Cov Lus Nug Nug Txog Tus Kws Kho Mob (FAQs)​​ 

Hloov kho Lub Yim Hli 1, 2025​​ 

Cov Lus Nug Nquag Nug nram qab no muab cov lus qhia ntxiv thiab kev piav qhia rau cov neeg muab kev pabcuam Medi-Cal txog tus qauv nkag mus rau CGT. Thaum Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tau txais cov lus nug ntxiv, cov FAQ no yuav raug hloov kho tshiab. Yog xav paub ntxiv txog CGT Access Model, thov mus saib cov FAQs dav dav.
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General​​ 

Cov tshuaj twg yuav raug them raws li Medi-Cal's CGT Access Model?​​ 
Medi-Cal tus qauv nkag mus rau CGT yuav npog ob hom tshuaj CGT uas tau pom zoo los ntawm tsoomfwv Meskas Lub Chaw Haujlwm Saib Xyuas Khoom Noj thiab Tshuaj (FDA) uas CMS tau txheeb xyuas rau kev kho mob SCD. Qhov no suav nrog, CASGEVY ™ , uas yog ua los ntawm Vertex Pharmaceuticals, Inc., thiab LYFGENIA ™ , uas yog ua los ntawm bluebird bio, Inc.

Thaum twg kuv thiaj li pib them nqi rau cov tshuaj CGT SCD raws li Medi-Cal's CGT Access Model?
Cov kws kho mob uas tau sau npe yuav pib muab LYFGENIA rau cov tswv cuab Medi-Cal uas tsim nyog rau hnub ua haujlwm rau lossis tom qab Lub Xya Hli 1, 2025.
Cov kws kho mob uas tau sau npe yuav pib muab CASGEVY rau cov tswv cuab Medi-Cal uas tsim nyog rau hnub ua haujlwm rau lossis tom qab Lub Kaum Hli 1, 2025.
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Kev tsim nyog​​ 

Leej twg tsim nyog koom nrog Medi-Cal's CGT Access Model?​​ 
Yuav kom tsim nyog rau Medi-Cal's CGT Access Model, cov tswv cuab Medi-Cal yuav tsum ua tau raws li tag nrho cov qauv hauv qab no:​​ 

• Muaj cov ntaub ntawv kho mob ntawm SCD;​​ 

• Nkag mus rau npe rau hauv Medi-Cal puv npo thaum lub sijhawm tau txais cov tshuaj CGT (ceeb toom: ob qho tib si Medi-Cal tswj hwm kev saib xyuas thiab tus nqi-rau-kev pabcuam (FFS) cov tswvcuab yuav tsim nyog tau txais kev kho CGT);​​ 

• Muaj Medi-Cal ua lawv tus thawj them nyiaj;​​ 

• Tau txais ib qho ntawm ob qho tshuaj CGT los ntawm tus kws kho mob koom nrog; thiab​​ 

• Txaus siab rau tag nrho cov kev cai Medi-Cal uas tau tshaj tawm thiab CGT Access Model yuav tsum tau ua.​​ 

• Yog xav paub ntxiv, thov mus saib cov qauv kev pov hwm, suav nrog cov kev cai tso cai ua ntej, uas muaj nyob hauv online ntawm lub vev xaib no.​​ 

Cov txiaj ntsig​​ 

Kuv yuav tsum muab cov txiaj ntsig dab tsi raws li Medi-Cal's CGT Access Model?​​ 

Raws li CGT Access Model, cov chaw muab kev pabcuam yog lub luag haujlwm muab cov hauv qab no:​​ 

• Ib qho ntawm ob cov tshuaj CGT rau SCD​​ 

• CASGEVY los ntawm Vertex Pharmaceuticals, Inc.​​ 
  

• LYFGENIA los ntawm bluebird bio, Inc.​​ 
  

Fertility Preservation Services​​ 

• Raws li ib feem ntawm kev them nyiaj rov qab rau cov tshuaj CGT SCD, cov kws kho mob yuav tsum them:​​ 

