Tsev Cov Kev Pabcuam Kev Tshuaj Xyuas Thaum Ntxov thiab Tsis Tu Ncua, Kev Kuaj Mob, thiab Kev Kho Mob

Thaum Ntxov thiab Lub Sijhawm Saib Xyuas, Kev Ntsuas, thiab Kev Kho Mob

Kev Tshuaj Ntsuam Xyuas Thaum Ntxov thiab Lub Sij Hawm, Kev Ntsuas, & Kev Kho Mob (EPSDT) yog ib qho txiaj ntsig ntawm Medi-Cal rau cov tib neeg hnub nyoog qis dua 21 xyoos uas muaj kev tsim nyog tau txais Medi-Cal tag nrho. Cov txiaj ntsig no tso cai rau kev tshuaj xyuas ib ntus los txiav txim siab txog kev kho mob. Raws li kev txheeb xyuas kev xav tau thiab kev kuaj mob; Kev kho mob yog muab los kho lossis kho qhov tsis xws luag thiab mob ntev. Cov kev pabcuam EPSDT suav nrog tag nrho cov kev pabcuam hauv Medi-Cal. Ntxiv nrog rau cov txiaj ntsig Medi-Cal ib txwm muaj, tus neeg txais txiaj ntsig uas muaj hnub nyoog qis dua 21 xyoos tuaj yeem tau txais cov kev pabcuam tsim nyog ntxiv.

Raws li qhov yuav tsum tau muaj nyob rau hauv Tshooj 1905(r) ntawm Txoj Cai Xaus Saus thiab Title 42 Code of Federal Regulations (CFR) Section 441.50 et seq., Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) yog lub luag haujlwm muab kev pabcuam Medi-Cal tag nrho rau cov neeg tau txais txiaj ntsig hauv hnub nyoog qis dua 21 xyoos nrog kev tshuaj ntsuam xyuas zoo, Kev kuaj mob, thiab kev kho mob raws li EPSDT. Cov kev pabcuam no raug them yam tsis muaj nqi.

Ib Daim Ntawv Thov EPSDT Cov Kev Pabcuam Saib Xyuas Neeg Mob Li Cas?

Rau tag nrho cov nqi-rau-kev pabcuam Medi-Cal cov neeg tau txais txiaj ntsig uas tsis muaj California Cov Kev Pabcuam Menyuam Yaus (CCS) tsim nyog kho mob, tus kws khomob yuav tsum xa Daim Ntawv Tso Cai Khomob (TAR) rau Pediatric Day Health Care (PDHC) thiab Private Duty Nursing (PDN) cov kev pabcuam. Rau TAR cov ntaub ntawv, saib mus rau TAR Overview seem ntawm Medi-Cal Phau Ntawv Qhia. Ntxiv rau TAR, tus kws kho mob yuav tsum xa cov ntaub ntawv kho mob hauv qab no:

Plan of Treatment (POT) kos npe los ntawm ib tus kws kho mob (hauv 30 hnub txij li hnub pib pib hnub pab kho mob)
Kev Soj Ntsuam Kev Saib Xyuas Neeg Mob (hauv 30 hnub txij li hnub pib ua haujlwm kho mob)
Cov ntaub ntawv kho mob txhawb nqa cov kev pabcuam hauv tsev laus tau thov, piv txwv li cov ntaub ntawv kho mob, cov ntawv sau tseg, thiab cov ntawv kho mob

Yuav ua li cas yog tus me nyuam muaj cai CCS rau npe rau hauv Medi-Cal Managed Care Health Plan?

Rau cov neeg tau txais txiaj ntsig tau txais kev tso npe hauv Medi-Cal Managed Care Health Plan (MCP) uas muaj peev xwm CCS-tsim nyog tau txais kev kho mob, yuav tsum fax Daim Ntawv Thov Kev Tso Cai (SAR) rau cov neeg tau txais txiaj ntsig lub chaw ua haujlwm hauv nroog CCS County lossis xa SAR rau hauv Tus Muab Kev Pabcuam Electronic Data Interchange (PEDI).

Cov chaw muab kev pabcuam hauv Alpine, Amador, Calaveras, Colusa, El Dorado, Glenn, Imperial, Inyo, Mariposa, Mono, Nevada, Plumas, San Benito, Sierra, Sutter, Tehama, Tuolumne thiab Yuba counties, yuav tsum fax ib SAR rau Pediatric Day Health Care (PDHC) thiab PDN Cov Kev Pabcuam Kev Pabcuam rau Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (916) 440-5313 lossis upload SAR rau hauv PEDI.

Rau cov ntaub ntawv SAR dav dav, saib mus rau California Children's Services (CCS) Program-Service Authorization Request (SAR) seem ntawm Medi-Cal Provider Manual. Ntxiv rau SAR, tus kws kho mob yuav tsum xa cov ntaub ntawv kho mob hauv qab no:

Plan of Treatment (POT) kos npe los ntawm ib tus kws kho mob (hauv 30 hnub txij li hnub pib pib hnub pab kho mob)
Kev Soj Ntsuam Kev Saib Xyuas Neeg Mob (hauv 30 hnub txij li hnub pib ua haujlwm kho mob)
Cov ntaub ntawv kho mob txhawb nqa cov kev pabcuam hauv tsev laus tau thov, piv txwv li cov ntaub ntawv kho mob, cov ntawv sau tseg, thiab cov ntawv kho mob

Yuav ua li cas yog tus me nyuam muaj cai CCS rau npe nyob rau hauv Tag Nrho Tus Qauv Me Nyuam Medi-Cal Managed Care Health Plan?

