Tsev Cov Kev Pabcuam Cov Kev Pabcuam Medi-Cal Kev Tshawb Fawb Txog Kev Kho Mob & Txoj Cai Kho Mob​​ 

Clinical Research & Medical Policy Branch​​ 

Ib ntawm plaub ceg haujlwm hauv Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS), Kev Pabcuam Kev Pabcuam (BD) yog Lub Tsev Haujlwm Saib Xyuas Kev Tshawb Fawb & Kev Khomob Txoj Cai, uas yog lub luag haujlwm rau kev tshawb nrhiav, tsim, siv, thiab saib xyuas kev kho mob thiab kev them nyiaj rov qab rau feem ntau cov kev pabcuam khomob muab los ntawm Medi-Cal.​​ 

Txheej txheem cej luam​​ 

Thaum BD txiav txim siab txog kev them nqi kho mob thiab txoj cai them rov qab rau Medi-Cal, BD cov kws pab tswv yim hauv kev kho mob - koom tes nrog lwm cov kws pab tswv yim hauv kev kho mob thoob plaws DHCS - ua qhov kev tshuaj xyuas ywj pheej thiab xav txog ntau yam, suav nrog, tab sis tsis txwv rau: kev txiav txim siab txog kev them nqi los ntawm lwm tus neeg them nqi, suav nrog lwm cov kev pab cuam Medicaid hauv xeev; kev txiav txim siab txog kev them nqi rau tsoomfwv Meskas Medicare, kev pov hwm lag luam, thiab lwm yam; kev taw qhia los ntawm tsoomfwv Meskas cov koom haum saib xyuas/txoj cai xws li Federal Food and Drug Administration, thiab lwm yam; thiab cov lus qhia txog kev kho mob uas tau lees paub thoob tebchaws, thiab cov lus pom zoo; thiab cov ntaub ntawv sau los ntawm cov phooj ywg thiab cov kev tshawb fawb/kev sim tshuaj uas raug xaiv, tswj hwm. Thaum kawg, cov kws pab tswv yim hauv kev kho mob ntawm BD yuav tsum xyuas kom meej tias txhua lub cuab yeej, kev kuaj/txheej txheem, kev pabcuam, thiab/lossis tus lej them nqi uas ntxiv rau hauv Medi-Cal ua tau raws li cov kev cai "kev tsim nyog kho mob" thiab lwm cov qauv rau kev them nqi raws li tsoomfwv txoj haujlwm Medicaid.​​ 

Raws li California Welfare and Institutions Code ntu 14059.5: (a) Rau cov tib neeg hnub nyoog 21 xyoo lossis laus dua, kev pabcuam yog "kev kho mob tsim nyog" lossis "kev kho mob tsim nyog" thaum nws tsim nyog thiab tsim nyog los tiv thaiv txoj sia, los tiv thaiv kev mob hnyav lossis kev tsis taus loj, lossis kom txo qhov mob hnyav. (b)(1) Rau cov tib neeg hnub nyoog qis dua 21 xyoos, kev pabcuam yog "tsim nyog kho mob" lossis "tsim nyog kho mob" yog tias kev pabcuam ua tau raws li cov qauv teev tseg hauv Tshooj 1396d (r) (5) ntawm Title 42 ntawm United States Code. Raws li tau teev tseg hauv txoj cai Medi-Cal, Kev Tshuaj Xyuas Thaum Ntxov, Kev Kuaj Mob thiab Kev Kho Mob (EPSDT) yog qhov tsim nyog rau kev kho mob lossis yog qhov tsim nyog rau kev kho mob yog tias lawv kho lossis kho qhov tsis zoo thiab cov kab mob ntawm lub cev thiab lub hlwb thiab cov mob uas pom los ntawm kev tshuaj xyuas.​​ 

Cov txheej txheem thov nyiaj pab Medi-Cal​​ 

BD tau tsim Daim Ntawv Thov Kev Pab Medi-Cal (MBR) (DHCS 8712), uas yuav tsum tau ua kom tiav los ntawm cov neeg sab nraud (piv txwv li, cov neeg muab kev pab, cov chaw tsim khoom, cov neeg tawm tswv yim, thiab lwm yam) uas thov kom BD txiav txim siab ntxiv ib lub cuab yeej tshwj xeeb, kev sim/txheej txheem, kev pabcuam, thiab/lossis tus lej them nqi ua ib qho kev pab Medi-Cal. BD yuav tsis tuaj yeem lees txais MBR rau cov cai lossis cov kev pab cuam sab nraum peb cov cheeb tsam tau teev tseg. Yog tias BD tau txais MBR rau lub hom phiaj no, BD yuav xa MBR mus rau pab pawg DHCS kom ua raws li qhov tau teem tseg.​​ 

