Proposition 56

Proposition 56 (Prop 56) Updates -

Adverse Childhood Experiences (ACEs) Trauma Screening, Behavioral Health Integration (BHI) Incentive Program, CalHealthCares Program, Developmental Screenings, Enhanced Directed Payments for Physician Services, Family Planning Access Care and Treatment (PACT) Services, and Value-Based Payment (VBP) Program

In November 2016, California voters passed Proposition 56 (Prop 56), which increased the tax rate on cigarettes and other tobacco products. Several state bills have followed to direct Prop 56 funding for specified DHCS health care expenditures that improve health outcomes.

Starting in 2019, the Department of Health Care Services (DHCS) will use Prop 56 funding for ACEs and Developmental Screenings, Behavioral Health Integration grants, the CalHealthCares medical student loan repayment program, Directed Physician Payments, Family Planning Access Care and Treatment (PACT) services, and the Value Based Payment (VBP) Program.

The Alliance has issued Prop 56 payments to our contracted providers, and will continue to do so as statewide efforts to improve health move forward.

 

ACEs Trauma Screening

Effective, Wednesday, January 1, 2020, the Alliance will cover trauma screenings on an ongoing basis for all Alliance Medi-Cal members up to 65 years of age.

For more information regarding the Medi-Cal ACEs Trauma Screening benefit, please click here.

Beginning Wednesday, July 1, 2020, providers must attest to completing certified ACEs training on the DHCS website to continue receiving directed payments. To access ACEs training information, please click here.

Providers must utilize the required screening tools and HCPCS codes to be eligible for payment. Providers must also document all of the required elements such as the completed screening tool, results, discussion, and actions taken. This documentation must remain in the member's medical record and be available upon request.

To view the Prop 56 DHCS All Plan Letter for Fiscal Year 2018-2019 regarding ACEs Trauma Screening, please click here.

BHI Incentive Program

A portion of the Prop 56 tobacco tax revenue has been directed to support Behavioral Health Integration (BHI) proposals that improve physical and behavioral health outcomes, and expand integrated care to include primary care along with substance use disorder and mental health treatment.

Alliance contracted primary care, specialty care, hospital based and behavioral health providers (both mental health and substance use), or who will have a signed contract with the Alliance by Tuesday, January 21, 2020, are eligible to apply. FQHCs, RHCs, IHS and County providers can also apply.

BHI applications must be submitted to the Alliance by 5 pm (PST) on Tuesday, January 21, 2020. The Alliance will then submit the applications to the Department of Health Care Services (DHCS) for review.

To submit your BHI Incentive Program application, please email your completed application to BHI@alamedaalliance.org.

For more information regarding the BHI Incentive Program application, process guide, selection criteria, other resources, or to download the application form, please click here.

To access the BHI Pilot Overview FAQ, please click here.

 

CalHealthCares Program

As a result of Prop 56 the Department of Health Care Services (DHCS) has partnered with Physicians for a Healthy California (PHC) to create the CalHealthCares Program. This medical student loan repayment program incentivizes physicians and dentists for participating in the Medi-Cal program, and promotes increasing access to care for Medi-Cal patients. Through this program, eligible recently graduated healthcare providers may apply for a loan repayment in exchange for an increased patient caseload comprised of Medi-Cal patients.

The second application cycle for CalHealthCares will be available Monday, January 13, 2020.

For more information about the CalHealthCares Program, including eligibility requirements, FAQs, upcoming webinars, scoring matrix and electronic application forms, please click here.

 

Developmental Screenings

Effective Wednesday, January 1, 2020, providers are also be eligible for reimbursement for developmental screenings for children up to 30 months of age, and as medically necessary when risk is identified, under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.

To view the Proposition 56 DHCS All Plan Letter regarding Developmental Screenings, please click here.

 

 

Enhanced Directed Payments for Physician Services

Prop 56 funding has allowed the state to provide directed payments for physician services delivered to Medi-Cal patients. The supplemental payments include several eligible procedure codes. Such as office visits and evaluations, and preventative services to name a few.

To learn more about qualifying services and Prop 56 Supplemental Payments for Physician Services, please click here.

Providers must meet the developmental screening requirements and comply with AAP/Bright Futures periodicity schedules and guidelines to be eligible for payment. This includes utilizing a standardized tool to meet all of the four elements of the CMS criteria as listed in the DHCS APL.

To view the DHCS All Plan Letter regarding Prop 56 Directed Payments for Physician Services, please click here.

 

 

Family PACT

The Prop 56 Family Planning, Access, Care and Treatment (Family PACT) program provides time-limited supplemental payments, to Family PACT providers for Evaluation and Management (E&M) office visits rendered for comprehensive family planning services.

Alliance Medi-Cal members have the right to access family planning services through any qualified family planning provider in and out of the Alliance network without prior authorization (PA). The Alliance will also cover up to a 12-month supply of self-administered hormonal contraceptives when dispensed at one time by a provider, pharmacist, or a licensed or authorized location.

To learn more about the Proposition 56 Family PACT program, please click here.

Value-Based Payment (VBP) Program

As a part of the Governor’s Budget for 2019-2020, a portion of the Prop 56 tobacco tax revenue has been directed to fund the Value-Based Payment (VBP) Program. VBP provides incentive payments to providers for meeting specific measures aimed at improving care for high risk Medi-Cal populations, including the Behavioral Health Integration (BHI) Incentive Program.

For more information regarding the VBP Program, including measures, specifications, and other resources, please click here.