22-668 Alert! Proposition 56 Value-Based Payment Program Has Ended

Date: 08/31/22

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.

For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.

Services performed after June 30, 2022, will not be eligible for direct payments

Health Net* was notified that the Department of Health Care Services (DHCS) Value-Based Payment (VBP) program, funded through Proposition 56, has ended effective June 30, 2022.

The VBP Program was directed to Managed Care Plans (MCPs) to make enhanced payments to eligible network providers for meeting specific performance measures, These measures relate to prenatal/postpartum care, early childhood preventive care, chronic disease management, and behavioral care. The VBP Program was scheduled to end December 31, 2022, but it was updated due to legislative funding restrictions.

Services performed after June 30, 2022 will not be eligible to receive VBP enhanced payments. An update to the All Plan Letter will be released by DHCS to reflect the program end date of June 30, 2022. This change only applies to the VBP and does not impact other programs funded by Proposition 56.

We will continue processing payments for all eligible services with dates of service through June 30,2022.

Additional information

Providers are encouraged to access the provider portal 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 the Health Net Medi-Cal Provider Services Center within 60 days at 800-675-6110.