Tsev Cov Kev Pabcuam Cov Kev Pabcuam Medi-Cal Cov Lus Nug Feem Ntau (FAQs) rau Medi-Cal Title XIX Reimbursement​​ 

Cov Lus Nug Nquag (FAQs) rau Medi-Cal Title XIX Cov Nyiaj Them Rov Qab​​ 

Cov Lus Nug Nquag (FAQs) rau Medi-Cal Title XIX Cov Nyiaj Them Rov Qab​​ 

Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tau tsim cov FAQs no los muab cov lus qhia ntxiv thiab kev piav qhia rau cov neeg koom tes hauv zos txog kev them rov qab Title XIX. DHCS yuav hloov kho nplooj ntawv web no raws li qhov xav tau los teb cov lus nug ntxiv.​​ 

Cov ntaub ntawv dav dav​​ 

1. Title XIX yog dab tsi?​​ 

Section 432 of Title 42 of the Code of Federal Regulations (42 CFR 432) requires Title XIX to be established as a Medicaid program. These regulations define training and describe rates of Federal Financial Participation (FFP) for Medicaid staffing and training costs, among other requirements. DHCS is the Single State Agency responsible for the management of the state’s Medicaid (Medi-Cal) program and compliance with all federal statutes and regulations, including those relating to Title XIX reimbursement.​​ 

Since Medi-Cal is a federal “reimbursement” program, local partners that provide Medi-Cal services to Medi-Cal members and who meet Medi-Cal program requirements and claim qualified expenditures associated with the administration and provision of services for Medi-Cal members may be eligible to receive reimbursement from the federal government for a portion of the expenditures. The reimbursement local partners receive for their Medi-Cal program expenditures is primarily through Title XIX FFP.​​ 

2. Cov kev pab cuam twg uas tau them nyob rau hauv daim ntawv cog lus ntawm DHCS thiab CDPH uas tsim nyog rau Title XIX nyiaj txiag?​​ 

MCAH cov kev pab cuam tsim nyog rau Title XIX nyiaj txiag suav nrog Txoj Haujlwm Pabcuam Neeg Hluas Hauv Tsev Neeg (AFLP), Black Infant Health (BIH) Program, Comprehensive Perinatal Services Program (CPSP), Cov Ntaub Ntawv & Kev Kawm (I&E) Program, Perinatal Equity Initiative (PEI), thiab California Home Visiting Program (CHVP).​​ 

3. Cov nyiaj them rov qab Title XIX txawv li cas?​​ 

Tsoom Fwv Teb Chaws Chaw rau Medicare thiab Medicaid Services (CMS) cov kev cai tso cai rau kev sib koom ua ke rau kev tswj hwm cov dej num uas tau them rov qab ntawm tus nqi uas tsis tau txais txiaj ntsig (50/50) rau feem ntau ntawm cov nuj nqis tsim nyog rau kev tswj hwm ntawm Medi-Cal qhov kev pab cuam.​​ 

Tshooj Cai Kev Ruaj Ntseg Hauv Zej Zog (SSA) Tshooj 1903(a)(2) qhia meej tias kev sib phim ntawm tsoomfwv qib siab ntawm 75 feem pua yog vim muaj kev them nyiaj thiab/lossis kev cob qhia cov kws kho mob txawj ntse (SPMP) thiab cov neeg ua haujlwm txhawb nqa cov neeg ua haujlwm ntawm lub koom haum hauv Xeev lossis lwm lub koom haum pej xeem. Qhov no yog ua pov thawj los ntawm kev muaj daim ntawv tso cai kho mob, daim ntawv pov thawj, lossis lwm daim ntawv pov thawj uas tau muab los ntawm lub koom haum muab ntawv tso cai kho mob hauv tebchaws lossis xeev uas tau lees paub lossis daim ntawv kawm tiav qib siab hauv kev kho mob uas tau muab los ntawm lub tsev kawm qib siab lossis tsev kawm ntawv qib siab uas tau lees paub los ntawm lub koom haum kho mob tshaj lij. Raws li tau txhais hauv tsoomfwv cov cai, "kev kawm thiab kev cob qhia ua haujlwm" txhais tau tias ua tiav 2-xyoo lossis ntev dua qhov kev pab cuam uas ua rau muaj daim ntawv kawm tiav qib siab lossis daim ntawv pov thawj hauv kev ua haujlwm kho mob.​​ 

