Medi-Cal Fee-For-Service thiab Non-Medi-Cal Tus Muab Kev Pab Them Nqi Them Nqi
Daim ntawv ceeb toom no muab cov ntaub ntawv hais txog kev hloov pauv uas tseem tab tom tos rau cov nyiaj them rau cov neeg muab kev pab rau Medi-Cal tus nqi-rau-kev-pab (FFS) cov txiaj ntsig thiab cov kev pab cuam uas tsis yog Medi-Cal teev hauv qab no. Tsab Cai Lij Choj Sib Tham 1183 (Tsab Cai Lij Choj Txog Kev Kho Mob Xyoo 2008) ntxiv rau txoj cai lij choj ntawm lub xeev Welfare and Institutions (W&I) Code Tshooj 14105.191, yuav tsum tau txo cov nyiaj them rau cov neeg muab kev pab cuam los ntawm 1 feem pua lossis 5 feem pua, nyob ntawm hom neeg muab kev pab cuam, rau hnub ua haujlwm rau lossis tom qab Lub Peb Hlis 1, 2009. Cov kev txo nqi no yuav hloov cov kev txo nqi them rau cov neeg muab kev pab 10 feem pua uas tau siv yav dhau los raws li W&I Code Seem 14105.19, uas tau siv txij lub Xya Hli 1, 2008, mus txog thiab suav nrog Lub Ob Hlis 28, 2009.
Senate Bill (SB) 184 (Tshooj 47, Txoj Cai ntawm 2022), uas hloov kho W&I Code ntu 14105.192, tso cai rau Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) txhawm rau zam FFS cov chaw muab kev pabcuam thiab pawg ntawm cov kev pabcuam los ntawm Pawg Sib Tham Bill 97 kev txo cov nyiaj them poob haujlwm, siv rau hnub ua haujlwm rau lossis tom qab Lub Xya Hli 1, 2022 thiab Lub Ib Hlis 1, 2023.
Medi-Cal FFS
Qhov kev txo qis 5 feem pua yuav siv rau Medi-Cal FFS cov txiaj ntsig tau muab los ntawm cov hauv qab no:
- Intermediate Care Facilities (Nursing Facilities – Level A)
- Distinct Part Skilled Nursing Facilities
- Distinct Part Subacute Care Units
- Distinct Part Pediatric Subacute Care Units
- Cov Chaw Saib Xyuas Kev Noj Qab Haus Huv rau Cov Neeg Laus Hnub (Raws li qhov kev txiav txim ua ntej tshaj tawm los ntawm Lub Tsev Hais Plaub Hauv Cheeb Tsam hauv Teb Chaws Asmeskas thaum Lub Peb Hlis 9, 2009, tsuas yog cov kev pabcuam muab thaum lub Peb Hlis 1 txog Lub Peb Hlis 8, 2009, yuav raug txo kom them nyiaj rau lub sijhawm no.)
- Cov Chaw Muag Tshuaj (Cov tshuaj uas tau sau ntawv yuav thiab cov tshuaj uas yuav tsis tas yuav muaj ntawv yuav uas muab los ntawm daim ntawv yuav raws li qhov kev pab cuam Medi-Cal FFS raug zam los ntawm kev txo nqi them raws li kev txwv tsis pub them ua ntej uas tau muab los ntawm Tsev Hais Plaub Hauv Cheeb Tsam Tebchaws Meskas rau lub Ob Hlis 27, 2009. Qhov kev txo nqi them yuav tsis siv rau cov khoom ntawd lub sijhawm no.)
