公平与实践转型支付Program
The Department of Health Care Services (DHCS) is implementing a one-time $140 million* Equity and Practice Transformation (EPT) Program for primary care practices to advance population health and heath equity by working on up-stream care models, improving quality of care, value-based payment models, and practice transformation. These efforts aligned with value-based payment models will allow Medi-Cal providers to better serve the state’s diverse Medi-Cal member population. To align with the goals of the DHCS Comprehensive Quality and Strategy and Health Equity Roadmap and “50 by 2025: Bold Goals” Initiative, these funds incentivize delivery system transformation in primary care practices (pediatrics, family practice, adult medicine primary care, primary care OB/GYN, and behavioral health providers in primary care settings) and prepare them to participate in value-based payment contracting. These funds are allocated to three components throughout the phases of the program year(s) described below.
*EPT 的最初版本总共获得了 7 亿美元的资金。在California州 2024-2025 财年的最终预算中，拨款金额减少至 1.4 亿美元。
Medi-Cal 管理式护理计划 (MCP) 初始医疗服务提供者计划奖励付款
$ 25 million (12.5 million General Fund) incentivized MCPs to identify and work with small-to medium-sized independent practices in 2023 using a standardized assessment PhmCAT to support these practices as they developed practice transformation plans and applications to the larger EPT Provider Directed Payment Program.
EPT 提供商定向付款计划
$ 97 million ($48.5 million General Fund) over 3 years supports delivery system transformation, specifically targeting primary care practices that provide primary care pediatrics, family medicine, internal medicine, primary care OB/GYN services, or behavioral health services that are integrated in a primary care setting to Medi-Cal members.
共有 197 家诊所参与该Program ，根据分配的Medi-Cal患者人数和活动/里程碑的成功完成情况，有可能获得调整后的最高赔付。
The selection process for the Provider Directed Payment Program included two steps: (1) using a DHCS provided rubric, a review and points scoring (out of 90 total) of all applications by the MCP indicated in the practice’s application, and then (2) a DHCS review of applications recommended by the MCPs. Please see EPT Cohort 1 Selection Methodology for a detailed description of the selection process for practices.
Technical assistance and milestones focus on the following population health management (PHM) domains: access, empanelment, data to enable PHM, care delivery model (includes mental health, social health, and care delivery for populations of focus), value-based payment, and key performance indicators. Please see The Population Health Learning Center for more on milestones.
付款结构包括以下内容：
- 总潜在付款 = 指定的 Medi-Cal 成员（从 2024 年 11 月起）× PMPY 乘数。
- 每个里程碑付款 = 总潜在付款 ÷ 23 或 25 个里程碑（取决于有多少个里程碑与实践相关）。
实际付款场景示例：
- Assigned members for primary care: 920
- Multiplier/add-on: $305
- Total Potential Practice Payment (Assigned member x multiplier): 920 x $305= $280,6000
- 每完成一个里程碑的付款（总潜在执业付款/25个里程碑）： 11,224美元
表 1.
| 班级 | 开始 | End | 每位会员金额 |
|---|---|---|---|
| 一个 | 1 | 500 | $ 580.00 |
| 乙 | 501 | 700 | $ 397.00 |
| 碳 | 701 | 850 | $ 349.00 |
| 德 | 851 | 1000 | $ 305.00 |
| 埃 | 1001 | 1200 | $ 300.00 |
| 弗 | 1201 | 1400 | $ 260.00 |
| 格 | 1401 | 1600 | 180.00 美元 |
| 赫 | 1601 | 1800 | $ 170.00 |
| 我 | 1801 | 2000 | $ 162.00 |
| J | 2001 | 2250 | $ 144.00 |
| 钾 | 2251 | 2500 | $ 146.00 |
| 大号 | 2501 | 2750 | $ 145.00 |
| 米 | 2751 | 3000 | $ 121.00 |
| 否 | 3001 | 3250 | $ 110.00 |
| 哦 | 3251 | 3500 | $ 106.00 |
| 磷 | 3501 | 4000 | $ 95.00 |
| 问 | 4001 | 4500 | $ 88.00 |
| R | 4501 | 5000 | $ 85.00 |
| 年代 | 5001 | 5500 | 79.00 美元 |
| 电视 | 5501 | 6000 | 77.00 美元 |
| 乌 | 6001 | 6500 | $ 61.50 |
| 五 | 6501 | 7000 | $ 50.25 |
| 西 | 7001 | 7500 | $ 59.00 |
| 十 | 7501 | 8000 | $ 53.00 |
| 是 | 8001 | 8500 | $ 49.50 |
| 是 | 8501 | 9000 | $ 50.50 |
| AA | 9001 | 9500 | $ 48.00 |
| BB | 9501 | 10000 | $ 46.00 |
| 抄送 | 10001 | 11500 | $ 40.50 |
| DD | 11501 | 13000 | $ 45.00 |
| 电子工程 | 13001 | 14500 | $ 33.30 |
| FF | 14501 | 16000 | $ 40.00 |
| GG | 16001 | 17500 | $ 38.00 |
| 赫赫 | 17501 | 20000 | $ 37.00 |
| 二 | 20001 | 22500 | $ 36.50 |
| JJ | 22501 | 25000 | $ 31.50 |
| 乐清 | 25001 | 27500 | $ 30.50 |
| LL | 27501 | 30000 | $ 28.50 |
| MM | 30001 | 35000 | $ 28.00 |
| NN | 35001 | 45000 | $ 26.00 |
| OO | 45001 | 55000 | $ 22.50 |
| PP | 55001 | 60000 | $ 28.50 |
| QQ | 60001 | 65000 | 23.00 美元 |
| RR | 65001 | 75000 | $ 22.00 |
| SS | 75001 | 90000 | $ 22.00 |
| TT | 90001 | 105000 | $ 21.00 |
| UU | 105001 | 120000 | 18.00 美元 |
| VV | 120001 | 138000 | 23.00 美元 |
This methodology applies to all EPT milestones. The EPT program is subject to annual approval by CMS and thus may be submit to changes. The EPT program is subject to future budgetary authorization and appropriation by the California Legislature and the necessary federal approvals of the directed payment arrangement.
注意：2024-2026 年的付款计算符合 2025 年 3 月发布的 CMS 指南，并基于 2024 年 11 月的 Medi-Cal 会员数量，不包括 D-SNP 会员（根据 CMS 的要求）。
人口健康学习中心
$ 18 million ($9 million General Fund) over 3 years funds the program office for the Provider Directed Payment Program. The program office will be monitoring and supporting implementation of practices’ transformation activities, sharing, and spreading of best practices, facilitating technical assistance for practices (through state and national partners), and support the achievement of the state’s quality and health equity goals. DHCS partners with the Population Health Learning Center to provide the Learning Collaborative and serve as the program office for the Provider Directed Payment Program.
资源
- EPT 常见问题解答
- 供应商定向付款计划申请说明
- 初级保健实践和 Medi-Cal 管理式医疗计划指南
- phmCAT 工具
- MCP 的 EPT 评分标准
- EPT 初始规划奖励支付流程
- 最终供应商定向付款计划类别和里程碑
计划政策和信息
联系我们
如有问题，请通过ept@dhcs.ca.gov 与我们联系。