Rov qab mus rau Kev Kho Mob Ntxiv​​ 

Members who mandatorily transition from Medi-Cal Fee for Service (FFS) to enroll in a Medi Cal Managed Care Plan (MCP) on or after January 1, 2023 have the right to request Continuity of Care (CoC) with providers. Members may request up to 12 months of CoC with a provider if a verifiable pre-existing relationship exists with that provider. Additionally, if a Member has one of the conditions listed in Health and Safety Code (HSC) section 1373.96, the MCP must provide CoC for the completion of a course of treatment for that specific condition by a terminated provider or by a nonparticipating provider at the Member’s request. Members also have the right to CoC for Covered Services and active prior treatment authorizations for Covered Services.​​ 

CoC Txoj Cai rau 2024 MCP Kev Hloov Pauv muab kev taw qhia rau yav dhau los thiab tau txais MCPs, ob qho tib si Prime MCPs thiab lawv cov neeg ua haujlwm ua haujlwm, txog lawv cov luag num kom ntseeg tau tias CoC rau Cov Tswv Cuab yuav tsum hloov MCPs thaum Lub Ib Hlis 1, 2024.​​ 

Kev tiv thaiv hauv 2024 MCP hloov pauv txawv. Mus Saib Kev Kho Mob Ntxiv | Tswj Kev Npaj Kho Mob Hloov Hloov | DHCS kom paub meej ntxiv txog 2024 MCP kev hloov pauv thiab nws txawv li cas.​​ 

Below you will find the most frequently asked questions for new Medi-Cal Managed Care Members. In the frequently asked questions, a Medi-Cal managed care health plan will be referred to as the “Plan.”​​  

1. Yog ib tug tswvcuab tus kws khomob tsis tau cog lus nrog ib qho ntawm Medi-Cal txoj kev npaj khomob uas muaj kev tswjhwm khomob (Plans) uas muaj nyob rau hauv Lub Nroog Tus Tswvcuab, tus tswvcuab yuav mus saib tau tus kws khomob no li cas?​​ 

Teb 1a:  Yog tias Tus Tswv Cuab tau pom FFS tus kws kho mob ua ntej yuav tsum tau tso npe rau hauv Txoj Kev Npaj, Tus Tswv Cuab yuav tuaj yeem mus ntsib FFS tus kws kho mob txuas ntxiv mus txog 12 lub hlis thaum tseem nyob rau hauv Txoj Kev Npaj.  Lub sijhawm 12 lub hlis no yog "CoC lub sijhawm."  Txhawm rau saib xyuas txuas ntxiv nrog FFS tus kws kho mob, Tus Tswv Cuab yuav tsum:​​ 

1. Hu rau lub phiaj xwm tshiab.​​ 
2. Qhia rau Lub Hom Phiaj tias lawv xav tau txais kev kho mob ntxiv los ntawm FFS tus kws kho mob, thiab​​ 
3. Qhia rau Lub Hom Phiaj lub npe ntawm tus kws kho mob FFS.​​ 

Tus Tswvcuab tseem tuaj yeem pom tus kws khomob FFS thaum Lub Hom Phiaj txiav txim siab tias tus tswvcuab tau pom tus kws khomob hauv 12 lub hlis dhau los, tus kws khomob tsis muaj teebmeem kev saib xyuas zoo uas yuav ua rau lawv tsis tsim nyog rau kev koom nrog hauv Plan lub network, thiab tus kws khomob thiab Plan pom zoo rau tus nqi them.  Tsis pub dhau 30 hnub txij li hnub Lub Hom Phiaj tau txais tus tswv cuab qhov kev thov, lossis sai dua yog tias tus tswvcuab tus mob xav tau kev saib xyuas sai dua, Lub Hom Phiaj yuav tsum qhia rau Tus Tswvcuab yog tias lawv tuaj yeem kho nrog FFS tus kws kho mob txuas ntxiv lossis yog lawv yuav raug xa mus rau tus kws kho mob hauv Plan's provider network.  Yog tias tus neeg muab kev pabcuam FFS txaus siab txuas ntxiv mus ntsib Tus Tswvcuab, tabsis Lub Hom Phiaj hais tias tsis muaj, lossis yog tias Lub Hom Phiaj tsis ua raws li tus tswvcuab qhov kev thov raws sijhawm, tus tswvcuab tuaj yeem foob qhov kev tsis txaus siab nrog Txoj Haujlwm.​​ 

