California Lub Chaw Haujlwm Saib Xyuas Kev Cai Lij Choj tau tso cai Lub Chaw Haujlwm Saib Xyuas Kev Pab Cuam Noj Qab Haus Huv (DHCS) kom tsim qhov kev pab Whole-Child Model. Qhov kev pab no yuav koom nrog California Qhov Kev Pab Cuam Menyuam Yaus (CCS) qhov kev pab uas tau txais kev pab them nyiaj rau Qhov kev npaj kho mob Medi-Cal managed care. Nws txhais tau tias txhua qhov CCS thiab cov kev pab tsis yog CCS yuav raug tso cai lossis muab los ntawm Medi-Cal managed care.  Qhov kev pab Whole-Child Model yuav raug nqis tes ua hauv 21 lub tebchaws, tsis pub sai tshaj Lub Xya Hli 1, 2018.1

Cov ntaub ntawv nthuav tawm no tham txog qhov kev pab Whole-Child Model.  Nco tseg: cov ntaub ntawv nthuav tawm no yog txhawm rau CCS cov menyuam yaus thiab cov hluas muaj cai tau txais tag nrho cov thaj tsam Medi-Cal2 hla Qhov kev npaj kho mob Medi-Cal managed care thiab lub nroog uas koom nrog hauv Whole-Child Model.

1.   CCS yog dab tsi?

CCS yog lub xeev qhov kev pab rau cov menyuam yaus thiab cov hluas neeg loj hnub nyoog qis dua 21 xyoos uas muaj tus mob muaj feem tau txais kev pab xws li cov kab mob sib kis, cov kab mob ntshai thiab mob qhov muag.  Hla txoj haujlwm no, lawv tau txais kev kho mob raws li qhov lawv xav tau rau lawv tus mob muaj feem tau txais kev pab CCS.3

Muaj feem pua ntau txog ntawm cov tub ntxhais kawm thiab cov hluas uas muaj feem tau txais CCS uas muaj Medi-Cal.4 Ntawm cov neeg uas muaj Medi-Cal, coob tus neeg uas tau rau npe hauv Qhov kev npaj kho mob Medi-Cal managed care.  Qee tus menyuam tsuas yog muaj CCS.

Niaj hnub no, cov meyuam uas uaj CCS thiab nyob hauv Qhov kev npaj kho mob Medi-Cal managed care tau txais kev saib xyuas tshwj xeeb rau lawv tus mob CCS hauv cov kev pab pub dawb (FFS).5  Lawv tau txais cov kev pab thaum pib thiab qee cov kev pab kho coj tus cwj pwm hla lawv li Medi-Cal kev npaj kho mob.  Qhov no txhais tau tias cov menyuam yaus tau txais kev saib xyuas hla ntau cov kab ke sib cais.

Cov hom phiaj hauv paus ntawm qhov kev pab Whole-Child Model yog txhawm rau “[muab] cov kev kho mob muaj txiaj ntsig zoo thiab [tsom] mus rau txhua yam ntawm tus menyuam, suav nrog tus menyuam qhov xav tau tsis yog tsuas saib rau ntawm CCS kev noj qab haus huv xwb.[6]”

2.   Cov nroog twg thiab Qhov kev npaj kho mob Medi-Cal managed care twg tab tom koom nrog hauv qhov kev pab Whole-Child Model?6

Pib txij Lub Xya Hli 1, 2018 (peb qhov kev npaj thiab rau lub nroog):

CenCal Health hauv cov nroog San Luis Obispo thiab Santa Barbara.

Qhov Kev Npaj Kho Mob ntawm San Mateo hauv Nroog San Mateo.

California Cov Tuam Tsev Koom Tes Kho Mob hauv cov nroog Merced, Monterey thiab Santa Cruz.

Pib txij Lub Ib Hlis 1, 2019 (ob qho kev npaj thiab kaum tsib lub nroog):

Cov Chaw Sib Koom Tes Npaj Kho Mob ntawm California hauv cov nroog Del Norte, Humboldt, Lake, Lassen, Marin, Mendocino, Modoc, Napa, Siskiyou, Shasta, Solano, Sonoma, Trinity thiab Yolo.

