This issue brief provides an analysis of the fiscal impact in California of same-day billing for medical and mental health services in Federally Qualified Health Centers (FQHCs).
FQHCs are paid by Medi-Cal under the Prospective Payment System (PPS). In California, each licensed clinical site (clinic site) has its own PPS rate, with a fixed per-visit dollar amount payment rate for qualifying visits. These rates are increased by the Medicare Economic Index (MEI) each year. FQHCs may also apply for a rate change through the Medi-Cal Change in Scope-of-Service Request process.
Currently, while FQHCs may render both medical and mental health services on the same day to Medi-Cal patients, they cannot be reimbursed for both visits. California has considered several proposals to allow FQHCs to bill a medical visit and a mental health visit that take place on the same day at a single location as separate visits, referred to as “same-day billing.”
The analysis that follows estimates the impact of a policy change to allow same-day billing both without (Scenario 1) and with (Scenario 2) a requirement that FQHCs apply for a change in scope in order to have the option of billing for same-day visits for mental health. The analysis is not specific to a particular current or past proposal. The analysis provides an estimate of the annual impact of the two scenarios on both Medi-Cal mental health visits and Medi-Cal reimbursement costs.