PFNC Program Visión general​​ 

California Welfare and Institutions (W&I) Code §14105.965, enacted on August 2006, authorized the PFNC supplemental reimbursement program. This voluntary Certified Public Expenditure (CPE) based program provides additional funding to eligible governmental entities that provide Clinic services to Medi-Cal beneficiaries. Code of Federal Regulations §433.51 requires that an authorized representative of the contributing public agency certify that the expenditures of the governmental entity meet the eligibility requirements for federal financial participation (FFP). The Centers for Medicare and Medicaid Services (CMS) approved State Plan Amendment (SPA) 06-016 on August 8, 2012, authorizing the federal share of the supplemental reimbursement payments based on uncompensated costs for Medi-Cal fee-for-service Public Freestanding Non-hospital-based Clinics services . SPA 16-021 was approved by CMS on December 6, 2016, which makes technical revisions to update the clinic participation criteria in the relevant State Plan pages; specifically, those necessary to reflect hospital authorities that govern selected designated public hospitals.​​ 

PFNC Program Elegibilidad​​ 

To be eligible for the program, a PFNC provider must meet the following requirements, as specified in W&I Code §14105.965:​​ 

• Prestación de servicios a beneficiarios de Medi-Cal (definidos con más detalle en el SPA 06-016),​​ 
• Estar inscrito como proveedor de Medi-Cal durante el periodo que se reclama, y​​ 
• Be owned or operated by an eligible governmental entity, to include the state, a city, county, city and county, the University of California, health care district organized pursuant to Chapter 1 of Division 23 (commencing with Section 32000) of the Health and Safety Code, or hospital authority described in section 101850 or 101852, et seq. of the Health and Safety Code, as these laws were in effect as of July 1, 2016 (pursuant to SPA 16-021).​​ 
• Effective July 1, 2008, payment rules for State-owned and operated clinics are governed by the provisions set forth in SPA 08-014; therefore, effective July 1, 2008, such clinics are not eligible to receive supplemental reimbursement under the PFNC Program.​​ 

Los costes reclamados bajo el PFNC Program no han sido ni serán reclamados bajo ningún otro Program para obtener FFP. Los proveedores no pueden reclamar costes bajo el PFNC Program para ningún periodo de tiempo en el que estén reclamando, hayan reclamado, recibido reembolsos y/o participado en Programas aprobados por el Estado de California y/o CMS para los que estos costes hayan sido o vayan a ser utilizados para obtener FFP.​​ 

Los proveedores elegibles que decidan participar en el PFNC Program también deben cumplir lo siguiente:​​ 

• Celebrar un Acuerdo de Participación de Proveedores (APA) con Department of Health Care Services (DHCS)), y​​ 
• Acordar reembolsar al DHCS por sus costos administrativos asociados con la administración del programa PFNC.​​ 

Reembolso de PFNC​​ 

PFNC service providers eligible to participate in this program will receive supplemental reimbursement payments by completing a CMS approved cost report form annually. The supplemental reimbursement payment is based on claiming FFP on expenditures that have been incurred by the public provider and meet the requirements for a CPE. The supplemental reimbursement amount is determined by the methodology approved by CMS in SPA 06-016.​​ 

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Cómo ponerse en contacto con nosotros​​ 

As a public entity, if you would like to participate in the PFNC Program, or if you have any further questions, send inquiries to: PublicClinics@dhcs.ca.gov.​​