Tsev Cov Kev Kho Mob Ib Txwm Muaj Cov Kev Kho Mob Ib Txwm Muaj - Cov Lus Nug Feem Ntau

Traditional Health Care Practices – FAQs

Lub vev xaib no muab cov lus teb rau cov lus nug uas feem ntau hais txog Medi-Cal kev saib xyuas kev noj qab haus huv ib txwm muaj txiaj ntsig. Yog tias koj nrhiav tsis tau cov lus teb rau koj cov lus nug hauv qab no, thov hu rau traditionalhealing@dhcs.ca.gov.

Cov FAQ hauv qab no tau muab faib ua pawg hauv qab no:

Acronyms & Abbreviations

The table below is a list of common acronyms/abbreviations used throughout the FAQ.

Acronym/Abbreviation	Txhais
AIR	Txhua-Inclusive Rate
AI/AN	Neeg Asmeskas Khab/Alaska Native
AOD	Cawv thiab Lwm Yam Tshuaj
ASAM	American Society of Addiction Medicine
BHIN	Daim Ntawv Qhia Txog Tus Cwj Pwm Kev Noj Qab Haus Huv
CMS	Chaw rau Medicare thiab Medicaid Services
DHCS	Department of Health Care Services
DMC	Tshuaj Medi-Cal
DMC-ODS	Tshuaj Medi-Cal Organized Delivery System
EBPs	Cov ntaub ntawv pov thawj-raws li kev coj ua
IHS	Indian Kev Pabcuam Kev Noj Qab Haus Huv
IHCP	Indian Health Care Provider (ceeb toom: lo lus no yog hais txog cov kev pab cuam, tsis yog tus kws kho mob tus kheej)
MAT	Cov Tshuaj Kho Mob Ntshav Qab Zib (tseem hu ua tshuaj pab kho mob)
THCP	Cov kev coj noj coj ua zoo li qub
STC	Cov ntsiab lus tshwj xeeb thiab cov xwm txheej
SUD	Kev Siv Tshuaj Tsis Zoo

Indian Health Care Provider (IHCP) thiab DMC-ODS County Coordination

Yuav ua li cas IHCPs thiaj li tsim nyog los muab, thiab tau txais kev them nyiaj rau, Kev Kho Kho Kho Kho Kho Kho thiab Kev Pabcuam Ntuj Zoo rau Medi-Cal cov tswv cuab?

Yuav kom IHCP pib muab thiab tau txais kev them nyiaj rau kev muab cov kev pabcuam Traditional Healer thiab Natural Helper rau cov tswv cuab Medi-Cal uas tsim nyog, IHCPs yuav tsum tau sau npe ua tus kws kho mob Medi-Cal; xa ib pob ntawv xaiv rau DHCS; thiab tau txais tsab ntawv pom zoo.

Once an IHCP submits an opt-in package, DHCS will review and provide approval no earlier than 10 business days after submission. After DHCS approves the IHCP’s opt-in package, the IHCP must share a copy of the opt-in package and the approval letter with the DMC-ODS counties in which they plan to provide services. This county notification is for informational purposes only; DHCS is solely responsible for approving each IHCP opt-in package. DHCS will provide the IHCP with the appropriate county contact information. DMC-ODS County Contacts are also posted on the on the Traditional Health Care Practices webpage.

Cov IHCPs tuaj yeem xa cov ntawv thov rau lub nroog rau cov kev pabcuam uas siv tau rov qab mus txog hnub uas pob khoom xaiv tau xa mus rau DHCS tsuav yog DHCS pom zoo rau pob khoom.

Lub nroog DMC-ODS yuav paub li cas thaum IHCP tau txais kev pom zoo los them nqi rau cov kev pabcuam Traditional Healer thiab Natural Helper?

DHCS will post and regularly update a list of opt-in IHCPs on the Traditional Health Care Practices webpage. The list will include each IHCP’s effective date for claims submission. The IHCP must also share a copy of the approved opt-in package and DHCS approval letter with the DMC-ODS counties in which they plan to provide services.

DMC-ODS counties should communicate directly with IHCPs and may also, if needed, contact their DHCS liaison with questions about an IHCP’s opt-in status.

IHCPs tuaj yeem nrhiav cov ntaub ntawv tiv tauj rau DMC-ODS cov nroog li cas?

DHCS has DMC-ODS contact information for dedicated traditional health care practices points of contact available upon request. IHCPs are encouraged to coordinate with counties, including establishing payment mechanisms, as soon as possible if they are considering opting inor have submitted an opt-in package.

Puas yog IHCPs yuav tsum tau cog lus nrog DMC-ODS lub nroog los muab kev pabcuam kev noj qab haus huv ib txwm muaj?

IHCPs providing traditional health care practices to only American Indian/Alaska Native (AI/AN) members are not required to contract with DMC-ODS counties to receive payment, consistent with federal law and existing Medi-Cal policy (see U.S. Code, title 25, Section 1647a, Code of Federal Regulations, title 42, section 438.14 438.14(b)(4), and BHIN 22-053).

Cov IHCPs yuav tsum tau tuav daim ntawv cog lus nrog DMC-ODS cov nroog kom tau txais kev them nyiaj rau kev muab cov kev kho mob ib txwm muaj rau cov tswv cuab uas tsis yog AI/AN.

Puas yog IHCPs xav tau kev sib koom them nqi rau cov kev kho mob ib txwm muaj ncaj qha nrog cov nroog?

Cov nroog DMC-ODS muaj lub luag haujlwm them nyiaj rau IHCPs rau kev xa cov kev kho mob ib txwm muaj. Txhawm rau txhawb kev sib koom tes, IHCPs yuav tsum muab ib daim qauv ntawm lawv pob ntawv xaiv-nkag thiab tsab ntawv pom zoo ntawm DHCS rau cov nroog DMC-ODS thiab sib koom tes nrog lawv ncaj qha los tsim cov txheej txheem them nqi thiab them nyiaj, tsis hais IHCP puas nkag mus rau hauv daim ntawv cog lus nrog lub nroog.

Through the DMC-ODS Regional Model, Humboldt, Lassen, Mendocino, Modoc, Shasta, Siskiyou, and Solano counties delegate DMC-ODS administrator responsibilities, including billing and payment, to Partnership Healthplan (PHP). In these instances, PHP will administer the claims, but payments to IHCPs are still the responsibility of each county. For counties where PHP serves as the delegated administrator for DMC-ODS, the IHCP should share the opt-in package and DHCS approval letter with both the DMC-ODS county and PHP and work with both entities as needed to establish coordination around billing and payment. DMC-ODS County Points of Contact, posted on the on the Traditional Health Care Practices webpage, can assist IHCPs in coordinating and addressing billing and payment inquiries.

Puas yog DMC-ODS cov nroog yuav tsum muaj qee tus lej ntawm IHCPs muab kev saib xyuas kev noj qab haus huv ib txwm muaj hauv lawv Lub Nroog?

While counties are not required to have a certain number of IHCPs providing traditional health care practices, counties are required to demonstrate there are sufficient IHCPs participating in the provider network to ensure timely access to services for eligible American Indian/Alaska Native (AI/AN) members as outlined in Code of Federal Regulations, section 438.14 and BHIN 25-013. Additionally, DMC-ODS counties are required to coordinate access to traditional health care practices for members in their county who meet eligibility criteria, consistent with Code of Federal Regulations, section 438.14; BHIN 22-053; and BHIN 25-036.

