ບ້ານ ຜູ້ໃຫ້ບໍລິການ ແລະ ຄູ່ຮ່ວມງານ ຄຳຖາມທີ່ຖືກຖາມເລື້ອຍໆກ່ຽວກັບສ່ວນຫຼຸດຄ່າຢາ Medi-Cal​​ 

ຄຳຖາມທີ່ຖືກຖາມເລື້ອຍໆກ່ຽວກັບການຫຼຸດຄ່າຢາ Medi-Cal​​ 

ຄໍາຖາມທົ່ວໄປ​​ 

What are “Medi-Cal” rebates?​​   

“Medi-Cal” rebates are California’s federal Medicaid rebate programs. Medi-Cal is California’s health program which provides free or low-cost health coverage for California residents who meet eligibility requirements. Drug manufacturers are required to pay a rebate for all outpatient drugs that are dispensed and paid for by the State’s Medi-Cal program. Invoicing for drug rebates began January 1, 1991 and continues today​​ 

What are “Medi-Cal supplemental” rebates?​​   

“Medi-Cal supplemental” rebates are additional rebates drug manufacturers have agreed to pay the state. Supplemental rebates are based on the same utilization as the federal rebate program. Drug manufacturers that have agreed to pay supplemental rebates are included on the State’s Contract Drug List (CDL). Generally, these products are not subject to prior authorization. The Pharmacy Benefit’s Drug Contracting Branch is responsible for managing the program and negotiating contracts. Supplemental rebates are required for all federal programs except for utilization from managed care organizations (MCOs). Supplemental rebates have been part of the California rebate program since 1991. Prior to 1997, supplemental rebates were calculated as a percentage of Average Manufacturer Price (AMP) on all covered drugs. However since 1997, contracts are negotiated on specific drugs. California currently has two types of supplemental contracts: Net Cost and AMP. Supplemental contracts pertain to all rebate programs except for managed care organizations (MCO) that became rebate eligible in 2010.​​ 

ເງິນຄືນເພີ່ມເຕີມແມ່ນຂຶ້ນກັບຄ່າດອກເບ້ຍບໍ?​​      

Yes. Section 14105.33 of the Welfare & Institutions Code was amended in 1997 allowing state supplemental contracts to include interest and penalty provisions. Contracts include the following:​​ 

  • ຖ້າບໍ່ໄດ້ຮັບການຈ່າຍເງິນເພີ່ມເຕີມພາຍໃນ 38 ວັນນັບຈາກວັນທີເຄື່ອງໝາຍໄປສະນີຂອງໃບແຈ້ງໜີ້, ດອກເບ້ຍທີ່ຄິດໄລ່ຕາມອັດຕາ CMS (ອັດຕາໃບເກັບເງິນຂອງລັດຖະບານກາງປະຈໍາອາທິດ).​​ 
  • ຖ້າບໍ່ໄດ້ຮັບການຈ່າຍເງິນເພີ່ມເຕີມພາຍໃນ 69 ມື້ນັບຈາກວັນທີ່ເຄື່ອງໝາຍໄປສະນີຂອງໃບແຈ້ງໜີ້, ຄ່າປັບໃໝດອກເບ້ຍ 10 ເປີເຊັນຈະຖືກເພີ່ມໃສ່ອັດຕາດອກເບ້ຍ CMS. ດອກເບ້ຍ ແລະການປັບໃໝ 10% ຍັງສືບຕໍ່ເກີດຂຶ້ນຈົນຮອດວັນທີ postmark ຂອງການຈ່າຍເງິນ.​​ 

ຂ້ອຍໄດ້ຮັບໃບເກັບເງິນແຍກຕ່າງຫາກສໍາລັບການຜ່ອນຜັນເພີ່ມເຕີມບໍ?​​    

Yes. Beginning 4th quarter 2001, DHCS began sending labelers separate supplemental invoices. Prior to October 2001, labelers were instructed to calculate the supplemental rebate using their Medi-Cal invoice.​​ 

ກົດໝາຍຂອງລັດຖະບານກາງ ແລະລັດກ່ຽວກັບໂຄງການຫຼຸດຢາເສບຕິດໃນຄາລິຟໍເນຍ/ກົດໝາຍລັດຖະບານກາງແມ່ນຫຍັງ?​​     

