21-307 Updates for Prop 56 and Other Programs for 2017-2020
Date: 04/23/21
A new payment process now includes an RA
A new process was developed so payments can be made to providers for capitated encounters and to providers who have not submitted a current W-9 form. This new process will include a remittance advice (RA) sent with your payment.
Providers with no current W-9 form on file will get payments for supplemental and add-on services given during 2017–2020 for Prop 56 and for other programs.
Services eligible for added payments
The services that qualify for Prop 56, or programs that have add-on payments include:
- Physician services
- Sensitive services (Hyde Amendment)
- Developmental screening
- Family planning
W-9 needed for value-based payments
This new process does not include value-based payments (VBP). Providers must still submit a current W-9 form to receive VBP payments from the capitated encounters. You can email or fax your W-9 form to:
Email: HNCA W9 Submissions
(Add the words “Prop 56 W9” in the subject line.)
Fax: 833-794-0423
(Include a cover sheet and clearly add the words “Prop 56 W9” and “PROTECTED HEALTH INFORMATION.”)
What’s on the RA
The RA you receive for supplemental or add-on payments for 2017–2020 will give summary information on which encounters are included in the payment. This change will help resolve issues with supplemental payments for fee-for-service claims.
You will receive the RAs by the same method you receive payments – paper or electronic.
Prop 56 helps more people access health care
In November 2016, voters passed Proposition 56 to support access to health care for low-income Californians covered by the Medi-Cal program. On September 28, 2017, the Department of Health Care Services (DHCS) submitted State Plan Amendment (SPA) 17-030 for a one-year supplemental payment program for certain physician services. Support for this program is from the California Proposition 56 tobacco tax funds set apart for the 2017–2018 state fiscal year. It would affect Medi-Cal fee-for-service and managed care plans.
The program was extended past the initial one year with more physician services added and the fixed amount increased. By 2019, specific services for developmental screening, family planning and more were included. This payment is not considered part of the base provider compensation under the Provider Participation Agreement and is separate from Health Net’s contracting rates with primary care physicians (PCPs) or participating physicians groups (PPGs).
Additional information
Providers are encouraged to access CHWP’s provider portal online for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact CHWP at 877-658-0305.