Reminder: IHCPs are not required to contract with counties to be paid for covered services delivered to eligible AI/AN members.

Cov tswv cuab puas tuaj yeem tau txais kev saib xyuas kev noj qab haus huv ib txwm muaj los ntawm IHCPs sab nraum DMC-ODS Lub Nroog uas lawv tau tso npe rau hauv, xws li lub nroog nyob sib ze?

Raws li BHIN 22-053, cov tswv cuab ntawm American Indian/Alaska Native (AI/AN) uas tsim nyog tau txais kev kho mob ib txwm muaj raws li BHIN 25-036 yuav tau txais kev pabcuam los ntawm txhua qhov IHCP uas tau pom zoo los muab lawv, tsis hais IHCP puas muaj daim ntawv cog lus nrog lub nroog uas tus tswv cuab tau sau npe rau hauv. Cov nroog DMC-ODS tsis muaj lub luag haujlwm them rau cov kev pabcuam uas IHCPs muab rau cov tswv cuab uas tsis yog AI/AN uas tsis tau cog lus nrog lub nroog. Cov nroog DMC-ODS xaiv tau daim ntawv cog lus nrog IHCPs rau kev saib xyuas cov neeg uas tsis yog AI/AN.

IHCPs should bill the DMC-ODS County that the member receiving services is enrolled in, regardless of where the IHCP is located. Prior to delivering services, providers should verify which county is responsible for payment of a member’s care, as outlined in BHIN 24-008.

Kev piav qhia

Puas muaj ib daim ntawv teev tag nrho ntawm Cov Kev Kho Mob Ib Txhis thiab Kev Pabcuam Ntuj Kev Ua Haujlwm los ntawm Medi-Cal?

DHCS lees paub tias kev saib xyuas kev noj qab haus huv ib txwm muaj suav nrog ntau yam kev coj noj coj ua uas tsim nyog thiab tsis txhais cov kev pabcuam tshwj xeeb. Cov Kws Kho Mob Khab Ib Tus Kheej (IHCPs) tuaj yeem txheeb xyuas thiab muab ntau yam kev coj noj coj ua, raws li tau txiav txim los ntawm IHCP. Cov lus piav qhia hauv qab no hauv DHCS cov lus qhia tsis yog tsim los ua kom tiav.

Cov kev pab cuam kho mob ib txwm siv tau ntau yam kev cuam tshuam nrog rau kev kho suab paj nruag (xws li suab paj nruag thiab nkauj, seev cev, ntaus nruas), sab ntsuj plig (xws li kev ua koob tsheej, rituals, tshuaj ntsuab) thiab lwm yam kev sib koom ua ke.
Cov Kev Pabcuam Ntuj Pabcuam tuaj yeem pab txhawb kev taug kev, kev tsim kho kev puas siab puas ntsws, kev tswj tus kheej, thiab kev txhawb nqa kev raug mob rau cov tib neeg uas kho kev noj qab haus huv ntawm cov tswv cuab Medi-Cal tsim nyog.

Note that the Special Terms and Conditions (STCs), section 13.3(c), lists services and activities that are not covered.

Medi-Cal Kev Tsim Nyog Rau Cov Tswv Cuab rau Cov Kev Kho Mob ib txwm muaj

Puas muaj kev saib xyuas kev noj qab haus huv ib txwm muaj rau cov tswv cuab hnub nyoog qis dua 21 xyoos?

Cov kev kho mob ib txwm muaj rau cov tswv cuab Medi-Cal txawm tias muaj hnub nyoog li cas los xij uas yog 1) tau sau npe rau hauv Medi-Cal lossis CHIP hauv lub nroog DMC-ODS; 2) tau txais cov kev pabcuam uas xa los ntawm lossis los ntawm tus neeg muab kev pabcuam kho mob Indian Health Care Provider (IHCP) uas koom nrog; thiab 3) ua tau raws li cov qauv nkag mus rau DMC-ODS (qhia meej hauv BHIN 24-001).

Puas yog cov kev saib xyuas kev noj qab haus huv ib txwm muaj raws li tsoomfwv Kev Tshawb Fawb Thaum Ntxov thiab Lub Sijhawm Sijhawm, Diagnostic, thiab Treatment (EPSDT) cov cai?

Tsis yog. Federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) cov cai thiab cov cai siv tau rau cov kev pab cuam raws li Tshooj 1905(a) ntawm Txoj Cai Xaus Saus. Txij li cov kev saib xyuas kev noj qab haus huv ib txwm muaj kev tso cai raws li 1115 CalAIM Waiver thiab tsis nyob hauv Tshooj 1905(a), txoj cai EPSDT tsis muaj feem xyuam. Cov tswvcuab hnub nyoog qis dua 21 xyoos yuav tsum tau tso npe rau hauv Medi-Cal lossis CHIP hauv DMC-ODS county thiaj li tsim nyog tau txais kev pabcuam kev noj qab haus huv ib txwm muaj rau lub sijhawm no.

Puas yog DHCS yuav nthuav dav kev saib xyuas kev noj qab haus huv ib txwm muaj rau lwm lub tshuab xa khoom dhau ntawm Kev Siv Tshuaj Medi-Cal Organized Delivery System (DMC-ODS)?

Txij li xyoo 2015, thaum pib sib tham txog kev npaj rau DMC-ODS, DHCS tau ua haujlwm nrog cov neeg koom tes hauv Tribal thiab Urban Indian los tsim thiab txhawb nqa ib qho kev thov kom them rau Traditional Healer thiab Natural Helper cov kev pabcuam ua ib qho kev xaiv teb rau kab lis kev cai rau kev kho mob siv tshuaj yeeb (SUD) hauv DMC-ODS. Tau kaum xyoo tom qab ntawd, DHCS tau koom tes nrog Cov Pab Pawg Neeg thiab Cov Neeg Koom Tes Hauv Pab Pawg Neeg los tsim cov kev pabcuam uas tau npaj tseg, tshawb nrhiav cov qauv ODS ntawm Indian Health Program, thiab thov kev tso cai los ntawm tsoomfwv tebchaws rau kev pabcuam Traditional Healer thiab Natural Helper raws li DMC-ODS. Cov haujlwm no sawv cev rau kev lees paub ua ke tias cov kev pabcuam no tseem ceeb heev rau kev ua kom tau raws li kev xav tau kev noj qab haus huv thiab kab lis kev cai ntawm cov Neeg Amelikas Isdias/Alaska Natives; pab txhawb kev nkag mus rau kev saib xyuas; thiab txo qhov sib txawv ntawm kev tuag los ntawm kev siv tshuaj ntau dhau hauv cov zej zog Tribal.

At this time, coverage of traditional health care practices is limited to Medi-Cal/CHIP members who are seeking care for substance use and enrolled in Medi-Cal/CHIP in DMC-ODS counties. The 1115 waiver approval and Special Terms and Conditions permit DHCS to expand traditional health care practices to other delivery systems. This would require state budget action and additional financial resources; Medi-Cal coverage for traditional health care practices is not limited to members whose care is covered entirely by federal funds, so state funds must be authorized.