• Txog li peb ntu ntawm kev sau thiab khaws cia cov ntaub ntawv khaws cia, txog li kaum tsib xyoos rau cov tswv cuab tsim nyog.​​ 

• Kev tsim nyog qhov chaw nyob, zaub mov, thiab cov nqi mus ncig kuj yuav raug them, yog tias tsim nyog tau txais cov kev pabcuam khaws cia muaj menyuam.​​ 

Kuv tsis tas yuav muab cov txiaj ntsig dab tsi raws li Medi-Cal's CGT Access Model?​​ 
Cov kws kho mob tsuas yog yuav tsum muab ib qho ntawm ob hom tshuaj CGT SCD thiab, yog tias xav tau, cov kev pab cuam tiv thaiv kev xeeb tub (raws li tau hais los saum toj no). Dua li ntawm qhov no, txhua yam kev pabcuam kho mob thiab tsis yog kev kho mob tsis raug them nyob rau hauv CGT Access Model thiab yuav muab thiab them nyob ntawm tus tswv cuab Medi-Cal txoj cai, raws li hauv qab no:​​ 

• Medi-Cal FFS: Cov neeg muab kev pab FFS yuav tsum xa thiab them nqi rau DHCS ncaj qha rau txhua yam kev pabcuam kho mob thiab tsis yog kev pabcuam CGT, suav nrog kev thauj mus los (sab nraud ntawm tus nqi tshuaj, kev tiv thaiv kev xeeb tub, thiab chaw nyob, pluas noj, thiab cov nqi mus ncig uas tsim nyog kom tau txais cov kev pabcuam tiv thaiv kev xeeb tub raws li tau hais los saum toj no).​​ 
  

• Kev Kho Mob Tswj Xyuas Medi-Cal: Tus tswv cuab txoj kev npaj kho mob tswj hwm Medi-Cal (MCP) yog lub luag haujlwm rau kev sib koom tes kho mob thiab pab kom tau txais ib qho ntawm ob hom tshuaj kho mob CGT sickle cell. Yog xav paub ntxiv txog kev sib koom tes kho mob Medi-Cal MCP thiab lwm yam uas yuav tsum tau ua, thov saib daim ntawv All Plan Letter uas siv tau ntawm DHCS lub vev xaib. Ntxiv mus, Medi-Cal MCPs yuav tsum them rau txhua yam kev pabcuam kho mob thiab tsis yog kev pabcuam CGT, suav nrog kev thauj mus los (sab nraud ntawm tus nqi tshuaj, kev tiv thaiv kev xeeb tub, thiab chaw nyob, pluas noj, thiab cov nqi mus ncig uas tsim nyog kom tau txais kev pabcuam tiv thaiv kev xeeb tub, raws li tau hais los saum toj no).​​ 

Kuv tuaj yeem txuas kuv tus neeg mob mus rau kev pabcuam li cas?​​ 
Yog tias koj tus neeg mob xav tau LYFGENIA, kuv qhov kev txhawb nqa bluebird muab Cov Neeg Taw Qhia Rau Cov Neeg Mob uas tuaj yeem pab koj thiab koj tus neeg mob tshawb nrhiav seb kev kho mob gene puas yog ib qho kev xaiv, coj koj tus neeg mob mus rau cov kauj ruam mus rau kev kho mob, thiab txuas lawv nrog cov neeg thiab cov peev txheej pab tau raws txoj kev. Koj tus neeg mob tuaj yeem ua tiav Daim Ntawv Sau Npe Rau Kev Pabcuam ncaj qha ntawm lawv tus kheej. Los yog, koj tuaj yeem ua kom tiav Daim Ntawv Sau Npe Rau Kev Pabcuam rau tus neeg mob thiab kuv qhov kev pabcuam bluebird yuav tiv tauj koj tus neeg mob los piav qhia txog qhov kev pabcuam thiab lees paub lawv qhov kev txaus siab rau kev sau npe. DHCS sau tseg tias kuv qhov kev pab txhawb nqa bluebird muaj pub dawb, thiab tsis muaj lub luag haujlwm los mus tom ntej nrog kev kho mob CGT SCD.

