California cov kab ke tiv thiav thiab pab txhawb

Daim Ntawv Thov Zam Kev Kho Mob (Medical Exemption Requests (MERs))

Lub Ib Hli 2017, Nthuav Tawm #5595.09 Hmong

1. Daim Ntawv Thov Zam Kev Kho Mob (Medical Exemption Requests (MER)) yog dab tsi?

Xeev California tab tom ua cov txheej txheem hloov chaw cov neeg laus thiab cov neeg xiam oos qhab uas muaj Medi-Cal mus rau managed care plans hloov qhov kev rhais chaw, lossis tus nqi pab cuam,Medi-Cal. i Qhov MER yog ib daim ntawv thov kom tawm ntawm Managed Care Plan. Yog tias koj xav tawm ntawm managed care thiab hloov kom tau txais kev kho mob hla cov chaw kho mob uas koj xaiv lossis tus kws kho mob uas sau nqi ntawm cov kev kho mob (FFS) Medi-Cal, koj tuaj yeem thov MER. Koj yuav tsum haum raws li cov qauv tam sim no kom muaj feem tau txais MER.

2. Cov Txheej Txheem Ua Haujlwm Li Cas?

Koj thiab koj tus kws kho mob yuav sau daim ntawv foos MER thiab muab xa rov qab rau hauv Lub Chaw Haujlwm Saib Xyuas Kev Kho Mob hla Cov Kev Xaiv Kho Mob. DHCS tus neeg ua haujlwm yuav tshuaj xyuas koj daim ntawm tshaj tawm MER thiab txhua cov pov thawj los ntawm koj tus kws kho mob txhawm rau txiav txim siab yog tias koj tuaj yeem muaj kev nyab xeeb hloov mus rau Managed care planstxoj hauv kev. ii Feem ntau, yog tias koj tsuas yog tau txais kev tswj hwm kho mob lossis tau txais kev tshuaj xyuas kab mob tas li uas koj tau txais kev pab los ntawm MER.

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3. Leej Twg Thiaj Muaj Cai Tau Txais MER

- Koj muaj ib tus mob uas kho nyuaj (Saib cov npe hauv qab no hauv Tshooj 7); THIAB

--Koj tus mob yuav hnyav dua qub yog tias koj hloov kws kho mob;

--Koj tab tom muaj qhov kev kho mob uas tsis pub muaj dab tsi los cuam tshuam;

- Yog tias koj yog Ib Tus Neeg Asmeskas Neeg Is-Dias iii

- Yog tias koj tau kuaj mob HIV/AIDS

- Yog tias koj tau rau npe nkag hauv Medi-Cal qhov kev zam, suav nrog cov kev zam HCBS, NF/AH, IHO, lossis AIDS, ces koj yuav muaj cai ib leeg rau qhov MER. Txawm li cas los xij, koj yuav tsum tau sau kom tiav daim ntawv thov MER txhawm rau kom tau txais MER.

4. Leej Twg Tsis Tuaj Yeem Thov qhov MER

- Koj nyob hauv Lub Nroog Uas Npaj Cov Kab Ke Kho Mob (COHS) Lub Nroog iv

--Koj puav leej muaj Medi-Cal thiab Medicare (“medi-medi”) thiab koj nyob hauv Lub Nroog Pib Koom Tes Kho Mob – Los Angeles, Riverside, San Bernardino, San Diego, lossis Nroog Santa Clara

--Koj tau rau npe hauv ib qho Medi-Cal plan rau ntau dua 90 hnub ua ke.

--Koj tus kws kho mob koom rog ib feem ntawm managed care plan hauv lub nroog uas ko nyob.

-- Koj qhov kev npaj kho mob ob tau teem caij pib TOM QAB koj rau npe nkag hauv managed care plan. 22 C.C.R. § 53887(a)(2)(B)(1)-(3).

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5. Thaum Twg Koj Yuav Tsu Tau Thov MER

Thaum koj tau txais tsab ntawv ceebtoom uas koj yuav tsum tau xaiv managed care plan, koj muaj sij hawm 30 hnub xa daim ntawv MER. 22 C.C.R. § 53882(c). Yog tias koj tsis tau thov MER nyob hauv sij hawm 30 hnub, koj yuav raug rau npe ib leeg hauv Managed Care Plan. 22 C.C.R. § 53882(d)(1).

