Kev saib xyuas txuas ntxiv
Continuity of Care (Coc) yog dab tsi?
CoC means that you may be able to keep a Medi-Cal provider for up to 12 months after you enroll in a new managed care plan. This includes your primary care doctor, specialists, and most therapists. Therapists you may be able to keep include physical, occupational, respiratory, and speech therapists, and behavioral health treatment providers. A Medi-Cal managed care health plan will be referred to as the “Plan.”
Koj tuaj yeem tau txais kev tiv thaiv CoC los khaws Medi-Cal tus kws kho mob ntev txog 12 lub hlis yog tias tag nrho cov no siv rau koj:
- Koj yuav tsum tau rau npe rau hauv ib txoj kev npaj saib xyuas, thiab
- Koj xav khaws ib tus kws kho mob Medi-Cal uas tsis nyob hauv koj txoj kev npaj tshiab, thiab
- Koj tau mus rau tus kws kho mob tsawg kawg ib zaug hauv 12 lub hlis dhau los, thiab
- Koj tus kws kho mob txaus siab ua haujlwm nrog koj txoj kev npaj los ntawm kev pom zoo nrog koj txoj kev npaj tshiab kom tau nyiaj.
CoC kuj txhais tau tias koj tuaj yeem tau txais cov kev pabcuam khomob thiab cov tshuaj uas koj xav tau ntxiv tomqab koj tau tso npe rau hauv Txoj Kev Npaj. Yog tias koj tau txais daim ntawv xaj lossis kev tso cai rau cov tshuaj, kev pabcuam, kev kho mob, txheej txheem, lossis kev phais uas tau teem tseg tom qab koj koom nrog Txoj Haujlwm tshiab, koj tseem tuaj yeem tau txais nws. Qee qhov xwm txheej, koj yuav tsum muaj ib tus kws kho mob sib txawv xa kev saib xyuas lossis ua cov txheej txheem koj xav tau. Tham nrog koj tus kws kho mob Plan tshiab txog cov kev pabcuam thiab tshuaj uas koj xav tau.
Be sure to read the Frequently Asked Questions for more detailed information about this or contact your Plan.
Qhov no puas siv tau rau kuv?
Cov ntaub ntawv no siv tau rau koj yog tias:
- Koj tau txais Medi-Cal tsis tu ncua (tus nqi-rau-kev pabcuam) thiab
- Koj yog ib tug tswv cuab tshiab hauv Medi-Cal txoj kev npaj saib xyuas, thiab
- Koj tau tso npe rau hauv koj qhov Medi-Cal txoj kev npaj khomob hauv xyoo tas los.
Raws li ib feem ntawm 2024 MCP kev hloov pauv, qee qhov Medi-Cal MCPs tab tom hloov 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.
CoC siv rau koj yog tias:
- Koj txoj kev npaj Medi-Cal tsis muaj nyob hauv koj lub nroog lawm txij li lub Ib Hlis 1, 2024, lossis
- Koj txoj kev npaj Medi-Cal xyoo 2023 yog Health Net hauv Los Angeles County thiab Health Net qhia rau koj nyob rau nruab nrab Lub Kaum Ib Hlis 2023 tias koj yuav raug xa rov qab rau lawv tus khub Molina Healthcare thaum Lub Ib Hlis 1, 2024, lossis
- Koj tau txais Medi-Cal cov kev pab cuam los ntawm Kaiser Permanente cov chaw muab kev pab thiab Kaiser qhia rau koj tias koj yuav raug tso npe rau hauv Kaiser Permanente Medi-Cal Plan, pib lub Ib Hlis 1, 2024, los yog
- Koj muaj hnub nyoog 25 xyoos lossis qis dua, thiab tau txais cov kev pabcuam tu menyuam lossis siv los txais cov kev pabcuam tu menyuam yaus, thiab tau tso npe rau hauv Medi-Cal tswj kev saib xyuas los ntawm ib txwm (tus nqi-rau-kev pabcuam) Medi-Cal.
Kuv puas tuaj yeem khaws kuv cov neeg muab kev pabcuam hauv kuv txoj kev npaj Medi-Cal tshiab?
You will get most of your needed health care services through your new Medi-Cal plan’s provider network (group). It has doctors, therapists, imaging centers, transportation, etc.
Not all providers are in all networks. Providers you had in FFS Medi-Cal might not be in your new plan’s network. CoC requires that you may need plan approval to go to some providers. You have rights that include possibly keeping a Medi-Cal provider for up to 12 months who is not in your new plan’s network.
What if I have Medi-Cal and Medicare?
This information applies only to your Medi-Cal providers. Your new Medi-Cal plan does not limit Medicare providers. Medicare providers do not have to be in your Medi-Cal plan’s provider network. This applies to both Medi-Cal only beneficiaries and those dually eligible for Medicare and Medi-Cal, for their Medi-Cal Providers.
Kuv tuaj yeem thov kom mus ntsib kuv tus kws kho mob li cas?
Call your Plan to find out if you qualify to continue seeing your provider. Tell your Medi-Cal plan that you want to continue seeing your current doctor. You will need to provide the name of your doctor or hospital, your medical condition, and the treatments you are receiving. If your doctor agrees to keep seeing you as a patient and will work with your new Medi-Cal managed care plan, you may be able to continue seeing your doctor for up to 12 months, this is called CoC.