Rau cov hnub ua haujlwm rau thiab tom qab Lub Ib Hlis 1, 2022, cov chaw muab kev pabcuam thiab cov kev pabcuam hauv qab no raug zam los ntawm kev txo nqi them:
- Complex rehabilitation technology thiab complex rehabilitation technology services (CRTS/CRTS)
Rau cov hnub ua haujlwm rau lossis tom qab Lub Xya Hli 1, 2022, cov chaw muab kev pabcuam thiab cov kev pabcuam hauv qab no raug zam los ntawm kev txo cov nyiaj them poob haujlwm:
- Certified Acupuncturist
- Alternative Birthing Centers
- Kev pab tiv thaiv mob hawb pob
- Cov kws kho mob
- Cov txhab nyiaj ntshav
- Chronic Dialysis Clinics
- Fabricating Optical Laboratory
- Dispensing Opticians
- Assistive Devices and Sick Room Supply Dealers (Durable Medical Equipment [DME])
- Air Ambulance Transportation Services
- Daim ntawv tso cai Clinical Social Worker-Individual
- Daim ntawv tso cai Clinical Social Worker-Group
- Hearing Aid Dispensers
- Kev sib yuav thiab Tsev Neeg Therapist-Ib leeg
- Kev Sib Yuav thiab Tsev Neeg Therapist-Pab Pawg
- Certified Nurse
- Nurse Anesthetists
- Certified Nurse Practitioner
- Pab Pawg Certified Nurse Practitioner
- RVNS Tus Kws Kho Mob Tus Kheej
- Clinical Nurse Specialist Crossover Provider xwb
- Tus kws kho mob ua haujlwm
- Optometrist Optometry Pawg
- Pawg Optometrist
- Orthotists
- Tus neeg mob sab nraud Heroin Detox Center
- Portable X-Ray
- Community Clinic
- Dawb Clinic
- Kev phais phais
- Rehabilitation Clinic
- Cov chaw kho mob raug zam los ntawm daim ntawv tso cai
- Psychologist
- Kev saib xyuas tus neeg mob nyob deb (RPM)
- Tus kws kho mob ua pa
- Pawg kws kho mob ua pa
- California Cov Kev Pabcuam Menyuam (CCS)/ Cov Neeg Muaj Kev Tsis Taus Genetically Handicapped Persons Program (GHPP) Tsis Yog-Institutional
- Tus kws kho hais lus
Txog hnub uas cov kev pab cuam nyob rau lossis tom qab Lub Ib Hlis 1, 2023, cov chaw muab kev pabcuam thiab cov kev pabcuam hauv qab no raug zam los ntawm kev txo cov nyiaj them poob haujlwm:
- Doula Cov Kev Pabcuam Ib Leeg
- Doula Group Cov Chaw Pabcuam
- Cov kws kho mob
- Prothetists
Non-Medi-Cal FFS
Qhov kev txo nqi them 1 feem pua yuav siv rau cov kev pabcuam uas muab los ntawm cov kev pabcuam uas tsis yog Medi-Cal teev hauv qab no. (Daim ntawv txiav txim plaub ntug uas tau muab rau lub Ob Hlis 27, 2009, uas zam cov tshuaj uas tau sau ntawv yuav thiab cov tshuaj uas yuav tsis tas yuav muaj ntawv yuav uas muab los ntawm daim ntawv yuav los ntawm kev txo nqi them, tsis siv rau cov tshuaj uas tau muab los ntawm cov kev pab cuam uas tsis yog Medi-Cal uas teev hauv qab no.) Daim ntawv txwv tsis pub ua ntej uas tau muab los ntawm Tsev Hais Plaub Hauv Cheeb Tsam Tebchaws Meskas rau lub Peb Hlis 9, 2009, zam rau cov chaw saib xyuas neeg laus thaum nruab hnub los ntawm kev txo nqi them rau lossis tom qab lub Peb Hlis 9, 2009, tsis siv rau cov kev pab cuam teev hauv qab no.
- California Children's Services (CCS)
- CCS/Healthy Families
- Genetically Handicapped Persons Program
- State-Tsuas Tsev Neeg Planning Program
- Lub Xeev nkaus xwb Child Health and Disability Prevention Program
Kev ua
Vim yog cov kev hloov pauv uas xav tau los siv cov kev txo cov nyiaj them poob haujlwm, cov nyiaj them rau CCS, CCS/Cov Tsev Neeg Noj Qab Haus Huv, Kev Pabcuam Cov Neeg Tsis Txaus Siab, thiab Cov Kev Pabcuam Hauv Xeev nkaus xwb yuav raug txo qis 5 feem pua rau cov chaw muag tshuaj thiab rau cov kev pab cuam nyob rau hauv ib lub tsev tu mus sij hawm ntev es tsis yog qhov muaj feem cuam tshuam txog 1 feem pua ntawm kev txo qis.