Yog tias koj xav zam ntawm kev rau npe nkag hauv managed care, koj thiab koj tus kws kho mob yuav tsum tau sau kom tiav daim ntawv foos MER uas nyob tom kawg ntawm cov ntawv rau npe nkag. Koj kuj tuam yeem hu rau Qhov Chaw Xaiv Kho Mob (HCO) ntawm 1-800-430-4263 kom tau txais daim ntawv theej ntawm daim ntawv foos MER lossis rub tawm thiab luam daim ntawv foos ntawm no: http://www.healthcareoptions.dhcs.ca.gov/HCOCSP/Enrollment/Exception_ to_Plan_Enrollment_Forms.aspx.

Nws yog ib qho tseem ceeb rau koj tus kws kho mob kom suav nrog cov ntaub ntawv uas piav qhia txog cov kev tab tom kho mob thiab/lossis cov kev kho mob nyuaj uas koj tau txais, thiab vim li cas qhov no thiaj tiv thaiv koj tsis pub kom hloov chaw mus rau managed care tam sim no. Koj yuav tsum nco ntsoov muab cov lus piav qhia tias vim li cas koj tsis tuaj yeem muaj kev nyab xeeb hloov chaw rau managed care lub sij hawm no. Cov ntaub ntawv no yuav tsum yog los ntawm tus kws kho mob uas koj nquag mus ntsib tas li thiab tus uas paub txog koj tus mob zoo. Cov pov thawj uas zoo tshaj plaws rau qhov no yog tsab ntawv tuaj ntawm koj tus kws kho mob, uas koj sau rau hauv koj daim MER, thiab txhua cov ntaub ntawv sau tseg kev kho mob uas koj tus kws kho mob xav tias tsim nyog txhawb rau cov ntaub ntawv no.

Hu Rau Lub Chaw Xaiv Kho Mob (HCO) yog tias koj muaj lus nug. Koj lossis koj tus kws kho mob kuj tuaj yeem tau txais kevv pab los ntawm koj daim ntawv thov zam kho mob uas yogh u rau Medi-Cal managed care ombudsman ntawm 1-888-452-8609, lossis xa email mus rau cov chaw nyob txuas ntxiv no: merhelp@dhcs.ca.gov. Thaum koj hu rau HCO, kom nco ntsoov sau cov ntsiab lus tseg tias koj hu xovtooj thaum twg thiab tham nrog leej twg. Sau koj cov lus sib tham khaws cia tseg tuaj yeem pab koj kho tej yam ua tsis raug.

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Qhov laj thawj nquag tshwm sim tshaj plaws rau MER raug tsis kam lees yog DHCS tau txiav txim siab tias koj tus mob zoo lawm thiab koj tuaj yeem nyab xeeb hloov mus rau managed care. Koj tus kws kho mob yuav tsum piav qhia tias vim li cas, thiab muab cov pov thawj, koj tus mob tsis tuaj yeem nyab xeeb tau.

6. Cov Txheej Txheem Raws Kev Cai Lij Choj rau Qhov Kev Zam los ntawm Kev Rau Npe Nkag

Cov qauv xaiv kev muaj cai rau qhov kev zam kho mob los ntawm tsab cai rau npe nkag hauv qhov kev npaj kho mob managed care nrhiav pom nyob hauv 22 C.C.R. § 53887. Tus neeg thov qhov muaj cai yuav thov tus nqi saib xyuas Medi-Cal raws li qhov kev zam rau tus mob kho nyuaj uas yuav tsum tau txuas ntxiv kho ntau txog 12 lub hli lossis ntev dua. 22 C.C.R. §§ 53887(a), (a)(4).

Cov cai teev tseg tias tus neeg muaj cai uas tab tom tau txais tus nqi kho mob Medi-Cal rau cov kev pab uas “kho hom mob kho nyuaj,” los ntawm tus kws kho mob, tus saib xyuas neeg mob raug tso cai, lossis tus tus neeg saib xyuas yug menyuam raug tso cai uas koom nrog hauv Medi-Cal tab sis tsis muaj ntawv cog lus ua ib tus kws kho mob ntawm qhov kev npaj kho mob (hauv Ob-Qhov Kev npaj kho mob hauv nroog) hauv lub nroog koj nyob uas raug tso cai tau txais kev pab, tuaj yeem thov zam kev kho mob txhawm rau txuas ntxiv tus nqi kho mob Medi-Cal rau lub hom phiaj txuas ntxiv kho mob. 22 C.C.R. § 53887(a)(2).