Koj tuaj yeem tau txais kev tiv thaiv CoC los khaws Medi-Cal tus kws kho mob ntev txog 12 lub hlis yog tias tag nrho cov no siv rau koj:
- Koj yuav tsum tau rau npe rau hauv ib txoj kev npaj saib xyuas, thiab
- Koj xav khaws ib tus kws kho mob Medi-Cal uas tsis nyob hauv koj txoj kev npaj tshiab, thiab
- Koj tau mus rau tus kws kho mob tsawg kawg ib zaug hauv 12 lub hlis dhau los, thiab
- Koj tus kws kho mob txaus siab ua haujlwm nrog koj txoj kev npaj los ntawm kev pom zoo nrog koj txoj kev npaj tshiab kom tau nyiaj.
Be sure to read the Frequently Asked Questions for more detailed information about this or contact your plan.
Kuv puas tuaj yeem tau txais Kev Kho Mob Ntxiv rau txhua tus ntawm kuv tus kws kho mob?
No. CoC doesn’t apply to all providers. For some providers, such as transportation providers, you will need a new one from your new Medi-Cal plan’s provider network. Plans can tell you which providers you may be able to keep under Continuity of Care.
Please visit Frequently Asked Questions for more detailed information on the types of providers.
Kuv yuav ua li cas thiaj tau txais Kev Kho Mob Ntxiv?
Muaj peb txoj hauv kev kom tau txais CoC:
1. Hu rau your new plan. Your plan’s phone number is in your enrollment packet and on your health plan card.
Nug koj txoj kev npaj yog tias lawv twb ua haujlwm nrog koj cov kws kho mob thiab kws kho mob lawm.
- Yog tias lawv ua, koj tuaj yeem khaws koj cov kws kho mob thiab kws kho mob.
- If they don’t, you can ask if you can keep your doctors and therapists. You can only keep them for up to 12 months.
2. Nug koj tus kws kho mob lossis tus kws kho mob hu rau koj txoj kev npaj. Ib tus kws kho mob tuaj yeem hu rau lub phiaj xwm thiab nug kom khaws koj li lawv tus neeg mob.
3. Nug ib tug neeg hauv tsev neeg lossis tus neeg sawv cev rau koj hu rau koj txoj kev npaj. Lwm tus tuaj yeem hu koj txoj kev npaj rau koj. Lawv tuaj yeem ua daim ntawv thov rau koj los ua koj tus neeg sawv cev tso cai. Koj txoj kev npaj yuav nug koj ncaj qha yog tias koj tsis ua li cas nrog ib tus neeg thov rau koj.
What if my provider doesn’t want to work with my plan?
If your previous Medi-Cal provider does not want to work with your managed care plan, you will need to choose a new provider in your plan’s network.
Kuv puas tuaj yeem tau txais tag nrho kuv cov tshuaj?
Yog lawm, feem ntau koj tuaj yeem tau txais cov tshuaj tib yam txawm tias koj tus kws kho mob yav dhau los Medi-Cal tsis ua haujlwm nrog koj txoj kev npaj tshiab. Medi-Cal Rx them rau koj cov tshuaj noj. Koj tus kws kho mob tshiab tuaj yeem sau ntawv rau lawv kom koj tau txais los ntawm koj lub tsev muag tshuaj. Koj txoj kev npaj kuj tseem them cov tshuaj uas koj tus kws kho mob muab rau koj hauv chaw ua haujlwm lossis chaw kho mob.
Yog xav paub ntxiv txog Medi-Cal Rx cov kev pab them nqi kho mob thiab cov khw muag tshuaj uas noj Medi-Cal, mus rau medi-calrx.dhcs.ca.gov. Lossis hu rau Medi-Cal Rx Lub Chaw Pabcuam Cov Neeg Siv Khoom ntawm
(800) 977-2273 (TTY: State Relay ntawm 711). Hu tau dawb.
Tham nrog koj tus kws kho mob tshiab txog cov tshuaj koj noj.
What if I have a scheduled surgery or an appointment with a specialist or doctor I haven’t been to before?
If you want to keep a scheduled surgery or appointment with a specialist you have not gone to before, call your plan to ask if you can keep the surgery or appointment. Your plan will either let you keep it or help you schedule it with a provider in your plan’s network.
Yuav ua li cas yog tias kuv muaj lus nug ntxiv?
Nov yog ob qhov chaw kom tau txais kev pab:
Chaw ua haujlwm ntawm Ombudsman
Hu rau (888) 452-8609, Monday txog Friday, 8 teev sawv ntxov txog 5 teev tsaus ntuj Hu tau dawb. Los yog email: MMCDOmbudsmanOffice@dhcs.ca.gov
Koj tuaj yeem hu lossis email rau ib qho ntawm cov laj thawj no:
- If you contacted your plan or provider but still need help with your CoC request
- Kom tau txais lus qhia yog tias koj tsis pom zoo nrog koj cov kev kho mob lossis kev pabcuam
- Nug lwm cov lus nug txog koj txoj kev npaj, tus kws kho mob, lossis Medi-Cal.
Lossis mus rau ntawm www.dhcs.ca.gov/ombudsman
Department of Managed Health Care (DMHC) Help Center
Hu rau (888) 466-2219 24 teev hauv ib hnub, 7 hnub hauv ib lub lis piam. Hu tau dawb.
Lawv tuaj yeem pab koj nrhiav kev pab kho mob lossis pab yog tias koj muaj kev tsis txaus siab txog kev npaj khomob.
Los yog mus rau dmhc.ca.gov
Lwm hom ntawv
Yog tias koj xav tau cov ntaub ntawv no ua lwm hom ntawv thov mus saib
AFS: Alternative Format Selection (ca.gov)
Contact DHCS with any questions or comments on Continuity of Care at MCQMD@dhcs.ca.gov