MAY 2022

 

   

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Medi-Cal Explained:
How Health Centers
Are Paid

Authors: Athena Chapman and Samantha Pellén

Introduction

COMMUNITY HEALTH CENTERS and Federally Qualified
Health Centers in California are an integral part of
the delivery system and provide access to care for
millions in vulnerable populations. This system
is often referred to as the "safety net." Federally
Qualified Health Centers (FQHCs) are paid for the
care they provide to Medi-Cal enrollees through
a complicated structure governed by state and
federal law. This issue brief examines existing com-
munity health centers (CHCs) and FQHC payment
methods in Medi-Cal. It also examines the role of
Alternative Payment Models (APMs) - financial
incentives for the provision of high-quality and/or
cost-efficient care - as one strategy health centers
could use to increase access, improve care, and
help modernize the payment system for FOHCs.

Overview of FQHCs/CHCs in
California

Community health centers is a broad term that
refers to community-based health care organi-
zations that deliver comprehensive and culturally
competent primary and preventive care services
to California's medically underserved populations
without regard to a patient's ability to pay for care.
CHCs include FQHCs, FQHC Look-Alikes, rural
health centers, free clinics, community clinics, and
other health centers that serve special patient
populations, such as people experiencing home-
lessness, and migratory and seasonal agricultural

workers.' Additionally, in California, FQOHCs can
also be part of a public hospital system network.

FQHCs are a specific type of CHC. They are public
or tax-exempt entities that must meet certain fed-
eral requirements to receive grant funding under
Section 330 of the Public Health Service Act. These
requirements include serving in a designated med-
ically underserved area, or a medically underserved
population, providing services regardless of a
patient's ability to pay (i.e., a sliding fee scale), and
operating under the governance of a patient-ma-
jority board of directors.

CHCs serve an ethnically and culturally diverse
patient population with a range of physical,
behavioral, and oral health needs in both urban
and rural settings. CHCs often customize their ser-
vices to fit the priorities of their communities and
increasingly focus on assessing nonmedical needs
and addressing social determinants of health to
improve the overall health of patients. CHCs serve
patients across the state of California with sites in
54 out of 58 counties.2 As of 2020 data, there are
more than 1,200 licensed CHCs including FQHC
and FQHC Look-Alikes across California serving
over seven million patients. FOHCs in particular

 

The California Health Care Foundation is ded-
icated to advancing meaningful, measurable
improvements in the way the health care delivery
system provides care to the

people of California, particularly )
those with low incomes and

those whose needs are not well
served by the status quo. We
work to ensure that people have C H C F
access to the care they need,

when they need it, at a price they can afford.

For more information, visit www.chcf.org.

 

 

 

 

California Health Care Foundation

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MAY 2022

 

have experienced significant increases in size
and number since implementation of the federal
Affordable Care Act (ACA) in 2014. FOHC clinic
sites have increased steadily to accommodate the
increased patient load, with some regions tripling
the number of patient visits during the initial imple-
mentation of the ACA.* Payer mix has remained
consistent since adjusting immediately following
the ACA as insurance expansion increased enroll-
ment in Medi-Cal and reduced the number of
uninsured patients. Medi-Cal continues to be the
largest payer for CHCs, with approximately 47%
of all CHC patients enrolled in the Medi-Cal man-
aged care system (see Figure 1).°

Aligned with CHCs' mission to serve the most vul-
nerable populations in California, over half of their

patients have incomes that fall below the federal
poverty line.* The majority of CHC patients identify
as Latino/x (54%)' and approximately a third have
a limited English proficiency. CHCs are a crucial
component of California's safety net and often
serve as the entry point into the health care system
for their patients and as a connection to local social
services and supports needed to improving patient
experience, access, and outcomes.

This issue brief focuses specifically on efforts related
to APM models for FOHCs and FOHC Look-Alikes
that receive prospective payment system (PPS)
reimbursement for serving Medi-Cal patients. PPS
is a payment method in which a predetermined
fixed amount is paid to a clinic for the services
provided during a patient visit and is described

Figure 1. Community Health Centers by Patient Coverage in California, 2020

saa)
SOT
VA

MediCal

Private
Insurance
10%

litae
6%

Managed Care
ey

MediCal
Li

   

Medicare
5%

Covered
Moat
1%
Vue
Local Health
aCe UK
uN

 
 
 

Medicare Managed Care
2%

Source: "Primary Care Clinic Annual Utilization Data" (2020), Dept. of Health Care Access and Information.