Cov cai kuj tseem teev tseg tias tus neeg muaj cai tau txais kev pab uas yog neeg Asmeskas Is-Dias, ib tus neeg nyob ntawm Tus Neeg Asmeskas Is-Dias tsev neeg, lossis xaiv kom tau txais cov kev pab kho mob hla Lub Chaw Kho Mob Neeg Is-Dias thiab sau daim ntawv lees txais los ntawm Lub Chaw Kho Mob Neeg Is-Dias txhawm rau tus nqi kho mob, tej zaum yuav thov zam kev kho mob txhawm rau txuas ntxiv kho mob rau Medi-Cal rau lub hom phiaj txuas ntxiv kho mob. 22 C.C.R. § 53887(a)(1).

Tus mob uas yuav haum rau cov qauv xaiv “kho hom mob kho nyuaj” suav nrog, lwm tus mob uas tus neeg muaj qhov kho nyuaj thiab/lossis kho zoo qeeb uas yuav tsum tau txuas ntxiv ncua lub sij hawm kho thiab/lossis tus neeg tau txais tso cai rau kho lossis tau txais cov kev

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pab kho mob nyuaj rau tus mob hnyav, kev kho mob uas tsis tuaj yeem cuam tshuam tau. 22 C.C.R. § 53887(a)(2)(A)(7).

Lwm yam mob uas haum raws li tus qauv xaiv “kho hom mob kho nyuaj” suav nrog:

- Tus neeg muaj cai tau txais kev pab yog neeg cev xeeb tub.

- Tus neeg muaj cai tau txais kev pab yog saib raws li kev ntsuas qhov yuav tsum tau hloov khoom hauv lub cev; tau txais kev tso cai rau thiab tab tom nyob tos cov khoom coj los hloov; lossis tau txais kev hloov khoom hauv lub cev thiab tam sim no tseem tab tom npaj yuav raug phais mob lossis tsom saib tej yam teebmeem kev kho mob uas cuam tshuam txog kev phais mob. Cov neeg tau txais kev pab uas tab tom siv tshuaj kho mob npaj yuav phais mob yuav tsis muaj cai raug zam raws li nqi lus no.

- Tus neeg muaj cai tau txais kev kev pab tab tom kho mob lim ntshav hauv lub raum.

- Tus neeg muaj cai tau txais kev pab tau mus kuaj mob HIV lossis tau txais kev kuaj yam tsos mob tawm tsam cov ntshav dawb tiv thaiv lub cev (AIDS).

- Tus neeg muaj cai tau txais kev pab tau raug kuaj mob khees xaws thiab tam sim no tau txais kev siv duab hluav taws xob tua kab mob lossis lwm yam kev kho mob uas tsis yog phais mob rau tus mob khees xaws uas yuav txuas ntxiv kho ntev txog 12 hli lossis tau txais kev tso cai rau kho tus mob no.

- Tus neeg muaj cai tau txais kev pab tau txais kev tso cai rau phais mob los ntawm Medi-Cal cov nqi pab kho mob thiab tab tom nyob tos phais mob lossis tab tom npaj yuav phais mob sai.

- Tus neeg muaj cai tau txais kev pab muaj qhov kho mob hlab ntshav, xws li ntau txoj hlab ntshav khov, kho cov hlab ntshav khiav tsis xwm yeem, xws li ntshav khiav tsis zoo lossis muaj cov keeb kab mob nyob hauv cov ntshav, lossis muaj tus mob uas kho nyuaj thiab/lossis tsis tuaj yeem pab kho tau hauv 1. Txog 6. saum toj saud, xws li mob cov hlab ntshav txhaws lossis ua haujlwm tsis tau uas yuav tsum tau txais kev kho mob tas li thiab/lossis tau

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txais kev tso cai rau kho lossis tab tom tais kev kho tus mob kho nyuaj, yam kev tswj hwm kho mob uas tsis tuaj yeem raugcuam tshuam. v

- Tus neeg muaj cai tau txais kev pab uas tau rau npe hauv Medi-Cal qhov kev zam uas tso cai tus neeg tau txais cov kev pab kho mob me, kho mob hnyav, kho mob kiag tam sim lossis cov kws saib xyuas neeg mob hauv tsev ntau tshaj li hauv lub chaw kho mob me, lub tsev kho mob loj, lub chaw kho mob sai lossis cov tsev kws kho mob.

- Tus neeg muaj cai tau txais kev pab koom nrog hauv txoj haujlwm pib tau tsim thiab ua haujlwm raws li tsab cai tshooj 14087.3, 14094.3, lossis 14490 ntawm Tsab Cai Saib Xyuas Kev Noj Qab Nyob Zoo thiab Cov Koom Haum. 22 C.C.R. § 53887 (a)(2)(A)(1)-(9).