CalOptima hauv Nroog Orange.

3.   Yuav ua li cas kuv thiaj paub yog tias kuv tus menyuam yuav raug hloov mus rau qhov kev pab Whole-Child Model?

Koj tus menyuam yuav tau txais ib tsab ntawv ceebtoom 90, 60 thiab 30 hnub ua ntej hloov pauv.7 Qhov kev npaj kho mob Medi-Cal kuj tseem yuav tiv toj rau koj.8

4.   Kuv nyob hauv Nroog Modoc. Kuv tus menyuam muaj CCS tab sis tsis muaj cov kev pab txhua yam Medi-Cal. Puas yog kuv tus menyuam yuav tau txais rau npe nkag rau qhov kev pab Whole-Child Model?

Tsis yog. Txhawm rau kom tau koom nrog hauv qhov kev pab Whole-Child Model, koj tus menyuam yuav tsum muaj qhov kev pab txhua yam Medi-Cal.9 Koj tua menyuam yuav txuas ntxiv tau txais cov kev pab CCS raws li qhov nws muaj yav dhau los.

5.   Kuv tus menyuam muaj CCS tab sis tsis yog Medi-Cal Managed care. Puas yog nws li CCS yuav muaj qhov cuam tshuam?

Tsis yog. CCS Teev Tseg-Tsuas yog cov menyuam thiab cov menyuam yaus muaj Medi-Cal thiab lwm cov kev pab them nqi kho mob yuav txuas ntxiv tau txais cov kev pab raws li qhov lawv ua hnub no.10  CCS cov kev pab rau cov menyuam yaus uas tsis muaj Medi-Cal yuav txuas ntxiv ua ntawm FFS.11

6.   Thaum nyob hauv qhov kev pab Whole Child Model, puas yog kuv tus menyuam cov nyiaj pab CCS hloov pauv?

Tsis yog. Koj tus menyuam yuav txuas ntxiv muaj tib co nyiaj pab tau muab los ntawm CCS cov chaw kho mob tshaj tawm, cov tsev kho mob tshwj xeeb, cov tsev kho mob rau menyuam yaus, cov chaw muaj tshuaj thaib lwm cov kev pab, nrog rau cov uas yog kev kho mob tsim nyog.12

7.   Puas kuv tus menyuam tuaj yeem txuas ntxiv mus ntsib tus kws kho mob thiab kws kho mob tshwj xeeb CCS no?

Koj tus menyuam tuaj yeem txuas ntxiv mus ntsib tib tus kws kho mob thiab kws kho mob tshwj xeeb CCS yog tias lawv nyob hauv Medi-Cal managed care cov chaw kho mob koom tes nrog.  Yog tias tsis yog, ces koj tus menyuam tuaj yeem mus ntsib cov kws kho mob no ntev txog 12 lub hlis tom qab hloov mus rau qhov kev pab Whole-Child Model.13 Qhov kev pab hauv 12 lub hlis tuaj yeem txuas ntxiv raws li qhov xwm txheej muaj tseeb.

Puas yog yuav muaj qee yam hloov pauv rau qhov kev pab CCS hauv cov nroog thiab qhov kev npaj kho mob Medi-Cal managed care uas tsis koom nrog hauv qhov kev pab Whole-Child Model?

Tsis yog.

8.   Nrog rau kev hawm kuv tus menyuam cov kev pab CCS, yam twg yuav yog Medi-Cal managed care cov luag haujlwm?

Koj tus menyuam qhov kev npaj kho mob Medi-Cal managed care yuav txhim kho cov kev pab, muab cov kev tuav tswj thiab kev pab dhia dej num.14 Qee cov CCS tuav tswj lub luag haujlwm,, uas yog cov luag haujlwm tam sim no ntawm qhov kev pab nroog CCS, yuav hloov mus rau qhov kev npaj kho mob Medi-Cal managed care.  Cov luag haujlwm suav nrog cov qauv xaiv thiab cov kev thov pab txhawb thiab cov chaw pab them nyiaj rov qab rau CCS-cov kev pab cuam tshuam.15

Lub Nroog qhov kev pab CCS yuav txuas ntxiv ua lub luag haujlwm rau cov kev pab Feem Kho Mob Lub Cev.16

9.   Puas yog cov nroog hauv cheeb tsam cov chaw haujlwm CCS ua lub luag haujlwm rau ib yam dab tsi raws li qhov kev pab Whole-Child Model?

