23-1271m For Family Planning Services, Provider Augmented Reimbursement Now Based on Medi-Cal FFS Rate
Date: 11/06/23
Augmented rate retired on August 15, 2023
The Department of Health Care Services (DHCS) has retired the family planning augmented reimbursement required by All Plan Letters (APLs) 10-003 and
10-014.
- APL 10-003: Augmented Reimbursement for Family Planning Services
- APL 10-014: Correction to All Plan Letter 10-003 Regarding Augmented Reimbursement for Family Planning Services.
The updated reimbursement rate information is as follows:
- Health Net will pay non-contracted providers the appropriate Medi-Cal
fee-for-service (FFS) base rate plus any applicable Centers for Medicare and Medicaid Services-approved directed payments as outlined in federal regulation (i.e., 2016 Final Rule and Title 42, Code of Federal Regulations section 438.6(c)). - Delegated entities shall pay non-contracted providers based on the
Medi-Cal FFS base rate.
Additional information
Providers are encouraged to access California Health & Wellness Plan’s (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.
This information applies to Physicians, Independent Practice Associations (IPAs), Hospitals, Ancillary providers, Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.