Vim muaj kev txaus siab rau kev nthuav dav los ntawm cov neeg koom tes hauv Pab Pawg Neeg, DHCS npaj yuav koom tes nrog Cov Pab Pawg Neeg, Cov neeg koom tes hauv Pab Pawg Neeg, cov phiaj xwm kev noj qab haus huv ntawm lub nroog, cov phiaj xwm kev saib xyuas kev noj qab haus huv, thiab lwm tus neeg koom nrog, raws li qhov tsim nyog, txog kev nthuav dav mus rau lwm lub tshuab xa khoom. Txhua qhov kev nthuav dav yuav ua raws li cov kev cai ceeb toom ntawm CMS, kev ceeb toom rau pej xeem, thiab cov txheej txheem kev sab laj ntawm Pawg Neeg. DHCS yuav txuas ntxiv sib txuas lus txog cov cib fim rau kev koom tes ntxiv.

Traditional Healer and Natural Helper Requirements/Qualifications

Cov kws kho mob/cov kws kho mob twg tuaj yeem xa cov kev pabcuam raws li qhov txiaj ntsig no?

Cov kev saib xyuas kev noj qab haus huv ib txwm raug them raws li Medi-Cal cov txiaj ntsig tsuas yog thaum xa los ntawm Cov Kws Kho Mob thiab Cov Pabcuam Tib Neeg uas ua haujlwm lossis cog lus los ntawm cov koom nrog Indian Health Care Providers (IHCPs). Cov ntsiab lus dav dav rau txhua tus tau tsim los koom tes nrog Pawg Neeg thiab Pawg Neeg Koom Tes ua lub hauv paus rau kev siv thiab txhawb kom muaj kev nkag siab sib koom ntawm IHCPs thiab DMC-ODS counties:

Ib Tus Kws Kho Mob Ib txwm yog ib tus neeg tam sim no lees paub tias yog ib tus thawj coj ntawm sab ntsuj plig nyob rau hauv qhov zoo nrog Native American Pawg, Nation, Band, Rancheria, los yog ib haiv neeg hauv zej zog, thiab nrog ob xyoos ntawm kev paub dhau los ua ib tus thawj coj ntawm haiv neeg Asmeskas uas tau lees paub los ntawm Pawg Neeg Qhab Asmeskas, Nation, Band, Rancheria, lossis Native zej zog uas tau cog lus los ntawm IeHCP. Ib Tug Kws Kho Mob Ib txwm yog ib tus neeg muaj kev paub, kev txawj ntse thiab kev coj ua raws li kev xav, kev ntseeg, thiab cov kev paub uas tau lees paub los ntawm lub zej zog Indian uas tau muab los ntawm ntau tiam neeg thiab uas tuaj yeem tsim los ntawm kev paub txog cov txwj laus ntawm lub zej zog Indian.
Tus Kws Pabcuam Ntuj yog tus kws pab tswv yim txog kev noj qab haus huv tau cog lus lossis ua haujlwm los ntawm IHCP uas nrhiav kev pabcuam kev noj qab haus huv, rov qab los, thiab kev txhawb nqa kev sib raug zoo hauv cov ntsiab lus ntawm Pawg Neeg. Tus Pabcuam Ntuj tuaj yeem yog tus thawj coj ntawm sab ntsuj plig, raug xaiv los ua haujlwm, tus kws tshaj lij lossis lwm tus neeg uas yog ib tus tswvcuab ntseeg ntawm Pawg Neeg Qhab Asmeskas, Tebchaws, Band, Rancheria, lossis haiv neeg hauv zej zog.

Puas yog DHCS xav kom cov Kws Kho Mob Ib Txwm thiab Cov Neeg Pab Ntuj Tsim Nyog yuav tsum muaj daim ntawv pov thawj los ntawm lub nroog lossis muaj qee yam kev tsim nyog, xws li daim ntawv tso cai lossis daim ntawv pov thawj?

Tsis yog. Cov kws kho mob ib txwm lossis cov neeg pab ntuj tsim tsis tas yuav muaj daim ntawv tso cai lossis daim ntawv pov thawj. Cov Kws Kho Mob Ib Txwm thiab Cov Neeg Pab Txog Kev Noj Qab Haus Huv tsis raug rau cov kev cai ntawm DMC-ODS lub nroog cov kws kho mob uas tau teev tseg hauv MHSUDS 18-019.

Cov IHCPs uas koom nrog yuav tsum tsim cov txheej txheem los txiav txim siab seb 1) cov neeg ua haujlwm lossis cov neeg cog lus puas tsim nyog los muab cov kev kho mob ib txwm muaj; thiab 2) muaj kev paub dhau los thiab kev cob qhia tsim nyog. IHCPs yuav tsum suav nrog lawv cov cai thiab cov txheej txheem rau kev tsim, tshuaj xyuas, thiab pom zoo cov kev tsim nyog ntawm tus kws kho mob ua ib feem ntawm lawv cov pob khoom xa mus rau DHCS. DHCS tab tom sib koom tes nrog cov neeg koom tes hauv Tribal los muab kev pab txog kev txawj ntse rau IHCPs ntawm kev sau cov ntaub ntawv tsim nyog ntawm tus kws kho mob.

Kev Koom Tes

Cov Chaw Muab Kev Kho Mob Hauv Is Nrias teb (IHCPs) puas yuav tsum tau ntawv pov thawj Drug Medi-Cal (DMC) thiab/lossis Alcohol and Other Drug (AOD)?

IHCPs uas muab kev saib xyuas kev noj qab haus huv ib txwm muaj yuav tsum tau tso npe ua Medi-Cal cov kws kho mob. Yog tias IHCP tab tom muab DMC-ODS cov kev pabcuam tshaj li kev saib xyuas kev noj qab haus huv ib txwm muaj, nws kuj yuav tsum dhau los ua Tshuaj Medi-Cal (DMC) tau ntawv pov thawj kom xa thiab tau txais kev them nyiaj rau lwm yam kev pabcuam DMC-ODS.

Cov kev pab cuam muaj los ntawm IHCP	Tshuaj Medi-Cal (DMC) Certification
Tsuas yog kev saib xyuas kev noj qab haus huv ib txwm muaj (thiab tsis muaj lwm yam kev pabcuam DMC-ODS)	Tsis xav tau
Kev saib xyuas kev noj qab haus huv ib txwm muaj thiab lwm yam kev pabcuam DMC-ODS	xav tau

Saib BHIN 24-001 thiab BHIN 25-036 kom paub ntxiv txog cov kev cai ntawm daim ntawv pov thawj DMC.

Consistent with federal law, IHCPs enrolled as Medi-Cal providers are not required to obtain DHCS’ certification for Alcohol and Other Drug (AOD) programs if they meet all applicable standards.

Kuv yuav ua li cas thiaj paub yog tias kuv lub koom haum yog Indian Health Care Provider (IHCP) uas tsim nyog los koom nrog cov kev pab kho mob ib txwm muaj?

Consistent with BHIN 25-036, CMS’ Special Terms and Conditions, and the Code of Federal Regulations, title 42, section 438.14, traditional health care practices are covered when received through IHCPs, which include Indian Health Service (IHS) facilities, facilities operated by Tribes or Tribal organizations (Tribal Facilities) under the Indian Self-Determination and Education Assistance Act, and facilities operated by urban Indian organizations (UIO facilities) under Title V of the Indian Health Care Improvement Act.

Organizations that do not fall under the definition of IHCPs may enter into contracts with participating IHCPs to provide traditional health care practices, and are encouraged to engage with DHCS’ Technical Assistance partners. Interested organizations may email traditionalhealing@dhcs.ca.gov or visit the TA portal to request additional support.