Rau cov neeg tau txais txiaj ntsig tau txais kev tso npe hauv Ib Tus Qauv Me Nyuam Yaus (WCM) Medi-Cal Managed Care Health Plan (MCP), uas muaj CCS-tsim nyog kho mob thiab raug tswj los ntawm WCM MCP, thov kev tso cai ntawm cov kev pabcuam PDN yuav raug xa mus rau MCP txhawm rau tshuaj xyuas thiab tso cai.

MCP yog lub luag haujlwm rau kev tso cai ntawm PDN cov kev pabcuam. Cov kws kho mob yuav tsum xa daim ntawv tso cai rau MCP rau tag nrho cov kev pabcuam PDN ntsig txog CCS Program uas tsim nyog tau txais kev kho mob. Cov kws kho mob yuav tsum xa cov ntaub ntawv kho mob hauv qab no:

POT kos npe los ntawm tus kws kho mob (nyob rau hauv 30 hnub txij li hnub pib kev pab kho mob)
Kev Soj Ntsuam Kev Saib Xyuas Neeg Mob (hauv 30 hnub txij li hnub pib ua haujlwm kho mob)
Cov ntaub ntawv kho mob txhawb nqa cov kev pabcuam hauv tsev laus tau thov, piv txwv li cov ntaub ntawv kho mob, cov ntawv sau tseg, thiab cov ntawv kho mob
Lwm cov ntaub ntawv, raws li tau teev tseg los ntawm MCP

Txoj haujlwm WCM yuav tsum tau ua nyob rau hauv 21 lub nroog uas tau teev tseg hauv peb theem.

Theem 1 - Siv rau lub Xya Hli 1, 2018

WCM Medi-Cal Managed Care Health Plan
CenCal Health, Central California Alliance for Health, Health Plan of San Mateo
WCM Counties
San Luis Obispo, Santa Barbara, Merced, Monterey, Santa Cruz, San Mateo

Theem 2 - Siv rau lub Xya Hli 1, 2019

WCM Medi-Cal Managed Care Health Plan
Partnership Health Plan
WCM Counties
Del Norte, Humboldt, Lake, Lassen, Marin, Mendocino, Modoc, Napa, Siskiyou, Shasta, Solano, Sonoma, Trinity, Yolo

Theem 3 - Tsis pub dhau Lub Xya Hli 1, 2019

WCM Medi-Cal Managed Care Health Plan
CalOptima
WCM County
Orange

Electronic Visit Verification (EVV)

Tsoom Fwv Teb Chaws txoj cai lij choj hais kom cov xeev siv EVV rau txhua qhov kev pab cuam kho mob tus kheej uas tau txais Medicaid (PCS) thiab cov kev pab kho mob hauv tsev (HHCS) uas yuav tsum tau mus ntsib hauv tsev los ntawm tus kws kho mob.

Cov chaw muab kev cuam tshuam los ntawm EVV

HHCS tau siv rau lub Ib Hlis 1, 2023 thiab txhua tus neeg muab kev pabcuam uas cuam tshuam yuav tsum sau npe nrog EVV. Cov chaw muab kev pab cuam saib xyuas menyuam yaus hauv California (CCS) Private Duty Nursing (PDN), suav nrog Individual Nurse Providers (INP) thiab Home Health Agencies (HHA) raug cuam tshuam los ntawm EVV.

Yog xav paub ntxiv txog EVV, thov mus saib nplooj ntawv web DHCS EVV.

Yog xav paub ntxiv txog INPs uas raug cuam tshuam, thov mus saib nplooj ntawv web EVV INP

Cov ntaub ntawv tiv tauj

Yog tias koj muaj lus nug txog cov sijhawm ua haujlwm hauv tsev PDN/CHHA/PDHC uas tau pom zoo los ntawm EPSDT rau koj tus menyuam, lossis yog tias koj xav tshaj tawm tias tsis tau daws qhov teeb meem kev pabcuam ib nrab lossis tsis muaj kev pabcuam, thov xa email rau EPSDT@dhcs.ca.gov.

Rau cov lus nug txog SAR, email CCSDirectedReview@dhcs.ca.gov lossis hu rau (916) 552-9105.

Thaum xa email lossis xa xov, thov sau koj lub npe, lub npe ntawm tus menyuam, tus menyuam tus lej Medi-Cal, thiab tus lej xovtooj uas peb tuaj yeem tiv tauj koj kom peb tuaj yeem teb koj qhov kev thov.

Yog koj muaj lus nug txog TAR, thov email rau PDNinquiries@dhcs.ca.gov los yog hu rau (800) 541-5555.