Article
7. Enhanced Clinically Integrated Program for Federally Qualified Health Centers
14199.70.
For purposes of this article, the following definitions apply:(a) “Enhanced Clinically Integrated Program” or “ECIP” means the supplemental payment program set forth in Section 14199.72.
(b) “Federally qualified health center” or “FQHC” means any community or public federally qualified health center, as defined in Section 1396d(l)(2)(B) of Title 42 of the United States Code,
including FQHC look-alikes.
(c) “Bona fide labor-management cooperation committee” or “bona fide LMCC” means a joint labor-management committee established pursuant to the federal Labor Management Cooperation Act of 1978 (29 U.S.C. Sec. 175a). For purposes of this article, a bona fide LMCC is not involved in the governance of an FQHC but exists to promote worker training, workforce expansion, and support for workers during training. A bona fide LMCC has the following composition:
(1) Fifty percent of the committee consists of representatives of organized labor unions that represent health center workers in the state.
(2) The other 50 percent of the committee consists of representatives of FQHCs
located in the state.
(d) “Participating FQHC” means an FQHC participating in ECIP at one or more of the FQHC’s sites.
(e) “Health center worker” means an employee of an FQHC who provides direct patient care and services directly supporting patient care, including clinicians, clinical support staff, custodial workers, and nonmanagerial administrative staff.
14199.71.
The Legislature finds and declares all of the following:(a) California has successfully expanded Medi-Cal to cover approximately 14 million residents, roughly one-third of the state’s population. However, for the state to fully deliver on its promise of universal access to quality care, the health care safety net must be fully funded. Access to quality care requires building provider capacity through investment in both the clinical and nonclinical workforce.
(b) With approximately one-third of the state’s population receiving health care services through Medi-Cal, it is imperative that patient-centered innovations
drive Medi-Cal reforms.
(c) The federal Patient Protection and Affordable Care Act (Public Law 111-148) made a significant investment in federally qualified health centers (FQHCs) to incentivize upfront health care services that prevent longer term avoidable high-cost services.
(d) FQHCs are fundamental to the California health care safety net, as their mission is to provide primary and preventive care to low-income and underserved populations.
(e) However, hiring and retaining staff remain among the largest challenges for FQHCs due to a variety of factors, including low wages, difficult working conditions, high workloads, and lack of resources for training.
(f) FQHCs are under-resourced compared to providers that operate outside of the safety net due to FQHCs’ lower reimbursements and per-visit payments, as well as the fact that FQHCs serve medically underserved populations, are required to provide a schedule of discounts adjusted on the basis of the patient’s ability to pay, are underresourced compared to providers that operate outside of the safety net, and provide more unreimbursed services than other health care providers. FQHCs are further weakened postpandemic due to the uneven distribution of bailout funds, which favored large health care systems and providers that served fewer Medi-Cal patients.
(g) A well-resourced
enhanced clinical model can increase patient access to quality care by expanding access to specialists, health care providers providing direct patient care, investing in workforce training and support, and improving capital funding to help clinics grow and meet community needs.
(h) This article would create a supplemental payment program for private and public FQHCs, including FQHC look-alikes, for the specific purpose of alleviating workforce shortages in both the short term and the long term, including investing in training the future workforce.
(i) Increasing wages and salaries will also help to attract and retain much-needed qualified health care workers, in particular registered nurses, licensed vocational nurses, licensed clinical social workers, licensed mental health workers, medical assistants, and advanced practice professionals, while opening new positions will lower caseloads that contribute to turnover and burnout and allow clinics to see more patients.
(j) It is the intent of the Legislature that this article support the creation of FQHC labor-management cooperation committees (LMCCs) to help meet staffing needs. LMCCs can engage in activities to grow the workforce, including training, upgrading skills, and educational activities.
14199.72.
(a) The department shall authorize a new supplemental payment program for FQHCs pursuant to Section 1396a(bb)(6) of Title 42 of the United States Code, or, pursuant to the department’s discretion, another type of payment program that the department determines will best meet the clinical and financial goals of ECIP and is permissible under federal law. If federal financial participation is not sought or is not obtained, the department shall implement the new payment program using state-only funds.(b) The new program shall be known, and may be cited, as the Enhanced Clinically Integrated Program (ECIP).
(c) ECIP funding shall be subject to an appropriation by the Legislature through the annual Budget Act or any other legislation for purposes of this article. The department shall request an amount, as necessary to fund, implement, and maintain ECIP at sufficient capacity, on an ongoing basis in future fiscal years.
(d) Participation in ECIP shall be optional for FQHCs.
(e) Funding provided pursuant to ECIP shall be provided in addition to all other funding received by FQHCs, including through the prospective payment system (PPS), any other payment methodology adopted pursuant to Section 1396a(bb)(6) of Title 42 of the United States Code, or any other supplemental payment program.
