La ndelayo Lawulo loLawulo lweMpilo, iMagare, kunye neMedicaid Iimbuyekezo zokubanjelwa zifakwe kwi-alfabhethi, efaka imiqathango embalwa nje. Nceda uqaphele ukuba uluhlu luye lwafikelela kude kwi-glossary ye-inshorensi njengoko kunokwenzeka ukuba.
Umyinge wexabiso lomenzi (AMP)
I-AMP isiseko seentlawulo zeziyobisi zonyango kwiifommesi phantsi kweMedicaid.
Amaziko e-Medicare & Services Services Medicaid achaza oku njengento abathengisi abahlawula ngayo izidakamizwa, kwaye akunjalo ngokwenene imbuyekezo yeemveliso zeziyobisi. I-arhente isebenza izinto ezinzima kwimilinganiselo ye-dollar ebhaliweyo ingxelo yekota nganye yezemali esekelwe kwicandelo kunye nendlela yokulawulwa, kwaye ixubungula ixabiso elithintekayo kwi-formula ukubala umda ophezulu wenyuso (jonga ngezantsi). I-FUL yinani langempela leentlawulo zeMedicaid.
Ixabiso lentengo yokuthengisa (ASP)
I-CMS isebenzisa I-ASP njengenombolo ehamba phambili yokubala ukubuyiswa kweziyobisi ezikhutshwe phantsi kwe-Medicare Part B. nganye kwikota, wonke umenzi weziyobisi ogunyazisiweyo yi-US Food and Drug Administration kufuneka abike kwi-CMS intengo ephakathi kwento ehlawulisayo kuyo yonke into eyenza ukuba ithengise kubathengisi, kwizibhedlele nakwii-pharmacy . I-ASP ihluke kwi-AMP ngokuyinhloko ngokuphakanyiswa. Loo mahluko uvela kwiinyaniso ukuba ii-ASP azilungelelanisi uhlobo lomkhiqizo okanye umthengi.
Umyinge wexabiso lentengo (AWP)
I-PBM kunye neenkampani ze-inshorensi zempilo zixhomekeka kakhulu kwi-AWP ukubala iirhafu zokubuyiswa kwemveliso yeziyobisi. Kufana ngokufanayo ne-AMP kuba abavelisi beyezabisi basebenzisa indlela efanayo yokubika ixabiso. Umyinge wento yokuba abathengisi abahlawula iimveliso bahlala behluke kwi-AMP, nangona kunjalo, njengoko kuchaziwe ngezantsi.
U-Thompson Reuters uqulunqa aze ashicilele i-AWP rhoqo ngonyaka kwiBlack Red Book .
Ukuhlawula iiMali
Ukuhlawulwa kweemali zongezwa kwiirhafu zokubuyiselwa kwemveliso ukugubungela iindleko zekhemishi zokwenza ibhizinisi kunye nokubonelela ngononophelo kunye nokucebisa. UMbutho weSizwe wezoThengiswa kweziThengisa uluhlu lweendleko njengoko kubandakanya imivuzo yabasebenzi, ukuhlawulwa kwemali okanye ukuhlawulwa kweenqwelo, ukuthengiswa kweziyobisi, ukunikezela ngolwazi oluprintwe kwizigulane kunye nokudibanisa omnye kunye nezigulane. Ukuhlawulwa kwemirhumo, eyahlukileyo ngohlobo lomkhiqizo kwaye ixoxisana nabanini-mshishino bangegunyeni okanye isetyenziswe yimirhumo yezempilo karhulumente, kufuneka iphinde ivumele inzuzo encinci kwi-pharmacy. Oko akusoloko kunjalo kwaye kuya kuba yinyani phantsi kweMedicaid njengoko amazwe ekhangele ukulondolozwa kwenkqubo esoloko ibe yinto enye ebhajethi enkulu.
I-Federal Upper Limit (FUL)
I-CMS ibala i-FUL yamaninzi amayeza anikezelwa kumxhamli weMedicaid ngokuphindaphinda i-AMP yemveliso ngo-175%. Isibonelelo soKhuselo lweMonde kunye noMthetho woNonophelo ojongene noTywala, okanye i-Obamacare, amazinga okubuyisela ama-FUL athatywayo kwigama lomnxeba kunye neziyobisi zonyango ezifumanekayo ezivela kumenzi omnye. Okuphawulekayo kukuba, akudingeki ukuba uhlawule iintlawulo ze-FUL kuzo zonke iziganeko.
I-formula ebizwa ngokuba yindleko evumelekileyo, okanye i-MAC, ingasetyenziselwa iimveliso zonyango zonyango.