California Welfare and Institutions Code 14138.12 – (a) (1) The department shall authorize a payment reform …
(a) (1) The department shall authorize a payment reform project for FQHCs using an APM in accordance with this article.
(2) Implementation of the APM project shall begin no sooner than January 1, 2024, subject to any necessary federal approvals.
Terms Used In California Welfare and Institutions Code 14138.12
- Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
- department: means the State Department of Health Services. See California Welfare and Institutions Code 14062
- Medi-Cal: means the California Medical Assistance Program. See California Welfare and Institutions Code 14063
(3) Before implementation of an APM project for a participating FQHC site, the department shall notify the FQHC site in writing of the applicable draft clinic-specific PMPM rate(s) for the participating FQHC site. A participating FQHC, with respect to one or more sites of its choosing, may opt to withdraw its participation in the project subject to a notice requirement as determined by the department, but not less than 120 days before implementation of an APM project.
(4) At least 90 days prior to implementation of an APM project for a participating FQHC site, the department shall notify a principal health plan in writing of the principal health plan’s specific APM supplemental capitation rates for the participating FQHC. The notification from the department to the principal health plan shall be based on the rates submitted by the department for federal approval. If the APM supplemental capitation rates are modified after the notification to a principal health plan, the department shall notify a principal health plan of the revised rates.
(5) At least 90 days prior to implementation of an APM project for a participating FQHC site, the department shall notify a principal health plan and the FQHC site in writing of the clinic-specific PMPM rate for the participating FQHC site.
(b) The APM project shall comply with federal APM requirements and the department shall file a state plan amendment and seek any federal approvals as necessary for the implementation of this article. Nothing in this article shall be construed to authorize the department to seek federal approval to affirmatively waive Section 1396a(bb)(6) of Title 42 of the United States Code.
(c) Nothing in this article shall be construed to limit or eliminate services provided by FQHCs as covered benefits in the Medi-Cal program.
(Amended by Stats. 2022, Ch. 47, Sec. 109. (SB 184) Effective June 30, 2022.)