梅迪卡爾州的助產服務
加州目前認可兩種助產士：有時稱為護士助產士（NMW）的認證護士助產士（CNM）和持牌助產士（LM）。LM 和 CNM 都可以獨立執行，他們不需要醫生監督，並且有資格在加州衛生護理服務部（DHCS）註冊為 Medi-Cal 提供者。註冊 Medi-Cal 的 CNM 和 LM 可在其適用的實踐範圍內提供 Medi-Cal 保障和服務，在服務費 (FFS) 和託管照護提供系統中的託管護理計劃 (MCP) 中提供 Medi-Cal 保障範圍內的保障和服務。
護士-助產士 (CNM)
- CNM 獲加州註冊護士委員會（BRN）授權為註冊護士（RNs），並獲得 BRN 的額外認證，以執行助產。
- CNM 在加利福尼亞州的實踐範圍在《商業和職業守則》第 2746.5 條中定義。CNM 不需要醫生監督才能在加利福尼亞執行。
- 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.
持牌助產士 (LM)
- LM 獲得加利福尼亞醫療委員會授權。
- 在加利福尼亞州的 LM 實踐範圍在《商業和職業守則》第 2507 條中定義。LM 不需要醫生監督才能在加利福尼亞執行。
- 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.
如何成為 Medi-Cal 助產士提供者
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.
醫療服務費 (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.
醫療管理服務：
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).
加州醫療補助健康保健計劃提供者手冊
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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- 非醫生醫生 (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:
- 全面產生產服務計劃（CPSP）
- 流產（中斷）（ca.gov）
- 替代生育中心
- 家庭計劃
所有計劃信件（APL）
Medi-Cal 管理護理通過 APL 與 Medi-Cal MCP 溝通，這些 APL 傳達對聯邦和/或州級別政策或程序變更的信息或解釋，並向承包商提供指示（如果適用）有關如何在營運基礎上實施這些更改。 CNM 和 LM 的信息可以在幾個不同的 APL 中找到，包括：
- APL 18-022：獨立出生中心的門禁要求及提供助產士服務
- APL 16-017：提供認證護士助產士和替代生育中心設施服務（取代 APL 15-017）
- APL 18-022：獨立出生中心及提供助產士服務的門禁要求（取代 APL 16-017）
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APL 24-003: Abortion Services
醫療訓練
Medi-Cal 學習入口網站為 Medi-Cal 提供者（包括 CNM 和 LM）以及計費者提供有關計費基礎知識、政策、程序、新措施以及 Medi-Cal 即將進行的更改的自我節奏的線上培訓。
- 首次使用者：在 learn.medi- cal.ca.gov 完成一次性註冊
- Returning users: Log in on learn.medi-cal.ca.gov to view or search the course catalog.
以下為 CNM 和 LM 的建議培訓：
- 基本帳單：本培訓系列專注於 Medi-Cal 帳單基礎知識，包括收件人資格、成本分配、治療授權請求 (TAR)、CMS-1500 或 UB-04 索賠完成和索償跟進。
- CPSP 錄製網絡研討會：本單元將使參與者熟悉從受孕日期到分產月後 60 天，為註冊 CPSP 的孕婦醫療服務受眾提供的廣泛服務。 收件人和提供者參與是自願的。 帳單信息也包括在內。
- 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.
資源
以下是 CNM 和 LM 可能會有幫助的其他資源：
- 生育護理途徑
- 利害關係人新聞訂閱
- 中醫服務供應商入口網站
- 加利福尼亞州布魯尼亞州 (CNM)
- CNM 常見問題
- 大學管理學系 (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).
- 更新了持牌助產士和認證護士助產士的 Medi-Cal 成立營業地點註冊要求和程序
- DHCS 持牌助產士申請信息
聯絡我們
如果 CNM 和 LM 有其他問題，他們可以聯繫 DHCS 尋求進一步協助，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.