 

California Health Care Foundation

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MAY 2022

 

in more detail below. However, the remaining
community clinics also represent opportunities for
exploring innovative reimbursement strategies,
as they total approximately a third of all health
centers in California (see Figure 2). Even if these
health centers are not federally qualified providers
and are not eligible to receive PPS reimbursement,
they also provide care to a proportion of Medi-Cal
patients. While Rural Health Clinics do receive the
PPS payment, they are not a focus of this brief.

Figure 2. Community Health Centers by Category, 2020*
3%

1,246 Total

 

MM FQHCs ® FQHC Look-Alikes
® Free/Community Clinics
@ Rural Health Clinics

Source: "Primary Care Clinic Annual Utilization Data" (2020),
Dept. of Health Care Access and Information.

* There were 82 community health centers that did not submit a
2020 report to HCAI

FOQHCs across the state vary in size, structure, and
scope of service offerings. While regional differ-
ences factor into organizational affiliation, FOHCs
have increasingly broadened their network struc-
ture through participation in independent practice
associations, private practice acquisitions, and
hospital partnerships. FOHCs have also launched
efforts to integrate and expand behavioral health

services, often contracting with provider networks
to offer services for nonspecialty mental health con-
ditions, also referred to as mild-to-moderate con-
ditions. An analysis of FQHCs by region indicates
that while FQHCs have experienced significant
growth since the 2014 implementation of the ACA,
the extent of that growth has varied widely across
the state due to several factors such as market
penetration, access to care, and patient choice.
During 2014-19, while the number of patient
encounters among FOHCs increased statewide
by 45%, regions such as Humboldt/Del Norte, the
Bay Area, and Los Angeles grew at a slower pace
comparatively. Over this same period, the Inland
Empire region saw the number of FOHC patient
visits triple, with growth estimated at 206%.°

While the median California FQHC has generated
positive operating margins overall, these margins
have been trending downward, with operating
losses of 1.1% found among FQHCs in the lowest
25th percentile in 2019.'° California FQHCs oper-
ating in the top 75th percentile had positive oper-
ating margins of 6.6%, above the state benchmark
of 3%, while the FOHCs operating in the 50th
percentile had margins below 2.5%.'' While the
declines in operating margins have been attributed
to expenses outpacing revenues, the recent finan-
cial impact of the COVID-19 pandemic further
highlighted significant risk to the future viability
of FOHCs absent additional funding support, par-
ticularly among those FOHCs that sustained large
losses.' Overall, the financial health of FOHCs
underscores the variability and diversity among
health centers in California, and across urban and
rural regions, that will require a nuanced approach
when considering participation in APMs.

 

California Health Care Foundation

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Prospective Payment System
Overview

Under federal law, FOHCs are subject to special
cost-related payment structures. Established in
2000, Section 702 of the Medicare, Medicaid, and
SCHIP Benefits Improvement and Protection Act
shifted the FOHC payment method from a retro-
spective cost-based system to PPS. The intent was
to offset the costs that FQHCs incur for providing
care to uninsured and underinsured patients while
ensuring FQHCs are paid appropriately and can
provide covered services to Medicaid enrollees.

Under PPS, FQHCs are paid a predetermined rate
that encompasses reimbursement for all services
provided during a single visit, and it is adjusted
annually for inflation. In California, these rates are in
a publicly available fee schedule on the California
Department of Health Care Services (DHCS) web-
site."3 Defined under federal law, FOQHCs must
either directly provide, or contract for access to,
preventive and primary health care services such
as family and internal medicine, pediatrics, obstet-
rics and gynecology, diagnostic laboratory and
radiology services, emergency services, preventive
dental services, and pharmacy services (in certain
centers).'"* FOHCs may also provide other outpa-
tient services such as vision services, behavioral
health services, and other ambulatory care services
included in the state's Medicaid plan. FOQHCs may
offer some nonmedical services to their patients,
such as language interpretation services and health
education."

States have some flexibility in the scope of services
considered in the PPS rate development calcula-
tion and must have a process to adjust PPS rates
to reflect changes to the scope of services pro-
vided by the FQHC, such as when a new covered
benefit is added to the Medicaid program. States
also have strategies to ensure that FOHCs are
reimbursed for services that are not included in the
PPS rate but can improve outcomes for patients.

For example, some states use a higher annual
inflation rate when setting PPS rates, and others
use an "enhanced" PPS rate whose supplemental
payments incentivize FOHCs to provide specified
services, such as case management.

