​​Updates on Tribal Federally Qualified Health Center Medi-Cal Provider Type

​This webpage provides information regarding the implementation of the Tribal Federally Qualified Health Center (Tribal FQHC) provider type in the Medi-Cal Program.  The new Tribal FQHC provider type allows Tribal health programs to expand service locations (i.e., in the patient's home), receive reimbursement for different combinations of visits on the same day (i.e., a primary care visit and a visit with a medical specialist), and bill for chiropractic services for all Medi-Cal recipients seen at the Tribal health program.  Tribal FQHCs will receive payment for services at the Federal Indian Health Services All-Inclusive Rate.  

Please see below for further information regarding Tribal FQHCs.

All Plan Letter (APL) 21-008 Update

• DHCS released APL 21-008 to Managed Care Plans (MCPs) on May 13, 2021
• Please note that Attachment 2 of the APL, which will list the names and locations of clinics that have elected to participate in Medi-Cal as a Tribal FQHC will be updated following receipt of the Elect to Participate Form (DHCS 7108) described below.  During initial rollout of the Tribal FQHC provider type, Attachment 2 will be updated monthly.  Attachment 2 will be updated on a quarterly basis beginning in September 2021.

Tribal FQHC Provider Manual Update

• Tribal FQHC Medi-Cal provider manual sections were published on May 14, 2021.  Please see the Tribal FQHC bulletin to view the following manual sections:
• Tribally Federally Qualified Health Centers  
• Tribal Federally Qualified Health Centers Billing Codes

Mental Health Associates Update

• Mental health associates are not billable providers in FQHCs.  However, CMS approved State Plan Amendment 20-0024 which temporarily adds Associate Clinical Social Workers (LCSWs) and Associate Marriage and Family Therapists (AMFT) services in FQHCs during the Public Health Emergency (PHE)
• LCSWs and AMFTs are not licensed practitioners, per the California Board of Behavioral Sciences. Therefore, services are billed under the supervising licensed, billable behavioral health practitioner of the Tribal FQHC. 
• The licensed behavioral health practitioners must supervise and assume the professional liability of services furnished by the unlicensed LCSWs and AMFTs.
• The licensed practitioner must also comply with supervision requirements established by the Board of Behavioral Sciences
• DHCS is working with CMS regarding billing for LCSWs and AMFTs following the end of the PHE
• DHCS is also in discussions with CMS regarding billing for Licensed Professional Clinical Counselors (LPCC), Associate LPCCs, and Psychological Assistants in Tribal FQHCs. 

Changing Provider Types in Medi-Cal from an Indian Health Services Memorandum of Agreement Provider to a Tribal FQHC

• Tribal programs can change provider types by completing an “Elect to Participate" Indian Health Services Memorandum of Agreement (IHS/MOA) and Tribal Federally Qualified Health Center (FQHC) (form DHCS 7108).  The DHCS Form 7108 is available now at www.medi-cal.ca.gov. From the Home Tab select Resources, select References, from the Billing section select Forms, from the Provider Enrollment section select the “Elect to Participate" DHCS 7108 form.
• DHCS can only accept hard copies of the signed "Elect to Participate" DHCS 7108
• Please submit the document/s to:     
  

              Department of Health Care Services

              Provider Enrollment Division

              MS 4704

              P.O. Box 997413

              Sacramento, CA  95899-7413

• Note: One “Elect to Participate" for each clinic site is required and all Tribal clinic corporations must choose to be designated as the same provider type.
• Tribal health programs that are not currently enrolled in Medi-Cal must complete the application process through DHCS' Provider Application and Validation for Enrollment (PAVE) System and submit form DHCS 7108 with their initial application.

Tribal FQHC Inbox and Responses to Questions Received Regarding Tribal FQHCs

Please email issues and questions to the Tribal FQHC inbox at: TribalFQHC@dhcs.ca.gov. The inbox is monitored daily.

• Questions Received on Tribal Federally Qualified Health Center (Tribal FQHC) as of 7/15/21

Presentation on Tribal FQHCs held and Responses to Questions Received

• DHCS hosted a webinar regarding the implementation of the Tribal FQHC provider type on June 11, 2021. To view the meeting materials and presentation please visit the Indian Health Program Meetings, Webinars, and Presentations page.