ກົດໝາຍຂອງລັດຖະບານກາງ:​​ 

ກົດໝາຍວ່າດ້ວຍປະກັນສັງຄົມພາກ 1927 [42 USC 1396r-8] (a)​​  

ກົດໝາຍຂອງລັດຖະບານກາງທີ່ກ່ຽວຂ້ອງກັບໂຄງການ Medicaid (Medi-Cal in California). ເຂົ້າເບິ່ງໜ້າເວັບປະກັນສັງຄົມ ສຳລັບຂໍ້ມູນເພີ່ມເຕີມ.​​ 

ກົດໝາຍຂອງລັດ:​​ 

  • Welfare and Institutions (W&I) Code Section 14105. Contains information on the Medi-Cal Drug Rebate Program.​​ 
  • Senate Bill 391, 1997 Amended W & I Code 14105.33. Authorized the State to charge interest and a penalty for late state supplemental rebate payments. (Effective date 10/1/97)​​ 

To Access W & I Code, visit the California Legislative Information website, and select the button labeled “California Law,”  then select Welfare and Institutions Code. Next enter a section, select the “Enter” button to search.​​ 

ໂຄງການປະເພດໃດແດ່ທີ່ມີສ່ວນຮ່ວມໃນໂຄງການການຜ່ອນຜັນຢາຂອງພະແນກບໍລິການການດູແລສຸຂະພາບ?​​ 

California invoices drug manufacturers for all federal Medicaid programs, including those incorporated by waiver. In addition, manufacturers receive supplemental invoices if they have entered into a contract with the State. Programs for which rebates are due include: Medi-Cal (FFS, COHS, Managed Care Organizations (MCOs)), CCS/Healthy Families, GHPP, Blood Factors, FPACT and BCCTP. Separate invoices are mailed for pharmacy, PADs and compound claims for many of the programs.​​ 

What is “FPACT”?​​      

Family Planning, Access, Care, and Treatment (FPACT) was a State-only program until December 1, 1999 when CMS approved California’s 1115 waiver. As a result, the program became eligible for Title XIX funding. Effective 4Q1999, the State began invoicing for rebates. With the approval of the waiver, the FPACT program also became eligible for supplemental rebates. The Department of Health Care Services submitted a State Plan Amendment (SPA) to transition the current FPACT waiver into the Medi-Cal State Plan. The SPA was approved on March 24, 2011 by CMS. As approved by CMS, the SPA transitioned the FPACT waiver into the State Plan with a retroactive effective date of July 1, 2010. Additional information is available on the FPACT program webpage.​​ 

What is a “Physician Administered Drug (PAD)”?​​      

A physician administered drug is any covered outpatient drug provided or administered to a recipient, and billed by a provider other than a pharmacy. Such providers include, but are not limited to, physician offices, clinics and hospitals. A covered outpatient drug is broadly defined as a drug that may be dispensed only upon prescription, and is approved for safety and effectiveness as a prescription drug under the Federal Food, Drug and Cosmetic Act. Physician-administered drugs include both injectable and non-injectable drugs.​​ 

What is “HCPCS”?​​   

Healthcare Common Procedure Coding System (HCPCS) ແມ່ນໂຄງສ້າງການເຂົ້າລະຫັດແບບດຽວກັນລະດັບຊາດທີ່ພັດທະນາໂດຍສູນບໍລິການ Medicare & Medicaid (CMS) ເພື່ອມາດຕະຖານລະບົບລະຫັດທີ່ໃຊ້ເພື່ອປະມວນຜົນການຮຽກຮ້ອງຂອງ Medicare ແລະ Medicaid (Medi-Cal) ບົນພື້ນຖານລະດັບຊາດ.​​ 

