California Welfare and Institutions Code

§ 14138.15

WIC § 14138.15 Effective Jun 30, 2022Div. 9 · Part 3 · Ch. 7 · Art. 4.1

Statute text

(a)A principal health plan shall be compensated by the department for the APM scope of services provided to its APM enrollees pursuant to this section.

(b)For each principal health plan that contains at least one participating FQHC in its provider network, the department shall determine an APM supplemental capitation amount for each APM aid category to be paid by the department to the principal health plan, which shall be expressed as a PMPM amount. This supplemental capitation amount will be in addition to the funding for the APM scope of services already contained in the principal health plan’s capitated rates paid by the department and shall be actuarially sound in accordance with Section 438.4 of Title 42 of the Code of Federal Regulations. The department shall determine the APM supplemental capitation amount for each APM aid category, taking into account all of the following factors:

(1)The clinic-specific PMPM amounts for each participating FQHC in the plan’s network.

…

Legislative history

Amended by Stats. 2022, Ch. 47, Sec. 112. (SB 184) Effective June 30, 2022.