7. Yog Tias Koj Li MER Tau Txais Kev Pab Nyiaj

Koj tuaj yeem txuas ntxiv mus ntsib koj tus kws kho mob Medi-Cal li txhua zaus, tab sis koj yuav tsum tau rov thov dua rau MER hauv txhua 12 hli. DHCS yuav kom koj rov thov dua txhawm rau txiav txim siab seb koj tus mob hnyav ntawv puas muaj qhov hloov pauv. Yog tias koj tus mob zoo lawm, koj li MER yuav raug tsis kam lees. Thov qhia paub tias MER cov nyiaj pab yog muaj tsawg heev.

8. Yog tias koj li MER raug Tsis Kam Lees thiab koj Xaiv Sau Ntawv Foob

Yog tias koj li MER raug tsis kam lees, ces koj muaj sij hawm 90 hnub los sau ntawv foob thiab koj tsis tuaj yeem raug tso rau hauv managed care plan thaum lub sij hawm ntawd. Sai npaum li sai tau uas koj qhov MER raug tsis kam lees, koj yuav tsum thov koj daim ntawv foob los ntawm DHCS.

Thaum koj tau thov koj daim ntawv, ces koj yauv sau daim ntawv foob. Cov lus qhia rau sau ntawv foob muaj nyob hauv qab no.

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9. Qhov Kev Foob MER Raug Tsis Kam Lees

Koj muaj sij hawm 90 hnub txij li hnub xa daim ntawv tsis kam lees txhawm rau foob. Ib qho phiaj xwm koj yuav tau saib yog toss au ntawv rau MER cov khoom plig thaum kawg 90 hnub txhawm rau txuas lub sijhawm uas koj muaj peev xwm txuas ntxiv mus cuag koj tus kws kho mob. Thaum koj sau ntawv thov foob, koj yuav tsum hais rau “pab them cov nqi tseem tshuav” uas txhais tau tias koj yuav txuas ntxiv hauv FFS Medi-Cal kom mus txog hnub tau txais cov txiaj ntsig foob.

Koj tuaj yeem thov kom sau ntawv foob uas yog sau rau ntawm daim ntawv foos thov foob, uas muaj Tsab Ntawv Ceebtoom Kev Txiav Txim, uas koj tsis pom zoo nrog qhov kev txiav txim thiab koj xav sau ntawv foob. Koj kuj tuaj yeem thov foob qhov tsis txaus siab hauv xovtooj, lossis hauv fev lossis hauv ib tsab ntawv lossis daim ntawv foos mus rau qhov chaw nyob hauv qab no:California Department of Social Services State Hearings Division P.O. Box 944243, Mail Station 19-37 Sacramento, CA 94244-24301-800-952-5253 (suab lus) 1-800-952-8349 (TDD) (916) 229-4110 (fev)

Lub rooj saib xyuas kev ncaj ncees huav tsum tau teeb tsa nyob hauv sij hawm 30 hnub txij li hnub thov tuaj thiab sau ib tsab ntawv ceebtoom txog lub sij hawm thiab kev ceebtoom txog lub sij hawm thiab qhov chaw yuav tsum xa nyob hauv sij hawm 10 hnub ua ntej hnub saib xyuas kev ncaj ncees. Cal. Welf. & Inst. Tsab cai § 10952.

Thaum koj hais qhov tsis txaus siab, koj yuav muaj peev xwm nthuav tawm cov pov thawj uas koj tus mob tsis zoo txaus qhov yuav hloov mus rau managed care plan. Txoj hauv kev zoo tshaj plaws ua qhov no yog kom tau txais ib tsab ntawv los ntawm koj tus kws kho mob teev tseg tias koj yuav muaj kev cuam tshuam txog kev siv tshuaj kho mob yog tias koj raug yuam kom mus cuag lwm tus kws kho mob. Koj tus kws khomob yuav tsum tau muab cov pov thawj uas koj tus mob tsis zoo thiab koj tsis tuaj yeem muaj kev nyab xeeb qhov raug xa mus rau managed care plan tus kws kho mob. Cov ntaub ntawv pab txhawb

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yuav suav nrog qhov kev npaj kho mob, cov ntawv sau tseg los ntawm kev mus cuag kws kho mob 5 zaug tas los no, thiab cov ntaub ntawv sau txog keeb kwm kho mob tam sim no thiab cov kuaj ntsuas tau los ntawm kws kho mob. vi