ການຮ້ອງຂໍຢາທີ່ແພດຄຸ້ມຄອງຕ້ອງການລະຫັດ HCPCS ເພື່ອກໍານົດຂັ້ນຕອນແລະກໍານົດຈໍານວນທີ່ຈະຈ່າຍຄືນໃຫ້ຜູ້ໃຫ້ບໍລິການ. ນອກຈາກນັ້ນ, ທຸກໆການຮຽກຮ້ອງຂອງແພດຄຸ້ມຄອງຢາ (PAD) ຈະຕ້ອງປະກອບມີລະຫັດຢາແຫ່ງຊາດ (NDC) ເພື່ອໃຫ້ຜູ້ຜະລິດຢາສາມາດຖືກເອີ້ນເກັບເງິນຄືນ. DHCS ຍັງຕ້ອງການການອ້າງສິດທີ່ເຕັມໄປດ້ວຍຢາທີ່ຊື້ 340B ເພື່ອລວມເອົາຕົວແກ້ໄຂ “UD”, ເຊິ່ງຖອນການຮຽກຮ້ອງອອກຈາກໃບແຈ້ງໜີ້ການຄືນເງິນຂອງຜູ້ຜະລິດຢາ.​​ 

What is “FPACT HCPCS”?​​     

FPACT HCPCS are Family Planning Access Care and Treatment (FPACT) Physician Administered Drug (PAD) claims. These are claims from non-pharmacy providers. Usually the claim is submitted by a clinic, but not always. The claim requires a HCPCS code, the NDC and a “UD” modifier if filled with a 340B purchased drug.​​ 

What is a “COHS”?​​     

County Organized Health Systems (COHS) is a non-profit, independent public agency that contracts with the State to administer Medi-Cal benefits through local care providers and/or Health Maintenance Organizations. COHS have been part of the Medi-Cal program since CMS approved the first COHS plan in 1983. COHS have been part of the rebate program since 1991 and invoiced separately since fourth quarter 2001.​​ 

ມີ COHS ເທົ່າໃດ?​​    

ມີຫົກແຜນ COHS ທີ່ກວມເອົາ 22 ເຂດປົກຄອງ.​​ 

  1. “CalOPTIMA” – Orange County​​ 
  2. “Central California Alliance for Health” – Santa Cruz, Monterey and Merced counties​​ 
  3. “Health Plan of San Mateo” – San Mateo County​​ 
  4. “Partnership Health Plan” – Napa, Solano, Yolo, Sonoma, Marin, Mendocino, Del Norte, Humboldt, Lake, Lassen, Modoc, Shasta, Siskiyou and Trinity counties.​​ 
  5. “CenCal” – Santa Barbara and San Luis Obispo counties​​ 
  6. “Gold Coast Health Plan” — Ventura County​​ 

What is “CCS/GHPP”?​​     

California Children’s Services (CCS) is a program that treats children with certain physical limitations and chronic health conditions or diseases. The Genetically Handicapped Persons Program (GHPP) is a health program for adults with certain genetic diseases. CMS approved a Medicaid program waiver, effective September 01, 2005, which allowed the State to invoice drug manufacturers for rebates.​​ 

ການຍົກເວັ້ນໂຄງການ Medicaid ເພື່ອເກັບຄືນຄ່າຢາສຳລັບການນຳໃຊ້ CCS ແລະ GHPP ຂອງລັດເທົ່ານັ້ນໝົດອາຍຸໃນວັນທີ 31, 2020. ເນື່ອງຈາກການບໍ່ຂະຫຍາຍເງິນທຶນຂອງລັດຖະບານກາງສໍາລັບປະຊາກອນ CCS ແລະ GHPP, DHCS ບໍ່ມີສິດອຳນາດໃນການອອກໃບແຈ້ງໜີ້ ແລະເກັບຄ່າເງິນຄືນຈາກ Medicaid ຂອງລັດຖະບານກາງສຳລັບໂຄງການເຫຼົ່ານີ້ອີກຕໍ່ໄປ. ຕັ້ງແຕ່ Q1 2021, ໃບແຈ້ງໜີ້ CCS ແລະ GHPP ໄດ້ຖືກຖອນອອກຈາກໃບແຈ້ງໜີ້ແລ້ວ.​​ 

What are “Blood Factors”?​​     

Blood Factors or Factor 8 is an essential blood-clotting protein, also known as anti-hemophilic factor (AHF). DHCS invoices drug manufacturers on separate invoices for drugs that are used to treat blood factor diseases. Providers of AHF drugs are reimbursed at their acquisition cost plus 20 percent.​​ 

