Proposition 56
In November 2016, California voters passed Proposition 56, also known as the California Healthcare Research and Prevention Tobacco Tax Act. Prop. 56, which imposed a $2-a-pack tax on cigarettes and a proportional tax on other nicotine products, starting April 2017. The proposition allocated money for many things, but a large percentage was earmarked to support Medi-Cal providers.
Starting in 2019, the Legislature and Department of Health Care Services (DHCS) has been using Prop. 56 funding for loan repayment for physicians and dentists, Value Based Payment Program (VBPP), Developmental Screening and ACEs screening, Family Planning Incentives, and Behavioral Health Integration grants. In June of 2022, the funding for VBPP was end dated, but all other Prop 56 Supplemental payments have continued. CenCal Health will continue with these Supplemental Prop 56 payments as directed by DHCS.
Prop56 add-on payment process update
The program provides supplemental payments for certain eligible medical and screening services provided to Medi-Cal beneficiaries. More in depth information on the program can be found here.
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- In April 2023 moving forward, claims received and paid, where Prop 56 Supplemental Add-On payments are due, are no longer reflected on the individual claims, but are being reimbursed monthly by separate check from CenCal Health.
- These payments will be made by the 15th of the following month after the claim with the Prop 56 service was paid.
- An itemized report is available in our secure Provider Portal.
- Effective for DOS on or after 01/01/2024, explain code “HT” will no longer appear on paid claims.
Please contact the Claims Department at (805) 562-1083 if you have additional questions.
Proposition 56 All Plan Letter (APL)
The purpose of this All Plan Letter (APL) is to provide Medi-Cal managed care health plans (MCPs) with guidance on directed payments, funded by the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56).
Developmental Screening APL 23-016
Prop 56 Directed Payment for Private Services APL 23-015
DHCS Webinar: Prop 56 New Incentive Payments for Quality
APL 23-008 Family Planning Services
Please reference the All Plan Letter section of our website for more resources.
Behavioral Health Integration (BHI)
Program Update: DHCS has notified CenCal Health and alike Managed Care Plans (MCP) that an implementation date will be discussed following additional information provided by the MCP and its providers. CenCal Health will continue to update providers who applied for the BHI program as updates from DHCS are received.
If you have any questions, please reach out to DHCS-BHIIPA@dhcs.ca.gov or email BHIprogram@cencalhealth.org or for further details, please reference DHCS BHI Incentive Program Webpage
The Department of Health Care Services (DHCS) Behavioral Health Integration (BHI) Incentive Program goals are to incentivize improvement through Prop 56 funding for physical & behavioral health outcomes and deliver efficient care and patient experience. DHCS is providing this funding to incentivize Medi-Cal providers and health plans to partner together to promote BHI in their practice.
Click here for CenCal Health’s Integration Overview & BHI Project Examples
Integration Program Details:
- Three (3) Year Program: April 1, 2020 – December 31, 2022
- $93 million statewide financial allocation plus additional Federal funds
- Funding per MCP will be 5% of capitation currently paid by DHCS
- Funding is an incentive for providers and does not count toward PPS calculation
Eligible Providers
Eligible providers contracted with CenCal Health or contracted with the Holman Group include: Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHC), Hospital Information Systems (HIS) clinics, hospitals, medical groups, individual providers, mental health and substance use providers, county mental health, and substance use providers.
Reference our recorded webinar or CenCal Health’s presentation for additional project details.
Online DHCS Application
Contracted Providers are required to submit an application to CenCal Health to operate one (1), or more, of six (6) BHI projects. A separate application is required for each project. Please fill out DHCS’s statewide application, and reference program process guides, and more FAQ’s.
Submit Application
Submit your application directly to CenCal Health via email at BHIprogram@cencalhealth.org.
