Claims

DHCS Proposition 56 Supplemental Payments

California Proposition 56 increased the excise tax rate on cigarettes, electronic cigarettes, and other tobacco products in phases beginning April 1, 2017. The Department of Health Care Services (DHCS) is responsible for structuring the supplemental payments from Proposition 56 funds. DHCS has provided guidance and requirements to Medi-Cal managed care plans on how funds are to be distributed to Medi-Cal providers through policy guidance called All-Plan Letters (APL).

Please visit the DHCS Proposition 56 Program website at https://www.dhcs.ca.gov/provgovpart/Pages/Proposition-56.aspx

For additional health plan and delegate responsibilities please see this document: Proposition 56 Memo

Supplemental Payment Programs Through Proposition 56

Adverse Childhood Experiences (ACEs) Screening Services— DHCS APL 19-018 Prop 56

Effective for dates of service beginning January 01, 2020. Network Providers must meet the criteria documented in the APL to be eligible for the payment.

Beginning July 1, 2020, Medi-Cal providers must attest to completing a certified core ACE training on the DHCS website to continue receiving payment for ACE screenings:

  • The Becoming ACEs Aware in California Training is a free, two-hour training to learn about Adverse Childhood Experiences (ACEs), toxic stress, screening, risk assessment, and evidence-based care to effectively intervene on toxic stress.
  • Providers may receive 2.0 Continuing Medical Education (CME) and 2.0 Maintenance of Certification (MOC) credits upon completion.
  • The training is available to any provider, but it is particularly geared towards primary care clinicians who serve Medi-Cal (California’s Medicaid program) beneficiaries.
  • Be sure to check out the ACEs Aware website to access resources and support around ACEs, toxic stress and trauma-informed care.

For additional reference on eligible codes please see this document: Proposition 56 Provider Coding Grid

Developmental Screening— DHCS APL 19-016 Prop 56

Effective for dates of service beginning January 01, 2020. Proposition 56 supplemental payments must be in addition to whatever other payments the Network Providers would normally receive for developmental screenings. For additional reference on eligible codes please see this document: Proposition 56 Memo

Family Planning Services— DHCS APL 20-013 Prop 56

Supplemental payment to providers qualified to offer family planning services for specific family planning procedure codes. For additional reference on eligible codes please see this document: Proposition 56 Memo

Physician Services –DHCS APL 19-015 Prop 56

Supplemental payment for qualified network providers (excluding FQHCs, RHC/IHCs and Cost-Based Reimbursement Clinics and members dually eligible for Medi-Cal and Medicare Part B, regardless of enrollment in Medicare Part A or Part D). For additional reference on eligible codes please see this document: Proposition 56 Memo

Value-Based Payment (VBP) Program Directed Payments — DHCS APL 20-014 Prop 56

For dates of service on or after July 1, 2019. This Prop 56 program provides VBP supplemental payments to Network Providers to improve health care in the domains of prenatal and postpartum care, early childhood prevention, chronic disease management, and behavioral health care.

FQHCs, AIHS Programs, and Cost-Based Reimbursement Clinics are not eligible Network Providers for the purposes of the VBP Program. Please see the reference on eligible code sets for 2019 and 2020 below. SFHP is providing these code sets as guidance to assist provider offices. Code updates for 2020 to be communicated in early 2021. For additional reference on eligible codes please see this document: Proposition 56 Provider Coding Grid

Women’s Health (Pregnancy/Abortion)— DHCS APL 19-013 Prop 56

Supplemental payment for abortion services rendered by qualified providers (in OR out of network) who are eligible to provide and bill for eligible CPT codes will receive an associated supplemental payment in order to bring their payment total to the amount identified in the APL. For additional reference on eligible codes please see this document: Proposition 56 Provider Coding Grid

For further questions regarding Proposition 56 payments, please contact SFHP’s Provider Relations Department at 1(415) 547-7818 ext. 7084 or email provider.relations@sfhp.org