BCCTP ແມ່ນຫຍັງ?​​    

Breast Cancer and Cervical Treatment Program (BCCTP) provides cancer treatment for eligible low-income California residents who are screened by Cancer Detection Program: Every Woman Counts (CDP:EWC) or Family Planning Access Care and Treatment (FPACT) programs and found to be in need of treatment for breast and/or cervical cancer. Assembly bill (AB) 430, (Chapter 171, Statutes of 2001) provided the State with statutory authority to implement the optional federal Breast and Cervical Cancer and Treatment Act of 2000. California’s SPA was approved by the federal government with an effective date of January 1, 2000. Drug manufacturers have been required to pay rebates since the program was included in California’s Medicaid State Plan. Visit the BCCTP webpage for more information.​​  

ອັດຕາການຈ່າຍຄືນຂອງຄາລິຟໍເນຍສໍາລັບການຮ້ອງຂໍເງິນຮ້ານຂາຍຢາແມ່ນຫຍັງ?​​    

ມີຜົນບັງຄັບໃຊ້ສຳລັບການຮຽກຮ້ອງທາງຮ້ານຂາຍຢາກັບວັນທີໃຫ້ບໍລິການໃນ ຫຼື ຫຼັງຈາກວັນທີ 1 ເມສາ 2017, ການຊົດເຊີຍ Medi-Cal ໂດຍອີງໃສ່ລາຄາທີ່ຕໍ່າກວ່າຂອງການຊື້ຕົວຈິງ (AAC) ບວກກັບຄ່າທໍານຽມການແຈກຢາຍແບບມືອາຊີບ, ຫຼືຄ່າບໍລິການຕາມປະເພນີ. AAC ຖືກກໍານົດເປັນຕ່ໍາສຸດຂອງ:​​ 

  • ຄ່າໃຊ້ຈ່າຍຂອງການຊື້ຢາສະເລ່ຍແຫ່ງຊາດ (NADAC), ຫຼືຄ່າໃຊ້ຈ່າຍໃນການໄດ້ມາຂາຍຍົກ (WAC) + 0% ຖ້າ NADAC ບໍ່ມີ,​​ 
  • Federal Upper Limit (FUL), ຫຼື​​ 
  • ຄ່າໃຊ້ຈ່າຍສ່ວນປະກອບທີ່ອະນຸຍາດສູງສຸດ (MAIC).​​ 

ຈໍານວນມື້ສູງສຸດຂອງຄາລິຟໍເນຍແມ່ນເທົ່າໃດເມື່ອແຈກຢາຍຢາ?​​    

ຄາລິຟໍເນຍມີເວລາສູງສຸດ 100 ມື້ສໍາລັບການສະຫນອງຢາສ່ວນໃຫຍ່. ນີ້ແຕກຕ່າງຈາກລັດອື່ນໆຈໍານວນຫຼາຍທີ່ມີການສະຫນອງສູງສຸດ 30 ມື້. ມັນເປັນສິ່ງ ສຳ ຄັນທີ່ຈະຕ້ອງພິຈາລະນາການສະ ໜອງ ສູງສຸດ 100 ມື້ໃນເວລາໂຕ້ແຍ້ງການ ນຳ ໃຊ້.​​ 

ເປັນຫຍັງ Medi-Cal ຈຶ່ງຈ່າຍເງິນຄືນໃຫ້ບາງຜູ້ໃຫ້ບໍລິການໃນອັດຕາທີ່ຕໍ່າດັ່ງກ່າວ?​​      

ເງິນໂດລາທີ່ຈ່າຍຄືນບໍ່ແມ່ນຕົວຊີ້ບອກທີ່ດີທີ່ສຸດຂອງຈໍານວນຫົວຫນ່ວຍ (ເມັດ, milligrams, vials, ແລະອື່ນໆ) ຂອງຢາໄດ້ຖືກແຈກຢາຍເພາະວ່າຜູ້ໃຫ້ບໍລິການບາງຄົນບໍ່ລວມເອົາຂໍ້ມູນທັງຫມົດ.​​ 