Opt-in Process

What are DHCS’ criteria for approving or denying opt-in packages?

DHCS will approve opt-in packages that are complete and are aligned with BHIN 25-036 and relevant DMC-ODS policy requirements. DMC-ODS counties do not play a role in reviewing or approving opt-in packages.

Ib pob khoom xaiv koom nrog suav tias yog "ua tiav" yog tias txhua qhov chaw ntawm pob khoom xaiv koom tau teb thiab cov ntaub ntawv tsim nyog tau xa mus. Ib pob khoom yuav suav tias tiav lawm yog tias cov cai thiab cov txheej txheem raug xa tuaj ua qauv. Hauv qhov xwm txheej no, Tus Kws Muab Kev Kho Mob Indian (IHCP) yuav xa cov lus piav qhia txog cov kauj ruam los ua kom tiav cov P&Ps nrog rau hnub uas kwv yees tias yuav ua tiav.

Ib pob khoom xaiv koom yuav raug pom zoo tsis pub dhau 10 hnub ua haujlwm tom qab hnub xa yog tias pob khoom tiav thiab ua raws li txhua yam uas yuav tsum tau ua.

If the opt-in package is deemed “incomplete,” or does not address all requirements, DHCS will provide the IHCP with feedback to clarify how the opt-in materials must be revised and continue to work with the IHCP to achieve approval.

Tus txheej txheem rau IHCP yog dab tsi los xa thiab tau txais kev pom zoo rau lwm Cov Kev Cai Ua Raws Cai (EBPs)?

Rau IHCPs uas tsuas muab kev kho mob ib txwm muaj xwb (thiab tsis muaj lwm yam kev pabcuam DMC-ODS): Yog tias tsis muaj EBP rau cov pej xeem uas lawv tsom mus rau thiab hom teeb meem lossis kev mob nkeeg uas lawv tab tom daws, IHCP yuav ceeb toom rau DHCS tias nws npaj siab yuav siv cov kev coj ua sib pab (xws li cov kev coj ua uas hloov kho raws li kab lis kev cai, Cov Kev Coj Ua Uas Tau Txhais Los Ntawm Lub Zej Zog, thiab/lossis cov kev coj ua uas cog lus tias yuav ua raws li kab lis kev cai). Cov cai thiab cov txheej txheem uas tau xa tuaj yuav tsum qhia txog seb cov kev coj ua sib pab tau pom tias muaj txiaj ntsig zoo rau cov pej xeem uas tau tsom mus rau.

Rau IHCPs uas kuj muab lwm cov kev pabcuam DMC-ODS: IHCPs yuav tsum tau siv tsawg kawg yog ob ntawm EBPs uas teev nyob rau hauv BHIN 25-036.

What resources are available for IHCPs if they have questions about the opt-in process?

DHCS tab tom koom tes nrog Tribal TA cov neeg koom tes, Kauffman thiab Associates, California Consortium for Urban Indian Health (CCUIH) thiab California Rural Indian Health Board (CRIHB) los muab kev pab txog kev txawj ntse rau IHCPs. Cov peev txheej TA muaj nyob rau ntawm nplooj ntawv web Traditional Health Care practices. Thov xa email rau traditionalhealing@dhcs.ca.gov lossis mus saib lub portal TA kom thov kev pab ntxiv.

DHCS yuav teb sai npaum li cas rau IHCPs txog lawv qhov kev xaiv ntawm pob xa tuaj?

Qhov nruab nrab cov lus teb thiab lub sijhawm pom zoo yuav txawv raws li qhov ntim ntawm cov pob xaiv tau txais. Lub Tsev Haujlwm tsom mus muab kev pom zoo nyob rau hauv 30 hnub ua haujlwm (thiab tej zaum yuav tsis ntxov dua 10 hnub ua haujlwm). DHCS tau cog lus los tshuaj xyuas kom sai li sai tau thiab yuav sib txuas lus nrog IHCPs yog tias xav tau cov ntaub ntawv ntxiv lossis cov ntaub ntawv ntxiv.

Txoj Cai thiab Cov Txheej Txheem (P&Ps) yuav tsum muaj li cas kom tau txais kev pom zoo los ntawm DHCS?

IHCPs should develop and submit P&Ps that account for all requirements outlined in BHIN 25-036 and Enclosure 1 of BHIN 25-036 and that are specific to the IHCP’s organizational structure, resources, and community. IHCP P&P submissions should reflect how their individual organization will implement and meet these requirements and will be unique to each IHCP. In other words, re-stating the DHCS policy is not sufficient; the IHCP must describe its approach to implementing the policies and coordinating care for Medi-Cal members. IHCPs may submit draft P&Ps, as long as the IHCP includes an explanation of steps the IHCP must take to finalize them, along with the date the IHCP will submit the final materials.

The availability of Medi-Cal funds for traditional health care practices is contingent on IHCP’s comprehensive implementation of these P&Ps and the requirements included in BHIN 25-036 and the CMS Special Terms and Conditions. For support with opt-in package and P&P development, IHCPs are encouraged to reach out to traditionalhealing@dhcs.ca.gov or visit the TA portal to request additional support.

Kev Them Nqi, Kev Thov Nyiaj thiab Kev Them Nyiaj

Cov txheej txheem them nqi thiab thov rau kev muab cov kev pabcuam Traditional Healer thiab Natural Helper yog dab tsi?

Kauj Ruam 1: IHCP thiab DMC-ODC Lub Nroog sib koom tes los tsim cov txheej txheem them nqi, suav nrog:

Ib qho txheej txheem los xyuas kom meej tias cov nqi IHCP xa mus rau DMC-ODS cov nroog suav nrog txhua cov ntaub ntawv uas lub nroog xav tau los xa cov ntawv thov raws li txoj cai rau DHCS (saib FAQ ntawm nplooj ntawv no nrog rau daim ntawv teev cov khoom uas yuav tsum tau suav nrog rau cov ntawv thov rau Traditional Healer thiab Natural Helper cov kev pabcuam).
Ib qho txheej txheem rau lub nroog txais cov nqi los ntawm cov IHCPs uas tsis tau cog lus (out-of-network). Qhov no yuav suav nrog daim ntawv cog lus them nyiaj sab nraud ntawm lub network lossis lwm txoj hauv kev them nyiaj raug cai ntawm IHCP thiab Lub Nroog (ceeb toom: Cov nroog tsis tuaj yeem yuam kom IHCP uas tsis tau cog lus xa cov nqi lossis lwm cov ntaub ntawv los ntawm cov ntaub ntawv kho mob hluav taws xob tshwj xeeb).
Kev lees paub txog hnub uas IHCPs tuaj yeem them rov qab rau kev xa cov kev kho mob ib txwm muaj, tom qab DHCS pom zoo rau IHCP qhov kev xaiv koom nrog.

Kauj Ruam 2: IHCP xa daim nqi rau tus tswv cuab lub nroog DMC-ODS. Cov IHCPs yuav tsum xa daim ntawv them nqi rau tus tswv cuab lub luag haujlwm rau DMC-ODS County, raws li tau teev tseg hauv BHIN 24-008, tom qab muab kev pabcuam Traditional Healer lossis Natural Helper.

Kauj Ruam 3: Lub Nroog DMC-ODS xa daim ntawv thov mus rau DHCS. Thaum lub Nroog DMC-ODS tau txais daim nqi los ntawm IHCP, nws yuav tsum xa daim ntawv thov mus rau DHCS.