4. Yuav ua li cas yog tias daim ntawv pov thawj lossis daim ntawv tso cai rau kev faib tawm tshwj xeeb (xws li Tus Kws Lij Choj Ua Haujlwm Ua Haujlwm (LVN), thiab lwm yam) yuav tsum muaj tsawg dua 2 xyoos?​​ 

42 CFR 432.50(d)(1)(ii) hais tias, hauv qhov tseem ceeb: "'kev kawm thiab kev cob qhia ua haujlwm' txhais tau tias ua tiav qhov kev pab cuam 2-xyoo lossis ntev dua uas ua rau muaj daim ntawv kawm tiav qib siab lossis daim ntawv pov thawj hauv kev ua haujlwm kho mob." (ntxiv qhov tseem ceeb). Yog li ntawd, thiab yog tsis muaj CMS pom zoo lwm yam, qhov kev pab cuam uas ua rau tau txais daim ntawv kawm tiav lossis daim ntawv pov thawj yuav tsum muaj 2 xyoos lossis ntev dua thiab kev paub dhau los tom qab kawm tiav lossis daim ntawv pov thawj, xws li kev cob qhia hauv txoj haujlwm, yuav tsis tsim nyog rau qhov yuav tsum tau ua 2 xyoos.​​ 

5. Cov kev cai uas tsis yog tsoom fwv teb chaws yog dab tsi?​​ 

Cov koom tes hauv zos yuav tsum muab cov peev nyiaj uas tsis yog tsoomfwv tsim nyog (piv txwv li, cov nyiaj hauv nroog / nroog / xeev) kom tsim nyog tau txais kev them rov qab Title XIX.​​ 

6.​​  Puas yog Cov Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv Hauv Zos (LHJ) yuav tsum sau cov ntaub ntawv pov thawj ntawm tus neeg mob ua ib tug tswv cuab Medi-Cal kom tau txais kev them rov qab Title XIX?​​ 

Cov LHJ yuav tsum sau cov ntaub ntawv txog tus neeg mob lub neej kom paub tseeb tias tus tswv cuab tau sau npe rau hauv Medi-Cal thaum lub sijhawm muab kev pabcuam [GA1]. Cov LHJs kuj tseem yuav tsum sau ntawv thaum tus neeg siv khoom muaj cai tsim nyog.​​ 

SPMP Requirements & Analysis​​ 

7. Cov cai ntawm kev siv SPMPs yog dab tsi?​​ 

Cov dej num ua los ntawm SPMP yuav tsum tau siv lawv cov kev paub txog kev kho mob , kev cob qhia, thiab / lossis kev txawj ntse. Ib tus neeg koom tes hauv zos yuav tsum muaj Daim Ntawv Qhia Txog Lub Chaw Haujlwm tau kos npe thiab TXIX SPMP Daim Ntawv Pom Zoo nrog Lub Xeev txhawm rau txheeb xyuas qhov kev xav tau. Kev faib tawm SPMP suav nrog cov kws kho mob tau piav qhia hauv Title 42, CFR Tshooj 432.2 thiab 432.50, thiab ntawm SPMP cov ntaub ntawv faib tawm.​​ 

8. Kev sib raug zoo ntawm "tus tswv ntiav haujlwm-tus neeg ua haujlwm" txhais li cas rau lub hom phiaj ntawm Title XIX thov?​​ 

Raws li 42 CFR 432.2, SPMPs yog cov neeg ua haujlwm rau pej xeem, xws li kws kho mob, kws kho hniav, kws saib xyuas neeg mob, thiab lwm tus neeg ua haujlwm tshwj xeeb, uas muaj kev kawm txuj ci thiab kev cob qhia hauv kev kho mob lossis kev kho mob tsim nyog. Piv txwv li, DHCS ncaj qha ntiav SPMPs, xws li cov kws kho mob thiab cov kws saib xyuas neeg mob, uas muab cov lus qhia txog kev kho mob thiab DHCS thov 75% FFP rau lawv txoj haujlwm ntawm Medi-Cal qhov kev pab cuam. Ntxiv rau kev ntiav SPMPs ncaj qha, DHCS kuj tseem tuav ntau daim ntawv cog lus sib tham (IAs) nrog rau lwm lub xeev, suav nrog California Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (CDPH), kom tso cai rau ob leeg CDPH thov cov nyiaj pab txhawb Title XIX rau qee cov neeg ua haujlwm SPMP thiab tso cai rau cov koom haum pej xeem hauv zos uas muaj kev cog lus tshwj xeeb nrog CDPH ua ib yam.​​ 

