Огляд програми PFNC​​ 

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.​​ 

Право на участь у програмі PFNC​​ 

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

• Надавали послуги бенефіціарам програми Medi-Cal (більш детально визначено в Угоді 06-016),​​ 
• Бути зареєстрованим в якості постачальника послуг Medi-Cal на період, на який подається заява, та​​ 
• 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.​​ 

Витрати, заявлені в рамках Програми PFNC, не були і не будуть заявлені в рамках жодної іншої програми для отримання FFP. Постачальники не можуть вимагати відшкодування витрат за програмою PFNC за будь-який період часу, в якому вони вимагають, вимагали, отримали відшкодування та/або брали участь у програмах, затверджених штатом Каліфорнія та/або CMS, за якими ці витрати були або будуть використані для отримання FFP.​​ 

Постачальники, які вирішили взяти участь у Програмі PFNC, повинні також дотримуватися наступних вимог:​​ 

• Укласти угоду про участь постачальника послуг (Provider Participation Agreement, PPA) з Департаментом медичних послуг (Department of Health Care Services, DHCS) та​​ 
• Погодитися відшкодувати DHCS адміністративні витрати, пов'язані з управлінням програмою PFNC.​​ 

Відшкодування PFNC​​ 

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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Як з нами зв'язатися​​ 

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.​​