PFNC 프로그램 개요​​ 

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 프로그램 자격​​ 

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

• Medi-Cal 수혜자에게 서비스 제공( SPA 06-016에 추가 정의됨),​​ 
• 청구 기간 동안 Medi-Cal 제공자로 등록되어 있어야 합니다.​​ 
• 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 프로그램에 따라 청구된 비용은 FFP를 획득하기 위한 다른 프로그램에 따라 청구되지 않았으며 앞으로도 청구되지 않을 것입니다. 제공자는 캘리포니아 주 및/또는 CMS가 승인한 프로그램에 참여하여 해당 비용을 청구했거나, 청구했거나, 환급을 받았거나, 해당 비용이 FFP 획득에 사용되었거나 사용될 기간에 대해서는 PFNC 프로그램에 따른 비용을 청구할 수 없습니다.​​ 

PFNC 프로그램에 참여하기로 선택한 적격 제공업체는 다음 사항도 준수해야 합니다:​​ 

• 제공자 참여 계약(PPA)을 Department of Health Care Services (DHCS))과 체결합니다.​​ 
• PFNC 프로그램 관리와 관련된 관리 비용을 DHCS에 상환하는 데 동의합니다.​​ 

PFNC 환급​​ 

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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문의 방법​​ 

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.​​