Cov koom haum pej xeem hauv cheeb tsam uas tswj hwm kev cog lus nrog California Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (CDPH) yuav tsum muaj kev lees paub meej rau CDPH txog kev tsim thiab kev saib xyuas kev sib raug zoo ntawm tus tswv ntiav-neeg ua haujlwm, raws li tau teev tseg hauv Daim Ntawv Pom Zoo Nyiaj Txiag (AFA) txheej txheem. Qhov kev sib raug zoo no yog qhov tseem ceeb kom ua tau raws li qhov yuav tsum tau ua ntawm Daim Ntawv Pom Zoo Sib Tham (IA) ntawm CDPH thiab California Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS). Raws li IA, DHCS them rov qab CDPH rau Maternal, Me Nyuam, thiab Cov Hluas Kev Noj Qab Haus Huv (MCAH) cov kev siv nyiaj pab rau Medi-Cal cov tswv cuab hauv cheeb tsam, thiab CDPH, dhau los, them rov qab cov koom haum pej xeem hauv zos.​​ 

Kev lees paub ntawm kev sib raug zoo ntawm tus tswv ntiav-neeg ua haujlwm tau pom los ntawm ob cov ntaub ntawv uas yuav tsum tau suav nrog hauv AFA xa:​​ 

  • Cov Lus Qhia Txog Lub Luag Haujlwm:
    Txhua tus neeg ua haujlwm uas tau txais nyiaj los ntawm IA yuav tsum muaj cov lus qhia txog lub luag haujlwm uas qhia meej txog lawv lub luag haujlwm, lub luag haujlwm, thiab qhov dav ntawm txoj haujlwm uas lawv yuav ua hauv cov ntsiab lus ntawm MCAH program. Cov lus qhia txog lub luag haujlwm ua kom paub meej txog kev sib raug zoo ntawm tus neeg ua haujlwm nrog cov hom phiaj ntawm qhov kev pab cuam thiab kev ua raws li cov cai ntawm lub xeev thiab tsoomfwv. Nws yuav tsum muaj xws li:​​ 
  • Txoj hauj lwm npe thiab kev faib tawm.​​ 
  • Kev piav qhia txog cov dej num thiab lub luag hauj lwm ntsig txog Medi-Cal cov kev pab cuam.​​ 
  • Kev faib sijhawm rau Medi-Cal cov dej num thiab lwm yam dej num, raws li muaj.​​ 
  • Kev saib xyuas thiab tshaj tawm kev sib raug zoo.​​ 
  • Daim Ntawv Qhia Lub Koom Haum:
    Ib daim ntawv qhia txog lub koom haum yuav tsum nrog rau cov lus hais hauv lub luag haujlwm, muab cov duab sawv cev ntawm cov qauv kev tshaj tawm thiab cov txheej txheem saib xyuas hauv lub koom haum pej xeem hauv zos. Daim duab no qhia tau hais tias:​​ 
  • Kev tso cov neeg ua haujlwm hauv lub koom haum.​​ 
  • Kev saib xyuas kev sib raug zoo los xyuas kom muaj kev lav phib xaub thiab kev saib xyuas cov haujlwm.​​ 
  • Kev koom ua ke ntawm cov luag haujlwm uas tau txais nyiaj los ntawm IA rau hauv cov txheej txheem dav dav.​​ 

