Prop 56

Question 1

Prop 56 Physicians

Model Type

Answer 1

Model B - Risk Based

Question 2

Prop 56 Physicians

Risk Corridor for FY 17-18, 18-19, and 19-20

Answer 2

PYs FY 17-18 - No risk corr
PYs FY 18-19 - 1-Sided (Min exp. w/o Admin & UG)
PYs FY 19-20 - 2-Sided (Phys, Dev, Trauma)

Question 3

Prop 56 Physicians

Effective Date

Answer 3

Effective 7/1/19 (Jul ‘19 - Dec ‘20 Bridge Period)

Question 4

Prop 56 Physicians
Pre-print Justification: 
A) Uniform Dollar Increase
B) Minimum Fe Schedule
C) Value Based Payment
D) Delivery System Reform
E) State-Only Funded Increase
F) Not DP, Actuarial Equiv Built Into Rates

Answer 4

Uniform Dollar Increase - 23 codes (same codes as FY 18-19)

Question 5

Prop 56 Physicians

Rate Adjustment Type

Answer 5

Directed Payment Add-on (has PMPM) (UW/AG)

Question 6

Prop 56 Physicians

Annual Appropriation

Answer 6

FY 19-20 $1.3 TF (12mo) $1.95 BP (18mo)

Question 7

Prop 56 Physicians

Exclusions

Answer 7

1. Medicare Part B (Duals)
2. FQHC, RHC, IHS, CBRC
3. Non-contracted Eligible Providers

Question 8

Prop 56 Developmental Screenings

Model Type

Answer 8

Model B - Risk-Based

Question 9

Prop 56 Developmental Screenings

Risk Corridor

Answer 9

PYs FY 19-20 - 2-Sided (Phys, Dev, Trauma)

Question 10

Prop 56 Developmental Screenings

Effective Date

Answer 10

Effective 1/1/20 (Jul ‘19 - Dec ‘20 Bridge Period)

Question 11

Prop 56 Developmental Screenings
Pre-print Justification: 
A) Uniform Dollar Increase
B) Minimum Fe Schedule
C) Value Based Payment
D) Delivery System Reform
E) State-Only Funded Increase
F) Not DP, Actuarial Equiv Built Into Rates

Answer 11

Uniform Dollar Increase (contracted providers)
https://www.dhcs.ca.gov/provgovpart/Documents/Developmental_Screenings_Proposal_for_Comment_March_2019.pdf
Note: The notice published online is not fully accurate

Question 12

Prop 56 Developmental Screenings

Rate Adjustment Type

Answer 12

Directed Payment Add-on (has PMPM) (UW/AG)

Question 13

Prop 56 Developmental Screenings

Annual Appropriations

Answer 13

Accrual:
$53.6 M TF ($53.6 M TF BP) using PMPMs
(w/ FFS: $60 M TF)

Cash:
FY 19-20 $32.8 M
FY 20-21 $43.2 M

Question 14

Prop 56 Developmental Screenings

Exclusions

Answer 14

1. Medicare Part B beneficiaries (Duals)
2. FQHC/RHC/IHS/CBRC
3. Non-Contracted Eligible Providers

Question 15

Prop 56 Developmental Screenings

Programmatic Details

Answer 15

Target Population any Child (age 0-20), majority of utilization expected to be 0-30 mths, however, payments will be made for any Child regardless of age.
Note Child age range differs from Child COA age range.

CPT Code: 96110 (w/o modifier KX)
Note the requirement to use modifier KX is new and will be required for Autism Screening.

APL not finalized as of yet, in development

Supplemental Rate: $59.90