Participation in ECIP shall result in total payments to participating FQHCs that are greater than the PPS rate otherwise required to be paid to the FQHC.
(f) (1) If the department seeks federal financial participation for ECIP in the first year after the effective date of this article, it shall apply for federal approval no later than February 1, 2023, or else it shall provide public notice by that date that it intends to implement the new payment program using state-only funds. The department may seek federal financial participation for ECIP at any time in subsequent years.
(2) To the extent the department does not seek federal financial participation for any portion of ECIP or for the entirety of ECIP, the department shall fund the program
through solely state funds, subject to an appropriation as described in subdivision (c).
(3) The department may choose to implement this article as a state-only funded program from the outset, in which case the department shall implement the program as necessary to best meet the clinical and financial goals of ECIP and as permissible under federal law.
(g) Payments received by participating FQHCs pursuant to this section shall be considered separate and apart from the prospective payment system (PPS) methodology set forth in Section 14132.100 and Section 1396a(bb) of Title 42 of the United States Code and shall not be subject to adjustment during annual reconciliation of the PPS rate.
(h) Subject to an appropriation as
described in subdivision (c), no later than July 1, 2023, the department shall make funding available for the purpose of direct compensation of health center workers.
(i) ECIP shall improve quality and access to care by allocating funds, if appropriated, to FQHCs that meet both of the following standards for program participation:
(1) Commitment to ensuring that all health center workers are paid a minimum wage equivalent to at least twenty-five dollars ($25) per hour within three months of receiving supplemental funding, whether the worker is compensated by a fixed amount, such as a salary, or receives wages based on a standard of time, task, piece, commission basis, or another
method of calculation.
(2) Commitment to participation in a bona fide LMCC. FQHCs that participate in a bona fide LMCC and receive supplemental payments pursuant to ECIP shall enter into memoranda of understanding with the department requiring FQHCs to fund the bona fide LMCC for the purposes described in paragraph (2) of subdivision (j).
(j) Funds, if appropriated, shall be distributed to participating FQHCs as follows:
(1) Eighty percent shall be allocated to FQHCs that seek to participate in ECIP for the purpose of improving patient access primarily by strengthening the workforce, through improved wages, benefits, and salaries,
addressing specialist physician health care providers providing direct patient care reimbursement, reimbursement, and investing in clinic infrastructure and capacity. These funds shall be further broken down as follows:
(A) Up to 15 percent of the amount allocated pursuant to this paragraph may be used for the purposes of investing in capital needs, specialists health care providers providing direct patient care reimbursement or other contractor payments, information technology, or other physical infrastructure and capacity improvements.
(B) The balance of the amount allocated pursuant to this paragraph shall be used as follows:
(i) First, to ensure that all health center workers are paid the minimum wage required pursuant to subdivision (i).
(ii) Subsequently, to increase wages, salaries, or benefits for all other health center workers employed by the participating FQHC.
(C) FQHCs that access funding pursuant to this paragraph may use the funds to deliver services suited to their individual site needs, subject to the requirements of this paragraph.
(2) Twenty percent shall be allocated to FQHCs that participate in ECIP for
purposes of training workers and financially supporting workers as they train through a bona fide LMCC.
(k) If federal financial participation is sought, the department shall have discretion to modify the terms of ECIP if necessary to obtain federal approval so long as the modifications further the goals of increasing FQHC workforce compensation particularly for lower-paid workers and furthering the creation of and participation in bona fide LMCCs for FQHC worker education and training.
(l) Nothing in this article shall be construed to limit or eliminate services provided by FQHCs as covered benefits in the Medi-Cal program.
14199.73.
The department shall notify each FQHC in the state about ECIP and shall invite each FQHC in the state to apply for participation in ECIP with respect to one or more of the FQHC’s sites.14199.74.
The department shall develop all of the following, consistent with federal law:(a) The eligibility criteria to be used in evaluating applications from interested FQHCs that voluntarily elect to participate in the pilot project. The criteria shall be designed to ensure that participating FQHCs meet all of the following:
(1) Demonstrate that funds are used for training, retention, and growth of the clinic workforce using appropriate measures.
(2) Demonstrate improvements in quality and access to care using department-approved metrics.
(3) Demonstrate ability to collect and submit patient encounter data in a form and manner that satisfies department requirements, including utilizing the most recent current procedural terminology (CPT) codes.
(4) Demonstrate compliance with local, state, and federal workplace health and safety rules and regulations.
(5) Accomplish the purposes of ECIP through such other appropriate means as the department determines.
(b) A process for applying for, and distributing, supplemental funds, including the criteria for allocating funds among applicants.
(c) Reporting requirements for use of funds.
(d) A methodology for adjusting funding allocations based on health care inflation.
14199.75.
Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this article by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions, until any necessary regulations are adopted.14199.76.
The provisions of this article are severable. If any provision of this article or its application is held invalid, that invalidity shall not affect other provisions or applications that can be given effect without the invalid provision or application.