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New Medi-Cal incentive payments took effect January 1

January 17, 2020
Area(s) of Interest: Practice Management Public Payors 


On January 1, 2020, a number of new supplemental Medi-Cal payments took effect. In addition to the supplemental primary care payments made possible by the Proposition 56 tobacco tax, California’s 2019-2020 fiscal year budget contained significant new funding for new programs including the value-based payments and developmental and trauma screenings. Supplemental payments for family planning services have also been extended.

Value-Based Payment Program

The Value-Based Payment Program became effective July 1, 2019, offering incentive payments to physicians providing in-network services to Medi-Cal managed care patients if they meet specific measures aimed at improving care for certain high-cost or high-need populations, including prenatal/post-partum care, early childhood prevention, chronic disease management and new in 2020 behavioral health integration. Value-based payments are only available in Medi-Cal managed care and do not apply to fee-for-service Medi-Cal.

While the Value-Based Payment Program became effective in July 2019, timing of the value-based payments remains unknown at this time as the California Department of Health Care Services (DHCS) continues to await federal approval on the proposal. CMA will provide additional details when available. For more information the Value-Based Payment measures and incentive amounts, visit the DHCS website.

Developmental Screening

Effective for January 1, 2020, dates of service, the developmental screening incentive payments are available in the Medi-Cal fee-for-service and Medi-Cal managed care settings for children up to 30 months of age. Developmental screening payments will apply to CPT code 96110 and the supplemental payment of $59.90 will be in addition to the office visit that accompanies the screening services. Additional details on the frequency of the screenings and standardized screening tool options that must be utilized in order to be eligible for the payments can be found on the DHCS website.

Once federal approval is obtained, payments will be made retroactively back to January 1.

Trauma Screening

Effective for January 1, 2020, dates of service, trauma screening incentive payments are available in Medi-Cal fee-for-service and Medi-Cal managed care settings for children and adults up to age 65. Trauma screening payments will apply to HCPCS codes G9919 and G9920 and the incentive payment of $29 will be in addition to the office visit that accompanies the screening services. Trauma screenings performed in Federally Qualified Health Centers, Rural Health Clinics, and Indian Health Services – Memorandum of Understanding clinics will also be reimbursed at the fee-for-service rate of $29.

For children and adolescents, the Pediatric Adverse Childhood Experiences and Related Life-Events Screener (PEARLS) tool must be utilized and for adults the Adverse Childhood Experiences (ACEs) assessment must be utilized to be eligible for the incentive payments. Additional details on the frequency and screening tool options can be found on the DHCS website.

Additionally, physicians must complete a certified training on proper screening for ACEs and then self-attest to completing the training in order to be eligible for the supplemental trauma screening payments beginning July 1, 2020. More information on the training and self attestation can be found on the DHCS website.

Once federal approval is obtained, payments will be made retroactively back to January 1.

Family Planning Services

Providers offering certain family planning services are eligible to receive supplemental payments for service rendered during the period of July 1, 2019, through December 31, 2021. The supplemental payments, which are significant, will be provided for specific family planning services, including:

  • Long acting reversible contraceptives
  • Other contraceptives (other than oral) when provided as medical benefit
  • Emergency contraceptives
  • Pregnancy testing
  • Sterilization (male and female)

Federal approval for these family planning supplemental payments was received on August 20, 2019. For more information, visit the DHCS webpage.

For More Information

CMA recently hosted a webinar examining the supplemental Medi-Cal payments made possible by the Proposition 56 tobacco tax funding – including how to ensure you’re getting your fair share.

The one-hour webinar — Proposition 56 funds: What’s new for FY 19-20 and beyond — is now available free for CMA members and their staff for on-demand viewing.

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