Proposition 56 Value Based Payment Program
Overview
The Department of Health Care Services (DHCS) is releasing, as described below, the Value-Based Payment (VBP) Program measures. Additional details about the measure specifications will follow. The final measure set is subject to federal approvals. For FY 19-20 the Governor’s Budget proposes a VBP through Medi-Cal managed care health plans (MCPs) that will provide incentive payments to providers for meeting specific measures aimed at improving care for certain high-cost or high-need populations. These risk-based incentive payments will be targeted at physicians that meet specific achievement on metrics targeting areas such as behavioral health integration; chronic disease management; prenatal/post-partum care; and early childhood prevention. At May Revision, a total of $544.2M ($250M Proposition 56 funds) in 2019-20 is proposed for this program, of which $140M ($70M in Proposition 56 funds) is specifically for Behavioral Health Integration. The program will be implemented for at least three years in the managed care delivery system, subject to funding approved in the final 2019 Budget. The implementation date will be July 1, 2019 for all measures including behavioral health integration measures; and January 1, 2020 for the Behavioral Health Integration Project Plan component.
When determining these measures, DHCS took into consideration several factors including: stakeholder and advocate comments, whether or not a measure aligned with other Department quality efforts; the number of impacted beneficiaries; and whether or not the measure could be run administratively, among others.
To address and consider health disparities, DHCS will pay an increased incentive amount for events tied to beneficiaries diagnosed as having a substance use disorder or serious mental illness, or who are homeless.
Please see the links to the supporting documentation for this program below. The program was authorized by CMS and the California State Legislature to operate from July 1, 2019 through June 30, 2022. The program spans the following rating periods: July 1, 2019 through December 31, 2020, Calendar Year(CY) 2021 (January 1, 2021 through December 31, 2021) and CY2022 (January 1, 2022 through December 2022).
The Proposition 56 – VBP Directed Payment program ended as of June 30, 2022 and is the only Proposition 56 Directed Payment program that ended. Note: Only the services specifically tied to Proposition 56 – VBP will no longer be eligible for a Directed Payment for dates of service after June 30, 2022.
Current Materials
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