Thaum cov kev pabcuam Traditional Healer thiab Natural Helper muab los ntawm IHCP uas tsim nyog tau txais All-Inclusive Rate (AIR), DMC-ODS County yuav tsum thov kom them nyiaj ntawm AIR. Daim ntawv thov yuav tsum muaj cov lej taxonomy thiab NPI rau tus kws kho mob uas tsim nyog rau AIR (nrog rau IHCP qhov chaw NPI).

Rau cov kev pabcuam Traditional Healer thiab Natural Helper uas tsis tsim nyog rau AIR, cov lej taxonomy thiab cov NPIs ntawm tus kws kho mob tsis tas yuav tsum muaj. Saib cov nqi rau cov kev pabcuam uas tsis tsim nyog AIR hauv Medi-Cal Behavioral Health Fee Schedule.

Saib BHIN 25-036 kom paub meej txog cov lus qhia txog kev them nqi ntawm THCP.

Kauj Ruam 4A: Lub Nroog DMC-ODS them rau IHCP. Cov nroog DMC-ODS yuav tsum them nyiaj rau IHCPs uas muab kev kho mob ib txwm rau cov tswv cuab Medi-Cal raws sijhawm thiab sai sai rov qab mus rau hnub uas tau sau tseg hauv tsab ntawv pom zoo ntawm IHCP. Raws li txoj cai lij choj hauv tebchaws thiab lub xeev , DMC-ODS Counties yuav tsum them IHCPs rau kev xa cov kev kho mob ib txwm muaj rau cov tswv cuab ntawm American Indian/Alaska Native txawm tias IHCP puas muaj daim ntawv cog lus nrog lub nroog los xij.

Kauj Ruam 4B: DHCS ua cov ntaub ntawv thov thiab them nyiaj rau lub nroog DMC-ODS.

Leej twg yog tus them rau cov kev pabcuam Traditional Healer thiab Natural Helper?

Raws li txoj cai lij choj hauv tebchaws thiab BHIN 22-053, DMC-ODS Counties yuav tsum them cov IHCP uas tau pom zoo rau cov kev pabcuam THCP uas tsim nyog, txawm tias lawv tsis nyob hauv network los xij.

Tshwj xeeb, rau cov IHCPs sab nraud ntawm lub network, DMC-ODS Counties yuav tsum them nyiaj yog tias cov kev kho mob ib txwm muaj rau tus tswv cuab American Indian/Alaska Native Medi-Cal uas ua tau raws li lwm yam kev cai tsim nyog tau teev tseg hauv BHIN 25-036.

Cov ntaub ntawv twg yuav tsum muaj nyob rau hauv cov ntaub ntawv thov THCP uas xa mus rau DHCS los ntawm DMC-ODS Counties?

Tus Tswv Cuab CIN (Tus lej qhia txog tus neeg siv khoom)
Hnub yug ntawm tus tswv cuab
Cov tswv cuab kev sib deev
Tus lej txheej txheem (H0051 rau Tus Kws Kho Mob Ib Txwm thiab T1016 rau Tus Pab Cuam Ntuj)
Hnub Ua Haujlwm
Tus naj npawb ntawm cov chav tsev
Qhov chaw pabcuam (lus cim: kev coj ua kev kho mob ib txwm muaj nyob rau txhua qhov chaw pabcuam)
Tus nqi them
IHCP NPI
Rau Cov Kev Sib Tham Uas Tsim Nyog Rau Tus Nqi Tag Nrho Xwb: Tus neeg muab kev pabcuam NPI thiab tus lej taxonomy (saib BHIN 25-036 rau cov ntaub ntawv hais txog kev tsim nyog AIR)
Cov Lus Qhia Tshiab: Tus lej kuaj mob ICD-10 uas siv tau, ua raws li cov lus qhia uas muab rau hauv BHIN 22-013 thiab phau ntawv qhia them nqi DMC-ODS.
Cov ntaub ntawv hais txog ICD-10 diagnostic codes muab los ntawm CMS.

Cov nqi uas IHCP xa tuaj yuav tsum muaj tag nrho cov ntaub ntawv xav tau rau DMC-ODS Counties kom xa daim ntawv thov tiav rau DHCS.

Yuav tsum muaj tus lej ICD-10 uas siv tau rau DHCS los ua txhua daim ntawv thov THCP uas tau xa tuaj. Cov nroog tsis muaj lub luag haujlwm los txheeb xyuas lossis pom zoo cov lej kuaj mob tshwj xeeb uas IHCPs siv uas tsis tuav daim ntawv cog lus nrog lub nroog.
IHCPs uas tsis muaj daim ntawv cog lus hauv nroog tuaj yeem siv tag nrho cov lej ICD-10 tam sim no, raws li DHCS cov lus qhia. Cov nroog yuav tsis txwv tsis pub cov neeg muab kev pabcuam sab nraud ntawm lub network no thiab yuav tsum ua haujlwm nrog lawv kom pom zoo rau kev thov cov kev daws teeb meem yog tias cov cai EHR ntawm lub nroog txwv tsis pub siv cov lej ICD-10 uas yuav raug tso cai raws li kev taw qhia ntawm lub xeev; cov cai EHR tshwj xeeb ntawm lub nroog yuav tsum tsis txhob ua teeb meem rau kev xa cov kev thov raws sijhawm thiab ua raws li txoj cai. Daim ntawv teev cov lej kuaj mob ICD-10 uas CMS muab tau muaj nyob rau hauv qhov txuas hauv qab no: CMS ICD-10 Diagnostic Code

Puas yuav tsum tau siv cov cai sau se tshwj xeeb thaum them nqi rau Kev Kho Mob Kho Mob thiab Kev Pabcuam Ntuj?

Yuav kom tau txais kev them nyiaj ntawm Tus Nqi Tag Nrho (AIR), cov kev thov rau cov kev pabcuam uas muab los ntawm Cov Kws Kho Mob Ib Txwm thiab Cov Neeg Pab Ntuj uas tsim nyog rau kev them nqi ntawm AIR yuav tsum suav nrog cov lej taxonomy tsim nyog (saib daim ntawv teev cov kws tshaj lij kev noj qab haus huv tsim nyog hauv Supplement 6 Attachment 4.19-B ntawm Lub Xeev Txoj Kev Npaj).

Cov kev thov rau cov kev pabcuam uas muab los ntawm Traditional Healer thiab Natural Helper uas tsis tsim nyog rau AIR tsis tas yuav tsum muaj cov lej tshwj xeeb rau cov neeg muab kev pabcuam kom tau txais kev them nyiaj; cov nqi rau cov kev pabcuam uas tsis tsim nyog rau AIR tau teev nyob rau ntawm Daim Ntawv Teev Nqi (saib 2025-2026 DMC-ODS Daim Ntawv Teev Nqi Kev Kho Mob Ib Txwm).

Lub tsev qiv ntawv DHCS MedCCC muaj cov lus qhia ntxiv txog kev them nqi thiab kev thov rau cov kev kho mob ib txwm muaj nyob rau hauv DMC-ODS Cov Lus Qhia Txog Kev Pabcuam.

Puas yog IHCPs yuav tsum suav nrog NPIs rau Cov Kws Kho Mob Ib Txwm thiab Cov Neeg Pab Ntuj thaum them nqi rau Cov Nroog rau cov kev pabcuam kho mob ib txwm?

