Kev Tshawb Fawb Txog Kev Kho Mob thiab Kev Npaj Kho Kom Zoo
Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) ua haujlwm nrog Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv Tswj (DMHC) los ua cov kev soj ntsuam kev kho mob niaj hnub ntawm Medi-Cal Managed Care Health Plans (MCPs) rau cov pej xeem xaiv txhua xyoo. Daim ntawv ntsuam xyuas kev kho mob yog kev ntsuam xyuas dav dav ntawm MCP txoj kev ua raws li Txoj Cai Kev Kho Mob Tswj Xyuas Lub Sijhawm (Knox-Keene Health Care Service Plan Act).
DHCS lub Chaw Saib Xyuas Kev Saib Xyuas Zoo thiab Kev Saib Xyuas (MCQMD) yog lub luag haujlwm rau kev ua kom muaj kev saib xyuas thiab kev saib xyuas tag nrho ntawm MCPs. MCQMD xaiv Lub Chaw Saib Xyuas Kev Sau Npe thiab Kev Sau Npe (CERD) ntawm DHCS' Kev Tshuaj Xyuas thiab Kev Tshawb Fawb (A&I) los ua cov kev tshuaj xyuas uas tau txib.
MCQMD thiab A&I tau koom tes ua ke los tsim Cov Lus Qhia Txog Kev Pab Txuj Ci (TAG) rau txhua rau pawg kev tshuaj xyuas. Cov TAGs yog tsim los txheeb xyuas cov ntsiab lus tseem ceeb uas yuav raug soj ntsuam kom qhia rau MCPs txog cov txheej txheem kev tshuaj xyuas thiab ua kom pom tseeb dua.
DHCS ua qhov kev tshawb pom qhov tseeb txog lub peev xwm ntawm MCPs los muab cov kev pabcuam kev noj qab haus huv zoo, kev ua haujlwm zoo ntawm kev tshuaj xyuas los ntawm cov phooj ywg, thiab cov txheej txheem tswj kev siv, thiab kev ua tau zoo tag nrho hauv kev muab cov txiaj ntsig kev kho mob rau nws cov neeg sau npe. Cov kev tshuaj xyuas no pab DHCS nrog nws txoj kev siv zog saib xyuas tag nrho, thiab txheeb xyuas cov cheeb tsam uas tsis ua raws li txoj cai, uas yog lub hauv paus rau kev kho kom raug.
Cov MCPs yuav tsum tau muab Daim Ntawv Npaj Kho (CAP) thaum ua tiav DHCS Medical Audit lossis lwm yam kev saib xyuas uas pom cov ntsiab lus. DHCS ua cov kev ntsuam xyuas xa CAP thiab muab kev pab txog kev txawj ntse kom ntseeg tau tias ua raws li txoj cai.
Daim Ntawv Ceeb Toom Txog Kev Kho Mob thiab Cov Kev Npaj Kho Kom Zoo:
Saib hauv qab no rau Daim Ntawv Tshaj Qhia Kev Tshawb Fawb tsis ntev los no thiab cov phiaj xwm kho kom raug
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