Teb 1b:  Lub Xeev tam sim no xav kom Medi-Cal cov phiaj xwm kev noj qab haus huv (Plans) muab qee cov kev pab kho mob (xws li kev saib xyuas mus sij hawm ntev) uas tau txog thaum nyuam qhuav muaj los ntawm Medi Cal FFS cov kws kho mob. Cov tswvcuab uas tau txais kev pabcuam kev noj qab haus huv zoo li no tuaj yeem thov kom tau txais kev pabcuam txuas ntxiv los ntawm lawv cov kws khomob FFS raws li tib yam yuav tsum tau teev tseg hauv Teb 1a.​​ 

For further information about CoC policies for the populations described in Answers 1a and 1b, please see All Plan Letter 23-022: Continuity of care for Medi-Cal Beneficiaries who newly enroll in Medi-Cal Managed Care from Medi-Cal Fee-for-Service, on or after January 1, 2023.​​ 

Answer 1c:  Members may also be able to keep seeing their provider if their provider stops participating with the Plan’s provider network. In addition to the requirements set forth in this FAQ for CoC, which are solely based on DHCS policy, additional requirements pertaining to CoC are set forth in the Knox Keene Act, Health and Safety Code H&S section 1373.96 and require most health plans in California—including Medi-Cal plans—to, at the request of a Member, provide for the completion of covered services by a terminated or nonparticipating health plan provider. H&S section 1373.96 requires that these health plans complete services for the following health conditions: acute, serious chronic, pregnancy, terminal illness, the care of a newborn child between birth and age 36 months, and surgeries or other procedures that were previously authorized as a part of a documented course of treatment. Most Plans must allow for the completion of these services for certain timeframes which are specific to each condition and defined under H&S section 1373.96. Under H&S section 1373.96, Members do not need to have transitioned from FFS to Medi-Cal Managed Care to qualify for the completion of services if they have a qualifying health condition. Members should call their Plan for more information about completing services as required by the Knox Keene Act.​​ 

2. Cov kws kho mob twg yuav ib tug tswvcuab mus txuas ntxiv mus saib sab nraum Medi Cal tswj kev saib xyuas kev noj qab haus huv lub network (Plan's) network ntawm cov chaw muab kev pab?​​ 

A Member may ask the Plan to allow them to continue to see a FFS provider who is not in the Plan’s provider network. A Member may continue to see their FFS provider for 12 months:​​ 

• Yog tias Tus Tswv Cuab muaj kev sib raug zoo tam sim no nrog FFS tus kws kho mob,​​ 
• Yog tias Txoj Kev Npaj tsis muaj teeb meem kev saib xyuas zoo nrog tus kws kho mob,​​  
• If the provider will accept the Plan’s contracted rates or FFS rates, and​​ 
• Tus kws kho mob yog California State Plan pom zoo muab kev pab.​​ 

If these requirements are met, the Plan must allow the Member to continue to see providers who are physicians; surgeons; specialists; physical therapists; occupational therapists; respiratory therapists; behavioral health treatment providers; speech therapists; durable medical equipment providers; Long-Term Care (LTC) providers which include Skilled Nursing Facilities (SNF), Intermediate Care Facilities for the Developmentally Disabled (ICF/DD), ICF/DD-Habilitative (ICF/DD-H), ICF/DD-Nursing (ICF/DD-N), and Subacute Care (adult and pediatric). The Plan is not required to allow the Member to continue to receive services from providers of radiology; laboratory; dialysis centers; transportation, other ancillary services, carved-out Medi-Cal services (Medi-Cal services that are not provided by the Plan); or services not covered by Medi-Cal.​​ 

3. Puas muaj ib tug tswv cuab ntawm Medi-Cal nyob rau hauv Medi-Cal txoj kev npaj kho mob uas tau tswj hwm (Plan) txuas ntxiv mus ntsib tus kws kho mob uas twb muaj lawm uas tsis yog ib feem ntawm lub phiaj xwm network?​​ 

