Physician Non-Physician Practitioner (PNPP) Supplemental Reimbursement Program
PNPP Program Overview
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, 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.
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 below, 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.
| Government-Operated Hospitals: Alameda County Medical Center
Alameda Hospital (DPH date July 1, 2016)
Arrowhead Regional Medical Center
Contra Costa Regional Medical Center
Kern Medical Center
Natividad Medical Center
Riverside University Health System - Medical Center
San Francisco General Hospital
San Joaquin General Hospital
San Leandro Hospital (DPH date July 1, 2016)
San Mateo County General Hospital
Santa Clara Valley Medical Center
Tuolumne General Hospital (Closed June 2007)
Ventura County Medical Center |
Los Angeles County (LA Co.) Hospitals: LA Co. Harbor/UCLA Medical Center
LA Co. Martin Luther King Jr. /Drew Medical Center (Closed August 2007)
LA Co. Olive View Medical Center
LA Co. Rancho Los Amigos National Rehabilitation Center
LA Co. University of Southern California Medical Center
State Government-Operated UC Hospitals:
UC Davis Medical Center
UC Irvine Medical Center
UC San Diego Medical Center
UC San Francisco Medical Center
UC Los Angeles Medical Center
Santa Monica UCLA Medical Center (aka - Santa Monica UCLA Medical Center & Orthopedic Hospital) |
PNPP Reimbursement
How To Contact Us
Links
California State Plan, Attachment 4.19-B, pages 52-63 (SPA 05-023 and SPA 16-020)
Time Study Implementation Plan
PPL 14-001