Kev hloov pauv ntawm lub kaw lus kom siv qhov feem pua tsawg kom raug raws li W&I Code Seem 14105.191 tau teem sijhawm kom ua tiav li ntawm peb lub hlis. Thaum twg siv tau lawm, Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) yuav teeb tsa Kev Kho Kom Them Nqi Yuam Kev los kho cov nyiaj them ua ntej kev hloov pauv ntawm lub kaw lus kom pom tseeb qhov feem pua ntawm kev txo qis.
Kev zam
Cov kev pabcuam hauv qab no, cov chaw thiab cov nyiaj them poob haujlwm raug zam los ntawm 1 feem pua thiab 5 feem pua ntawm cov neeg muab kev pab them nqi txo tau piav qhia saum toj no:
- Daim ntawv cog lus kho mob mob hauv tsev kho mob
- Tsoom Fwv Teb Chaws Tsim Nyog Cov Kev Pabcuam Kho Mob
- Cov kev pab cuam kho mob nyob deb nroog
- Long-Term Care Facilities, suav nrog:
- Freestanding txawj tu tsev kho mob
- Cov chaw zov me nyuam nruab nrab rau cov neeg xiam oob khab
- Freestanding subacute care units ntawm cov kws kho mob tshwj xeeb
- Cov chaw muaj lossis ua haujlwm los ntawm Lub Xeev Lub Tsev Haujlwm Saib Xyuas Kev Puas Hlwb lossis Lub Xeev Lub Tsev Haujlwm Saib Xyuas Kev Loj Hlob
- Kev pab tsev kho mob
- Cov kev pabcuam cog lus uas tus thawj coj ntawm DHCS xaiv
- Kev them nyiaj rau cov neeg muab kev pabcuam rau qhov kev them nyiaj tau txais los ntawm kev lees paub kev siv nyiaj hauv pej xeem lossis kev hloov pauv hauv tsoomfwv
- Cov kev pab cuam raws li daim ntawv cog lus pab hauv zos thiab cov ntawv cog lus sib koom ua ke rau qhov uas cov nyiaj tsis suav nrog hauv cov nyiaj uas tsim nyog rau DHCS
- Kev them nyiaj rau Medi-Cal tswj cov phiaj xwm saib xyuas rau cov kev pabcuam rau cov neeg siv khoom hloov pauv los ntawm Agnews Developmental Center mus rau hauv lub nroog
- Qhov Kev Pabcuam Kev Kho Mob Cancer Mis thiab Cervical thiab Cancer Detection Programs: Txhua Tus Poj Niam suav
- Family Planning, Access, Care and Treatment (PACT) Waiver Program
- Cov tsev kho mob me me thiab nyob deb nroog
Tsis muaj ib qho kev txo qis uas tau piav qhia saum toj no yuav siv rau kev them nyiaj rau cov kev pabcuam them nrog cov nyiaj uas tsim nyog rau lwm lub tuam tsev lossis lub koomhaum.
Cov kev txo nqi 10 feem pua ntawm Medi-Cal FFS cov nyiaj them rau cov kev pabcuam uas cov tsev kho mob pw hauv tsev kho mob uas tsis muaj daim ntawv cog lus nrog DHCS raws li Selective Provider Contracting Program (W&I Code Section 14081 et seq.) tau teev tseg hauv W&I Code Section 14166.245, pib siv txij lub Xya Hli 1, 2008, thiab yuav txuas ntxiv mus siv. Ntxiv rau, kev hloov pauv nyiaj rov qab rau cov kev pabcuam pw hauv tsev kho mob uas tsis yog daim ntawv cog lus uas nyuam qhuav raug yuam los ntawm W&I Code Section 14166.245, raws li tau hloov kho los ntawm Assembly Bill 1183 thiab siv tau rau lub Kaum Hli 1, 2008, kuj tseem yuav siv tau.