Koj yuav tsum tau sib cav tias koj muaj cai tau txais qhov kev zam raws li qhov tseeb uas (1) koj muaj tus mob kho nyuaj (2) yuav tsum tau txais kev saib xyuas kho mob txuas ntxiv, thiab (3) koj tau txais kev kho tus mob uas kho nyuaj, kev ua haujlwm kho mob yuav tsis pub kom muaj dab tsi cuam tshuam, raws li teev tseg hauv tshooj cai 22 C.C.R. § 53887(a)(2)(A)(7). Lwm yam ntxiv rau kev txiav txim yog raws li qhov peb paub, koj yuav muaj feem ua tiav yog tias tus kws kho mob uas ua tiav qhov MER pom koj tas li. Qhov MER yuav raug tsis kam lees yog tias tus kws kho mob tsuas yog pom tus neeg mob hauv txhua rau lub hli xwb.

Thov nco ntsoov tias yog thaum uas koj yeej koj qhov saib xyuas kev ncaj ncees thiab Tus Kws Txiav Txim Plaub Ntug xa koj daim ntawv thov rau MER, DHCS muaj tus kws lij choj los xaiv (“cov kev xaiv”) uas txiav txim thiab tseem tsis kam lees koj li MER. Thaum zoo li no, koj tuaj yeem sau ntawv foob kom rov saib xyuas kev ncaj ncees dua (koj muaj sij hawm 30 hnub txij li hnub koj tau txais tsab ntawv txiav txim). Koj kuj tuaj yeem sau ntawv xaj hauv lub tsev hais plaub. Koj muaj sij hawm ib xyoo txij li hnub txiav txim los sau cov ntawv foob ntawd. Yog tias koj ua tiav daim ntawv foob, thiab Tus Thawj Coj ntawm DHCS xaiv koj qhov kev txiav txim, koj kuj tseem muaj cai tau txais cov kev kho mob txuas ntxiv, thiab yuav tsum nug qhov ntawv los ntawm qhov managed care plan uas koj xaiv rau npe hauv. Saib Tshooj Cai 11 hauv qab no.

10. Yog Tias Koj Qhov MER Raug Tsis Kam Lees thiab Koj Tsis Tau Sau Ntawv Foob –Txuas Ntxiv Kho Mob thiab Daim Ntawv Pom Zoo Kho Ib Leeg

Tshooj cai no siv tau yog tias koj li MER raug tsis kam lees thiab koj xaiv tsis sau ntawv foob. Yog tias koj tsis tau txais kev pab rau daim ntawv thov zam kev kho mob rau koj tus mob kho nyuajj thiab koj tsis sau ntawv foob, ces koj yuav tsum tau koom nrog hauv managed care plan. Koj tuaj yeem thov kom txuas ntxiv mus ntsib koj cov kws kho mob uas tsis koom nrog

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ntawm managed care plan cov chaw kho mob koo nrog uas yog thov yam uas yu tias kev txuas ntxiv kho mob. vii

Managed care plans yuav tsum tso cai koj txuas ntxiv mus ntsib koj tus kws khomob tsis koom nrog hauv cov kws kho mob koom tes nrog thaum:

- Qhov managed care plan tuaj yeem txiav txim siab seb koj puas muaj peev xwm txuas ntxiv sib cuam tshuam nrog tus kws kho mob (koj tau ntsib tus kws kho mob yam tsawg kawg ib zaug nyob hauv sij hawm 12 hli dhau los);

- Koj tus kws kho mob yeej xav lees txais tus nqi siab dua ntawm managed care plan daim ntawv cog lus lossis Medi-Cal FFS cov nqi; thiab

- Tus kws kho mob haum raws li managed care plan cov qauv txheej txheem kev paub uas siv tau thiab tsis muaj qhov teebmeem kev kho mob tsis tau txais txiaj ntsig. Tsab Ntawv Txhua Qhov Kev Npaj Kho Mob 13-023 p. 1 (Lub Kaum Ob Hli 24, 2013). viii

Lwm txoj kev xaiv yog kom tau tawm ntawm cov kws kho mob koom tes nrog mus siv qov kev kho mob-ib leeg daim ntawv cog lus. ix Nov yog daim ntawv cog lus nrog tus kws kho mob sab nraud ntawm cov kws kho mob koom tes nrog kom tso cai them nyiaj ntawm cov nqi kho mob tshwj xeeb rau cov kev pab tau xaiv thaum lub sij hawm tshwj xeeb rau tus neeg thov kho mob ib leeg hauv managed care.