Thaum kawg, kev sib raug zoo ntawm "tus tswv ntiav haujlwm-tus neeg ua haujlwm" suav nrog kev tshuaj xyuas thiab kev ntsuam xyuas ntawm yam uas cov neeg koom tes hauv zos ua thiab cov nuj nqis uas lawv thov rau ob tus neeg ua haujlwm tsis yog SPMP thiab SPMP ua haujlwm ntawm MCAH cov kev pab cuam thiab, ib yam li niaj zaus, cov neeg koom tes hauv zos yuav tsum khaws cov ntaub ntawv txhawb nqa ntawm kev sib raug zoo ntawm tus tswv ntiav haujlwm-tus neeg ua haujlwm thiab ua rau nws muaj rau ob qho tib si CDPH/DHCS thaum thov yog tias muaj kev tshuaj xyuas hauv xeev lossis tsoomfwv.​​ 

9. Yog tias tus khub koom tes hauv zos muaj daim ntawv cog lus nrog ib lub koom haum ua ib feem ntawm lawv qhov kev pab cuam MCAH, cov kev pabcuam uas cov neeg ua haujlwm ntawm lub koom haum cog lus muab puas tuaj yeem tsim nyog tau txais nyiaj Title XIX yog tias muab rau cov tswv cuab Medi-Cal?​​ 

Yog, ob tus neeg ua haujlwm uas ua haujlwm ncaj qha nrog cov neeg koom tes hauv zos (piv txwv li, nyob rau ntawm daim ntawv them nyiaj hli) nrog rau cov neeg ua haujlwm cog lus ua haujlwm yuav tsim nyog tau txais nyiaj txiag Title XIX tsuav yog lawv ua tau raws li txhua txoj cai lij choj thiab kev cai lij choj hauv tsoomfwv uas siv tau txog Title XIX thov thiab ua li ntawd raws li DHCS thiab CDPH cov cai. Thov nco ntsoov tias yog cov neeg ua haujlwm cog lus ua haujlwm rau lwm tus, nws yog ib qho tseem ceeb heev uas cov neeg koom tes hauv zos yuav tsum xyuas kom meej tias txhua tus nqi uas tau thov rau Title XIX nyiaj pab yog rau lub hom phiaj ntawm kev muab cov kev pabcuam MCAH rau cov tswv cuab Medi-Cal, pab txuas cov tswv cuab Medi-Cal nrog cov kev pabcuam thiab kev txhawb nqa uas MCAH them, thiab/lossis pab coj cov neeg ntxiv rau hauv qhov kev pab cuam Medi-Cal (piv txwv li, kev sau npe cuam tshuam). Thaum kawg, cov neeg koom tes hauv zos yuav tsum khaws cov ntaub ntawv pov thawj tsim nyog thiab ua tiav ntawm kev sib raug zoo ntawm tus tswv ntiav haujlwm thiab cov neeg ua haujlwm (piv txwv li, kev cai lij choj lossis kev koom tes ua haujlwm) nrog rau txhua yam uas xav tau thiab ua kom muaj rau CDPH, DHCS, thiab/lossis lub xeev thiab tsoomfwv cov koom haum tswj hwm thaum thov lossis thaum muaj kev tshuaj xyuas.​​ 

10. Cov kev faib tawm twg uas muaj feem tsim nyog tau txais kev txhawb nqa SPMP Title XIX rov qab (75 feem pua)?​​ 

Raws li 42 CFR Tshooj 432.2 thiab 432.50, thiab txoj cai lij choj ntsig txog lub xeev, cov kev faib tawm SPMP uas tsim nyog suav nrog cov hauv qab no:​​ 

  • Tus kws kho mob​​ 
  • Sau npe Nurse​​ 
  • Daim Ntawv Tso Cai Ua Haujlwm Ua Haujlwm​​ 
  • Tus kws kho mob​​ 
  • Tus kws kho mob​​ 
  • Kws kho hniav​​ 
  • Hniav Hygienist​​ 
  • Registered Dental Assistant​​ 
  • Kws Pab Txog Kev Noj Haus (muaj daim Bachelor's degree hauv kev noj haus/kev noj zaub mov thiab sau npe nrog Pawg Neeg Saib Xyuas Kev Noj Haus)​​ 
  • Tus Neeg Ua Haujlwm Pabcuam Zej Zog Hauv Tsev Kho Mob uas Muaj Ntawv Tso Cai (LCSW) nrog kev tshwj xeeb hauv kev kho mob lossis daim ntawv kawm tiav qib master hauv kev ua haujlwm pabcuam zej zog​​ 
  • Daim ntawv tso cai Clinical Psychologist​​ 
  • Daim ntawv tso cai Audiologist​​ 
  • Daim ntawv tso cai Physical Therapist​​ 
  • Daim ntawv tso cai ua haujlwm kho mob​​ 
  • Daim ntawv tso cai hais lus Pathologist​​ 
  • Daim ntawv tso cai sib yuav thiab Tsev Neeg Therapist​​ 