The option to continue seeing an out-of-network provider through the CoC applies to a Member who previously (in the past 12 months) was seeing a Medi-Cal FFS provider and is now required to enroll into a Plan. CoC also applies to specific Medi-Cal Member populations. Members who were receiving specialty mental health services and becomes eligible to receive non-specialty mental health services may receive CoC with psychiatrists and/or mental health providers who are permitted through the California Medicaid State Plan to provide outpatient non-specialty mental health services. CoC also applies to Members who mandatorily transition from Covered California to a Plan, and Members who mandatorily transition from Medi-Cal FFS to enroll in a MCP on or after January 1, 2023. For more information on the 2024 Medi Cal Managed Care Plan Transition Policy please visit Continuity of Care | Managed Care Plan Transition | DHCS.​​ 

CoC tsis siv rau ib tug tswv cuab uas tau nyob rau hauv Plan rau 12 lub hlis los yog ntau tshaj los yog rau ib tug tswv cuab uas nyuam qhuav tau txais Medi Cal thiab yuav tsum rau npe rau hauv ib tug Plan. Cov tswv cuab no feem ntau yuav tsum pom cov neeg muab kev pabcuam uas yog ib feem ntawm Txoj Haujlwm Pabcuam Network.​​ 

However, Members may also be able to keep seeing their provider if their provider stops participating with the Plan’s provider network. In addition to the requirements set forth in this FAQ for CoC, which are solely based on DHCS policy, additional requirements pertaining to CoC are set forth in the Knox Keene Act, H&S section 1373.96 and require most health plans in California—including Medi-Cal plans—to, at the request of a Member, provide for the completion of covered services by a terminated or nonparticipating health plan provider. The H&S section 133.96 requires these health plans to complete services for the following health conditions: acute, serious chronic, pregnancy and postpartum, terminal illness, the care of a newborn child between birth and age 36 months, and surgeries or other procedures that were previously authorized as a part of a documented course of treatment. Most Plans must allow for the completion of these services for certain timeframes which are specific to each health condition and defined under H&S section 1373.96. Under H&S section 1373.96, Members do not need to have transitioned from FFS to Medi-Cal Managed Care to qualify for the completion of services if they have a qualifying health condition. Members should call their Plan for more information about completing services as required by the Knox Keene Act.​​    

4. Yog tias tus Tswvcuab hloov ntawm ib qho Medi-Cal txoj kev npaj khomob (Plan) mus rau lwm qhov lossis poob kev tsim nyog thiab tom qab ntawd rov tau txais kev tsim nyog, Tus Tswvcuab puas tau ntxiv 12 lub hlis mus ntsib lawv tus kws khomob Medi Cal Fee-for-Service (FFS)?​​ 

The Member only gets 12 months from the date of his or her initial enrollment into a Plan.  However, if a Member changes plans within the first 12 months of initial enrollment or loses Medi-Cal Managed Care eligibility and then later regains eligibility, the Member has the right to a new 12 months. If the Member changes plans or loses and then later regains Medi-Cal Managed Care eligibility a second time or more, the 12-month period does not start over and the Member does not have a right to a new 12 months of CoC.​​  

5. Thaum twg Medi-Cal tswj hwm txoj kev npaj khomob (Plan) yuav ceebtoom rau Tus Tswvcuab seb lawv puas tuaj yeem mus ntsib lawv qhov Medi-Cal Fee-rau-Service tam sim no?​​   

Txoj Kev Npaj yuav tsum ua kom tiav txhua qhov kev thov thiab muab ntawv ceeb toom rau txhua tus Tswvcuab tsis pub dhau 30 hnub txij li hnub Lub Hom Phiaj tau txais qhov kev thov, lossis sai dua yog tias tus tswvcuab tus mob yuav tsum tau saib xyuas tam sim ntawd.​​  

6. Tus Tswv Cuab Tus Nqi Medi Cal Fee-for-Service (FFS) puas tuaj yeem tau txais kev pom zoo los ntawm Medi-Cal qhov kev npaj khomob (Plan) xa tus tswvcuab mus rau lwm tus kws kho mob sab nraud?​​ 

Tsis yog. Ib tus neeg muab kev pabcuam FFS tsis tuaj yeem xa tus Tswvcuab mus rau lwm tus kws kho mob sab nraud yam tsis tau tso cai ua ntej los ntawm Txoj Haujlwm.  Ib tus kws kho mob sab nraud, pom zoo los ntawm Txoj Kev Npaj, raws li lub sijhawm CoC, yuav tsum ua haujlwm nrog Txoj Haujlwm thiab nws cov chaw muab kev cog lus sib cog lus.  Yog tias Lub Hom Phiaj tsis muaj hom kws tshwj xeeb hauv nws lub network uas tus Tswv Cuab xav tau, ces Lub Hom Phiaj yuav tsum muab tus Tswv Cuab xa mus rau ib tus kws kho mob tshwj xeeb uas tsim nyog sab nraud ntawm Lub Hom Phiaj tus neeg muab kev pab cuam network.​​  

