CA AB2428

Primary care clinics with additional physical plants added to their license under consolidated licenses or prior to January 1, 2017 are exempt from separate enrollment requirements in Medi-Cal if the clinic notifies the department of the additional physical plant.

FQHCs and RHCs adding a new licensed location to an existing primary care license may elect to have either separate reimbursement rates for the new location or one unified prospective payment system rate for all locations on the license.

If FQHCs or RHCs choose a unified rate for multiple locations, they must submit a change in scope of service request within 90 days after their first full fiscal year, with the rate calculated based on combined costs and visits of all locations.

Specialized services (pharmacy, dental, Drug Medi-Cal, and specialty mental health) may be reimbursed separately outside the per-visit rate if costs are adjusted out through scope-of-service change requests.

The bill requires the State Department of Health Care Services to seek federal approvals and state plan amendments to implement these provisions, with implementation contingent on federal financial participation.