Thov saib daim ntawv SPMP kev faib tawm.​​ 

11. Puas yog tus nqi nce ntxiv rau cov neeg ua haujlwm txhawb nqa?​​ 

Yog. Raws li tsoomfwv cov cai, cov neeg ua haujlwm txhawb nqa ncaj qha tsim nyog rau FFP txhim kho. Raws li txoj cai no, cov neeg ua haujlwm hauv kev tuav ntaub ntawv, cov neeg sau ntawv, thiab cov neeg theej ntawv thiab cov neeg ua haujlwm hauv cov ntaub ntawv thiab cov ntaub ntawv uas muab cov kev pabcuam sau ntawv uas txhawb nqa lub luag haujlwm ntawm SPMP, uas raug saib xyuas ncaj qha los ntawm SPMP, thiab cov uas muaj kev sib raug zoo ntawm tus tswv ntiav haujlwm thiab tus neeg ua haujlwm nrog Medi-Cal, raws li tau piav qhia hauv lo lus nug #7. Yuav tsum tau txheeb xyuas qhov kev sib raug zoo ntawm Daim Ntawv Qhia Txog Lub Koom Haum.

12. Cov kev faib tawm twg tsis tsim nyog rau kev them rov qab SPMP Title XIX (75 feem pua), thiab yuav raug them rov qab ntawm kev them rov qab Title XIX uas tsis tau txhim kho (50 feem pua)?​​ 

SPMP suav nrog tsuas yog cov kws tshaj lij hauv kev kho mob. SPMP tsis suav nrog cov kws kho mob uas tsis yog kws kho mob, xws li cov thawj coj pej xeem, cov thawj coj nyiaj txiag kho mob, cov kws tshuaj ntsuam lossis cov thawj coj loj ntawm kev pab pej xeem lossis Medicaid cov kev pab cuam.
Cov hauv qab no yog cov piv txwv ntawm qhov yuav tsis yog SPMP kev faib tawm, raws li tsoomfwv cov lus qhia thiab lub xeev txoj cai:​​ 

  • Muaj daim ntawv kawm tiav qib Master hauv Social Work yam tsis muaj daim ntawv tso cai LCSW​​ 
  • Muaj daim ntawv kawm tiav qib Master hauv Public Health (MPH)​​ 
  • Health Education Consultant (HEC)​​ 
  • Community Health Workers (CHWs)​​ 

13. Kuv yuav txiav txim siab li cas yog tias ib qho haujlwm tsim nyog tau txais kev txhawb nqa SPMP Title XIX nyiaj rov qab (75 feem pua)?​​ 

Rau ib qho Title XIX txhim kho SPMP thov (75/25), cov neeg koom tes hauv nroog yuav tsum tau koom nrog kev tshuaj xyuas ob qho tib si, uas suav nrog kev txiav txim siab ntawm ob qho tib si kev faib ua haujlwm thiab kev ua haujlwm. Txog qhov kawg no, cov neeg koom tes hauv nroog yuav tsum nug cov hauv qab no:​​ 

