医疗事故恢复计划
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Department of Health Care Services (DHCS)医疗事故赔偿Program旨在为Medi-Cal代表其成员支付的、涉及第三方诉讼（如医疗和牙科事故、出生伤害、虐待老人和非正常死亡）的服务寻求补偿。 当Medi-Cal会员从负有责任的第三方获得和解金、判决或裁决作为对其所受伤害的赔偿时，联邦和州法律要求医疗事故赔偿Program追回Medi-Cal支付的任何相关服务的资金。
对于涉及人身伤害、集体诉讼或工人赔偿的索赔，请使用下面的链接联系相应的恢复部门。
留置权程序
The Medi-Cal member or personal representative is required by law to report an action or claim in writing to DHCS pursuant to Welfare and Institutions (W&I) Code Section 14124.70 et seq. Notifications must be submitted to the online case notification webpage or by mail within 30 days of filing an action or claim, and MUST include the following pursuant to W&I Code Section14124.73(c):
(1) Medi-Cal 會員的受傷日期、
(2) Medi-Cal 会员的 Medi-Cal 识别号码、
（3）责任第三者或保险人的联系信息，
（4）索赔管理员的联系信息，包括其索赔编号，以及
（五）代表责任第三人或者保险人的辩护律师的联系方式。
请等待 30 天，以便 DHCS 发送确认收到通知的信函。
DHCS 留置权概述：医疗事故
- 向 DHCS 报告受伤情况
Per Welfare and Institutions Code 14124.73, the injured party is required to notify DHCS within 30 days of filing a claim or action. The notification must include the date of injury, Medi-Cal member’s identification number, and the name and contact information for the liable third party. The notification should be reported via Online Forms. - DHCS 检查确定受伤一方是否为 Medi-Cal 会员
如果受伤方不是 Medi-Cal 会员，DHCS 将通知提交方。 - 如果受害方是 Medi-Cal 会员，则会产生医疗事故案件
A DHCS representative will contact the attorney, insurance, or member to request documentation regarding the injury event. Per Welfare and Institutions Code 14124.71, DHCS has the right to assert a lien against any settlement, judgment, or award obtained from a liable third party. - 是否可以提供最终治疗日期（FDOT）或结算日期（SD）？
A FDOT and/or SD allows DHCS to determine the services attributable to the liable third party. Without a FDOT or SD, DHCS is unable perfect its lien under Welfare and Institutions Code 14124.76. If a FDOT or SD is available, you may complete the Preliminary or final lien Request Form (see below for more details). - 在订购付款数据之前，DHCS 将允许至少 120 天的时间从 FDOT 或 SD
根据福利和机构法第 14115 条规定，医疗服务提供者自服务之日起最多有一年的时间向 Medi-Cal 开具账单。医疗服务提供者通常会在服务日期后的四个月内向加州医疗补助计划 (Medi-Cal) 提交账单。DHCS 在 FDOT 或 SD 之后等待 120 天，允许医疗服务提供者有合理的时间向 Medi-Cal 收费。 - DHCS 从管理式护理计划 (MCP) 订购付款数据
如果会员在治疗期间参加了多个计划，则可以从多个 MCP 订购数据。DHCS 不将 MCP 付款数据存储在内部，也不控制 MCP 的响应时间。通常情况下，医疗护理计划 (MCP) 会在 120 天内回复 DHCS 的记录请求，但可能需要更多时间。可能需要从多个独立医师协会 (IPA) 订购病历。 - 付款数据到达后，DHCS 将进行审核，并创建留置权（如适用）
根据《福利与机构法》第 14124.71 条、DHCS 有权收回为会员提供的福利的合理价值。 - DHCS will send a “lien” or “no lien” letter to the appropriate parties
根据福利和机构法典 14124.75， 在与原始索赔或诉讼相关的所有和解达成之前，DHCS 保留对所提供福利的合理价值的补偿权利。
申请初步或最终留置权
在提交留置权申请之前，必须在该部设立一个案件，所有初步和最终留置权申请都必须在线提交。如需就已确定的案件向医疗事故股申请初步或最终留置权，请单击下面的链接。在填写申请表时，您需要提供与申请相关的信息以及必要的证明文件。
请注意：医疗事故股不再通过TMU@dhcs.ca.gov 接受初步或最终留置权申请。
When the member has completed treatment or a settlement has occurred, DHCS will order and review the payment records to establish a “lien,” or list of injury related services subject to collection. Use the Online Forms to tell DHCS when treatment ends or a settlement has occurred or use the Preliminary or Final Lien Request Form to request a lien. DHCS has the right to recover up to the date of settlement or full resolution of all actions associated with the injury, pursuant to W&I Code Section 14127.785. Upon each settlement, the member or personal representative is required to notify DHCS so that an updated lien may be prepared pursuant to W&I Code Section 14124.76 and 14124.79. For more information on the lien process and timeframes, visit our Frequently Asked Questions.
If funds will be placed into a Special Needs Trust, please go to the Special Needs Trust webpage for further instructions on notifying DHCS’ Special Needs Trust Unit.