Yog tias koj tau sau tshuaj CASGEVY rau koj tus neeg mob, koj tus neeg mob tuaj yeem sau npe rau hauv Vertex Connects Patient Support uas lawv yuav tau txais tus Case Manager uas yuav ua haujlwm ua tus neeg pab thoob plaws lawv txoj kev taug kev CGT. Cov Thawj Saib Xyuas Cov Ntaub Ntawv kuj pab sib koom tes txiav txim siab txog kev tso CASGEVY, teem sijhawm rau kev siv tshuaj apheresis, kev xa khoom thiab kev npaj khoom, muab cov xov xwm tshiab txog tus neeg mob txoj kev kho mob gene thaum lub sijhawm tsim khoom, thiab daws teeb meem. DHCS sau tseg tias kev sau npe rau hauv Vertex Connects Patient Support tsis tas yuav tsum tau txais CASGEVY. Txawm li cas los xij, yuav tsum muaj daim ntawv sau npe Vertex Connects uas ua tiav lawm kom tau txais cov kev pabcuam tswj xyuas cov ntaub ntawv thiab txiav txim siab seb puas tsim nyog rau qee qhov kev pabcuam. Cov tswv cuab yuav tau txais daim ntawv sau npe Vertex Connects thaum lawv tau txais kev kho mob CASGEVY los ntawm lawv pab neeg kho mob.
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Kev them nqi​​ 

Yuav them cov tshuaj CGT SCD li cas?​​ 
Txhua daim ntawv thov rau cov tshuaj CGT yuav tsum tau them ncaj qha rau DHCS siv tus lej them nqi tsim nyog (J3392 lossis J3394) thiab xa cov ntawv thov kho mob siv CMS-1500 (lossis 837P/I daim ntawv hluav taws xob sib npaug).​​ 

• Yog xav paub ntxiv txog yuav ua li cas kom tiav daim ntawv CMS-1500 (lossis 837P/I daim ntawv hluav taws xob sib npaug), thov saib CMS-1500 Completion (cms comp), CMS-1500 Cov Lus Qhia rau Kev Them Nqi (cms tips), CMS-1500 Cov Lus Qhia Txog Kev Xa Ntawv thiab Lub Sijhawm (cms sub), thiab CMS-1500 Cov Lus Qhia Txog Kev Them Nqi Tshwj Xeeb (cms spec) ntawm Phau Ntawv Qhia Txog Tus Muab Kev Pabcuam.
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Puas yog CGT SCD cov tshuaj tau muab tshem tawm los ntawm kev tswj xyuas tus me nyuam?​​ 

Yog lawm, cov tshuaj CGT rau qhov qhia txog SCD tsuas yog txiav tawm ntawm lub kaw lus tswj kev saib xyuas, uas txhais tau tias Medi-Cal MCPs tsis yog lub luag haujlwm rau cov tshuaj CGT SCD (lossis cov nqi khaws cia kev xeeb tub). Qhov no txhais tau tias cov kws kho mob yuav tsum tsis txhob xa cov ntawv thov kom them rov qab cov tshuaj CGT rau Medi-Cal MCPs. Txhua daim ntawv thov nyiaj pab kho mob CGT SCD yuav tsum xa ncaj qha mus rau DHCS uas cais cov nqi kho mob CGT SCD tawm ntawm cov nqi pw hauv tsev kho mob uas tsis yog kev kho mob lossis kev kho mob. Cov kws kho mob mam li xa ib daim ntawv thov kom them rov qab cov tshuaj CGT SCD ncaj qha mus rau DHCS thiab lwm daim ntawv thov sib cais rau Medi-Cal MCP rau txhua yam nqi pw hauv tsev kho mob uas cuam tshuam, tsis yog kev kho mob lossis kev kho mob. Txawm li cas los xij, thov nco ntsoov tias Medi-Cal MCPs tseem yog tus lav ris rau cov tshuaj CGT rau lwm yam, FDA pom zoo, cov cim tsis yog SCD nrog rau txhua yam nqi kho mob, tsis yog kev kho mob lossis kev kho mob uas cuam tshuam nrog cov tshuaj CGT.

