Proposition 56 Supplemental Payments

Proposition 56 was passed in 2016 to support access to health care for low-income Californians covered by the Medi-Cal program.

Known as the California Healthcare Research and Prevention Tobacco Tax Act, Prop. 56 raised the tax rate on cigarettes and other tobacco products to fund specific Department of Health Care Services (DHCS) health car​e programs.

These programs include supplemental payments for:

  • physician and dental services
  • the Family Planning, Access, Care and Treatment (FPACT) program
  • the Value-Based Payment (VBP) Program
  • developmental screenings for children
  • Adverse Childhood Experiences (ACEs) trauma screenings
  • medical abortions 

Learn more from L.A. Care's Proposition 56 Funding & Payments Webinar.

The Six Prop. 56 Programs

View specific claim information and timelines for each program.

Content CTA: 
APL19-015 Physician Services

Program

Supplemental payments for specified physician services, such as outpatient visits, psychiatric diagnostic evaluations, pharmacologic management and comprehensive preventive medicine evaluation & management.

Read the DHCS All Plan Letter for details.

Payments

Timeframe: Payments will be made quarterly, within 90 days of receipt of a qualifying clean claim or accepted encounter, if the following claims and encounter submission requirements are met:

DOS on or after: 7/1/2019

Clean Claim or Accepted Encounter Received:  Within 180 days of DOS. Please note that the terms of your L.A. Care contract apply (within 180 days of DOS).

APL20-013 Family Planning Services

Program

Supplemental payments for specified family planning services, such as long acting reversible contraceptives (LARCs), other contraceptives (other than oral) when provided as a medical benefit, emergency contraceptives, pregnancy testing, and sterilization (male and female).

Read the DHCS All Plan Letter for details.

Payments

Timeframe: Payments will be made quarterly, within 90 days of receipt of a qualifying clean claim or accepted encounter, if the following claims and encounter submission requirements are met:

DOS on or after: 7/1/2019

Clean Claim or Accepted Encounter Received:  Within 180 days of DOS. Please note that the terms of your L.A. Care contract apply (within 180 days of DOS).

APL20-014 Value-Based Payment Program

Program

Supplemental payments for specified VBP services, which are tied to quality measures in the domains of:

  • Prenatal/Postpartum Care
  • Early Childhood Prevention 
  • Chronic Disease Management
  • Behavioral Health Integration

Read the DHCS All Plan Letter for details.

View L.A. Care's VBP Measure Grid.

Learn more about DHCS VBP Program Measures.

Payments

Timeframe: Payments will be made quarterly, within 90 days of receipt of a qualifying clean claim or accepted encounter, if the following claims and encounter submission requirements are met:

DOS on or after: 7/1/2019

Clean Claim or Accepted Encounter Received:  Within 180 days of DOS. Please note that the terms of your L.A. Care contract apply (within 180 days of DOS).

APL19-016 Developmental Screening Services

Program

Supplemental payments for developmental screenings provided in accordance with AAP/Bright Futures guidelines.

View L.A. Care's Developmental Screenings Flyer for eligibility and requirements.

Read the DHCS All Plan Letter for program details.

Payments

Timeframe: Payments will be made quarterly, within 90 days of receipt of a qualifying clean claim or accepted encounter, if the following claims and encounter submission requirements are met:

DOS on or after: 1/1/2020

Clean Claim or Accepted Encounter Received:  Within 180 days of DOS. Please note that the terms of your L.A. Care contract apply (within 180 days of DOS).

APL19-018 Adverse Childhood Experiences Screening Services (ACEs)

Program

Supplemental payments for ACEs Trauma Screenings provided using the appropriate PEARLS tool or a qualifying ACEs questionnaire.

Read the DHCS All Plan Letter for details.

Learn more about the Becoming ACEs Aware training required for reimbursement.

Payments

Timeframe: Payments will be made quarterly, within 90 days of receipt of a qualifying clean claim or accepted encounter, if the following claims and encounter submission requirements are met:

DOS on or after: 1/1/2020

Clean Claim or Accepted Encounter Received:  Within 180 days of DOS. Please note that the terms of your L.A. Care contract apply (within 180 days of DOS).

APL19-013 Hyde Reimbursements for Medical Pregnancy Termination Services

Program

Supplemental payments for medical pregnancy termination (abortion) services.

Read the DHCS All Plan Letter for details.

Payments

Timeframe: Payments will be made quarterly, within 90 days of receipt of a qualifying clean claim or accepted encounter, if the following claims and encounter submission requirements are met:

DOS on or after: 7/1/2017

Clean Claim or Accepted Encounter Received:  Within 180 days of DOS. Please note that the terms of your L.A. Care contract apply (within 180 days of DOS).