Cov NPIs yuav tsum suav nrog rau Cov Kws Kho Mob Ib Txwm/Cov Neeg Pab Ntuj uas yog cov kws kho mob AIR-Eligible thaum IHCP thov kev them nyiaj ntawm All Inclusive-Rate (AIR). Tus kws kho mob tus NPI yuav tsum tau them rau qhov kev thov ntawm AIR. Tus kws kho mob uas tsim nyog rau AIR yuav tsum tau sau npe rau hauv Medi-Cal ua tus kws muab kev pab cuam Ordering, Referring, thiab Prescribing (ORP) los ntawm PAVE system.

Cov NPIs ntawm tus kws kho mob tsis tas yuav muab rau ntawm cov nqi yog tias IHCP tsis nrhiav kev them nyiaj ntawm AIR.

When can IHCPs begin billing for traditional health care practices?

IHCPs that meet all requirements to provide traditional health care practices may submit bills to DMC-ODS counties back to the date their complete opt-in package was submitted to DHCS, as long as DHCS approves the package. Counties must submit claims to DHCS within 12 months of the month of services (per W&I Code, Section 14021.6(g)). IHCPs and counties should coordinate to ensure counties are able to submit timely and complete claims.

Yuav ua li cas IHCPs tau txais kev them nyiaj rau Cov Kev Pabcuam Khomob thiab Kev Pabcuam Ntuj?

Approved IHCPs must submit bills to the DMC-ODS county in which the member is enrolled in Medi-Cal or CHIP, consistent with BHIN 24-008. IHCPs should communicate directly with the county’s point of contact for traditional health care practices to establish processes for claiming and payment.

Cov nroog DMC-ODS yuav tsum them nyiaj rau cov IHCPs uas koom nrog uas muab kev pabcuam Traditional Healer thiab Natural Helper raws li cov txheej txheem uas lub xeev tau tsim raws li tau teev tseg hauv BHIN 25-036 thiab txhua txoj cai ntawm tsoomfwv thiab lub xeev uas siv tau uas tau piav qhia hauv BHIN 22-053.

Dab tsi yog tus nqi rau kev kho mob ib txwm muaj?

When Traditional healer and Natural helper services are provided by an IHCP that is eligible to receive the All-Inclusive Rate (AIR) and by a practitioner listed in California’s Medicaid State Plan, the DMC-ODS county shall claim and provide payment to the IHCP at the AIR, consistent with BHIN 22-053 and CMS’ Special Terms and Conditions. For State Fiscal Year (SFY) 2025-2026, rates for Traditional Healer and Natural Helper services eligible for the AIR are $801.00. For services not eligible for the AIR, rates depend on the Indian Health Care Provider’s (IHCP’s) contract status with the DMC-ODS county. See table below for more detail.

IHCP Daim Ntawv Pom Zoo	Member’s AI/AN Status	Yuav txiav txim siab npaum li cas cov nqi uas tsis yog AIR
IHCPs nrog DMC-ODS County daim ntawv cog lus	AI/AN	Cov nqi raug txiav txim raws li kev sib tham ntawm IHCP thiab DMC-ODS lub nroog.
IHCPs nrog DMC-ODS County daim ntawv cog lus	Non-AI/AN	Cov nqi raug txiav txim raws li kev sib tham ntawm IHCP thiab DMC-ODS lub nroog.
IHCPs tsis muaj DMC-ODS County daim ntawv cog lus	AI/AN	Cov nqi uas IHCP tau txais yuav tsis raug rau kev sib tham. DMC-ODS counties yuav tsum them tus nqi tsim los ntawm DHCS los ntawm DMC-ODS lub sijhawm them nqi.
IHCPs tsis muaj DMC-ODS County daim ntawv cog lus	Non-AI/AN	DMC-ODS txoj cai xaiv kev cog lus siv tau. Lub nroog feem ntau tsis tas yuav them IHCPs rau cov kev pabcuam uas tsis yog AI/AN cov tswvcuab yog lawv tsis muaj daim ntawv cog lus nrog IHCP.

The Traditional Healer and Natural Helper rates that DMC-ODS counties may claim for services not eligible for the AIR are posted under the Drug Medi-Cal Organized Delivery System section of the Medi-Cal Behavioral Health Fee Schedules page.

Rau SFY 2025-2026, cov nqi no yog:

Cov kev pab cuam kho mob ib txwm tsis tsim nyog rau AIR: $801.00
Cov kev pabcuam Natural Helper uas tsis tsim nyog rau AIR: $345.37

Yuav thov pab pawg li cas?

Rau ob qho kev pabcuam uas tsim nyog rau AIR thiab tsis tsim nyog rau AIR, cov kev thov yuav tsum siv HCPCS H0051 rau cov kev pabcuam Traditional Healer thiab HCPCS T1016 rau cov kev pabcuam Natural Helper. Thaum muab cov kev pabcuam Traditional Healer lossis Natural Helper hauv kev teeb tsa pab pawg, cov lus thov yuav tsum muaj lub HQ hloov kho kom paub qhov txawv ntawm kev mus ntsib pab pawg.

Rau cov Kws Kho Mob Ib Txwm lossis Cov Neeg Pab Ntuj uas muab kev pabcuam rau pawg neeg, tus neeg muab kev pabcuam thiab lub nroog yuav tsum thov rau ib tus tswv cuab hauv pawg ntawm ib qho AIR (thaum siv tau) lossis ib qho nqi them rau DMC-ODS. Txawm hais tias txoj cai no txawv ntawm pawg neeg thov kev pab rau lwm cov kev pabcuam DMC-ODS, nws sib haum nrog cov lus qhia them nqi rau pawg neeg uas siv rau cov kev pabcuam kev noj qab haus huv tsis yog tshwj xeeb.

Medi-Cal yuav them txog li ib tus Kws Kho Mob Ib Txwm thiab ib tus Neeg Pab Cuam Ntuj rau ib tus tswv cuab hauv ib hnub. Txawm li cas los xij, ib tug tswv cuab yuav tau txais kev pabcuam ua pab pawg thiab ib tus neeg hauv ib hnub. Piv txwv li, ib tug tswv cuab tuaj yeem tau txais kev pabcuam ib leeg los ntawm tus kws kho mob ib txwm muaj thaum sawv ntxov thiab tom qab ntawd koom nrog kev pabcuam pab pawg nrog tus kws kho mob ib txwm muaj thaum tav su. Hauv qhov xwm txheej no, IHCP thiab DMC-ODS lub nroog yuav thov rau qhov kev pabcuam ib leeg uas tau muab rau tus tswv cuab thaum sawv ntxov. Rau kev pabcuam pab pawg thaum tav su, daim ntawv thov yuav tsum txheeb xyuas ib tus tswv cuab sib txawv ntawm pawg uas tsis tau txais kev pabcuam Kws Kho Mob Ib Txwm Hnub ntawd.

For group billing of Traditional Healer/Natural Helper services, is there an “upper limit” on group sizes?

Tsis yog. Cov kev pabcuam pab pawg rau Cov Kws Kho Mob Ib Txwm thiab/lossis Cov Kev Pabcuam Ntuj tsis raug rau "cov kev txwv siab dua" ntawm qhov loj ntawm pawg. Cov lus qhia ntxaws txog kev them nqi rau cov kev pabcuam pab pawg tau teev tseg hauv BHIN 25-036, Ntu IV. Kev Thov thiab Kev Them Nyiaj.

