Some Medi-Cal managed care plans slow to distribute Prop 56 funds October 18, 2018 Managed Care, Medi-Cal Payor Issues and Reimbursement 0 In May, the California Department of Health Care Services (DHCS) distributed the Proposition 56 supplemental funds for FY 2017-2018 to the Medi-Cal managed care plans. At the California Medical Association’s request, DHCS specified that plans must distribute the funds to providers within 90 days. However, the 90-day window ended August 31 and CMA has received complaints from physicians that some plans have still not issued supplemental payments. The supplemental payments are a result of the California Health Care, Research and Prevention Tobacco Tax Act of 2016 (Prop 56), which created new revenues dedicated to the Medi-Cal program. Physicians receive supplemental payments in both fee-for-service and Medi-Cal managed care when providing Medi-Cal services under certain CPT codes. The eligible codes and amounts approved for additional payment for FY 2017-2018 are: CPT CODE FY 2017 – 2018 SUPPLEMENTAL AMOUNT 90863 $5.00 99201, 99211 $10.00 99202, 99212, 99213 $15.00 99203, 99204, 99214, 99215 $25.00 90791, 90792 $35.00 99205 $50.00 The supplemental payments bring Medi-Cal reimbursement rates for these codes up to about 65 percent of Medicare rates. Practices that believe they have not received their supplemental payments are strongly encouraged to reach out to the plan contact for Proposition 56 directly. Physicians with questions or concerns about Prop 56 payments are also encouraged to contact CMA’s Reimbursement Helpline at (888) 401-5911 or economicservices@cmadocs.org. Comments are closed.
