Enhanced Clinically Integrated Program for Federally Qualified Health Centers.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Under existing law, federally qualified health center (FQHC) services are covered benefits under the Medi-Cal program, to be reimbursed on a per-visit basis, as specified, to the extent that federal financial participation is obtained.

Existing federal law authorizes a state plan to provide for payment in any fiscal year to an FQHC for specified services in an amount that is determined under an alternative payment methodology (APM) if it is agreed to by the state and the FQHC and results in a payment to the FQHC of an amount that is at least equal to the amount otherwise required to be paid to the FQHC. Existing state law requires the department to authorize an APM pilot project for FQHCs that agree to participate, for implementation with respect to a county for a period of up to 3 years.

This bill would require the department to authorize a new payment program for FQHCs pursuant to federal law, to be named the Enhanced Clinically Integrated Program (ECIP). The bill would, subject to an appropriation, require the nonfederal share of ECIP funding be used to support the ability of FQHCs to pay wages, conduct workforce training, and improve delivery of care. The bill would require the department to request at least this amount to fund the program on an ongoing basis in future fiscal years.

Under the bill, participation in ECIP would be optional for FQHCs, and participating FQHCs would not receive payment rates lower than available through their standard prospective payment system (PPS) rate. The bill would also set forth a funding stream for FQHCs participating in labor-management cooperation committees, as specified.

The bill would require the department to establish a statewide 15-member board, as specified, with the responsibility of developing eligibility criteria, an application process, a fund distribution process, and reporting requirements.

The bill would require the department, no later than February 1, 2023, to seek any necessary federal approvals. The bill would condition implementation of these provisions on receipt of those federal approvals and the availability of federal financial participation (FFP). The bill would require the department to seek to maximize FFP for ECIP funding streams, as specified.