7. Yuav ua li cas yog tus Tswv Cuab Tus Nqi Medi Cal Fee-for-Service (FFS) yuav tsis tuaj yeem ua haujlwm nrog Medi-Cal cov phiaj xwm kev noj qab haus huv (Plan)?​​   

Yog tias tus neeg muab kev pabcuam FFS tsis tuaj yeem lossis tsis tuaj yeem ua haujlwm nrog Txoj Kev Npaj, Txoj Haujlwm yuav hloov tus tswvcuab mus rau tus kws khomob uas yog ib feem ntawm Txoj Haujlwm Pabcuam Network.​​  

8. Yuav ua li cas yog ib tug tswv cuab muaj kev tso cai kho mob tseem ceeb?​​ 

If a Member has an active prior treatment authorization for a service, it remains in effect following a Member’s enrollment into a Plan for 90 days. The Plan will arrange for services under the active prior treatment authorization with a provider that is in the Plan’s network, or if there is no provider in the Plan’s network to provide the service, with an out-of-network provider if the Plan and out-of-network provider come to an agreement. After 90 days, the active treatment authorization remains in effect for the duration of the treatment authorization or until the Plan provides a new authorization if medically necessary, whichever is shorter.​​ 

9. Ib tug tswvcuab puas tuaj yeem khaws lawv Cov Khoom Siv Kho Mob (DME) thiab Cov Khoom Siv Kho Mob?​​ 

Yes. Members can keep their existing DME rentals and medical supplies from their existing provider for at least 90 days following their enrollment into a Plan. If the existing provider is not in the Plan’s network of providers, after 90 days, the Plan may switch the Member to a provider that is in the Plan’s network and arrange for new DME and medical supplies to be delivered to the Member if medically necessary. Call your Plan for help with these services.​​ 

10. Puas yog “Lub Sijhawm Saib Xyuas Ntxiv” (txog li 12 lub hlis txij li hnub uas tus tswvcuab tuaj koom) puas muaj kev cuam tshuam rau cov txheej txheem uas twb muaj lawm rau Cov Kev Thov Kho Mob (MERs)?​​ 

DHCS will provide Medi-Cal managed care health plans with a list (the Exemption Transition Data Report) of Members whose MERs were denied.  Plans are required to consider a request for exemption from Plan enrollment that is clinically denied as a request for CoC to complete a course of treatment with an existing FFS provider.  
Otherwise, the CoC requirements mandate Plans to provide access to certain out-of-network providers for Members who are required to transition from FFS into a Plan.  To ensure a smooth transition into a Plan, a Member may continue to see their FFS provider for 12 months:​​  

• Yog tias Tus Tswv Cuab muaj kev sib raug zoo tam sim no nrog FFS tus kws kho mob,​​  
• Yog tias Txoj Kev Npaj tsis muaj teeb meem kev saib xyuas zoo nrog tus kws kho mob,​​  
• Yog tias tus kws kho mob yuav lees txais cov nqi cog lus lossis FFS tus nqi, thiab ​​ 
• Tus kws kho mob yog California State Plan pom zoo muab kev pab​​ 

Lub sijhawm CoC cov kev cai rau Cov Kev Npaj tsis tshem tawm cov cai ntawm Cov Tswv Cuab tsim nyog los ua daim MER lossis daim ntawv thov rho npe txhua lub sijhawm.  Cov txheej txheem MER uas twb muaj lawm (22, California Txoj Cai Tswjfwm Ntiag Tug, ntu 53887) thiab ua tiav cov kev pabcuam kev pabcuam (H&S ntu 1373.96) nyob twj ywm rau txhua tus tswv cuab uas yuav tsum tau rau npe rau hauv Cov Kev Npaj.​​  

Further information on MERs is provided in All Plan Letter (APL) 17-007, Continuity of Care for New Enrollees Transitioned to Managed Care After Requesting a Medical Exemption and Implementation of Monthly Medical Exemption Review Denial Reporting (PDF)​​ 

