MedicaidReimbursementHigh impact
Direct Network FFS Targeted Rate Increases Unilateral Notification
L.A. Care Health Plan·CA·Reimbursement
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
L.A. Care is implementing Targeted Rate Increases (TRI) retroactive to January 1, 2024, which will automatically pay the higher of your contracted rate or the new TRI rate for specific CPT codes. For 2024 services, they will make one-time true-up payments by December 31, 2024, and starting January 1, 2025, claims systems will automatically pay the higher rate while discontinuing separate Prop 56 payments.
Action Required
By December 31, 2024: Review all 2024 claims for TRI-applicable CPT codes to verify receipt of one-time true-up payments from L.A. Care. Starting January 1, 2025: Update billing expectations as L.A. Care will automatically pay the higher of contracted rates or TRI rates, and discontinue separate Prop 56 equivalent payments. Monitor reimbursements to ensure proper payment of higher rates for applicable services.