Adverse Childhood Experiences (ACEs)
The ACEs Aware initiative is first-in-the-nation! It’s a statewide effort to screen children/adults in primary care settings, and to treat the impacts of toxic stress with trauma-informed care. ACEs Aware is built on the consensus of scientific evidence demonstrating that early detection and evidence-based intervention improves outcomes. The goal is to reduce ACEs and toxic stress by half (in one generation), and to launch a national movement to ensure everyone is ACEs Aware.
To learn more, reference our Adverse Childhood Experiences (ACEs) Aware Resource
Provider Training
DHCS is offering provider training on trauma and trauma-informed care at ACEsAware.org. Reimbursement will continue effective July 1, 2020 only to providers that have completed the required two (2) hour training available on the ACES Aware website.
Providers will have to self-attest after taking the two (2) hour course directly through DHCS’s online Trauma Screening Training Attestation form. Please make a copy of your email confirmation, and email a copy of your training certificate to CenCal Health Provider Services Department at psrgroup@cencalhealth.org.
Screening Tools
Standardized screening tools include Pediatric ACEs and Related Life-Events Screener (PEARLS), and the ACEs Assessment Tool for adults. The screening tool surveys the member’s history of exposure to 10 categories of ACEs by age 18. Note that the score is the total number of ACE categories experienced, and not the severity or frequency of any specific experience. The total score ranges from 0 to 10.
Clinical Practice
The ACEs Screening Clinical Algorithm helps a provider assess whether a patient is at low, intermediate, or high risk of a toxic stress pathology.
Billing
Effective July 1, 2020, CenCal Health providers must complete the certified ACEs Aware Training and must attest prior to receiving payment. Billing requires that the appropriate screening tool was used, the results were reviewed, interpreted, and documented, discussed with the member and/or family, and any clinically appropriate actions were documented. Effective January 1, 2020, CenCal Health will reimburse for annual ACEs screening for members under age 21, and once per lifetime for members ages 21 to 65. The rate is $29 per screening for all providers.
The Healthcare Common Procedure System (HCPCS) billing codes used are:
- G9919: ACE score of 4 or greater, at high risk for toxic stress
- G9920: ACE score of 0 – 3, at lower risk for toxic stress
Additional Resources:
For more information on this service, or for help improving your clinical care, please email CenCal Health’s Quality Improvement Department at qualityimprovement@cencalhealth.org.
Developmental Screenings
Developmental screenings identify areas in which a child’s development differs from same-age norms. Due to development being dynamic in nature, and surveillance and screenings having limitations, periodic screening with a validated instrument are recommended to detect a problem not detected by surveillance. Repeated and regular screening is necessary to ensure timely identification of problems and early intervention, especially in later-developing skills such as language.
Billing
Effective January 1, 2020, through June 30, 2021 DHCS approved reimbursement for Developmental Screening Services. CenCal Health will reimburse (dual members are excluded) all contracted providers $59.90 when billing with CPT code 96110 without KX modifier.
Screening Tools
CenCal Health Contracted Providers are eligible for this payment and screening must be in accordance with the Bright Futures/AAP periodicity schedule and guidelines for 9 months, 18 months and 30 months of age and when medically necessary based on developmental surveillance.
Family PACT Planning Program
The Family Planning, Access, Care, and Treatment (Family PACT) Program will continue to provide time-limited supplemental payments to Family PACT providers for Evaluation and Management (E&M) office visits rendered for comprehensive family planning services for the period of July 1, 2019 through December 31, 2021.
This directed payment program is intended to enhance the quality of patient care by ensuring that Providers in California who offer family planning services receive enhanced payment for their delivery of effective, efficient, and affordable health care services. Timely access to vital family planning services is a critical component of beneficiary and population health.
In particular, this program is focused on the following categories of family planning services:
- Long-acting contraceptives
- Other contraceptives (other than oral contraceptives) when provided as a medical benefit
- Emergency contraceptives when provided as a medical benefit
- Pregnancy testing
- Sterilization procedures (for females and males)
For more information on Prop 56 and Family PACT, access the DHCS website here