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 tab tom txiav txim siab txog kev them nyiaj kho mob thiab txoj cai them rov qab rau Medi-Cal, BD cov kws pab tswv yim kho mob - koom tes nrog lwm tus kws kho mob thoob plaws DHCS - ua kev tshuaj xyuas ywj pheej thiab xav txog ntau yam, suav nrog, tab sis tsis txwv rau: kev txiav txim siab ntawm lwm tus neeg them nyiaj, suav nrog lwm lub xeev cov kev pab cuam Medicaid; kev txiav txim them nqi rau tsoom fwv Medicare, kev tuav pov hwm kev lag luam, thiab lwm yam.; kev taw qhia los ntawm tsoomfwv saib xyuas / cov cai tswjfwm xws li Tsoom Fwv Saib Xyuas Khoom Noj thiab Tshuaj, thiab lwm yam.; thiab cov ntaub ntawv pov thawj, kev lees paub hauv lub tebchaws cov txheej txheem kev kho mob, thiab cov lus pom zoo; thiab cov phooj ywg-saib cov ntaub ntawv thiab randomized, tswj kev soj ntsuam kev tshawb fawb/sim. Thaum kawg, BD cov kws pab tswv yim kho mob yuav tsum xyuas kom meej tias txhua yam khoom siv, kev sim / txheej txheem, kev pabcuam, thiab / lossis cov lej sau nqi ntxiv raws li cov txiaj ntsig hauv Medi-Cal ua tau raws li qhov tsim nyog "kev xav tau kho mob" thiab lwm yam qauv rau kev pov hwm raws li tsoomfwv Medicaid program.
Ua raws li California Welfare thiab Institutions Code tshooj 14059.5: (a) Rau cov neeg muaj hnub nyoog 21 xyoos lossis laus dua, kev pabcuam yog "tsim nyog kho mob" lossis "kev kho mob tsim nyog" thaum tsim nyog thiab tsim nyog los tiv thaiv lub neej, tiv thaiv kev mob loj lossis kev tsis taus loj, lossis txo qhov mob hnyav. (b)(1) Rau cov tib neeg hnub nyoog qis dua 21 xyoos, qhov kev pabcuam yog "tsim nyog kho mob" lossis "tseem ceeb kho mob" yog tias qhov kev pabcuam ua tau raws li cov qauv teev tseg hauv Tshooj 1396d(r)(5) ntawm Title 42 ntawm Tebchaws Meskas Txoj Cai. Raws li tau teev tseg hauv Medi-Cal txoj cai, Kev Tshuaj Ntsuam Xyuas Thaum Ntxov thiab Lub Sij Hawm, Kev kuaj mob thiab Kev Kho Mob (EPSDT) yog qhov tsim nyog rau kev kho mob lossis kev kho mob yog tias lawv kho lossis kho qhov tsis xws luag thiab mob lub cev thiab mob hlwb thiab cov xwm txheej uas pom los ntawm kev tshuaj ntsuam.
Cov txheej txheem thov nyiaj pab Medi-Cal
BD tau tsim Medi-Cal Cov Nyiaj Pab Thov (MBR) (DHCS 8712), uas yuav tsum ua kom tiav los ntawm cov neeg sab nraud (xws li, cov chaw muab kev pabcuam, cov chaw tsim khoom, cov neeg tawm tswv yim, thiab lwm yam) uas thov BD qhov kev txiav txim siab ntxiv ib qho khoom siv, kuaj / txheej txheem, kev pabcuam, thiab / lossis cov lej them nqi raws li Medi-Cal cov txiaj ntsig. BD yuav tsis tuaj yeem lees txais MBR rau cov cai tswjfwm lossis cov haujlwm sab nraud ntawm peb thaj chaw uas tau teev tseg. Yog tias BD tau txais MBR rau lub hom phiaj no, BD yuav hloov MBR mus rau pab pawg DHCS tsim nyog rau kev taug qab.
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.
- Yog xav paub ntxiv txog PRA, thov mus saib DHCS' Public Records Act lub vev xaib.
Cov peev txheej
Cov ntaub ntawv tiv tauj
Hu rau 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 tseem tuaj yeem xa tuaj rau peb ntawm qhov chaw nyob hauv qab no:
Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv- Kev Pabcuam Pabcuam
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 txoj cai tswjfwm rau cov kev pabcuam hauv tsev neeg thiab cov kev pabcuam (tshwj tsis yog cov kev pabcuam rho menyuam), tshwj xeeb kev puas siab puas ntsws (SMH) thiab kev siv tshuaj tsis zoo (SUD)/Drug Medi-Cal Organized Delivery System (DMC-ODS) cov kev pabcuam muab los ntawm lub nroog tus cwj pwm kev noj qab haus huv, tshuaj kho mob sab nraud, suav nrog kws kho mob nkag mus rau cov khoom noj khoom haus, kev noj zaub mov noj, tsom iav / ntaub, lossis khoom siv kho mob. Tsis tas li ntawd, BD tsis saib xyuas txoj cai kev pab them nqi kho mob rau cov kev pab cuam tshwj xeeb hauv qab no: California Children's Services (CCS) Program, Family Planning, Access, Care, and Treatment (FPACT) Program, Txoj Kev Kho Mob Cev thiab Cervical Cancer (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.
