MedicaidReimbursementMedium impact
24-530 New Federally Qualified Health Centers Alternative Payment Methodology Pilot Begins July 1, 2024
Health Net·CA · Family Medicine, Internal Medicine, General Practice +7 more·Prior Authorization
Effective date
Jul 1, 2024
We identified it
Jun 20, 2026
Summary
Three California FQHCs are moving from traditional Prospective Payment System to a new Alternative Payment Methodology with per-member-per-month payments starting July 1, 2024. Physician groups contracted with these FQHCs should not make additional payments as services are included in the PMPM rate, but must still pay PPS rates for non-contracted FQHC services.
Action Required
Immediately: Billing team must identify members receiving services at the three participating FQHCs (County of Santa Clara, Harbor Community Health Centers, and Winters Healthcare Foundation). For contracted FQHCs under APM, stop making additional payments as costs are included in PMPM. For non-contracted FQHCs, continue paying PPS rates. Monitor DHCS website for updated participating FQHC lists and rates.