  • Nqe Lus Nug #1: Puas yog txoj haujlwm suav tias yog qhov muaj feem tsim nyog tau txais kev faib tawm SPMP?​​ 
    • Yog tias "yog", ces koj tuaj yeem mus rau lo lus nug # 2.​​ 
      • EX: Tus kws kho mob, tus nais maum, thiab lwm yam.​​ 
    • Yog tias "tsis yog", kev tshuaj xyuas yuav tsum nres ntawm no, thiab koj yuav thov kom tsis txhob txhim kho (50/50) Title XIX.​​ 
      • Piv txwv li: Tus Neeg Ua Haujlwm Saib Xyuas Kev Noj Qab Haus Huv Hauv Zej Zog, thiab lwm yam.​​ 
  • Lo lus nug #2: Puas yog qhov kev ua ub no tshwj xeeb uas tau ua tiav xav tau SPMP txoj kev paub txog kev kho mob, kev cob qhia, thiab/lossis kev txawj ntse?​​ 
    • If “yes”, then you would describe that activity as well as provide and maintain appropriate supporting document for CDPH/DHCS and in the event of an audit.​​ 
      • EX: Ua kev ntsuam xyuas niam txiv kev nyuaj siab rau cov tib neeg cev xeeb tub. Qhov no yuav tsum muaj daim ntawv tso cai kho mob tshwj xeeb thiab cov txheej txheem kev txawj.​​ 
    • Yog tias "tsis yog", txawm tias txoj haujlwm yuav tsim nyog rau SPMP, qhov kev ua ub no yuav tsis yog thiab yog li koj yuav thov tsis tau txhim kho (50/50) Title XIX.​​ 
      • EX: Yog tias muaj peev xwm SPMP kev faib tawm uas tsim nyog tau ua kev tswj hwm lossis lwm yam haujlwm uas tsis xav tau SPMP kev paub, kev cob qhia thiab / lossis kev txawj ntse, ces nws yuav tsis tsim nyog rau kev txhim kho (75/25) Title XIX thov.​​ 

Cov ntaub ntawv & Sijhawm kawm​​ 

14. Lub sij hawm kawm yog dab tsi?​​ 

Kev tshawb fawb sij hawm yog cov ntaub ntawv tseem ceeb rau Title XIX thov thiab raug siv los txiav txim siab feem pua ntawm cov neeg ua haujlwm lub sijhawm uas haum rau FFP thiab tsis sib xws. Txhawm rau thov cov nyiaj Medi-Cal Title XIX, cov neeg ua haujlwm koom tes hauv cheeb tsam yuav tsum sau tag nrho cov sijhawm ua haujlwm tiag tiag ua haujlwm hauv txhua qhov kev pabcuam thaum lub sijhawm kawm.​​ 

15. Yog xav tau sijhawm kawm, yuav tsum ua li cas?​​ 

Kev tshawb fawb sij hawm yuav tsum tau ua rau cov neeg ua haujlwm siv TXIX ib hlis ib hlis twg thiab suav txog 100 feem pua ntawm tag nrho cov neeg ua haujlwm lub sijhawm. Cov neeg koom tes hauv zos yuav tsum siv lub sijhawm kawm ntawv pom zoo los ntawm CDPH.​​ 

16. Yuav khaws cov ntaub ntawv los ntawm ib lub sij hawm kawm ntev npaum li cas?​​ 

Cov koom tes hauv zos thiab Lub Nroog yog lub luag haujlwm los tswj cov ntaub ntawv uas tso cai rau lub koom haum hauv lub xeev tau cog lus thiab DHCS los txheeb xyuas thiab ua pov thawj Title XIX thov kom tsawg kawg ntawm peb lub xyoo nyiaj txiag.​​ 

Cov Kev Pabcuam Tshwj Xeeb & Cov Feem Xyuam Hauv Medi-Cal​​ 

17. Dab tsi yog qhov tso cai rau cov nuj nqis uas tsis raug tso cai thiab/los yog txoj hauv kev los siv nyiaj los txhawb kev noj qab haus huv niam, Me Nyuam, thiab Tub Ntxhais Hluas (MCAH), Black Infant Health/Perinatal Equity Initiative (BIH/PEI), Qhov Kev Pabcuam Tsev Neeg Hluas (AFLP), thiab California Home Visiting Program (CHVP)?​​ 

Cov nuj nqis tso cai suav nrog feem pua ntawm cov neeg ua haujlwm them rov qab rau txhua tus neeg ua haujlwm thiab cov nqi khiav haujlwm, suav nrog cov neeg ua haujlwm mus ncig thiab kev cob qhia, tuav lub rooj los txhawb kev koom tes hauv Medi-Cal, tsim cov kev qhia hauv zej zog los txhawb cov kev pabcuam Medi-Cal, thiab lwm yam.​​ 

