus tsim nyog los ntawm kev koom tes nrog cov koom haum pej xeem lossis cov koom haum ntiag tug hauv zos thiab cov neeg muab kev kho mob kom coj cov menyuam yaus uas muaj peev xwm tsim nyog mus rau qhov chaw kuaj mob thiab kho mob ntawm cov kws tshaj lij.
Txoj Haujlwm CCS raug txib los ntawm Txoj Cai Kev Noj Qab Haus Huv thiab Cov Tsev Kawm Ntawv thiab Txoj Cai Cai California (Title 22, Seem 51013) kom ua haujlwm ua "tus neeg sawv cev ntawm Medi-Cal" rau cov neeg tau txais txiaj ntsig Medi-Cal uas muaj cov mob tsim nyog rau CCS. Medi-Cal yuav tsum xa txhua tus neeg siv khoom uas tsim nyog rau CCS mus rau CCS kom tau txais cov kev pabcuam tswj xyuas cov ntaub ntawv thiab kev tso cai rau kev kho mob. Txoj cai lij choj kuj tseem yuav tsum tau kom txhua tus neeg thov CCS uas tsim nyog rau qhov kev pab cuam Medi-Cal thov Medi-Cal.
Program Administration
In counties with populations greater than 200,000 (independent counties), county staff perform all case management activities for eligible children residing within their county. This includes determining all phases of program eligibility, evaluating needs for specific services, determining the appropriate provider(s), and authorizing for medically necessary care. For counties with populations under 200,000 (dependent counties), the Children’s Medical Services (CMS) Branch provides medical case management and eligibility and benefits determination through its regional offices located in Sacramento and Los Angeles. Dependent counties interact directly with families and make decisions on financial and residential eligibility. Some dependent counties have opted to participate in the Case Management Improvement Project (CMIP) to partner with regional offices in determining medical eligibility and service authorization. The regional offices also provide consultation, technical assistance, and oversight to independent counties, individual CCS paneled providers, hospitals, and the Special Care Centers within their region.
Kev piav qhia txog nyiaj txiag
Cov nyiaj pab rau lub nroog CCS qhov kev pab cuam yog kev sib txuas ntawm cov nyiaj uas tsim nyog los ntawm lub nroog, Cov Nyiaj Txiag Hauv Xeev, thiab tseem fwv. AB 948, txoj cai hloov kho dua tshiab tau dhau los hauv xyoo 1992, tau txib kom Lub Xeev thiab lub nroog CCS cov kev pab cuam koom nrog rau cov nqi ntawm kev muab kev kho mob tshwj xeeb thiab kho kom rov zoo rau cov menyuam uas tsis taus lub cev los ntawm kev faib nyiaj ntawm Xeev General Fund thiab cov nyiaj hauv nroog. Cov nyiaj hauv Xeev muaj rau qhov kev pab cuam CCS raug txiav txim txhua xyoo los ntawm Txoj Cai Lij Choj Nyiaj Txiag.