Yog, cov nroog yuav txuas ntxiv ua cov kev txiav txim siab qhov muaj cai tau txais CCS thiab qhov muaj cai sau ntawv foob,17 lub chaw tuav tswj qhov ekv pab Medical Feem Kho Mob Lub Cev thiab cov kev pab lub rooj sib tham kev kho mob lub cev.18

10.   Muaj dab tsi tshwm sim yog tias kuv qhov kev npaj kho mob Medi-Cal managed care tsis kam lees kuv tus menyuam cov kev pab CCS?

Koj muaj peev xwm thov kev ncaj ncees dua los yog thov hais dua.  Dhau ntawm kev siv CCS cov txheej txheem foob, koj yuav ua raws li cov txheej txheem sau ntawv tsis txaus siab thiab ntawv foob hauv qhov chaw uas txhua qhov kev npaj kho mob Medi-Cal managed care yuav tsum tau ua.  Cov kev hais lus feem ntau, koj tuaj yeem sau ntawv foob hauv sij hawm 60 hnub txij li hnub Tau Txais Tsab Ntawv Ceebtoom Tshaj Tawm Kev Txiv Txiav Txim Cov Nyiaj Pab.  Qhov kev npaj kho mob Medi-Cal managed care muaj 5 hnub ua haujlwm tom qab tau txais tsab ntawv foob uas nws tau txais, thiab muaj sij hawm 30 hnub txij li hnub uas nws tau txais daim ntawv foob los qhia rau koj paub txog qhov kev txiav txim.19  Koj muaj sij hawm 120 hnub txij li hnub tau txais qhov kev txiav txim thov mus rau lub xeev kom saib xyuas kev ncaj nceess.20

11.   Hais txog CCS tus npawb cov ntawv21 – puas yog lawv tseem tuaj yeem thov?

Yog hauv qhov uas lawv muaj cov lus qhia.  Cov kev pab tau tso cai thov uas ruaj khov nrog cov npawb ntawm cov ntawv qhia yuavv tsum tau txais kev tso cai.  Txawm li cas los xij, qhov kev npaj tuav tswj kev kho mob yuav tsum tau tshuaj xyuas txhua yam thiab cov sij hawm muaj cov kev pab kim dua rau cov menyuam yaus thiab cov hluas raws li tsoomfwv tsab kev cai lij choj.22

Rau kev pab uas raug cai hu rau 800-776-5746 lossis ntxiv lus teb rau thov daim ntawv thov kev pab. Rau txhua lwm cov hom phiaj hu rau 916-504-5800 (CA Qaum Teb); 213-213-8000 (CA Qab Teb).

Disability Rights California tau txais kev 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