Tus neeg tau txais kev pab uas twb nyob hauv Medi-Cal Managed Care Plan tab sis xav tau kev pab kho mob tshwj xeeb los ntawm ib tus kws kho mob uas tsis nyob hauv cov kws kho mob koom tes nrog tuaj yeej thov daim ntawv cog lus kho mob ib leeg. Daim ntawv cog lus kho mob ib leeg, tso cai rau tus neeg tau txais kev pab kom nyob hauv lawv qhov kev npaj khomob managed care plan thaum tseem mus ntsib tus kws kho mob uas tsis koom nrog hauv cov kws kho mob koom tes nrog.

Txhawm rau thov daim ntawv cog lus kho mob ib leeg, koj tiv toj ncaj qha rau koj li managed care plan thiab thov kev tso cai kom mus ntsib tus kws kho mob uas tsis nyob hauv cov kws kho mob koom tes nrog.

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Txhawm rau tau txais qhov kev tso cai no, koj yuav tsum qhia pom tias koj yuav tsum tau txais yam kev kho mob uas tsis muaj ib tus kws kho mob nyob hauv hauv managed care plan cov kws kho mob koom tes nrog, lossis qhov uas koj muaj cai tau txais kev txuas ntxiv kho mob los ntawm tus kws kho mob uas tsis muaj daim ntawv cog lus nrog koj qhov managed care plan. Nws yogi b qho muaj txiaj ntsig zoo rau koj tus kws kho mob kom sau cov ntaub ntawv piav qhia txog qhov yuav tsum txuas ntxiv saib xyuas thiab/lossis yam kev kho mob nyuaj uas koj tau txais, thiab vim li cas thiaj yuav tsum tau kho mob los ntawm tus kws kho mob nyob sab nraud cov koom tes nrog.

Yog tias koj daim ntawv thov ntsib tus kws kho mob nyob sab nraud cov kws kho mob koom tes nrog raug tsis kam lees, koj yuav tsum tau tiv toj koj qhov kev npaj kho mob kiag tam sim txog cov kev xaiv hais qhov tsis txaus siab lossis sau ntawv foob. x

11. Yuav Ua Li Cas Yog Tias Kuv Muaj Medicare thiab Medi- Cal (muaj cai tau txais-ob qho)?

Yog tias koj muaj cov kev pab Medicare ntxiv rau Medi-Cal, koj yuav txuas ntxiv mus ntsib koj cov kws kho mob hauv Medicare txawm tias koj yeem ntawm tus kheej koom nrog Medi-Cal qhov kev npaj los xij lossis koj yuav tsum tau rau npe hauv qhov Medi-Cal kev npaj kho mob. xi Koj tsis tuaj yeem thov MER kom tawm tawm Medi-Cal managed care plan yog tias koj muaj tag nrho ob qho Medicare thiab Medi-Cal.

Yog tias koj xaiv koom nrog hauv qhov kev npaj Cal MediConnect lossis lwm hom kev npaj kho mob Medicare, koj yuav tsum tau mus ntsib Medicare cov kws kho mob uas tau cog lus nrog koj li Medicare lossis qhov kev npaj Cal MediConnect. Koj tuaj yeem nrhaiv cov ntaub ntawv ntau ntxiv txog Cal MediConnect ntawm no: www.calduals.org. Yog tias koj xav tau kev pab xaiv seb puas yog koj yuav tsum tau koom nrog Cal MediConnect lossis lwm qhov kev npaj Medicare, tiv toj koj tus HICAP kom tau txais kev pab dawb sab laj ntawm 1-800-434-0222

Koj tuaj yeem mus ntsib peb Tus Neeg Dhia Dej Num Pib Saib Xyuas nthuav tawm ntawm no: http://www.disabilityrightsca.org/pubs/553501.pdf.

Nplooj 11 ntawm 14

Peb xav hnov los ntawm koj! Thov ua kom tiav cov kev ntsuam xyuas txuas ntxiv no txog peb qhov kev tshaj tawm thiab qhia rau peb paub seb peb yuav tsum ua li cas! https://docs.google.com/forms/d/1d6ezTl2M5UMAWU66exLbc1SQ9wDPzvtuS3AGR4-cgwE/viewform?c=0&w=1

Rau kev pab ua raug cai hu rau 800-776-5746 los sis ua kom tiav ib thov daim ntawv thov kev pab. Rau txhua lwm qhov lub hom phiaj hu rau 916-504-5800 (Qaum teb CA); 213-213-8000 (Qab teb CA).