Puas Muaj Kev Kho Mob Kho Mob thiab/lossis Natural Helper pab pawg muaj xws li cov neeg tsis yog Medi-Cal rau npe?

Yog lawm. Cov kev pabcuam pab pawg muab los ntawm Cov Kws Khomob thiab/lossis Ntuj Pabcuam tuaj yeem suav nrog cov tswvcuab uas tsis yog Medi-Cal, tsuav yog muaj ib tus tswvcuab Medi-Cal tuaj koom uas IHCP thiab lub nroog tuaj yeem thov.

Cov chaw nyob puas tuaj yeem muab cov kev kho mob ib txwm muaj?

Cov kev pab cuam kho mob ib txwm muaj thiab/lossis Cov Kev Pab Cuam Ntuj yuav raug xa tuaj ua ib feem ntawm qhov kev pab cuam kho mob uas Medi-Cal them rau hauv IHCP uas muab kev kho mob SUD hauv tsev thiab tau txais tus nqi txhua hnub rau cov kev pab cuam kho mob hauv tsev. Tus nqi txhua hnub tuaj yeem txhawb nqa cov kev pab cuam hauv kev muab ntau yam kev kho mob thiab kev kawm. Txhawm rau txhawb nqa kev nkag mus rau cov kev kho mob ib txwm muaj, cov kev pabcuam ntxiv ntawm Tus Kws Kho Mob Ib Txwm Muaj thiab/lossis Tus Pabcuam Ntuj yuav raug them nqi thiab thov ntxiv rau tus nqi txhua hnub hauv tsev neeg ua cov kev pabcuam ntxiv hauv IHCPs hauv tsev neeg. Cov chaw muab kev pab kho mob nyob hauv tsev yuav xa daim nqi rau cov nroog DMC-ODS rau cov kev kho mob ib txwm muaj, ntawm tus nqi teev tseg hauv BHIN 25-036, rau txog li kaum ob (12) qhov kev pab kho mob ib txwm muaj thiab/lossis Natural Helper ntxiv rau ib hlis. Cov kev pab cuam ntxiv ntawm Tus Kws Kho Mob Ib Txwm lossis Tus Pab Cuam Ntuj yuav tshaj kaum ob zaug mus ntsib ib hlis thaum muaj kev kho mob rau tus tswv cuab. Saib BHIN 25-036 kom paub meej ntxiv txog kev them nqi, kev them nyiaj thiab cov kev txwv ntawm cov kev pabcuam.

Muaj pes tsawg tus kws kho mob uas tsim nyog tau txais kev pab kho mob/Natural Helper mus ntsib ib hnub twg tuaj yeem raug them nqi ntawm Tus Nqi Tag Nrho-Inclusive (AIR)?

Consistent with Supplement 6 Attachment 4.19-B to California’s State Plan, Traditional Healer and Natural Helper services qualify as ambulatory services.

Kev mus ntsib kws kho mob ib txwm lossis kev pab los ntawm Natural Helper uas tsim nyog rau AIR ntawm IHS/Tribal 638 cov chaw tuaj yeem suav tias yog ib zaug kev mus ntsib uas tso cai rau ib hnub uas tuaj yeem them ntawm AIR (IHS/Tribal 638 cov chaw tuaj yeem them 3 zaug kev mus ntsib ntawm AIR ib hnub, ib zaug kho mob, ib zaug taug kev, thiab ib zaug kev noj qab haus huv ntawm lub hlwb).

Cov neeg FQHC hauv pawg neeg yuav tau txais nyiaj rov qab rau peb zaug mus ntsib ib hnub, rau ib tus neeg tau txais kev pab, hauv kev sib xyaw ua ke ntawm kev kho mob, kev noj qab haus huv ntawm lub hlwb, kev kho hniav thiab/lossis kev mus los (saib cov lus qhia ntxiv hauv DHCS Provider Manual: Tribal FQHCs). Cov FQHC hauv pab pawg neeg uas muaj tus kws kho mob ib txwm uas tsim nyog tau txais AIR thiab tus kws pab cuam ntuj tsim nyog tau txais AIR yuav tsim nyog muab kev pabcuam taug kev mus los txog li 3 qhov kev pabcuam uas them tau yog tias cov kev pabcuam yog rau ntau yam laj thawj sib txawv.

Lub sijhawm twg rau IHCPs tau txais kev them nyiaj los ntawm DMC-ODS cov nroog rau kev saib xyuas kev noj qab haus huv ib txwm muaj?

DHCS xav kom DMC-ODS Counties them nyiaj rau IHCPs raws sijhawm thiab sai, txawm tias daim ntawv cog lus zoo li cas los xij. Cov Chaw Tiv Tauj Hauv Lub Nroog DMC-ODS tuaj yeem pab IHCPs teb cov lus nug txog kev them nqi thiab kev them nqi. Cov neeg tiv tauj no tau muab tso rau ntawm nplooj ntawv web Traditional Health Care Practices (saib BHIN 25-036 rau cov lus qhia ntxaws ntxiv txog kev thov thiab kev them nyiaj rau cov kev kho mob ib txwm muaj).

Kev txwv kev pabcuam thiab cov ntaub ntawv

Puas tuaj yeem muab kev saib xyuas kev noj qab haus huv ib txwm muaj nyob sab nraud ntawm qhov chaw kho mob?

Yog. Cov kev pabcuam kho mob ib txwm muaj, zoo li lwm cov kev pabcuam DMC-ODS, yuav muab tau rau hauv cov chaw ua haujlwm (tsuav yog tus kws kho mob Indian Health Care Provider (IHCP) ua tau raws li txhua yam kev cai). Cov kev coj ua kho mob ib txwm tsis raug suav hais tias yog "cov kev pabcuam hauv tsev kho mob" thiab tsis poob rau hauv txoj cai "plaub phab ntsa" (saib Tshooj 1905(a)(9) ntawm Txoj Cai, Code of Federal Regulations, title 42, ntu 440.90, thiab 1115 CalAIM tsab ntawv pom zoo hloov kho).

Puas muaj kev saib xyuas kev noj qab haus huv ib txwm muaj los ntawm telehealth?

Yes, traditional health care practices delivered via telehealth are covered under DMC-ODS consistent with BHIN 23-018.

Cov ntaub ntawv xav tau rau cov kev pab kho mob ib txwm muaj li cas?

IHCPs are required to follow the progress note and problem list documentation requirements Sections (c) and (d) of BHIN 23-068. Individual Traditional Healer/Natural Helper practitioners are not solely responsible for developing or maintaining the member’s clinical records. Other licensed or non-licensed practitioners may document on behalf of the Traditional Healer or Natural Helper, as needed.

Saib Xyuas & Saib Xyuas

Puas yog DHCS lossis DMC-ODS cov nroog puas muaj kev saib xyuas ntawm IHCPs muab kev pabcuam kev noj qab haus huv ib txwm muaj?

DHCS worked in consultation with Tribal partners to ensure the department’s approach to oversight and monitoring is appropriate and clearly laid out in policy (see BHIN 25-036 for detailed guidance). IHCPs will be monitored to ensure compliance with the requirements specified in BHIN 25-036 and the DHCS-approved “opt-in package.”

