California Welfare and Institutions Code ARTICLE 4.1 - Payment Reform Pilot Program for Federally Qualified Health Centers

• Section 14138.1.
  For purposes of this article, the following definitions apply:(a) “Alternative payment methodology” (APM) has the same meaning as specified in Section 1396a(bb)(6) of Title 42 of...
• Section 14138.10.a.
  The Legislature finds and declares all of the following:(a) The federal Patient Protection and Affordable Care Act has made and continues to make significant progress in...
• Section 14138.11.
  It is the intent of the Legislature to test an alternative payment methodology for FQHCs, as permitted by federal law, and to design and implement...
• Section 14138.12.
  (a) (1) The department shall authorize a payment reform pilot project for FQHCs using an APM in accordance with this article.(2) Implementation of the APM pilot project shall...
• Section 14138.13.
  (a) The department shall notify every FQHC in the state of the APM pilot project and shall invite any interested FQHC to apply for participation in...
• Section 14138.14.
  (a) A participating FQHC shall be compensated for the APM scope of services provided to its APM enrollees pursuant to this section.(b) A participating FQHC shall receive...
• Section 14138.15.
  (a) A principal health plan shall be compensated by the department for the services provided to its APM enrollees pursuant to this section.(b) For each principal health...
• Section 14138.16.
  (a) For the duration of the APM pilot project, the department shall establish a risk corridor structure for the principal health plans relating only to the...
• Section 14138.17.
  (a) In order to ensure participating FQHCs have an incentive to manage visits and costs, while at the same time exercising a reasonable amount of flexibility...
• Section 14138.18.
  (a) The department, in consultation with interested FQHCs and principal health plans, may modify any methodology, process, or provision specified in this article to the extent...
• Section 14138.19.
  In the event of an epidemic, or similar catastrophic occurrence that the department determines is likely to result in at least a 30 percent increase...
• Section 14138.21.
  (a) This article shall not be deemed to affect the amounts paid or the reimbursement methodology applicable to FQHCs for dental services that are provided outside...
• Section 14138.22.
  (a) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret,...
• Section 14138.23.
  For purposes of implementing this article, the department may enter into exclusive or nonexclusive contracts on a bid or negotiated basis, including contracts for the...

Last modified: October 22, 2018