2020 California Code
Welfare and Institutions Code - WIC
DIVISION 9 - PUBLIC SOCIAL SERVICES
PART 3 - AID AND MEDICAL ASSISTANCE
CHAPTER 7 - Basic Health Care
ARTICLE 4.1 - Payment Reform Pilot Program for Federally Qualified Health Centers
Section 14138.10.
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.
(d) 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.
(e) 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.
(g) FQHCs are essential community providers, providing high quality, cost-effective comprehensive primary care services to underserved communities.
(h) 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.
(i) 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.
(j) A reformed payment methodology will enable FQHCs to take advantage of alternative encounters. Alternative encounters, such as group visits, same-day mental health services, and telephone and email consultations, are effective care delivery methods and contribute to a patient’s overall health and well-being.
(Added by Stats. 2015, Ch. 760, Sec. 1. (SB 147) Effective January 1, 2016.)