Encounters and Visits

The PPS rate structure is designed to provide finan-
cial certainty to FOHCs and to reduce the incentive
to deliver unnecessary health care services, which
can occur in a volume-based fee-for-service (FFS)
system that reimburses and rewards providers for
each individual service. However, PPS is restrictive
and encounter-based, and an FOHC will receive
PPS only if the following criteria are met:

@ The service is provided within the four walls of
a clinic

@ The service is defined as an allowable encounter
/ set of services as defined under PPS

e@ Only one billable service is provided to a
patient per day (with the exception that a
medical visit and a dental visit can be provided
on the same day)

e The service is rendered by a billable provider
type

COVID-19 Reimbursement Flexibilities

The COVID-19 pandemic and public health
emergency has resulted in additional, temporary
flexibilities that allow FOQHCs to be reimbursed for
telehealth and phone visits and reimbursement
for care provided outside of the health center. It
is unclear what the long-term policy under PPS
will be around virtual visits and how that may vary
state by state.

However, it is anticipated that the implementation
of the new APM initiative described in the appendix
provides a pathway to include telehealth services
and other modalities into a global rate even after
the public health emergency has ended.

 

California Health Care Foundation

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Managed Care Plan Payments to FOHCs
Under PPS

As aresult of the PPS rate and requirements, FOHCs
represent a unique provider reimbursement struc-
ture. Under federal Medicaid law, managed care
plans (MCPs) have the flexibility to set their own
rates for FOHC payments but must pay them no
less than they would other contracted providers
for similar services."¢ If the total MCP payment to
an FQHC is less than the PPS amount, the state
must pay the difference quarterly through a recon-
ciliation process and supplemental payment com-
monly referred to as a wraparound payment. This
supplemental payment is disbursed in two stages:
an interim payment paid on a per visit basis each
time a claim is filed, and if necessary, a final pay-
ment once the reconciliation process is complete
between the state and the FOHC."

Challenges with PPS Payment
Structure

Under the PPS model, FOHCs can bill Medi-Cal
and receive reimbursement only for in-person visits
with billable providers. Additionally, PPS prevents
FQHCs from billing for more than one visit per day,
which results in patients having to visit the health
center on separate days if they have more than one
billable medical, dental, or behavioral health need.
These requirements are disruptive for the patient
and may result in unnecessary delays in care that
can result in poor health outcomes. This can be
demonstrated most clearly when a patient presents
inside a health center for a physical health appoint-
ment but has a clear behavioral health need. For
the FQHC to receive the PPS rate to address the
patient's behavioral health needs, the patient must
return on another day despite significant evidence
that delays in accessing behavioral health care
has negative consequences on overall mental and
physical health.

Not only does this result in delayed care for these
patients, but it also creates capacity issues that
may impact other patients, such as those with com-
plex needs who may require in-person care from a

clinician. The "within the four walls of the clinic"
requirement that patients be in a specific location
for visits when the services could be safely and
appropriately delivered in another setting unnec-
essarily limits access for patients that would prefer
and can benefit from these alternative sites and
provider types. For example, the PPS rate does not
allow FQHCs to bill directly for services provided
by clinic staff that are social workers or community
health workers. The costs for services provided by
these provider types must be built into the PPS rate
through the delivery of services that are incident
to a medical service provided by a physician, and
are not separately accounted for or billable in the
PPS rate. This structure does not adequately rec-
ognize the payment FOHCs would have to make to
these providers and can be a barrier to the use of
this culturally concordant, lower-cost workforce to
address social determinants of health by providing
services such as housing navigation and assistance
with access to medically tailored meals. Similarly,
it does not recognize home or community-based
services, which are particularly important for many
of the vulnerable populations that FOHCs serve.

The adjudication and timing of the PPS reconcilia-
tion process can impact health center operational
cash flow because it is a retroactive payment for
services already provided, which may affect the
capacity of a health center to serve patients.
Additionally, it is an administrative burden on both
the FOQHCs and the states to engage in the rec-
onciliation process, which can be complex, time
consuming, and result in delayed payments. This
process can be especially hard for a newly estab-
lished FQHC site engaging in its first PPS rate-set-
ting process, as it creates financial risk while the
reconciliation process is completed. States have
the option to streamline the administration of the
PPS wraparound payment by requiring that the
MCP calculate and make the payments directly to
the FQHC, but this option requires oversight to
ensure that payments are accurate and reflect what
the state would have otherwise paid. California has
not implemented this option to date.