Cov nuj nqis uas tsis pub siv suav nrog cov xwm txheej ntawm cov neeg siv khoom (kev cob qhia, kev kawm tiav, [RK2] [WK3] [RA4] thiab lwm yam); kev mus xyuas tsev lossis ib feem ntawm cov no nrog cov tswv cuab uas tsom mus rau cov kev pabcuam uas tsis yog Medi-Cal them; kev ncav tes, kev npaj cov kev pab cuam thiab kev tsim cov cai ntawm cov kev pab cuam uas tsis yog Medi-Cal uas tau txais nyiaj los ntawm lwm cov kev pab cuam hauv tsoomfwv thiab xeev; thiab kev pab kom tau txais chaw nyob, tsev nyob thiab kev thauj mus los rau cov kev pabcuam uas tsis yog Medi-Cal, [RK5] [WK6] [EJ7] thiab lwm yam.​​ 

Yog xav paub ntxiv txog kev tso cai ntxiv rau cov nuj nqis uas tsis raug tso cai, thov saib FFP cov lus qhia ntxiv ntawm CDPH Phau Ntawv Qhia Nyiaj Txiag.​​ 

18. "Feem pua ntawm Medi-Cal uas siv tau yooj yim" yog dab tsi thiab qhov ntawd siv rau Title XIX rau MCAH, BIH/PEI, AFLP, thiab CHVP li cas?​​ 

Feem pua ntawm Medi-Cal yog feem pua ntawm cov tib neeg uas muaj hnub nyoog li ntawm qhov kev pab cuam uas tau sau npe rau hauv Medi-Cal piv rau cov uas tsis yog tswv cuab ntawm Medi-Cal hauv LHJ. Qhov feem pua yog suav txhua ob xyoos los ntawm MCAH Division thiab yuav tsum tau txais kev pom zoo los ntawm CMS. Nws hloov tsis tau lossis hloov pauv tau. Yog tias ib chav tsev thov kev pab tsis tuaj yeem txiav txim siab tau tus lej tiag tiag ntawm cov neeg siv khoom, nws yuav tsum siv Feem Pua Medi-Cal.​​ 

The “Base Medi-Cal Percentage” applies to Title XIX for MCAH, BIH/PEI, AFLP, and CHVP through time study summaries that use the “Medi-Cal Percentage” to determine percentage of services provided to Medi-Cal members that is eligible for FFP. These summaries are a synopsis of all activities and time spent for all programs for staff persons identified on the MCAH program budget. The summaries determine the percentage of personnel match for operating expenses, amount of MCAH claimable activities, and the amount of Title XIX reimbursable activities based on the “Base Medi-Cal Percentage.”​​ 

19. Ib tus neeg ua haujlwm puas tuaj yeem thov rau Medi-Cal feem pua ntawm cov feem pua ntawm cov nyiaj tau los siab dua li cov feem pua ntawm Medi-Cal?​​ 

Cov neeg ua hauj lwm yuav tsum xam qhov feem pua ntawm Medi-Cal raws li cov neeg siv khoom tiag tiag rau txhua tus lej them nqi thaum twg los tau. Thaum ua tsis tau, ib tug neeg ua hauj lwm yuav siv qhov Base Medi-Cal feem pua, raws li tau piav saum toj no, uas tej zaum yuav txawv rau tus lej sau nqi.​​ 

Txhawm rau siv ntau feem Medi-Cal rau tib tus neeg ua haujlwm, Lub Chaw Haujlwm yuav tsum:​​ 

  • Xa nrog rau (AFA), dhau ntawm Daim Ntawv Qhia Nyiaj Txiag (I) Daim Ntawv Qhia Txog Kev Ncaj Ncees, cov ntaub ntawv thiab cov txheej txheem siv rau kev suav.​​ 
  • Tshawb xyuas txhua xyoo nyiaj txiag tias tsis muaj cov ntaub ntawv hloov pauv lossis hloov pauv hauv kev ua haujlwm. Yog tias muaj kev hloov pauv, yuav tsum tau xa ib qho kev hloov kho tshiab rau cov neeg ua haujlwm nrhiav ib feem pua ntawm Medi-Cal sib txawv rau kev tshuaj xyuas thiab pom zoo txhua xyoo nyiaj txiag.​​ 
  • Khaws cov txheej txheem, suav cov neeg siv khoom, cov ntaub ntawv thib ob, thiab lwm yam ntaub ntawv pov thawj rau kev tshuaj xyuas.​​ 