ຂໍ້ມູນການຄຸ້ມຄອງສຸຂະພາບອື່ນໆ ຫຼືຄວາມຮັບຜິດຊອບຂອງພາກສ່ວນທີສາມ (TPL) ບາງຄັ້ງບໍ່ໄດ້ລວມຢູ່ໃນການຮຽກຮ້ອງ Medi-Cal. ມັນເປັນເລື່ອງປົກກະຕິທີ່ຈະເຫັນຜູ້ໃຫ້ບໍລິການຈ່າຍຄືນພຽງແຕ່ສໍາລັບ co-pay (ie $5, $15, $30, ແລະອື່ນໆ) ໂດຍບໍ່ມີຂໍ້ມູນ TPL. ດ້ວຍເຫດຜົນນັ້ນ, ການຮຽກຮ້ອງສ່ວນໃຫຍ່ທີ່ມີຈຳນວນເງິນຄືນຕໍ່າແມ່ນຖືກຕ້ອງ ແລະຫົວໜ່ວຍທີ່ອອກໃບແຈ້ງໜີ້ສຳລັບເງິນຄືນແມ່ນຖືກຕ້ອງຄືກັນ.​​ 

It is typical for managed care organizations (MCOs) to provide either a low reimbursement or no reimbursement amount on the claim. CMS’s Medicaid Drug Rebate Program Notice for Manufacturer’s Release No. 84 addresses the issue of low or no reimbursement for MCO claims. According to CMS, rebates are owed even if the MCO invoice does not show any paid amount since the drug cost is part of the capitated payment made by the State to the MCO. Consequently, reimbursement amount should not be used to dispute utilization since it has no relationship to units.​​ 

ການປະຕິບັດໃບສັ່ງຢາຕາມປົກກະຕິສາມາດແຕກຕ່າງກັນແລະ / ຫຼືຖືກລົບລ້າງ?​​   

ແມ່ນແລ້ວ. ການຮ້ອງຂໍການອະນຸຍາດການປິ່ນປົວ (TAR) ສາມາດຖືກນໍາໃຊ້ເພື່ອລົບລ້າງການປະຕິບັດຕາມໃບສັ່ງແພດປົກກະຕິ (ເຊັ່ນ: ໃບສັ່ງຢາທີ່ເກີນຫົກໃບສັ່ງຢາຕໍ່ຄັ້ງຕໍ່ຜູ້ໄດ້ຮັບຜົນປະໂຫຍດຫນຶ່ງ, ປະລິມານທີ່ໃຫຍ່ກວ່າປະລິມານການແຈກຢາຍປົກກະຕິ, ຢາທີ່ບໍ່ມີຢູ່ໃນບັນຊີລາຍຊື່ຂອງຢາຕາມສັນຍາ, ແລະອື່ນໆ).​​ 

ເປັນຫຍັງຂ້ອຍຈໍາເປັນຕ້ອງສົ່ງຂໍ້ມູນລາຄາຜູ້ຜະລິດສະເລ່ຍ (AMP) ສໍາລັບ NDCs ບາງຢ່າງ?​​    

Only labelers who have an AMP based State Supplemental Drug Rebate Agreement with California need to provide AMP data. The contract requires AMP data to be submitted quarterly so a unit rebate amount (URA) can be calculated for invoice purposes. AMP data must be provided for each NDC for each quarter as required by the terms of the contract.​​ 

ຂໍ້ມູນລາຄາຜູ້ຜະລິດສະເລ່ຍ (AMP) ຮອດກຳນົດເວລາໃດໃນຄາລິຟໍເນຍ?​​     

AMP information for each NDC must be submitted to the California Department of Health Care Services (DHCS) fiscal intermediary, Gainwell Technologies, LLC (Gainwell), within 30 days after the end of each quarter. This deadline is the same as CMS’s deadline for the federal drug rebate program.​​ 

What happens if I don’t turn in the AMP data timely?​​   

ປ້າຍຊື່ຄວນຮູ້ວ່າຖ້າພວກເຂົາບໍ່ສົ່ງຂໍ້ມູນຂອງພວກເຂົາສໍາລັບສອງໄຕມາດຕິດຕໍ່ກັນ, ສັນຍາ AMP ເພີ່ມເຕີມຂອງຄາລິຟໍເນຍຂອງພວກເຂົາອາດຈະຖືກຍົກເລີກຫຼືບໍ່ໄດ້ຕໍ່ອາຍຸເມື່ອສັນຍາປະຈຸບັນຫມົດອາຍຸ. ໂດຍບໍ່ມີສັນຍາທີ່ມີການເຄື່ອນໄຫວ, DHCS ສາມາດເຮັດໃຫ້ຢາຂອງປ້າຍຊື່ສາມາດໃຊ້ໄດ້ຜ່ານການອະນຸຍາດກ່ອນ.​​ 

