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Some Medi-Cal managed care plans slow to distribute Prop 56 funds



October 17, 2018
Area(s) of Interest: Payor Issues and Reimbursement 

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.

Supplemental Payments Webinar

CMA is hosting a webinar with DHCS on Wednesday, November 7 to discuss the status of distribution of both 2017-2018 and 2018-2019 supplemental Medi-Cal funds and their distribution timelines. This webinar also will cover eligible services, supplemental payment amounts by CPT code and tips on ensuring your practice receives the full amount of eligible funds.

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