For IHCPs contracted with a DMC-ODS county, standard DHCS policy for county oversight of contracted providers applies, as outlined in BHIN 24-001. Counties are responsible for oversight and monitoring which can include compliance with basic program integrity requirements (for example, compliant claiming and service documentation) and other requirements outlined in the BHIN.

Rau cov IHCPs uas tsis muaj daim ntawv cog lus nrog lub nroog DMC-ODS, DHCS yog tus saib xyuas thiab saib xyuas tas mus li. Qhov no yuav suav nrog kev ua raws li cov cai hauv BHIN thiab kev xa pob khoom xaiv. DHCS yuav tshaj tawm Cov Phiaj Xwm Kev Ua Haujlwm Kho Kom Zoo rau IHCPs uas pom tias ua raws li txoj cai.

Tsis yog DHCS lossis DMC-ODS lub nroog yuav txiav txim siab seb qhov kev kho mob ib txwm muaj puas yog kab lis kev cai lossis kev kho mob tsim nyog rau ib tus tswv cuab Medi-Cal. Qhov no yog ib qho kev txiav txim siab ntawm tus kheej los ntawm Tus Kws Kho Mob lossis Tus Pabcuam Ntuj nrog kev saib xyuas los ntawm IHCP.

Traditional Health Care Practices – FAQs​​

Yuav ua li cas IHCPs thiaj li tsim nyog los muab, thiab tau txais kev them nyiaj rau, Kev Kho Kho Kho Kho Kho Kho thiab Kev Pabcuam Ntuj Zoo rau Medi-Cal cov tswv cuab?​​

Lub nroog DMC-ODS yuav paub li cas thaum IHCP tau txais kev pom zoo los them nqi rau cov kev pabcuam Traditional Healer thiab Natural Helper?​​

IHCPs tuaj yeem nrhiav cov ntaub ntawv tiv tauj rau DMC-ODS cov nroog li cas?​​

Puas yog IHCPs yuav tsum tau cog lus nrog DMC-ODS lub nroog los muab kev pabcuam kev noj qab haus huv ib txwm muaj?​​

Puas yog IHCPs xav tau kev sib koom them nqi rau cov kev kho mob ib txwm muaj ncaj qha nrog cov nroog?​​

Puas yog DMC-ODS cov nroog yuav tsum muaj qee tus lej ntawm IHCPs muab kev saib xyuas kev noj qab haus huv ib txwm muaj hauv lawv Lub Nroog?​​

Cov tswv cuab puas tuaj yeem tau txais kev saib xyuas kev noj qab haus huv ib txwm muaj los ntawm IHCPs sab nraum DMC-ODS Lub Nroog uas lawv tau tso npe rau hauv, xws li lub nroog nyob sib ze?​​

Puas muaj ib daim ntawv teev tag nrho ntawm Cov Kev Kho Mob Ib Txhis thiab Kev Pabcuam Ntuj Kev Ua Haujlwm los ntawm Medi-Cal?​​

Puas muaj kev saib xyuas kev noj qab haus huv ib txwm muaj rau cov tswv cuab hnub nyoog qis dua 21 xyoos?​​

Puas yog cov kev saib xyuas kev noj qab haus huv ib txwm muaj raws li tsoomfwv Kev Tshawb Fawb Thaum Ntxov thiab Lub Sijhawm Sijhawm, Diagnostic, thiab Treatment (EPSDT) cov cai?​​

Puas yog DHCS yuav nthuav dav kev saib xyuas kev noj qab haus huv ib txwm muaj rau lwm lub tshuab xa khoom dhau ntawm Kev Siv Tshuaj Medi-Cal Organized Delivery System (DMC-ODS)?​​

Cov kws kho mob/cov kws kho mob twg tuaj yeem xa cov kev pabcuam raws li qhov txiaj ntsig no?​​

Puas yog DHCS xav kom cov Kws Kho Mob Ib Txwm thiab Cov Neeg Pab Ntuj Tsim Nyog yuav tsum muaj daim ntawv pov thawj los ntawm lub nroog lossis muaj qee yam kev tsim nyog, xws li daim ntawv tso cai lossis daim ntawv pov thawj?​​

Cov Chaw Muab Kev Kho Mob Hauv Is Nrias teb (IHCPs) puas yuav tsum tau ntawv pov thawj Drug Medi-Cal (DMC) thiab/lossis Alcohol and Other Drug (AOD)?​​

Kuv yuav ua li cas thiaj paub yog tias kuv lub koom haum yog Indian Health Care Provider (IHCP) uas tsim nyog los koom nrog cov kev pab kho mob ib txwm muaj?​​

What are DHCS’ criteria for approving or denying opt-in packages?​​

Tus txheej txheem rau IHCP yog dab tsi los xa thiab tau txais kev pom zoo rau lwm Cov Kev Cai Ua Raws Cai (EBPs)?​​

What resources are available for IHCPs if they have questions about the opt-in process?​​

DHCS yuav teb sai npaum li cas rau IHCPs txog lawv qhov kev xaiv ntawm pob xa tuaj?​​

Txoj Cai thiab Cov Txheej Txheem (P&Ps) yuav tsum muaj li cas kom tau txais kev pom zoo los ntawm DHCS?​​

Cov txheej txheem them nqi thiab thov rau kev muab cov kev pabcuam Traditional Healer thiab Natural Helper yog dab tsi?​​

Leej twg yog tus them rau cov kev pabcuam Traditional Healer thiab Natural Helper?​​

Cov ntaub ntawv twg yuav tsum muaj nyob rau hauv cov ntaub ntawv thov THCP uas xa mus rau DHCS los ntawm DMC-ODS Counties?​​

Puas yuav tsum tau siv cov cai sau se tshwj xeeb thaum them nqi rau Kev Kho Mob Kho Mob thiab Kev Pabcuam Ntuj?​​

Puas yog IHCPs yuav tsum suav nrog NPIs rau Cov Kws Kho Mob Ib Txwm thiab Cov Neeg Pab Ntuj thaum them nqi rau Cov Nroog rau cov kev pabcuam kho mob ib txwm?​​

When can IHCPs begin billing for traditional health care practices?​​

Yuav ua li cas IHCPs tau txais kev them nyiaj rau Cov Kev Pabcuam Khomob thiab Kev Pabcuam Ntuj?​​

Dab tsi yog tus nqi rau kev kho mob ib txwm muaj?​​

Yuav thov pab pawg li cas?​​

For group billing of Traditional Healer/Natural Helper services, is there an “upper limit” on group sizes?​​

Cov chaw nyob puas tuaj yeem muab cov kev kho mob ib txwm muaj?​​

Muaj pes tsawg tus kws kho mob uas tsim nyog tau txais kev pab kho mob/Natural Helper mus ntsib ib hnub twg tuaj yeem raug them nqi ntawm Tus Nqi Tag Nrho-Inclusive (AIR)?​​

Lub sijhawm twg rau IHCPs tau txais kev them nyiaj los ntawm DMC-ODS cov nroog rau kev saib xyuas kev noj qab haus huv ib txwm muaj?​​

Puas tuaj yeem muab kev saib xyuas kev noj qab haus huv ib txwm muaj nyob sab nraud ntawm qhov chaw kho mob?​​

Puas muaj kev saib xyuas kev noj qab haus huv ib txwm muaj los ntawm telehealth?​​

Puas yog DHCS lossis DMC-ODS cov nroog puas muaj kev saib xyuas ntawm IHCPs muab kev pabcuam kev noj qab haus huv ib txwm muaj?​​