Disability Rights California tau pab nyiaj los ntawm ntau qhov chaw pab, kom pom tag nrho cov npe chaw pab nyiaj, mus rau http://www.disabilityrightsca.org/Documents/ListofGrantsAndContracts.html.

i Managed care plans yog pab pawg kws kho mob, cov tsev kho mob, cov chaw kuaj mob thiab lwm yam (kuj tseem hu tias “pab pawg sib koom tes”) uas ua haujlwm ua ke los muab kev saib xyuas rau lawv cov tswv cuab raws li yam kev kho mob uas xav tau. Thaum rau npe hauv Managed care plans, tus tswv cuab yuav tsum mus ntsib cov kws kho mob uas nyob hauv cov chaw kho mob koom tes nrog. Cov tswv cuab xaiv thawj tus kws kho mob (PCP) uas lawv yuav tsum xub mus ntsib. Tus PCP tuaj yeem kho los yog xa cov tswvcuab mus rau tus kws kho mob tshwj xeeb nyob hauv cov chaw kho mob koom tes nrog thiab qee zaus sab nraud cov chaw kho mob koom tes nrog. Kom paub cov ntaub ntawv ntau ntxiv txog Managed care plans, thov mus saib DRC Daim ntawv tshaj tawm: Medi-Cal Managed Care Health Plans: Cov chaw no yog dab tsi? Kuv yuav tsum paub txog dab tsi ntawm lawv? (Lub Ib Hli 2014, Pub #5495.01), http://www.disabilityrightsca.org/pubs/549501.pdf. “Rov Qab mus rau Cov Ntaub Ntawv Tseem Ceeb”

iihttp://www.dhcs.ca.gov/individuals/Documents/MMCD_SPD/Provider_Bull etin_July2012.pdf “Rov Qab mus rau Cov Ntaub Ntawv Tseem Ceeb”

iiihttp://www.healthcareoptions.dhcs.ca.gov/hcocsp/enrollment/content/en/ forms/MU_0003382.pdf?v=0815 "Rov Qab mus rau Cov Ntaub Ntawv Tseem Ceeb"

iv Muaj 22 lub nroog COHS: Del Norte, Humboldt, Lake, Lassen, Marin, Mendocino, Merced, Modoc, Monterey, Napa, Orange, San Luis Obispo, San Mateo, Santa Barbara, Santa Cruz, Shasta, Siskiyou, Solano, Sonoma, Trinity, Ventura thiab Yolo "Rov Qab mus Rau Cov Ntaub Ntawv Tseem Ceeb"v Koj yuav tsum muaj peev xwm muab cov pov thawj qhia rau pom tias koj qhov kev kho mob tam sim no tsis pub muaj kev cuam tshuam. Koj yuav tsum tham cov laj thawj nrog koj tus kws kho mob thiab sau cov ntawv no tseg hauv tsab ntawv pab txhawb uas koj yuav tau sau nyob hauv koj daim ntawv thov MER. Mus saib Tshooj 6, saum toj saud, kom paub cov ntaub ntawv ntau ntxiv. “Rov Qab mus rau Cov Ntaub Ntawv Tseem Ceeb”vi

Yog xav paub lus qhia ntxiv, mus saib http://www.dhcs.ca.gov/individuals/Documents/MMCD_SPD/Provider_Bulletin_July2012.pdf "Rov Qab mus rau Cov Ntaub Ntawv Tseem Ceeb"

vii Saib, raws li tau qhia hauv Tsab Ntawv Txhua Qhov Kev Npaj 15-001, p. 2 (Lub Ib Hli 14, 2015) (managed care plans “yuav tsum ntseeg tias txhua tus neeg tau txais kev pab txuas ntxiv tau txais kev pab kho mob tsim nyog Medi-Cal cov kev pab thiab kom ntseeg tias cov neeg nkag tshiab tau txais kev saib

xyuas txuas ntxiv nrog lawv cov kws kho mob kom ua tiav qhov kev kho mob no.” Koj tuaj yeem nrhiav pom tsab ntawv ntawm no: http://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2015/APL15-001.pdf. Kom paub cov ntaub ntawv ntau ntxiv txog kev txuas ntxiv kho mob, mus saib hauv http://www.disabilityrightsca.org/pubs/554501.pdf.

Managed care plans yuav tsum txiav txim siab qhov kev zam los ntawm qhov kev npaj rau npe nkag ntawm tus neeg tua txais kev pab uas tau thov txuas ntxiv kho mob. Tsab Cai Kev Noj Qab Haus Huv thiab Kev Nyab Xeeb § 1373.96.