ຂ້ອຍຈະສົ່ງຂໍ້ມູນ AMP ໄດ້ແນວໃດ?​​ 

AMP data for Supplemental contracts is submitted to Gainwell. AMP data is due within 30 days after the end of the quarter. Please contact the Drug Rebate Branch at drugrebatebranch@dhcs.ca.gov, for instructions on how to submit AMP data.​​  

ຈະເປັນແນວໃດຖ້າ AMP ຂອງຂ້ອຍປ່ຽນແປງ?​​    

If a labeler’s AMP changes for a period under contract, the labeler must submit that updated AMP to Gainwell. The AMP data is submitted in the same manner as the initial AMP was submitted. Please contact the Drug Rebate Branch at drugrebatebranch@dhcs.ca.gov, for instructions on how to submit AMP data.​​  

ຂ້ອຍຈະຮູ້ໄດ້ແນວໃດວ່າຂໍ້ມູນ AMP ຂອງຂ້ອຍຖືກສົ່ງບໍ່ຖືກຕ້ອງ (ie ຮູບແບບ, ຂໍ້ມູນທີ່ຂາດຫາຍໄປ, ແລະອື່ນໆ)?​​ 

Gainwell ຫຼືນັກວິເຄາະການຈ່າຍຄືນຢາຈະຕິດຕໍ່ກັບຜູ້ຕິດສະຫຼາກຖ້າມີບັນຫາກັບຂໍ້ມູນ AMP ທີ່ສົ່ງມາ.​​ 

What if I can’t find a copy of my state supplemental contract?​​   

ຕິດຕໍ່ນັກວິເຄາະການຄືນຄ່າຢາ DHCS ຂອງທ່ານ ຫຼືໃຫ້ຕົວແທນຂອງລັດຖະບານຂອງທ່ານຕິດຕໍ່ກັບສາຂາສັນຍາຢາຂອງຮ້ານຂາຍຢາ.​​ 

ຜູ້ໃຫ້ບໍລິການດ້ານສຸຂະພາບສາທາລະນະ (PHS) ມີຄຸນສົມບັດໃດແດ່ໃນຄາລິຟໍເນຍ ແລະມີສິດໄດ້ຮັບລາຄາ 340B?​​     

The drug rebate program was amended by the Veterans Health Care Act of 1992 (VHCA). Under the VHCA, Congress created the 340B program which is administered by the federal Health Resources and Services Administration (HRSA), Office of Pharmacy Affairs (OPA). The 340B program requires manufacturers of drugs that are paid for by state Medicaid programs to enter into an agreement with HRSA to provide statutory discounts on drugs to “covered entities”. Covered entities are required to identify claims for which the Medicaid beneficiary received a 340B purchased drug. The State is not entitled to rebates for those claims since the covered entity has already received a discount from the drug manufacturer. California’s rebate invoicing system automatically removes pharmacy and Physician Administered Drug (PAD) claims which include the appropriate PHS/340B identifier from the drug manufacturer’s invoice. Information about the 340B program and which entities qualify can be found on the HRSA 340 B Drug Pricing Program webpage.​​  

ຜູ້ໃຫ້ບໍລິການຕ້ອງການລະບຸການຮຽກຮ້ອງທີ່ຜູ້ໄດ້ຮັບຜົນປະໂຫຍດ Medi-Cal ໄດ້ຮັບຢາທີ່ຊື້ 340B ບໍ?​​    

Yes. In order to comply with federal law claims must be filled out correctly to prevent “duplicate discounts.” This occurs when the drug manufacturer gives the provider the discounted 340B price and pays a Medicaid rebate. In order to prevent the “duplicate discount”, providers must include the appropriate code on the claim. Physician Administered Drug claims require a “UD” modifier. Pharmacy claims need to have a “08” in the Basis of Cost Determination field. Both the “UD” modifier and the “08” inform DHCS that a 340B purchased drug was used for the claim. Our rebate system removes the claims from the drug manufacturers rebate invoice ensuring that the drug manufacturer is not subject to the “duplicate discount”.​​ 

