Alternative Payment Methodology (APM) Initiative

The required application for the Federally Qualified Health Center (FQHC) Alternative Payment Methodology (APM) is live as of December 1, 2022. The FQHC APM Application and associated documents are to be submitted DHCS the e-mailbox, FQHCAPM@dhcs.ca.gov, no later than January 31, 2023. Incomplete submissions will not be considered for participation in the APM.

FQHC Application Instructions : These are the instructions that outline the information that is required within the application process.

FQHC-Application : This is the main application file which must be filled out in its entirety.

FQHC APM Health Plan Assessment Form : This form is required to be filled out and returned with information regarding the FQHCs standing with each respective primary Managed Care Plan.

Application Spreadsheet format : This is an optional supplemental spreadsheet that provides an easy method to illustrate detailed information on each site as well as providing the Alternative Engagement Codes.

These forms will be posted on the DHCS website in the near future: https://www.dhcs.ca.gov/services/Pages/FQHC_APM.aspx

DHCS will be hosting a technical webinar on December 13, 2022 from 11:00-12:00 PST. Use this link  to attend at the specific time. No registration is required.


The California Primary Care Association and the Department of Health Care Services are commencing the process to build an alternative payment methodology (APM) for California's community health centers (CHCs).

CPCA Member Resources
You must be a CPCA Member and log-in to access.

Overview

Medi-Cal reimburses community health centers under the Prospective Payment System (PPS), a payment methodology that requires patients come to the health center to receive care. Health centers need more flexibility in how they deliver care to their patients and the APM CPCA is helping to build alongside DHCS and CPCA members will ensure they receive at least what they would have gotten under PPS but now with more flexibility for the health center and patient. 



For more information on value based payment, check out these resources:
Health Affairs, Value-Based Payment as a Tool to Address Excess US Health Spending
Millbank Quarterly, Health Centers and Value Based Payment: A Framework for Health Center Payment Reform and Early Experiences in Medicaid Value-Based Payment in Seven States

PPS Modernization Initiative


CPCA is actively working with the Department of Health Care Services (DHCS) and other key stakeholders to modernize PPS and change how health centers will be reimbursed. A modernized payment methodology for health centers will align with the implementation of CalAIM and the state’s efforts to promote a more holistic, patient-centered approach to care. 

The modernized PPS will allow participating health centers to move from the visit-based reimbursement methodology to a capitation payment methodology, commonly known as a per member per month payment. This new payment method will: 

  • Provide the flexibility to deliver care in innovative ways that will expand primary and specialty care access and help improve patient experience,
  • Simplify the payment processes for health centers alleviating many of the administrative challenges including billing wraparound payment, reconciliating payments, etc. 
  • Facilitate greater collaboration between health centers and Medi-Cal managed care plans, specifically in the areas of data collection and submission, care coordination and quality improvement. 

Member Engagement

CPCA members are leading the work with DHCS and our health plan partners to develop the Alternative Payment Methodology. Additionally, staff are hosting monthly PPS Modernization Workgroup Meetings where the general membership can join and stay updated on this APM work. For more details on future meetings or to be added to the group, please contact Charlotte Reische, creische@cpca.org .


CPCA Contacts:

Allie Budenz
Deputy Director of Quality Assurance
abudenz@cpca.org

What is APM?



APM: COVID-19 Opportunities & Challenges
APM: Find out what the patient needs

APM: Why now?


APM: Why now vs 20 years ago?

APM: Leverage all members of the team

APM: On the cusp of change