 

California Health Care Foundation

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Alternative Payment Models for
FQHCs

To alleviate several of the limitations that accom-
pany PPS and incentivize person-centered care and
health home models, states are authorized under
federal law to reimburse FOHCs using APMs.
APMs are payment arrangements that reward pro-
viders for efficiently delivering care that improves
outcomes, meets certain quality targets, or both.
APMs can be applied to a clinical condition, a spe-
cific episode of care, or a defined population.

APMs as defined broadly in the health care system
include a continuum of value-based payment
(VBP) options. APM and VBP are often used inter-
changeably. VBP models are an approach used by
a state or other payer to align financial incentives
and to reduce overutilization and inefficiencies
in the health care system. APMs are the specific
mechanism by which those approaches are imple-
mented, which range from FFS payments that
include quality or bonus payments for improving
outcomes or quality scores or both, to full risk-
based capitation payments in which a provider
is responsible for offering an agreed-upon set of
covered services to a patient for a single monthly
payment (known as capitation). For the purposes of
this issue brief series, when talking broadly about
APMs, it is considered inclusive of the various VBP
approaches. However, it is important to note that
for FQHCs, APMs can be used to pay the PPS rate
or to engage in more typical VBP arrangements as
explained above.

Under federal law, payment to an FQHC under
an APM must be equal to, or higher than, what
the clinic would have received under the PPS.
Following are several options for FOHC APM
design, including the benefits and potential limita-
tions of each model."

Shared Savings
Reimbursement structure:

e FQHCs can garner a percentage of savings
achieved using predefined benchmarks for
quality performance and remaining under a
total cost of care.

e There is no penalty if the benchmarks are not
achieved - there is no downside risk to the
FQHC.

e Shared savings payments are made after bench-
marks in quality and cost are achieved.

Benefits:

e The FOHC is not responsible for any losses
and experiences only the benefits of meeting
benchmarks.

e Incentivizes the use of patient-centered activ-
ities such as care coordination across medical
and social services.

Limitations:

e Successful arrangements require an FQHC to
have enough of a patient base to spread the
benchmarks across to reduce the impact of out-
liers and increase the potential shared savings
sufficiently to drive care transformation invest-
ments by the FQHC.

e If the shared savings arrangements are spread
across too many benchmarks, there may not be
enough of an impact on each one to meet the
goals of the payer.

e This model does not provide FQHCs up-front
funding to invest in staff and resources that
would increase the FOQHCs' ability to meet the
benchmarks and make other improvements to
patient care.

 

California Health Care Foundation

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Pay for Performance
Reimbursement structure:

e@ FOHCs receive a payment for meeting agreed-
upon quality and performance benchmarks.

e The payments are in addition to the PPS rate.

Benefits:

@ Creates an incentive for accountability on key
quality metrics and other patient outreach and
engagement activities.

@ Builds capacity for FOHC quality improvement
efforts.

Limitations:

e@ Requires sophisticated data exchange and
updates to workflows for tracking and reporting
that may require investments by FOQHCs to
effectively participate.

e There is limited evidence demonstrating sus-
tained quality and system improvements.

elf there are multiple pay-for-performance
arrangements with varying measures, there may
be reduced value because resources will not
support improvements across a broad scope.

Risk-Based Capitation Under Federal
FQHC APM Rules

Reimbursement structure:

e@ The FQHC receives a capitation payment (also
referred to as a per-member per-month) to cover
a defined set of services (such as primary care).

@ The capitation payment can be tied to meeting
certain quality metrics.

e@ The FOQHC does not have downside risk due to
the PPS reconciliation process, and the state has
the option to pay PPS or PPS plus some addi-
tional funds.

Benefits:
e@ FQHCs get the flexibility to manage care more
effectively for patients.

@ It can help drive improved quality outcomes and
metrics.

Limitations:

e There must be agreed-upon quality metrics
and benchmarks to make these arrangements
truly value-based, and the arrangement must

be designed with enough upside risk that it is
attractive to the FOHCs to participate because it
is a voluntary model.

e The capitation payments must be negotiated
to be robust enough to allow for effectively
managed care and to give the FOHC enough
flexibility to invest in system transformation and
quality improvement while still remaining eco-
nomical to achieve desired cost savings.

elf FQHC utilization/patient volume at a site
is low, an FQHC will be less able to make this
arrangement effective.