What is “EFT”?​​   

ທາງເລືອກການຈ່າຍເງິນ Electronic Fund Transfer (EFT) ອະນຸຍາດໃຫ້ຜູ້ໃຊ້ລົງທະບຽນສາມາດຈ່າຍໃບແຈ້ງໜີ້ຄືນຄ່າຢາຂອງເຂົາເຈົ້າທາງອີເລັກໂທຣນິກ ໂດຍບໍ່ຕ້ອງສົ່ງເອກະສານເຊັກແບບດັ້ງເດີມ. ທາງເລືອກທີ່ສະຫມັກໃຈນີ້ຮຽກຮ້ອງໃຫ້ຜູ້ເຂົ້າຮ່ວມປະຕິບັດຕາມຮູບແບບສະເພາະໃນເວລາທີ່ສົ່ງຂໍ້ມູນເອເລັກໂຕຣນິກ.  ກະ​ລຸ​ນາ​ຕິດ​ຕໍ່​ຫາ​ສາ​ຂາ​ການ​ຫຼຸດ​ຜ່ອນ​ຢາ​ເສບ​ຕິດ​ທີ່ drugrebatebrach@dhcs.ca.gov​, ສໍາ​ລັບ​ຂໍ້​ມູນ​ເພີ່ມ​ເຕີມ​ກ່ຽວ​ກັບ​ວິ​ທີ​ການ​ລົງ​ທະ​ບຽນ EFT​.​​ 

What is “EIS”?​​    

ລະບົບການໂຕ້ຕອບທາງອີເລັກໂທຣນິກ (EIS) ອະນຸຍາດໃຫ້ຜູ້ຜະລິດຢາທີ່ສະໝັກໃຊ້ເພື່ອດຶງເອົາໃບແຈ້ງໜີ້ໄຕມາດປັດຈຸບັນ ແລະດາວໂຫຼດຂໍ້ມູນການຮຽກຮ້ອງ 10 ປີໂດຍອີງໃສ່ໃບເກັບເງິນຄືນ.   ກະ​ລຸ​ນາ​ຕິດ​ຕໍ່​ຫາ​ທີມ​ງານ​ສາ​ຂາ Rebate ຢາ​ເສບ​ຕິດ​ຢູ່​ທີ່ drugrebateportal@dhcs.ca.gov​, ສໍາ​ລັບ​ຂໍ້​ມູນ​ເພີ່ມ​ເຕີມ​ກ່ຽວ​ກັບ​ການ​ໄດ້​ຮັບ​ການ​ເຂົ້າ​ເຖິງ​ລະ​ບົບ​.​​  

ເປີດການຮຽກຮ້ອງຈາກລະບົບ EIS​​ 

ຫຼັງຈາກບັນທຶກການເຊື່ອມຕໍ່ຂໍ້ມູນການຮຽກຮ້ອງທີ່ຈ່າຍແລ້ວ, ໃຫ້ໃຊ້ 7-Zip ເພື່ອສະກັດຂໍ້ມູນເຂົ້າໄປໃນຮູບແບບຂໍ້ຄວາມທີ່ສາມາດປ່ຽນເປັນໄຟລ໌ Excel.​​   

ຂະບວນການແຈ້ງການແມ່ນຫຍັງຖ້າປ້າຍຊື່ມີ NDC ທີ່ຖືກຍົກເລີກ?​​    

ປ້າຍກຳກັບຕ້ອງລາຍງານວັນທີສິ້ນສຸດໃຫ້ CMS ແລະ First Data Bank (FDB) ໃນກໍລະນີທີ່ NDC ຖືກປິດ ເພື່ອຮັບປະກັນວ່າເອກະສານສູດ Medi-Cal ມີຂໍ້ມູນປັດຈຸບັນຫຼາຍທີ່ສຸດ.​​ 

CMS ກໍານົດວັນທີສິ້ນສຸດສໍາລັບການຄືນເງິນເປັນ:​​ 

  • ຜະລິດຕະພັນວັນທີໄດ້ຖືກໂຍກຍ້າຍອອກຈາກຊັ້ນວາງຮ້ານຂາຍຢາ; ຫຼື​​ 
  • ວັນທີຂອງອາຍຸການເກັບຮັກສາ (ວັນທີສຸດທ້າຍທີ່ມັນສາມາດແຈກຢາຍໄດ້) ຂອງຈໍານວນສຸດທ້າຍທີ່ຂາຍ​​ 

