PFNCプログラムの概要​​ 

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プログラム参加資格​​ 

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

• Medi-Calの受益者( SPA 06-016で詳細に定義)に提供されるサービス、​​ 
• 請求されている期間のMedi-Calプロバイダーとして登録され、​​ 
• 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.​​ 

PFNCプログラムに基づいて請求される費用は、FFPを取得するための他のプログラムの下で請求されておらず、今後も請求されません。プロバイダーは、FFPの取得にこれらの費用が使用された、または使用されるカリフォルニア州および/またはCMSによって承認されたプログラムを請求している、請求した、払い戻しを受けた、および/またはプログラムに参加した期間、PFNCプログラムに基づく費用を請求することはできません。​​ 

PFNCプログラムへの参加を選択した適格プロバイダーは、以下も遵守する必要があります。​​ 

• 医療サービス省(DHCS)とプロバイダー参加契約(PPA)を締結し、​​ 
• PFNCプログラムの運営に関連する管理費をDHCSに払い戻すことに同意する。​​ 

PFNCの償還​​ 

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.​​ 

Subscribe To Our Email Service (LISTSERV)​​ 

Subscribe/Unsubscribe here if you wish to be added or removed from our email service.​​ 

当社への連絡方法​​ 

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.​​