• 1. Tsab ntawv tuaj ntawm Patricia McClelland, Tus Thawj Saib Xyuas Cov Kab Ke Saib Xyuas Lub Chaw Haujlwm Saib Xyuas Feem Kev Kho Mob, rau Cheeb Tsam California Cov Menyuam Yaus Cov Kev Pab (CCS) (Lub Ib Hlis 2017) muaj nyob ntawm Cheeb Tsam Nroog Cov Lus Qhia rau CCS Whole-Child Model (WCM) Kev Nqis Tes Ua; Saib ntxiv ntawm California Lub Chaw Haujlwm Saib Xyuas Kev Pab Cuam Kho Mob, California Cov Menyuam Li Kev Pab (CCS) Whole-Child Model (WCM), (Mus ntsib zaum kawg Lub Tsib Hlis 29, 2018) California Cov Menyuam Li Kev Pab (CCS) Whole-Child Model (WCM).
• 2. Tag nrho cov thaj tsam Medi-Cal txhais tau tias koj muaj cai tau txais txhua yam kev pab uas muaj raws li qhov kev pab Medi-Cal. Siv Tau Txij Lub Tsib Hlis 2016, cov menyuam yaus hnub nyoog qis dua 19 xyoo dhau ntawm kev txaus siab nkag tebchaws dhau ua ib tus neeg muaj cai rau tag nrho txhua yam Medi-Cal cov kev pab.
• 3. Kom paub cov ntaub ntawv ntau ntxiv txog CCS mus saib California Tub Ntxhais Kawm Cov Kev Pab.
• 4. Kom paub cov ntaub ntawv ntau ntxiv mus saib Cov Lus Piav Qhia Txog Qhov Kev Pab.
• 5. FFS txhais tau tias koj tuaj yeem mus rau ib qho chaw kho mob uas lees txais qhov pab kas phais kho mob tshwj xeeb xws li CCS lossis Medi-Cal. Cov kws kho mob tau txais them nyiaj rov qab rau txhua zaus mus ntsib lossis muab kev pab rau. Cov kev kho mob hauv kev tuav tswj, lub ceev cog lus nrog qhov kev npaj kho mob kom muab cov kev pab rau cov neeg tau txais kev pab kom sib hloov pauv rau qhov kev them nqi pab kas phais hauv ib lub hlis rau tus neeg rau npe nkag.-
• 6. California Lub Chaw Haujlwm Saib Xyuas Kev Pab Cuam Kho Mob, California Tub Ntxhais Kawm Cov Kev Pab Whole-Child Cov Ntsiab Lus Qhia Txog Qhov Kev Pab, pp. 16-17, (Lub Tsib Hlis 18, 2018) California Tub Ntxhais Kawm Cov Kev Pab Whole-Child Cov Ntsiab Lus Qhia Txog Qhov Kev Pab .
• 7. Id. ntawm 27.
• 8. California Lub Chaw Haujlwm Saib Xyuas Kev Pab Cuam Kho Mob, California Qhov Kev Pab Menyuam Yaus (CCS) Whole-Child Model Cov Lus Nug Nquag Nug, p. 3, (hloov kho tshiab Lub Yim Hli 2017) California Cov Kev Pab Menyuam Yaus (CCS) Whole-Child Model FAQs.
• 9. Id. ntawm 2. Pab pawg tsis suav nrog muaj xws li cov menyuam thiab cov hluas uas tsis muaj feem tau txais Medi-Cal tag nrho lossis tus uas muaj hnub nyoog 19 lossis 20 xyoo thiab tsis muaj cai txuas ntxiv tau txais tag nrho cov kev pab Medi-Cal raws li qhov Kev Noj Qab Nyob Zoo. & Inst. Tsab Cai § 14007.8 pab them rau cov menyuam yaus thiab cov hluas kom txog hnub nyoog 18 xyoo uas tseem tsis tau nkag rau kev txaus siab rhais chaw nyob.-
• 10. Hauv Lub Nroog Tau Ua Haujlwm Cov Kab Ke Kho Mob xws li Nroog Orange qhov CalOptima, Cov Nroog Sib Koom Tes thiab Npaj Kho Mob ntawm San Mateo kev rau npe hauv Medi-Cal tuav tswj kev kho mob yogi b tsab cai rau txhua tus neeg tau txais Medi-Call nrog lwm cov kev pab them nqi kho mob; kev rau npe nkag hauv Medi-Cal managed care yog yeem ntawm tus kheej rau cov neeg uas muaj lwm cov kev pab them nqi kho mob hauv lwm cov npe cov nroog muaj qhov kev pab Whole-Child.
