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Physician Non-Physician Practitioner (PNPP) Supplemental Reimbursement Program

PNPP Program Overview

PNPP is a Certified Public Expenditure (CPE) program, which provides supplemental reimbursement to eligible government-operated hospitals or government entities, with which they are affiliated, for the uncompensated Medicaid costs of providing physician and non-physician practitioner professional services to Medicaid beneficiaries.  
The California State Plan Amendment (SPA) No. 05-023, effective July 1, 2005, and approved by Centers for Medicare & Medicaid Services (CMS) on December 21, 2007, describes a supplemental reimbursement methodology for physician and non-physician practitioner professional costs.
SPA 16-020, approved by CMS on December 6, 2016, updated the State Plan language to reflect the current names of the Designated Public Hospital (DPH) participants and to account for any future hospital name changes.
State Plan, Attachment 4.19-B, pages 52-63 (SPA 05-023 and SPA 16-020) outlines the general supplemental reimbursement requirements, the eligible DPHs, and the reimbursement methodology. The State Plan authorizes a Time Study Implementation Plan, which describes the time study methodology in further detail.
Time studies are required to account for 100% of provider clinical time of the following practitioners in the following settings including up to 4 separate cost pools:
  1. University of California (UC) setting (physician practitioners)
  2. UC setting (non-physician practitioners)
  3. Non-UC setting (non-physician practitioners)
  4. Non-UC setting (Medicare approved physician time studies)

PNPP Program Provider Eligibility

The physician and non-physician practitioner costs are limited to professional costs incurred by the DPHs listed below, including any successor or differently named hospital, as applicable, and their affiliated government physician practice groups (i.e., practice group that is owned and operated by the same government entity that owns and operates the hospital). These professional costs are reported on the DPHs' Medi-Cal 2552 cost report and, in the case of the UC hospitals, the UC School of Medicine physician/non-physician practitioner cost report as approved by CMS.

Government-Operated Hospitals:
Alameda County Medical Center
Alameda Hospital (DPH date July 1, 2016)
Arrowhead Regional Medical Center
Contra Costa Regional Medical Center
Kern Medical Center
Natividad Medical Center
Riverside University Health System - Medical Center
San Francisco General Hospital
San Joaquin General Hospital
San Leandro Hospital (DPH date July 1, 2016)
San Mateo County General Hospital
Santa Clara Valley Medical Center
Tuolumne General Hospital (Closed June 2007)
Ventura County Medical Center
Los Angeles County (LA Co.) Hospitals:
LA Co. Harbor/UCLA Medical Center
LA Co. Martin Luther King Jr. /Drew Medical Center (Closed August 2007)
LA Co. Olive View Medical Center
LA Co. Rancho Los Amigos National Rehabilitation Center
LA Co. University of Southern California Medical Center
 
State Government-Operated UC Hospitals:
UC Davis Medical Center
UC Irvine Medical Center
UC San Diego Medical Center
UC San Francisco Medical Center
UC Los Angeles Medical Center
Santa Monica UCLA Medical Center (aka - Santa Monica UCLA Medical Center & Orthopedic Hospital)
 

PNPP Reimbursement

PNPP supplemental payments approximate the difference between the Fee for Service (FFS) payment and the allowable Medicaid costs related to the professional component of physician or non-physician practitioner services eligible for Federal Financial Participation (FFP). PNPP supplemental payments are made on an annual basis as detailed in Attachment 4.19-B, pages 52-63 (SPA 05-023 and SPA 16-020) and the Time Study Implementation Plan.

How To Contact Us

If you have any further questions, send inquiries to: PNPP@dhcs.ca.gov

Links

California State Plan, Attachment 4.19-B, pages 52-63 (SPA 05-023 and SPA 16-020)

Time Study Implementation Plan

PPL 14-001

Last modified on: 6/1/2017 10:32 AM