Medi-Cal 中的助产服务
加利福尼亚州目前认可两种助产士：认证护士助产士（CNM），有时也称为护士助产士（NMW）和执业助产士（LM）。LM 和 CNM 均可独立执业，不需要医生监督，并且有资格向加州卫生保健服务部 (DHCS) 注册成为 Medi-Cal 提供者。已加入 Medi-Cal 的 CNM 和 LM 可以在其适用的执业范围内，通过按服务收费 (FFS) 和管理式医疗交付系统中的管理式医疗计划 (MCP) 提供 Medi-Cal 承保的福利和服务。
护士助产士（CNM）
- CNM 由加州注册护士委员会 (BRN)授权为注册护士 (RN)，并获得 BRN 的额外认证以从事助产工作。
- 加利福尼亚州的 CNM 执业范围在《商业和职业法典》第 2746.5 节中定义。CNM 在加利福尼亚州执业不需要医生监督。
- Many Nurse Midwives maintain national board certification through the American Midwifery Certification Board (AMCB) those who maintain this certification are Certified Nurse-Midwives. Certification through AMCB is not required for practice in California.
执业助产士（LM）
- LM 由加州医疗委员会颁发执照。
- 加利福尼亚州的 LM 执业范围由《商业和职业法典》第 2507 条定义。在加利福尼亚州，LM 执业不需要医生监督。
- Many LMs maintain national board certification through the North American Registry of Midwives (NARM) those who maintain this certification are Certified Professional Midwives (CPM). Certification through NARM is not required for practice in California.
如何成为 Medi-Cal 助产士
The majority of California’s Medi-Cal pregnant enrollees are cared for through Managed Care Plans (MCP) a smaller number are cared for through fee for service (FFS). Midwives (CNMs and LMs) may enroll through the Provider Application and Validation for Enrollment (PAVE) portal to submit their Medi-Cal application to provide care for to people through both FFS and MCP.
Midwives (CNMs and LMs) interested in serving Medi-Cal managed care plan (MCP) members will also need to enter contracts with the member’s Medi-Cal MCP plan. LMs and CCNMs must contact the Medi-Cal MCP directly for instructions on how to become a Medi-Cal MCP network provider.
Medi-Cal 服务费用 (FFS) ：
Enrollment in Medi-Cal through PAVE is all that is required to start taking Medi-Cal FFS. DHCS pays out directly at rates set by the State for care provided to individuals covered by FFS. Please see Current Medi-Cal Rates.
Medi-Cal 管理式医疗：
CNMs and LMs interested in providing services to Medi-Cal managed care members who receive care through Medi-Cal MCPs must first enroll with Medi-Cal through PAVE. After enrolling with PAVE they must contract directly with the MCPs. Only CNMs and LMs who entered into contracts with Medi-Cal MCPs will be able to receive reimbursement for services provided to MCP members. To view a list of Medi-Cal MCPs in your county, please visit DHCS’ Medi-Cal Managed Care Health Plan Directory website.
DHCS’ Provider Application and Validation for Enrollment (PAVE) portal
For more information about PAVE, please visit DHCS’ PAVE Provider Portal (ca.gov) website. You may also call the PAVE Help Desk at (866) 252-1949, and one of DHCS’ experts will be happy to assist you (available Monday – Friday, 8:00 am – 6:00 pm Pacific time, excluding state holidays).
Medi-Cal 提供商手册
Medi-Cal coverage policy for both Medi-Cal FFS and managed care delivery systems as well as Medi-Cal FFS reimbursement policy can be found in the Medi-Cal Provider Manual. Medi-Cal covered benefits and services provided by CNMs and LMs within their respective scopes of practice can be found in several different sections of the Medi-Cal Provider Manual, including:
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- 非医师执业医师 (NMP) Manual: This manual includes billing guidance for LM and CNMs and information about care covered by Medi-Cal. Additional Resources and information can be found in the following subsections of the the Medi-Cal provider manual:
- Pregnancy/Obstetrics:
- 综合围产期服务计划(CPSP)
- 堕胎（abort）（ca.gov）
- 替代生育中心
- 计划生育
所有计划函 (APL)
Medi-Cal 管理式医疗通过 APL 与 Medi-Cal MCP 进行沟通，APL 传达联邦和/或州一级政策或程序变化的信息或解释，并向承包商提供如何在运营基础上实施这些变化的指导（如果适用）。 有关 CNM 和 LM 的信息可以在几种不同的 APL 中找到，其中包括：
- APL 18-022 ：独立产科中心的准入要求和助产士服务的提供
- APL 16-017 ：提供认证护士助产士和替代分娩中心设施服务（取代 APL 15-017）
- APL 18-022 ：独立产科中心的准入要求及助产士服务的提供（取代 APL 16-017）
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APL 24-003: Abortion Services
Medi-Cal 培训
Medi-Cal 学习门户为 Medi-Cal 提供商（包括 CNM 和 LM）和收费员提供有关收费基础知识、政策、程序、新举措和 Medi-Cal 即将发生的变化的自定进度在线培训。
- 首次使用者：在learn.medi-cal.ca.gov上完成一次性注册
- Returning users: Log in on learn.medi-cal.ca.gov to view or search the course catalog.
以下是针对 CNM 和 LM 的建议培训：
- 基本账单：本培训系列重点关注 Medi-Cal 账单基础知识，包括受助人资格、费用分摊、治疗授权请求 (TAR)、CMS-1500 或 UB-04 索赔完成和索赔跟进。
- CPSP 录制的网络研讨会：该模块将让参与者熟悉从受孕之日起到分娩月份后 60 天内参加 CPSP 的孕妇 Medi-Cal 受益人可享受的广泛服务。 接受者和提供者的参与都是自愿的。 还包括账单信息。
- Licensed Midwife Billing Webinar: This training provides an overview of Medi-Cal Fee-for-Service billing and claims instructions, as well as general program policy information for Licensed Midwives.
资源
以下是 CNM 和 LM 可能觉得有用的其他资源：
- 分娩护理途径
- 利益相关方新闻订阅
- Medi-Cal 提供商门户
- 加州 BRN（CNM）
- CNM 常见问题解答
- MBC（LM）
- California Department of Public Health CPSP: CNMs and LMs may enroll in Medi-Cal as direct/billing providers and apply as a Comprehensive Perinatal Services Program provider (CPSP).
- 更新了持照助产士和认证护士助产士的 Medi-Cal 既定营业地点登记要求和程序
- DHCS 执业助产士申请信息
联系我们
如果 CNM 和 LM 还有其他问题，他们可以联系 DHCS 寻求进一步帮助，如下所示：
- For billing and claim submission questions, please contact DHCS’ Fiscal Intermediary via phone through the Telephone Service Center (TSC) at 1-800-541-5555. For faster access to TSC resources, refer to the TSC Main Menu Prompt Options Guide.
- For policy guidance, please send an email to Medi-Cal.Benefits@dhcs.ca.gov.