Virtual Accountable Care Organization
with Shared Savings

Reimbursement structure:

@ FQHCs and MCPs work collectively to build a
virtual accountable care organization (ACO).

e Established when a group of small providers
work together to coordinate care across all the
organizing members to achieve goals related to
total cost of care.

eCan include a shared saving arrangement
with a payment received after benchmarks are
achieved.

e Can include an up-front payment from MCPs to
the FQHCs to allow for investments in staff and
resources to help achieve goals and improve
patient care.

Benefits:

® Incentivizes investment in activities that address
social determinants of health and coordination
across the system.

e@ FQHCs can leverage a larger population base
and collective resources to make a larger impact
than when done in isolation.

Limitations:

e Requires infrastructure investments to be effec-
tive and to create the necessary data exchanges
and capabilities, as ACOs rely on well-estab-
lished coding practices to realize the margins
that make these arrangements successful.

e Strong partnerships across the system of care,
including hospitals and other providers and not
just with the MCP, are necessary, and building
those strategic relationships and aligning incen-
tives may take time.

 

California Health Care Foundation

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Bundled Payments (upside only)
Reimbursement structure:

e@ FOHCs receive a predetermined, all-inclusive
payment that includes total allowable expendi-
tures, or "target price," for an episode of care.
"Episode of care" refers to the entire care con-
tinuum for a single condition or medical event
during a fixed period of time.

e@ FOHCs would receive reimbursement for the
individual services provided in the bundle based
upon established rates, and at the conclusion of
the fixed period of time or episode of care, all
the paid claims are aggregated and compared
to the predetermined target price.

e If the total cost of the episode of care is lower
than the target price, the FOHC would not be
at risk for that amount and would receive a per-
centage of the savings achieved.

Benefits:

e Bundled payments can include acute or chronic
events and incentivize coordination of care
across various medical providers and settings,
including FOHCs, hospitals, specialty groups,
and other participating providers.

@ Payment is contingent on quality performance,

which may increase care quality while lowering
health care costs.

Limitations:

e Technical infrastructure and internal data sys-
tems must be robust enough to support data
sharing across care teams and throughout the
span of time for an episode of care.

eFor FQHCs the specific challenge to this
approach is that the services would have to be
separate from the current PPS rate to avoid the
site being paid twice for the same service and
violating federal financing rules.

While there are varying degrees of risk and bene-
fits to MCPs and FOHCs, APMs offer the potential
to improve care for patients served by FOHCs and
bring additional stability to the safety-net delivery
system. Additionally, APMs offer an incentive for
FQHCs to invest in practice transformation that
should create additional efficiencies and reduce
the administrative burden on FQHCs over time.
While there may be some initial work and cost to

implement the APM, it should ultimately result in
systematic changes that will streamline the admin-
istration of benefits and financing. Some of these
potential benefits are explored in the appendix.

Conclusion

California and other states have prioritized
value-based payment arrangements that align clin-
ical and financial incentives and risk arrangements
among providers, plans, and purchasers to improve
health outcomes, enrich the patient experience,
and reduce health care costs and inefficiencies in
care delivery. Over the years, state policymakers
have signaled interest and intent in moving the
Medi-Cal system away from episodic FFS payment
and toward health care payment and delivery
reform innovations such as APMs. The FQHC
APM 2.0 initiative currently under consideration
builds on this long history and has the potential to
create transformation in FOHCs, the backbone of
California's primary care safety net.

Acknowledgments

Athena Chapman, MPP, is president and Samantha
Pell6n, MPH, is policy director at Chapman
Consulting, which provides strategic planning,
meeting facilitation, organizational support, market
research, and regulatory and statutory analysis to
organizations in the health care field.

www.chapmanconsult.com

Medi-Cal Explained is an ongoing series on Medi-Cal
for those who are new to the program, as well as those
who need a refresher. To see other publications in this
series, visit www.chcf.org/MC-explained.

 

California Health Care Foundation

www.chcf.org | 8
MAY 2022

 

Appendix. Federally Qualified
Health Center Alternative Payment
Model 2.0 Initiative

As of spring 2022, California's Department of
Health Care Services is preparing to submit a State
Plan Amendment to the Centers for Medicare &
Medicaid Services for federal approval of an alter-
native payment model structure for the state's
FOQHCs and FQHC Look-Alike sites that receive
PPS reimbursement. The initiative is known as
FOHC APM 2.0. It builds off previous state efforts
to design an APM pilot program for FQHCs and
health plans serving Medicaid patients.

