Enhanced Clinically Integrated Program for Federally Qualified Health Centers.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Under existing law, federally qualified health center (FQHC) services are covered benefits under the Medi-Cal program, to be reimbursed on a per-visit basis, as specified, to the extent that federal financial participation is obtained. Existing federal law authorizes a state plan to provide for payment in any fiscal year to an FQHC for specified services in an amount that is determined under an alternative payment methodology (APM) if it is agreed to by the state and the FQHC and results in a payment to the FQHC of an amount that is at least equal to the amount otherwise required to be paid to the FQHC. Existing state law requires the department to authorize an APM pilot project for FQHCs that agree to participate, for implementation with respect to a county for a period of up to 3 years. This bill would require the department to authorize a new supplemental payment program for FQHCs pursuant to federal law, or as specified, to be named the Enhanced Clinically Integrated Program (ECIP) . Under the bill, ECIP funding would be subject to an appropriation. The bill would require the department to request an amount, as necessary to fund, implement, and maintain ECIP at sufficient capacity, on an ongoing basis in future fiscal years. Under the bill, participation in ECIP would be optional for FQHCs, funding under ECIP would be provided in addition to all other funding received by FQHCs, as specified, and participation in ECIP would result in total payments to participating FQHCs that are greater than the prospective payment system (PPS) rate otherwise required to be paid to the FQHC. The bill would, subject to an appropriation, require the department, no later than July 1, 2023, to make funding available for the purpose of direct compensation of health center workers. The bill would require ECIP to improve quality and access to care by allocating funds, if appropriated, to FQHCs that meet certain standards relating to wage thresholds and commitment to participation in bona fide labor-management cooperation committees (LMCCs) , as specified. The bill would set forth various requirements for funding allocations to, and uses by, participating FQHCs. The bill would require the department to develop eligibility criteria, an application process, a fund distribution process, reporting requirements, and a methodology for adjusting funding allocations based on health care inflation. The bill would authorize the department to choose to implement the program as a state-only funded program, as specified. If the department seeks federal financial participation in the first year of the program, the bill would require the department to apply for federal approval no later than February 1, 2023, but would authorize seeking federal financial participation in subsequent years. If federal financial participation is sought, the department would have discretion to modify the terms of ECIP if necessary to obtain federal approval so long as the modifications further the goals of increasing FQHC workforce compensation particularly for lower-paid workers and furthering the creation of, and participation in, bona fide LMCCs for FQHC worker education and training. The bill would authorize the department to implement these provisions through all-county letters or similar instructions, until any necessary regulations are adopted. The bill would make these provisions severable.