Thaum xa daim MBR, tus neeg sab nrauv yuav tsum hais tag nrho cov khoom #1-9 raws li tau teev tseg hauv daim foos thiab tseem xyuas kom meej tias cov ntaub ntawv txhawb nqa lossis cov ntaub ntawv xa mus. Thov nco ntsoov tias cov ntaub ntawv txhawb nqa lossis cov ntaub ntawv yuav tsum raug xa mus ua qhov sib txuas thiab / lossis muab txuas ua ib daim ntawv cais thiab xa nrog MBR Daim Ntawv Thov ntawm email rau BD. Thov nco ntsoov tias tsis xa lossis ua tiav MBR nrog rau cov ntaub ntawv txhawb nqa lossis cov ntaub ntawv tsim nyog yuav ua rau MBR raug xa rov qab thiab qhov kev thov tsis raug tshuaj xyuas.​​ 

Raws li qhov xwm txheej ntawm qhov kev thov kev pab them nqi kho mob, BD yuav tsum tau sab laj nrog lwm qhov DHCS kev faib, uas tuaj yeem ua rau lub sijhawm xav tau los ua kom tiav peb qhov kev tshuaj xyuas; Txawm li cas los xij, qhov nruab nrab, BD yuav siv sijhawm kwv yees li ib (1) lub hlis los ua kom tiav nws cov kev ntsuam xyuas dav dav ntawm cov ntaub ntawv muab rau hauv MBR thiab ua nws txoj kev tshawb fawb ywj pheej ua ntej teb los ntawm email.​​ 

Cov lus qhia rau kev xa:​​ 

  • Ua tiav MBRs thiab cov ntaub ntawv txhawb nqa lossis cov ntaub ntawv yuav tsum xa mus rau BD hauv hluav taws xob ntawm email ntawm dhcsmedicalpolicy@dhcs.ca.gov.​​ 
  • Thov nco ntsoov tias MBR thiab cov ntaub ntawv txhawb nqa tau xa tuaj yuav raug nthuav tawm raws li PRA (saib Tsoom Fwv Txoj Cai Tshooj 6250 thiab lwm yam).​​ 
  • Yog li ntawd, BD xav kom cov neeg thov tsis txhob xa cov ntaub ntawv tsis pub lwm tus paub lossis cov tswv cuab.​​ 
  • For more information on the PRA, please see DHCS’ Public Records Act website.​​ 

Cov peev txheej​​ 

Cov ntaub ntawv tiv tauj​​ 

Yog xav tiv tauj DHCS/BD's Clinical Research & Medical Policy Branch, thov hu rau peb ntawm (916) 345-8134 lossis email rau peb ntawm dhcsmedicalpolicy@dhcs.ca.gov. Koj tuaj yeem xa ntawv rau peb ntawm qhov chaw nyob hauv qab no:​​ 

Department of Health Care Services-Benefits Division​​ 

Attn: Clinical Research & Medical Policy Branch​​ 

TIAB SA 4601​​ 

PO ib 997417​​ 

Sacramento, CA 95899-7417​​ 

Sau ntawv​​ 

  • Thov nco ntsoov tias BD tsis yog lub luag haujlwm tseem ceeb rau kev tsim cov cai pov hwm rau cov txiaj ntsig thiab cov kev pabcuam npaj tsev neeg (tshwj tsis yog cov kev pabcuam rho menyuam), kev noj qab haus huv tshwj xeeb (SMH) thiab kev siv tshuaj yeeb dej cawv (SUD) / Drug Medi-Cal Organized Delivery System (DMC-ODS) cov kev pabcuam muab los ntawm lub nroog behavioral health delivery system, cov tshuaj rau cov neeg mob sab nraud, suav nrog cov tshuaj uas kws kho mob muab (PADs), cov ntshav, optometry, enteral nutrition, tsom iav/kev tsim khoom, lossis cov khoom siv kho mob. Tsis tas li ntawd xwb, BD tsis saib xyuas txoj cai them nqi rau cov kev pab cuam tshwj xeeb hauv qab no: California Children's Services (CCS) Program, Family Planning, Access, Care, and Treatment (FPACT) Program, Breast and Cervical Cancer Treatment Program (BCCTP), lossis Genetically Handicapped Persons Program (GHPP).​​ 
  • Tsis tas li ntawd, thov nco ntsoov tias yog tias daim ntawv thov kev pab them nqi yuav xav tau ntxiv rau lub xeev thiab / lossis tsoomfwv kev pom zoo rau BD los siv (piv txwv li, cov cuab yeej tshwj xeeb, kev sim / txheej txheem, lossis kev pabcuam tsis poob rau hauv cov txiaj ntsig kev pabcuam uas twb muaj lawm), BD yuav tsis tuaj yeem muab qhov kev txiav txim siab them nyiaj zaum kawg thiab koj yuav raug ceeb toom los ntawm email.​​