“ “Managed Care Plans yuav tsum tau txiav txim siab daim ntawv thov zam los ntawm Managed Care Plans qhov kev rau npe nkag uas raug tsis kam lees daim ntawv thov kom ua tiav qhov kev kho mob nrog tus nqi tam sim no rau cov kev pab lossis tus kws kho mob tsis koom nrog hauv qhov kev npaj kho mob raws li H&S Tsab Cai § 1373.96, thiab ua raws li Managed Care Plan daim ntawv cog lus nrog Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv thiab lwm Lub Chaw Haujlwm Pab Cuam Kev Noj Qab Haus Huv kom txuas ntxiv kho mob Tsab Ntawv Txhua Qhov Kev Npaj. Managed Care Plan yuav tsum paub tseeb tias txhua tus neeg tau txais kev pab txuas ntxiv tau txais cov kev pab kho mob tsim nyog Medi-Cal cov kev pab thiab kom paub tseeb tias cov neeg rau npe nkag tshiab tau txais cov kev pab kho mob txuas ntxiv nrog lawv cov kws khomob kom ua tiav qhov kev kho mob raws li teev tseg hauv kev cai lij choj. Tus neeg tau txais kev pab cov kws kho mob uas raug xaiv los ntawm Lub Chaw Xaiv Kws Kho Mob Hauv Tebchaws ntawm Daim Ntawv Thov Zam Kev Kho Mob. Managed Care Plans yuav tsum haum raws li cov sij hawm txuas ntxiv kho mob uas tau teev tseg tshwj xeeb hauv H&S Tsab Cai § 1373.96. Tsab cai txuas ntxiv kho mob no ntxiv rau tsab cai lub sij hawm txuas ntxiv kho mob rau Cov Neeg Laus thiab Cov Neeg Xiam Oos Qhab tau tsim raws li Tsab Ntawv Txhua Qhov Kev Npaj 11-019, Tsab Ntawv Ob Qho Kev Npaj Kho Mob (DPL) 14-004 ntawm kev txuas ntxiv kho mob, Txab Ntawv Txhua Qhov Kev Npaj Kho Mob 14-021 txuas ntxiv kho mob rau cov neeg tau txais Medi-Cal uas hloov chaw mus rau managed care, thaib lwm qhov kev txuas ntxiv kho mob Tsab Ntawv Txhua Qhov Kev Npaj Kho Mob thiab DPLs. (Tsab Ntawv Txhua Qhov Kev Npaj Kho Mob 15-001, Lub Ib Hli 14, 2015)”

Muaj nyob ntawm: http://www.dss.cahwnet.gov/shd/res/htm/ParaRegs-Medi-Cal-Managed-Care-Two-Plan.htm "Rov Qab Mus Rau Cov Ntaub Ntawv Tseem Ceeb"

viii Koj tuaj yeem nrhiav pom tsab ntawv ntawm no: http://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicy Letters/APL2013/APL13-023.pdf "Rov Qab Mus Rau Cov Ntaub Ntawv Tseem Ceeb"

ix 42 C.F.R. § 438.206(b)(4), Medi-Cal Tsab Cai Sau Tiav ntawm Ex. A, Att. 9.

Tsis Muaj-COHS qhov kev npaj: Kev Noj Qab Haus Huv thiab Kev Nyab Xeeb (H&S) Tsab Cai Tshooj (§) 1373.96; 28 CCR § 1300.67.2.2(c)(7)(B). “Rov Qab mus rau Cov Ntaub Ntawv Tseem Ceeb”

x Thaum lub Xya Hli 1, 2017 hnub tag sij hawm rau sau ntawv foob yuav hloov pauv. Tom qab lub Xya Hli 1, 2017 koj muaj 60 hnub rau sau ntawv foob qhov tsis txaus siab nrog koj qhov kev npaj. “Rov Qab mus rau Cov Ntaub Ntawv Tseem Ceeb”

xi Yog tias koj muaj Medicare, koj yuav tsum tau koom nrog Medi-Cal qhov kev npaj yog tias koj nyob hauv ib ntawm Cov Chaw Koom Kho Mob pib hauv Cov Nroog (Cov Nroog Los Angeles, Riverside, San Bernardino, San Diego, lossis Santa Clara). Koj kuj yuav tsum tau koom nrog hauv Medi-Cal qhov kev npaj yog tias koj xav kom tau txais Cov Kev Pab Kho Mob Rau Neeg Loj Hauv Zej Zog (CBAS). “Rov Qab mus rau Cov Ntaub Ntawv Tseem Ceeb”