ຜູ້ຜະລິດຢາຈໍາເປັນຕ້ອງລາຍງານຂໍ້ມູນລາຄາສໍາລັບຢາທີ່ຢຸດເຊົາສໍາລັບ ສີ່ໄຕມາດ ທີ່ເກີນກວ່າວັນທີຢຸດເຊົາ.​​ 

ການຮຽກຮ້ອງທີ່ຖືກສົ່ງໂດຍອົງການຈັດຕັ້ງການດູແລທີ່ມີການຄຸ້ມຄອງແມ່ນຂຶ້ນກັບການຄືນເງິນບໍ?​​   

Yes. Section 2501 of the Affordable Care Act (ACA) amended section 1927(b)(1)(A) of the Social Security Act requires that the manufacturers “provide a rebate …including (for) such drugs dispensed to individuals enrolled with a Medicaid MCO if the organization is responsible for coverage of such drugs.” While section 1927(b)(1)(A) of the Act references payments made under the state plan, the amended statutory language does not limit the provision of additional manufacturer rebates to only drugs for which the MCO incurred a cost. When a drug is dispensed to a Medicaid beneficiary under a managed care arrangement, the state has made a capitated payment to the MCO for the drug. Regardless of the payment terms negotiated as part of the contract between the MCO and its participating providers to provide Medicaid coverage, the manufacturer is responsible for payment of rebates for covered outpatient drugs dispensed to Medicaid beneficiaries enrolled in MCOs. DHCS began collecting rebates for claims with a date of service of March 23, 2010, the implementation date of ACA.​​ 

ມັນຕ້ອງການໃຫ້ ROSI ແລະ/ຫຼື PQAS ຖືກສົ່ງກັບການຈ່າຍເງິນຄືນຂອງຜູ້ຕິດສະຫຼາກບໍ?​​    

Yes. The Centers for Medicare & Medicaid Services (CMS) requires that the Reconciliation of State Invoices (ROSI) and the Prior Quarter Adjustment Statement (PQAS) be included with every rebate payment. Without the ROSI and/or PQAS, the state will not be able to post your rebate payment. The data required on the forms is approved through the federal Office of Management and is mandated by CMS. It is also mandatory that drug manufacturers include ROSI and/or PQAS for any supplemental rebates paid. Submit checks, ROSI, PQAS and other supporting documents to the DHC Accounting address noted on your Invoice Cover Letters.​​ 

ພະແນກບໍລິການການດູແລສຸຂະພາບ
ພາກບັນຊີ
Medi-Cal​​ 

ບັນຊີການຄືນເງິນຄ່າຢາ
MS 1101​​ 

ຕູ້ໄປສະນີ 997415​​ 

Sacramento, CA 95899-7415​​ 

In order to ensure that payments are processed correctly, it is necessary to consult your Invoice Cover Letter for account information. Separate payments are required for many of the programs.​​ 

     ມີຜູ້ຮັບຜົນປະໂຫຍດຈໍານວນເທົ່າໃດທີ່ລົງທະບຽນຢູ່ໃນການດູແລຄຸ້ມຄອງ Medi-Cal ໃນຄາລິຟໍເນຍ?​​  

ສໍາລັບຂໍ້ມູນການດູແລທີ່ມີການຄຸ້ມຄອງ, ລວມທັງຂໍ້ມູນການລົງທະບຽນ, ໃຫ້ເຂົ້າໄປທີ່ ຫນ້າເວັບ Medi-Cal Managed Care.​​ 

ລັດຄາລິຟໍເນຍຕ້ອງການໃຫ້ຜູ້ຜະລິດຢາຈ່າຍຄ່າຊົດເຊີຍຄືນຕໍ່ກັບການຮຽກຮ້ອງປະສົມບໍ?​​   

Yes. California’s claims processing system has been capturing the information necessary to rebate drug manufacturers for compound rebates since October 2003. To ensure compliance with federal requirements, drug manufacturers will be invoiced for compounds in 2014. Invoicing will be retroactive to 2003 when the claims processing system began capturing the data.​​  

Back to Medi-Cal Drug Rebate ​​