20. Yuav ua li cas Title XIX cov dej num yuav raug code rau MCAH, BIH/PEI, AFLP, thiab CHVP?​​ 

Tag nrho Title XIX cov dej num uas tau them rov qab tau raug txheeb xyuas los ntawm lawv qhov FFP Function Code tsim nyog rau txhua yam haujlwm uas sau npe #1 txog #12.​​ 

Cov ntaub ntawv tiv tauj​​ 

21. Yog tias kuv muaj lus nug ntxiv txog kev thov Title XIX, kuv tuaj yeem tau txais cov ntaub ntawv ntxiv nyob qhov twg?​​ 

Yog tias koj muaj lus nug ntxiv txog kev thov Title XIX, DHCS tau tsim "Title XIX claiming toolkit," uas tau muab tso rau hauv DHCS lub vev xaib tshiab Title XIX claiming.​​ 

22. Yog tias kuv muaj lus nug ntxiv txog kev thov Title XIX, kuv tuaj yeem hu rau leej twg?​​ 

Yog tias koj muaj lus nug ntxiv txog Title XIX thov thiab them nyiaj rov qab, thov xa email rau DHCS ntawm Title19ClaimingBD@dhcs.ca.gov.​​ 

Glossary ntawm Common Acronyms​​ 

AFLP​​  Txoj Kev Pabcuam Tsev Neeg Hluas​​ 
AFA​​  Daim ntawv cog lus nyiaj txiag​​ 
A&I​​  Kev Tshawb Fawb thiab Kev Tshawb Fawb​​ 
BIH​​  Kev Noj Qab Haus Huv Me Me Dub​​ 
CAB​​  Community Advisory Board​​ 
CAP​​  Kho Kev Npaj Ua Haujlwm​​ 
CAT​​  Pab neeg ua haujlwm hauv zej zog​​ 
CCR​​  California Code of Regulations​​ 
CCS​​  California Children’s Service​​ 
CDC​​  Centers for Disease Control​​ 
CDPH​​  California Department of Public Health​​ 
CHDP​​  California Health and Disability Prevention​​ 
CHVP​​  California Home Visiting Program​​ 
CMS​​  Kev Pab Kho Mob Rau Menyuam Yaus​​ 
CPSP​​  Comprehensive Perinatal Services Program​​ 
CRT​​  Pab neeg xyuas Case​​ 
DHS​​  Department of Health Services​​ 
DHCS​​  Department of Health Care Services​​ 
EC​​  Executive Committee​​ 
EHR​​  Electronic Health Record​​ 
FFP​​  Tsoom Fwv Teb Chaws Kev Koom Tes Nyiaj Txiag​​ 
FTE​​  Full Time Sib npaug​​ 
HIPAA​​  Health Insurance Portability and Accountability Act​​ 
HRSA​​  Health Resources and Services Administration​​ 
LHJ​​  Local Health Jurisdiction​​ 
MCAH​​  Kev Noj Qab Haus Huv Niam Txiv, Me Nyuam thiab Tub Ntxhais Hluas​​ 
MCH​​  Maternal and Child Health​​ 
MCHB​​  Maternal and Child Health Bureau​​ 
PHI​​  Public Health Information​​ 
PHN​​  Public Health Nurse​​ 
PEI​​  Perinatal Equity Initiative​​ 
PSC​​  Perinatal Services Coordination​​ 
QA/QI​​  Quality Assurance/Quality Improvement​​ 
RN​​  Sau npe Nurse​​ 
SAWV​​  Scope ntawm Kev Ua Haujlwm​​ 
SCHIP​​  Kev Pab Cuam Pov Hwm Kev Noj Qab Haus Huv Rau Menyuam Yaus Hauv Xeev​​ 
SPMP​​  Cov kws tshaj lij kws kho mob​​ 
SIDS​​  Sudden Infant Death Syndrome​​ 
SUID​​  Sudden Unexpected Infant Death​​ 
W&I​​  Welfare thiab Institutions (code)​​ 
WIC​​  Poj Niam, Me Nyuam thiab Me Nyuam​​