• 11. Id. ntawm 4.
• 12. Id. ntawm 3.
• 13. Id.
• 14. Id. ntawm 2-3.
• 15. Tab ntawv tuaj ntawm McClelland, Tus Thawj Saib Xyuas Cov Kab Ke Saib Xyuas Lub Chaw Haujlwm Saib Xyuas Feem Kev Kho Mob, rau lub nroog California Cov Kev Pab Menyuam (CCS) (Lub Ib Hlis 2017) muaj nyob ntawmLub Nroog Cov Lus Qhia rau CCS Whole-Child Model (WCM) Kev Nqis Tes Ua.
• 16. California Lub Chaw Haujlwm Saib Xyuas Cov Kev Pab Kho Mob, California Qhov Kev Pab Cuam Menyuam Yaus (CCS) Whole-Child Model Cov Lus Nug Nquag Nug, p. 9, (hloov kho tshiab Lub Yim Hli 2017) California Qhov Kev Pab Cuam Menyuam Yaus (CCS) Whole-Child Model FAQs.
• 17. Tab ntawv tuaj ntawm McClelland, Tus Thawj Saib Xyuas Cov Kab Ke Saib Xyuas Lub Chaw Haujlwm Saib Xyuas Feem Kev Kho Mob, rau lub nroog California Cov Kev Pab Menyuam (CCS) (Lub Ib Hlis 2017) muaj nyob ntawm Lub Nroog Cov Lus Qhia rau CCS Whole-Child Model (WCM) Kev Nqis Tes Ua; California Lub Chaw Haujlwm Saib Xyuas Kev Pab Cuam Kho Mob, California Qhov Kev Pab Cuam Menyuam Yaus (CCS) Whole-Child Model Cov Lus Nug Nquag Nug, p. 3, (hloov kho tshiab Lub Yim Hli 2017) California Qhov Kev Pab Cuam Menyuam Yaus (CCS) Whole-Child Model FAQs.
• 18. Id. ntawm 5-6.
• 19. Koj tuaj yeem thov kom txiav txim daim ntawv foob sai dua yog tias koj tus menyuam tus mob yuav muaj qhov pheej hmoo. Qhov kev npaj kho mob Medi-Cal managed care muaj sij hawm 72 teev txij li hnub tau txais tsab ntawv foob tsis txaus siab qhia rau koj paub txog qhov kev txiav txim.
• 20. California Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv thiab Pab Cuam Tib Neeg, Chav Lis Haujlwm Saib Xyuas Kev Pab Cuam Kho Mob, California Cov Kev Pab Menyuam Yaus Whole-child Model Cov Kev Foob Tsis Txaus Siab, Cov Txheej Txheem Sau Ntawv Foob thiab Thov Saib Xyuas Kev Ncaj Ncees, nplooj 4-5, (Lub Kaum Ib Hlis 2016) California Cov Kev Pab Cuam Menyuam Yaus (CCS) Whole-Child Model (WCM) Cov Kev Foob, Cov Txheej Txheem Foob Kev Tsis Txaus Siab thiab Thov Saib Xyuas Kev Ncaj Ncees ; kuj tseem pom peb cov ntawv tshaj tawm cov ntawv foob thiab cov ntawv sau kev tsis txaus siab nyob ntawm Medi-Cal Managed Care: Cov Ntawv Foob Tsis Txaus Siab thiab Cov Kev Tsis Txaus Siab.
• 21. Kom paub cov ntaub ntawv ntau ntxiv mus saib California Cov Kev Pab Menyuam Yaus – Cov Ntawv.
• 22. Cov Lus Piav Qhia Ntawm Qhov Kev Tuav Tswj Kho Mob cov luag haujlwm raws li EPSDT – Kev Kuaj Xyuas Menyuam Yaus Thaum Ntxov, Kev Kuaj Mob thiab Kev Pab Kho Mob rau Cov Neeg Tau Txais Medi-Cal hnub nyoog qis dua 21 xyoos. Cov Yuav Tsum Tau Ua rau Cov Kev Pab Thaum Ntxov thiab Cov Kev Kuaj Menyuam Yaus, Kev Kuaj Mob, thiab Kev Pab Kho Mob rua Cov Neeg Tau Txais Kev Pab Medi-Cal Hnub Nyoog qis Dua Nees Nkaum Ib Xyoos.