Physician Non-Physician Practitioner Supplemental Reimbursement Program
PNPP Program Overview
Physician Non-Physician Practitioner Supplemental Reimbursement Program (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, effective July 1, 2016, and 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.
SPA 24-0026, effective April 1, 2024, and approved by CMS on December 16, 2024, supersedes SPAs 05-023 and 16-020 with technical edits to the supplemental payment methodology for the cost of governmental outpatient hospitals' professional services.
State Plan Attachment 4.19-B, pages 52-63 (SPAs 05-023, 16-020, and 24-0026) 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:
University of California (UC) setting (physician practitioners)
UC setting (non-physician practitioners)
Non-UC setting (non-physician practitioners)
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 in Appendix 1 of Attachment 4.19-A of the State Plan, 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.
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 State Plan Attachment 4.19-B, pages 52-63 (SPAs 05-023, 16-020, and 24-0026) and the Time Study Implementation Plan.
How To Contact Us
Links
California State Plan Attachment 4.19-B, pages 52-63 (SPAs 05-023, 16-020, and 24-0026)
Time Study Implementation Plan