Medi-Cal Proposition 35 Primary and Specialty Code List
Proposition 35 Stakeholder Feedback
The Department of Health Care Services (DHCS) is requesting an initial technical review of the Proposition 35 draft Primary and Specialty code list from stakeholders. As required by Proposition 35, DHCS will implement supplemental payments for Primary and Specialty services effective July 1, 2026.
The proposed supplemental payments will account for requirements under the Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) demonstration to achieve specified payment levels relative to Medicare for specified procedure code categories by December 31, 2026.
These rate increases will apply to eligible providers in the Medi-Cal Fee-For-Service delivery system, as well as eligible network providers contracted with Medi-Cal managed care plans.
DHCS is developing the code list and eligible provider criteria through a review of TRI codes, current utilization data by provider taxonomy, current Medi-Cal Base Rates relative to Medicare Rates, previous stakeholder feedback, and a review by DHCS’s Quality and Population Health Management (QPHM) Division. As stakeholders review the draft code list, DHCS asks that each organization consider the following questions:
- Are there particular codes that are higher priority, from your organization’s perspective?
- Are there codes that your organization would recommend removing?
- Does your organization have any general feedback on how DHCS can achieve the goals of Proposition 35?
- Would your organization recommend including other codes?
For each recommendation, please note how your organization’s recommendation may increase access to care for Medi-Cal members. Given fiscal and regulatory constraints, DHCS may not be able to provide Proposition 35 supplemental payments to all proposed codes.
Feedback Deadline: Friday, April 10th.
Please submit any feedback of the draft code list to the DHCS Proposition 35 Code List mailbox: P35CodeList Feedback@DHCS.ca.gov
Background
Assembly Bill (AB) 119 (Chapter 13, Statutes of 2023) authorized a Managed Care Organization (MCO) Provider Tax effective April 1, 2023, through December 31, 2026. Subject to federal approval, MCO tax revenues will be used to support the Medi-Cal program including, but not limited to, new targeted provider rate increases and other investments that advance access, quality, and equity for Medi-Cal members and promote provider participation in the Medi-Cal program.
California voters approved Proposition 35 at the November 5, 2024, General Election making permanent the MCO Tax, subject to continued federal approval, and dedicating the resulting revenues to specified Medi-Cal program purposes beginning in 2025.
The passage of Proposition 35 makes inoperative the additional provider payment increases and continuous coverage for children up to age five authorized by Senate Bill (SB) 159 (Chapter 40, Statutes of 2024), which would have been effective on January 1, 2025, or later. The passage of Proposition 35 does not impact the targeted provider rate increases which were implemented January 1, 2024.
Article 8 (commencing with Section 14199.129 of the Welfare & Institutions Code) of Proposition 35, creates the Protect Access to Healthcare Act Stakeholder Advisory Committee (PAHCA-SAC). The sole purpose of the PAHCA-SAC is to research and analyze approaches and best practices for the development and implementation of components of Proposition 35, including:
- Providing advice and written recommendations to DHCS;
- Preparing reports for submission to DHCS (as needed)
Under Proposition 35, MCO tax revenues are deposited in the Protect Access to Health Care Fund and cannot be used for any purposes other than those specified.
Contact DHCS
Questions or comments can be submitted to the DHCS Proposition 35 Code List mailbox: P35CodeListFeedback@dhcs.ca.gov