O
n Sept. 26, 2012, the
Alliance board approved a
change in policy regarding
payments for Medi-Cal Primary Care
Physician (PCP) services. Effective
January 1, 2013, Alliance Medi-
Cal PCPs will shift from capitated
payment to fee-for-service payment.
Thischangeinpolicyaccomplishes
two important objectives:
●●
The first is to ensure the Plan’s
compliance with the Affordable Care
Act (ACA), which requires payments
to Medicaid PCPs at Medicare rates
of payment for certain services.
●●
The second is to encourage primary
care participation at a local level
by enhancing payments for those
primary care codes that are not
eligible for the ACA payment rate.
This change is also important
in the context of the transition of
HF members to Medi-Cal, in that
Changes to Medi-Cal Primary Care Payment
it offers further-enhanced payment
for services provided to the newly
eligible Medi-Cal members beyond
the prior capitated payments for
Medi-Cal.
The ACA-eligible payments are
available to family practice, internal
medicine and pediatric PCPs, as
well as non-physician medical
practitioners under the supervision
of an eligible physician. The ACA
payments are available only for
certain codes, including CPT codes
99201-99499 (
ACA-eligible codes).
Federally
Qualified
Health
Center (FQHC) and Rural Health
Clinic (RHC) providers are not
eligible for increased payments
under the ACA.
Eligible PCPs will receive 100% of
Medicare rates for the ACA-eligible
codes and 150% of Medi-Cal fee-
for-service for the non-ACA-eligible
codes. All Alliance Medi-Cal PCPs
will receive the 150% of Medi-Cal
rates on the non-ACA-eligible codes.
By now, PCPs should have
received an amendment to their
contract with the Alliance including
the new payment methodology and
rates. Providers with any questions
should contact their Provider
Services Representative.
Physical
Accessibility
Review
T
he Physical Accessibility
Review (PAR) is a new
survey mandated by DHCS
as one of the expanded requirements
relating to the services we provide to
Medi-Cal members who are seniors
and/or persons with disabilities
(
SPDs) in Attachment C of the
Facility Site Review.
The PAR criterion evaluates the
level of accessibility of the health
care site. Eighty-six items are
assessed, with 29 of them considered
critical elements (CEs). CEs are
used to determine the level of access
to a provider. Providers who meet
all 29 CEs are designated as basic
access; providers who do not meet
all 29 CEs are designated as limited
access.
This survey is
not scored
and
is used for informational purposes
only. Regardless of the findings,
no
corrective action plan is required
.
The PARmust be done for all PCP
sites serving Medi-Cal patients, and
for specialists and allied providers
serving a high volume of Medi-Cal
members who are SPDs.
Surveying began on November 1,
2012.
Alliance staff are scheduling the
PAR with providers and conducting
the reviews. The estimated amount
of time for the PAR is two hours.
If you have any questions about
the PAR, please contact Kelly
Salazar, RN, at
(831) 430-5767
or
Pat Smith, RN, at
(831) 430-5586
.
DECEMBER 2012
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P ROV I DE R NEWS