23-1269m 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 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 CalViva Health at 888-893-1569.

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary providers, Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.

This information applies to Medi-Cal in Fresno, Kings and Madera counties.