Cal. Welf. & Inst. Code § 14138.10
Federally Qualified Health Center Alternative Payment Model Project
Redline — January 1, 2015 → current.View current text →
Current — January 1, 2021
As of January 1, 2015
The Legislature finds and declares all of the following:
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 driving health care delivery system reforms that emphasize health outcomes, efficiency, patient satisfaction, and value.
(b) California has expanded Medi-Cal to cover more than 12 million residents, roughly one-third of the state’s population. To meet the needs of the state’s growing patient population, California must continue to explore new strategies to expand access to high quality and cost-effective primary care services.
(c) With such a large portion of the state’s population receiving health care services through Medi-Cal, it is imperative that patient-centered innovations drive Medi-Cal reforms.
(a) Health care today is more than a face-to-face visit with a provider, but rather a whole-person approach, often including a physician, a care team of other health care providers, technology inside and outside of a health center, and wellness activities, including nutrition and exercise classes, all of which are designed to be more easily incorporated into a patient’s daily life.
(b) Accessible health care in a manner that fits a patient’s needs is important for improving patient satisfaction, building trust, and ultimately improving health outcomes.
(f) In an attempt to invest up front in health care services that can prevent longer term avoidable high-cost services, the federal Patient Protection and Affordable Care Act made a significant investment in FQHCs.
(c) FQHCs are essential community providers, providing high-quality, cost-effective comprehensive primary care services to underserved communities.
(d) Today, FQHCs face certain restrictions because the current payment structure reimburses an FQHC only when there is a traditional encounter with a provider. Current law prohibits payment for both a primary care visit and mental health visit on the same day.
(e) A more practical approach financially incentivizes FQHCs to provide the right care at the right time. Restructuring the current visit-based, fee-for-service model with a capitated equivalent affords FQHCs the assurance of payment and the flexibility to deliver care in the most appropriate patient-centered manner.
(f) A reformed payment methodology will enable FQHCs to take advantage of alternative encounters. Alternative encounters, such as group visits and email consultations, are effective care delivery methods and contribute to a patient’s overall health and well-being.
(g) An alternative payment methodology for FQHCs, designed and implemented as permitted by federal law, should do all of the following:
(1) Provide patient-centered care delivery options to California’s expansive Medi-Cal population.
(2) Promote cost efficiencies, and improve population health and patient satisfaction.
(3) Improve the capacity of FQHCs to deliver high-quality care to a population growing in numbers and in complexity of needs.
(4) Transition away from a payment system that rewards volume with a flexible alternative that recognizes the value added when Medi-Cal beneficiaries are able to more easily access the care they need and when providers are able to deliver care in the most appropriate manner to patients.
(5) Promote timely, accurate, complete, and systemic reporting of alternative encounters at FQHCs.
(6) Implement the APM where the FQHC receives at least the same amount of funding it would receive under the current payment system, and in a manner that does not disrupt patient care or threaten FQHC viability.
Official source: California Legislative Information. Reproduced from public-domain California statutes; confirm against the official source for the current text. Not legal advice.