Under federal law, participation in an APM must be
voluntary. Additionally, the APM payment to the
health center must be at least equal to the amount
they would otherwise receive under the prospec-
tive payment system. As permitted under federal
law, FOHCs participating in the APM may receive
a practice transformation payment above PPS
rates, provided that FQHCs meet certain quality
benchmarks.

Basic Design Structure

While several key design considerations and deci-
sions are still under development, the following
elements are similar to the previous APM proposal:

e Managed care plans must pay participating
FOHCs a capitated, per-member per-month
(PMPM) rate for all assigned Medi-Cal patients.

e The PMPM will be MCP-specific and cover all
Medi-Cal services within the FQHC's scope
except for services specifically excluded from

the APM (excluded services will be forthcoming
from DHCS).

e@ The PMPM payment will include total PPS, which
considers MCP historic utilization data specific
to the participating FQHC, and is inclusive of
payments for all MCP patients that received
care at the FOHC over a specified period.

Potential FQHC APM 2.0 Benefits

According to stakeholders interviewed for this
brief, the potential benefits of the FOHC APM 2.0
initiative include that it would:

e Align FQHC payments with broader Medi-Cal
financing and policy goals

e@ Incentivize person-centered care and flexibility
in services to increase access through a broader
range of providers, eliminate single-visit-per-day
requirements, and include options to provide
care outside of the clinic walls (e.g., telehealth
and alternative locations in the community)

elncrease alignment of quality goals and
pay-for-performance initiatives across Medi-Cal
to increase the impact of population health
management strategies

e@ Promote data exchange between MCPs and
FOQHCs, which over time will result in more
informed decisions and improved care coordi-
nation across the system

e Support the integration and coordination of
physical, behavioral, oral, and long-term ser-
vices to address the needs of the whole person

@ Recognize the role that FOQHCs have in early
intervention and primary care interventions to
reduce overall costs to the system and improve
outcomes

@ Provide FQHCs more flexibility to address
patient needs, which will lessen disparities and
help address social determinants of health

e@ Reduce administrative burdens and provides
more stable revenue streams for FOHCs

Timeline and Next Steps for FAHC APM
2.0 Initiative

Following additional stakeholder engagement, a
formal State Plan Amendment request is antici-
pated in July 2022 for federal approval by December
2022, with FQHC site selection and enrollment
in the APM program launching in advance of the
amendment submission. The APM PMPM payment
is expected to begin January 1, 2024.

 

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MAY 2022

 

Endnotes

1,

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11.
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13.

14.

15.

16,

17.

18.

19.

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. 2020 Primary Care Clinic Annual Utilization Data (2020),

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. Matthew Newman et al., Regional Markets Almanac,

2020: Cross-Site Analysis - The Changing Landscape of
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. Primary Care Clinic, CHHS.

. Primary Care Clinic, CHHS.

. Primary Care Clinic, CHHS.

. "CHC Data and Reports," CPCA.

. Regional Markets Almanac, CHCF.

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& Operational Performance Analysis, 2016-2019 (PDF),
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California Federally Qualified Health Centers, Capital Link.

The Pandemic's Financial Impact on California's
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FQHC Current Rates (2018), California Dept. of Health
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42 USC §§ 1396a(a)(10)(A) and 1396d(a)(2)(C) and 1396d(\)
(2).

Medicaid Payment Policy for Federally Qualified Health
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Medicare, Medicaid, and SCHIP Benefits Improvement
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Payment System (PPS) Reconciliation Request (PDF),
DHCS, June 2019.

Greg Howe, Tricia McGinnis, and Rob Houston,
Accelerating Value-Based Payment in California's Federally
Qualified Health Centers: Options for Medicaid Health
Plans (PDF), Center for Health Care Strategies, April 2019.

"Health and Human Services" (PDF) in Governor's Budget
Summary - 2012-13, State of California, 8.

S.B. 147, Reg. Sess. (Cal. 2015); and Federally Qualified
Health Centers (FOHC) Alternative Payment Methodology
(APM) Pilot: California Concept Paper (PDF), DHCS,
October 13, 2016. Originally slated to launch in October
2017, the FQHC APM Pilot Program sought to establish a
capitated model between FOHCs and Medi-Cal managed
care plans, but ultimately was not pursued due to federal
approvals associated with the prospective payment
system equivalency provision.

 

California Health Care Foundation

www.chct.org

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