Cov tshuaj CGT SCD puas raug txiav tawm ntawm Diagnosis Related Group (DRG) txoj kev them rov qab rau kev pw hauv tsev kho mob?
Yog lawm, cov tshuaj SCD raug txiav tawm ntawm txoj kev them rov qab DRG rau kev pw hauv tsev kho mob. Qhov no txhais tau tias cov neeg muab kev pab uas xa cov ntawv thov rau cov tshuaj CGT SCD yuav tsum cais cov nqi tshuaj CGT SCD tawm ntawm cov nqi pw hauv tsev kho mob uas tsis yog kev kho mob lossis kev kho mob. Cov kws kho mob mam li xa ib daim ntawv thov kom them rov qab cov tshuaj CGT SCD ncaj qha mus rau DHCS thiab lwm daim ntawv thov sib cais rau Medi-Cal MCP rau txhua yam nqi pw hauv tsev kho mob uas cuam tshuam, tsis yog kev kho mob lossis kev kho mob. DHCS nyuam qhuav tshaj tawm ib daim ntawv ceeb toom rau pej xeem txog Kev Hloov Kho Txoj Kev Npaj Hauv Xeev (SPA) 25-0022.
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Cov tshuaj CGT SCD tau txais nyiaj rov qab li cas?​​ 

HCPCS cov lej J3392 thiab J3394 tsis muaj cov nqi Medi-Cal FFS uas tau tsim tsa rau hauv cov ntaub ntawv. Yog li ntawd, cov lej no raug them "los ntawm daim ntawv qhia", uas txhais tau tias cov neeg muab kev pabcuam yuav tsum xa daim ntawv qhia nqi nrog rau lawv daim ntawv thov kom them rov qab. Yog xav paub ntxiv txog kev them nqi "los ntawm daim ntawv qhia", saib CMS-1500 Cov Lus Qhia Tshwj Xeeb Txog Kev Them Nqi (cms spec) ntu ntawm Phau Ntawv Qhia Txog Kev Muab Kev Pabcuam Medi-Cal.
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Center for International Blood and Marrow Transplant (CIBMTR) Research Requirements​​ 

Lub chaw kho mob dab tsi yog lub luag haujlwm ntawm CGT Access Model Study?​​ 
Cov chaw kho mob yuav muaj lub luag haujlwm los mus cuag cov neeg mob kom thov lawv txoj kev tso cai koom nrog CIBMTR Research Database Protocol uas txoj kev tshawb fawb no yuav raug tswj hwm thiab xa cov ntaub ntawv mus rau CIBMTR, raws li cov kev cai ntawm CGT Access Model kev tshawb fawb.

Cov chaw kho mob yuav nrhiav tau cov ntaub ntawv hais txog kev kawm txog CGT Access Model qhov twg?
Cov chaw rau cov tswv cuab ntawm CIBMTR yuav tau txais cov ntaub ntawv hais txog kev kawm txog CGT Access Model ncaj qha los ntawm CIBMTR.
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Tawm tswv yim​​ 

Cov kws kho mob yuav kawm paub ntxiv txog Medi-Cal tus qauv nkag mus rau CGT thiab/lossis muab cov lus taw qhia qhov twg?​​ 
Cov ntaub ntawv hais txog Medi-Cal's CGT Access Model muaj nyob rau ntawm DHCS lub vev xaib, uas muaj nyob rau ntawm qhov txuas hauv qab no: Cov lus taw qhia, cov lus nug, thiab cov lus pom kuj tseem tuaj yeem xa mus rau DHCS ntawm email ntawm dhcscgt@dhcs.ca.gov.




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