11. Puas yog Medi-Cal tswj hwm kev saib xyuas kev noj qab haus huv (Plan) yuav tsum tso cai rau Tus Tswv Cuab cov lus thov rau kev saib xyuas txuas ntxiv nrog lawv tus kws kho mob Medi Cal Fee-for-Service (FFS) uas twb muaj lawm?​​    

Txhua Txoj Kev Npaj yuav tsum tso cai rau txhua qhov kev thov los ntawm ib tus tswvcuab yuav tsum tau cuv npe rau CoC tsuav yog:​​  

• The Plan has confirmed, based on service data that it receives regularly from DHCS, that the Member’s FFS provider provided services to the Member any time within the last 12 months from the Member’s date of enrollment into a Plan; OR, the Plan has verified the existing relationship through other means,​​ 
• Yog tias Txoj Kev Npaj tsis muaj teeb meem kev saib xyuas zoo nrog tus kws kho mob,​​ 
• If the provider will accept the Plan’s contracted rates or FFS rates, and​​ 
• Tus kws kho mob yog California State Plan pom zoo muab kev pab​​ 

Additionally, Plans must comply with requirements of the H&S section 1373.96, which outlines specific circumstances in which Plans must provide Members with access to out-of-network providers at the Member’s request and if the Member has one of the health conditions listed in H&S section 1373.96.​​ 

12. “Qhov teeb meem ntawm kev saib xyuas zoo” txhais li cas?​​ 

Under these circumstances, a quality-of-care issue means a Medi-Cal managed care health plans (Plan) can document its concerns with the provider’s quality of care to the extent that the provider would not be eligible to provide services to any of the Plan’s Members.​​ 

13. Ib tug tswvcuab yuav tsum tau ua ntawv tsis txaus siab ntau npaum li cas yog tias Medi-Cal qhov kev npaj khomob tau tswjfwm (Plan) tsis kam thov rau Lub Sijhawm Khomob Ntxiv (txog 12 lub hlis txij li hnub sau npe) nrog Medi-Cal Fee-for-Service (FFS) uas twb muaj lawm?​​    

Ib tug tswvcuab uas yuav tsum tau cuv npe tuaj yeem ua ntawv tsis txaus siab nrog Lub Hom Phiaj txhua lub sijhawm.  Lub Hom Phiaj yuav tsum daws txhua qhov kev tsis txaus siab thiab sau ntawv ceeb toom rau Tus Tswv Cuab sai li sai tau raws li tus tswv cuab txoj kev noj qab haus huv xav tau, thiab tsis pub dhau 30 hnub txij li hnub MCP tau txais tsab ntawv ceeb toom ntawm qhov tsis txaus siab, lossis tsis pub ntev tshaj 72 teev nyob rau hauv rooj plaub ntawm kev tsis txaus siab sai.​​  

14. Yuav ua li cas yog tias ib tug tswv cuab uas yuav tsum tau rau npe rau hauv Medi-Cal tswj kev saib xyuas kev noj qab haus huv txoj kev npaj (Plan) muaj mob loj, mob, los yog tsis tu ncua kev kho mob los yog kev noj qab haus huv uas yuav tsum tau kev kho mob ceev los yog saib xyuas ua ntej lub Plan txiav txim seb tus tswv cuab yuav mus ntxiv. Kev kho mob nrog tus kws kho mob Medi Cal Fee-for-Service (FFS) lossis thaum lub sijhawm ua kev tsis txaus siab?​​  

If the Member has urgent medical needs, they must call their Plan primary care provider and their Plan. Under State and federal law, the Plan is required to ensure that the Member obtains all medically necessary Medi-Cal covered services.  A Plan primary care provider will assist the Member in obtaining all urgent medically necessary services and medications. Additional requirements pertaining to CoC are set forth in the Knox Keene Act, H&S section 1373.96 and require most health plans in California—including Medi-Cal plans—to, at the request of a Member, provide for the completion of covered services by a terminated or nonparticipating health plan provider.​​ 

15. Yuav ua li cas yog tus tswv cuab xav tau kev pab kho mob txuas ntxiv los ntawm Medi Cal Fee-for-Service (FFS) tus kws kho mob uas tsis yog ib feem ntawm Medi-Cal tswj hwm txoj kev pab them nqi kho mob (Plan) network rau ntau tshaj li 12 lub hlis tso cai?​​   

