Important Notice
DHCS has ended its Proposition 56 – Value-Based Payment (VBP) Program effective June 30, 2022. Accordingly, L.A. Care will only issue supplemental payments for dates of service through this date.
All other Prop 56 programs are continuing and not affected at this time, including supplemental payments for: specified physician and dental services, the Family Planning, Access, Care and Treatment (FPACT) program, developmental screenings for children, Adverse Childhood Experiences (ACEs) trauma screenings, and medical abortions.
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 care programs.
These programs include supplemental payments for:
- physician and dental services
- the Family Planning, Access, Care and Treatment (FPACT) 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 Five Prop. 56 Programs
View specific claim information and timelines for each program.
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 Claims or Accepted Encounters: Please note that the terms of your contract with your IPA (or L.A. Care for the Direct Network) apply with regards to timeliness.
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 Claims or Accepted Encounters: Please note that the terms of your contract with your IPA (or L.A. Care for the Direct Network) apply with regards to timeliness.
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 Claims or Accepted Encounters: Please note that the terms of your contract with your IPA (or L.A. Care for the Direct Network) apply with regards to timeliness.
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 Claims or Accepted Encounters: Please note that the terms of your contract with your IPA (or L.A. Care for the Direct Network) apply with regards to timeliness.
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 Claims or Accepted Encounters: Please note that the terms of your contract with your IPA (or L.A. Care for the Direct Network) apply with regards to timeliness.
WE'RE HERE TO HELP
Please contact us if you have questions or need assistance with the Prop. 56 Program.