§ 14138.10
396 words·~2 min read·
/ca/welfare-and-institutions-code/14138-10A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
The Legislature finds and declares all of the following:
(a)Health care today is more than a face-to-face visit with a provider, but rather a whole-person approach, often including a physician, a care team of other health care providers, technology inside and outside of a health center, and wellness activities, including nutrition and exercise classes, all of which are designed to be more easily incorporated into a patient’s daily life.
(b)Accessible health care in a manner that fits a patient’s needs is important for improving patient satisfaction, building trust, and ultimately improving health outcomes.
(c)FQHCs are essential community providers, providing high-quality, cost-effective comprehensive primary care services to underserved communities.
(d)Today, FQHCs face certain restrictions because the current payment structure reimburses an FQHC only when there is a traditional encounter with a provider. Current law prohibits payment for both a primary care visit and mental health visit on the same day.
(e)A more practical approach financially incentivizes FQHCs to provide the right care at the right time. Restructuring the current visit-based, fee-for-service model with a capitated equivalent affords FQHCs the assurance of payment and the flexibility to deliver care in the most appropriate patient-centered manner.
(f)A reformed payment methodology will enable FQHCs to take advantage of alternative encounters. Alternative encounters, such as group visits and email consultations, are effective care delivery methods and contribute to a patient’s overall health and well-being.
(g)An alternative payment methodology for FQHCs, designed and implemented as permitted by federal law, should do all of the following:
(1)Provide patient-centered care delivery options to California’s expansive Medi-Cal population.
(2)Promote cost efficiencies, and improve population health and patient satisfaction.
(3)Improve the capacity of FQHCs to deliver high-quality care to a population growing in numbers and in complexity of needs.
(4)Transition away from a payment system that rewards volume with a flexible alternative that recognizes the value added when Medi-Cal beneficiaries are able to more easily access the care they need and when providers are able to deliver care in the most appropriate manner to patients.
(5)Promote timely, accurate, complete, and systemic reporting of alternative encounters at FQHCs.
(6)Implement the APM where the FQHC receives at least the same amount of funding it would receive under the current payment system, and in a manner that does not disrupt patient care or threaten FQHC viability.