Txhua Txoj Kev Npaj tuaj yeem xaiv ua haujlwm nrog Tus Tswvcuab tus kws kho mob sab nraud dhau los ntawm 12 lub hlis CoC, tab sis lawv tsis tas yuav ua li ntawd.​​  

16. Ib tug tswvcuab uas yuav tsum tau sau npe yuav raug tso cai kom teem sijhawm teem sijhawm nrog Medi Cal Fee-for-Service (FFS) tom qab tau tso npe rau hauv Medi-Cal txoj kev npaj khomob (Plan)?​​        

Cov phiaj xwm yuav tsum tso cai rau cov tswv cuab tshiab tuaj yeem teem sijhawm teem sijhawm nrog FFS cov chaw muab kev pabcuam thaum lub sijhawm “CoC” (txog 12 lub hlis txij li hnub tso npe):​​  

• Yog tias lub sijhawm teem sijhawm nrog FFS tus muab kev pabcuam uas tus tswvcuab tau pom nyob rau hauv 12 lub hlis dhau los, raws li kev txheeb xyuas los ntawm Txoj Kev Npaj los ntawm FFS siv cov ntaub ntawv LOSSIS, Txoj Kev Npaj tau txheeb xyuas qhov kev sib raug zoo uas twb muaj lawm los ntawm lwm txoj kev,​​ 
• Yog tias Txoj Kev Npaj tsis muaj teeb meem kev saib xyuas zoo nrog tus kws kho mob,​​ 
• If the provider will accept the Plan’s contracted rates or FFS rates, and​​ 
• Tus kws kho mob yog California State Plan pom zoo muab kev pab.​​ 

Yog tias lub sijhawm teem sijhawm nrog tus kws kho mob Tus Tswvcuab tsis tau pom dua, tab sis vim tias muaj mob hnyav nws yog qhov tsim nyog rau kev kho mob kom lawv tuav lub sijhawm teem tseg, ces Lub Hom Phiaj yuav tsum tso cai rau tus tswvcuab tuav sijhawm raws li qhov yuav tsum tau ua rau "ua tiav cov kev pabcuam them nqi" los ntawm H&S ntu 1373.96. Yog tias qhov kev teem sijhawm tsis cuam tshuam txog kev mob hnyav (raws li tau hais tseg hauv H&S ntu 1373.96), tab sis yog qhov tsim nyog rau kev kho mob, Lub Hom Phiaj yuav tsum npaj rau Tus Tswv Cuab los tuav lub sij hawm los yog teem caij nrog tus kws kho mob.​​ 

17. Puas yog cov lus teb saum toj no siv tau rau Medi-Cal Cov Tswv Cuab uas tau txais cov kev pab tu ncua sij hawm nyob rau hauv Lub Chaw Saib Xyuas Neeg Mob (SNF)? Los yog muaj cov cai sib txawv uas siv rau Cov Tswv Cuab no?​​ 

Pib txij Lub Ib Hlis Ntuj 1, 2023 txog rau lub Rau Hli 30, 2023, Cov tswv cuab nyob hauv SNF thiab kev hloov ntawm FFS mus rau Txoj Kev Npaj yuav muaj 12 lub hlis ntawm CoC rau SNF qhov chaw. Cov tswv cuab no tsis tas yuav thov CoC kom nyob hauv SNF txuas ntxiv. Cov tswv cuab raug tso cai nyob hauv tib lub SNF raws li CoC tsuas yog tias tag nrho cov hauv qab no siv tau:​​ 

• Lub chaw muaj ntawv pov thawj thiab tso cai los ntawm California Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv;​​ 
• Lub tsev kho mob tau tso npe ua tus kws kho mob hauv Medi-Cal;​​ 
• SNF thiab Plan pom zoo rau cov nqi them uas ua tau raws li lub xeev txoj cai lij choj; thiab​​ 
• The facility meets the MCP’s applicable professional standards and has no disqualifying quality-of-care issues.​​ 

Following their initial 12-month CoC period, Members may request an additional 12 months of CoC, following the process established by APL 23-022.​​ 

Ib tug tswvcuab tshiab rau npe rau hauv Txoj Kev Npaj thiab nyob hauv SNF tom qab Lub Rau Hli 30, 2023 tsis tau txais CoC tsis siv neeg thiab yuav tsum hu rau lawv Txoj Kev Npaj kom thov CoC.​​ 

