Federally Qualified Health Centers (FQHC)
Alternative Payment Methodology (APM) Pilot
California State Senate Bill (SB) 147 (Chapter 760, Statutes of 2015) authorized a three-year APM pilot program for county and community-based FQHCs willing to participate in the pilot program. SB 147’s purpose is to incentivize delivery system and practice transformation at FQHCs through flexibilities available under a capitated model which would move the clinics away from the traditional volume-based, PPS, to a payment methodology that better aligns the evolving financing and delivery of health services. The proposed APM structure provides participating FQHCs the flexibility to deliver care in the most effective manner, without having to worry about the more restrictive traditional billing structure that is in place today. With the flexibility of payment reform, FQHCs will begin to provide and/or expand upon the innovative forms of care which are not reimbursed under traditional volume-based PPS.
Examples of non-traditional services could include but are not limited to:
- integrated primary and behavioral health visits on the same day,
- group visits,
- email visits,
- phone visits,
- community health worker contacts,
- case management, and
- care coordination across systems.
DHCS has an implementation target no sooner than January 1, 2018 for the proposed pilot.
