Proposition 56 Supplemental Payments for Certain Specified Services

Date: 05/18/18

On May 1, 2018, the Department of Health Care Services (DHCS) submitted APL 18-010 for a one-year supplemental payment program for certain specified services using Proposition 56 tobacco tax funds allocated for the 2017–2018 state fiscal year. This affects Medi-Cal fee-for-service (FFS) and managed care plans.

This update serves to notify participating providers that California Health & Wellness Plan (CHWP) will process supplemental payments for Proposition 56-eligible services rendered to CHWP members for dates of service July 1, 2017, through June 30, 2018. This payment is not considered part of the base provider compensation under the CHWP Participating Provider Agreement (PPA) and is separate from CHWP’s contracting rates with PCPs or IPAs.

OVERVIEW
The supplemental payment is a fixed amount for certain physician services listed in the table below and paid per claim or encounter. The supplemental amount paid is not affected by diagnosis codes submitted on the claim.

PHYSICIAN SERVICES
Participating providers who submit claims or encounters with the following Proposition 56-eligible CPT procedure codes will receive a supplemental payment in addition to the Medi-Cal allowable amount:

CPT code	Supplemental amount
90863	$5
99201, 99211	$10
99202, 99212, 99213	$15
99203, 99204, 99214, 99215	$25
90791, 90792	$35
99205	$50