18. Puas yog cov lus teb saum toj no siv tau rau Medi-Cal Cov Tswvcuab uas tau txais kev pabcuam Ntev-ntev hauv Lub Chaw Khomob Nruab Nrab rau Kev Loj Hlob (ICF/DD), ICF/DD-Habilitative (ICF/DD-H), lossis ICF/ DD-Nursing (ICF/DD-N) (hu ua ICF/DD) tsev? Los yog muaj cov cai sib txawv uas siv rau Cov Tswv Cuab no?​​ 

Pib txij Lub Ib Hlis Ntuj Tim 1, 2024, Cov tswv cuab nyob hauv ICF/DD lub tsev thiab hloov ntawm FFS mus rau Txoj Kev Npaj yuav muaj 12 lub hlis ntawm CoC rau ICF/DD qhov chaw nyob hauv tsev. Cov Tswv Cuab no tsis tas yuav thov CoC kom nyob twj ywm hauv ICF/DD lub tsev ntawd. Cov tswv cuab raug tso cai nyob hauv tib lub tsev ICF/DD hauv qab CoC tsuas yog tias tag nrho cov hauv qab no siv tau:​​ 

• Lub tsev tau ntawv pov thawj thiab tso cai los ntawm California Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv;​​ 
• Lub tsev yog California State Plan tau txais kev pab;​​ 
• Txoj Kev Npaj muaj peev xwm txiav txim siab tias Tus Tswv Cuab muaj kev sib raug zoo ua ntej nrog lub tsev;​​ 
• ICF/DD lub tsev thiab Plan pom zoo rau cov nqi them uas ua tau raws li lub xeev txoj cai lij choj; thiab​​ 
• The home meets the MCP’s applicable professional standards and has no disqualifying quality-of-care issues.​​ 

Following their initial 12-month “CoC period,” Members may request an additional 12 months of CoC, following the process established by APL 23-022.​​  

Ib tug tswvcuab tshiab rau npe rau hauv Txoj Kev Npaj thiab nyob hauv ICF/DD tom qab Lub Rau Hli 30, 2023 tsis tau txais CoC tsis siv neeg thiab yuav tsum hu rau lawv Txoj Kev Npaj thov CoC.​​ 

19. Puas yog cov lus teb saum toj no siv tau rau Medi-Cal Cov Tswv Cuab uas tau txais cov kev pab cuam Kho Mob Sij Hawm Ntev hauv Subacute Care (cov neeg laus thiab menyuam yaus) cov chaw? Los yog muaj cov cai sib txawv uas siv rau Cov Tswv Cuab no?​​ 

Pib txij Lub Ib Hlis Ntuj Tim 1, 2024, Cov tswv cuab nyob hauv Subacute Care chaw thiab hloov los ntawm FFS mus rau Ib Txoj Kev Npaj yuav muaj 12 lub hlis ntawm CoC rau qhov kev tso kawm Subacute Care. Cov Tswv Cuab no tsis tas yuav thov CoC kom nyob hauv qhov chaw kho mob Subacute. Cov tswv cuab raug tso cai nyob hauv tib qhov chaw kho mob Subacute raws li CoC tsuas yog tias tag nrho cov hauv qab no siv tau:​​ 

• Lub chaw muaj ntawv pov thawj thiab tso cai los ntawm California Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv;​​ 
• Lub tsev kho mob tau cog lus nrog DHCS Subacute Care Unit;​​ 
• Lub chaw yog California State Plan uas tau tso cai muab kev pab;​​ 
• Txoj Kev Npaj muaj peev xwm txiav txim siab tias Tus Tswv Cuab muaj kev sib raug zoo ua ntej nrog lub chaw;​​ 
• Lub chaw thiab Plan pom zoo rau cov nqi them uas ua tau raws li lub xeev txoj cai lij choj; thiab​​ 
• The facility meets the MCP’s applicable professional standards and has no disqualifying quality-of-care issues.​​ 

Following their initial 12-month “Continuity of Care period,” Members may request an additional 12 months of CoC, following the process established by APL 23-022. ​​ 

Ib tug tswvcuab tshiab rau npe rau hauv Txoj Kev Npaj thiab nyob hauv Subacute Care tom qab Lub Rau Hli 30, 2023 tsis tau txais CoC tsis siv neeg thiab yuav tsum hu rau lawv Txoj Kev Npaj thov CoC.​​