HCOLA PPS Quiz

The term “Community Health Centers” can refer to any of the following (select all that apply):

• FQHCs

• FQHC Lookalikes

• RHCs

• Free Clinics

• Community Clinics

All licensed primary care clinics in California are reimbursed through a PPS rate.

• True

• False

A PPS rate is calculated by taking a site’s total allowable costs, and dividing those by:

• How many total sites the organization has

• How many total visits the site has.

• How many months A&I takes to adjudicate the audit

• The amount of billable providers within the organization

A change in scope of services request (CSOSR):

• Is the process a health center must go through to change a PPS rate that has already been set.

• Typically takes 4-6 months from filing of request to issuing of final rate.

• Includes a 30% final rate reduction, or “haircut”.

• Is a fun and educational process with clear guidelines.

The annual reconciliation:

• Is the process where a health center site’s total annual Medi-Cal visits and payments are adjusted to match the site’s current PPS rate.

• Is the process where a health center’s PPS rate is “trued-up” to their actual costs for providing services.

• Occurs annually on the health center’s anniversary date.

• Is a yearly celebration where health centers and A&I come together to recognize their shared goal of providing excellent health care to all Californians.

PPS rules are clearly defined in statute and DHCS provides regular provider training to ensure FQHCs and RHCs understand the payment environment within Medi-Cal.

• True

• False

As long as a health center maintains proper documentation and provides it to A&I, all allowable costs are included in the PPS rate.

• True

• False

CPCA’s role in supporting members specific to PPS includes (select all that apply):

• Advocating to DHCS for clearer guidelines around PPS, and documentation and training for providers on same.

• Hands-on support in filling out a change in scope of services request.

• Working with consultants who specialize in PPS to bring training and education opportunities to members.

• Coordinating site visits for our State partners to better understand how health centers serve Medi-Cal beneficiaries.