Proposition 56-directed payments for private services

Background

On November 8, 2016, California voters approved Proposition 56 to increase the excise tax rate on cigarettes and tobacco products. Under Proposition 56, a portion of the tobacco tax revenue is allocated to the Department of Health Care Services (DHCS) for the purposes of funding specified expenditures, including increased funding for existing healthcare programs.

A portion of these appropriations are used for rate increases for state-supported medical pregnancy termination services in the Medi-Cal Managed Care program to fund the reimbursement requirements outlined below. Subject to future appropriation of funds by the California Legislature, DHCS intends to continue this directed payment arrangement on an annual basis for the duration of the program.

Update

The Proposition 56-directed payments for private services program will pay the individual rendering care providers that are qualified to provide and bill for medical pregnancy termination services with dates of service on or after July 1, 2017.

The measures eligible for directed payments and the corresponding amounts for qualifying services are listed below:

Note: Ongoing means the directed payment is in effect, subject to future budgetary authorization and appropriation by the California Legislature, until discontinued by DHCS via an amendment.

How will we process payments?

Care providers will receive monthly checks via mail along with remittance advice.

How will I receive my payment?

Care providers will receive payments directly via a direct-to-provider payment process from Anthem Blue Cross (Anthem). Independent physician associations will not receive supplemental payments. If you would like to receive line-level detail for the payments, send an email to prop56@anthem.com and we will send you a secure detail file within two weeks of receipt of your email. Please provide the following information:

• Billing tax ID(s)
• Provider name
• Check number
• Contact name
• Contact phone number
• Secure email address

Whom may I contact with questions or concerns?

Anthem has set up an email address specifically for Proposition 56-related questions, prop56@anthem.com.

How do I file a provider grievance?

Care providers may file grievances up to 180 calendar days from the date the provider becomes aware of the issue by:

• Calling the Medi-Cal Customer Care Center at 800-407-4627 (outside L.A. County) and 888-285-7801 (inside L.A. County).
• Visiting the provider website at https://mediproviders.anthem.com/ca/pages/forms.aspx.
• Faxing to the Grievance and Appeals department at 866-387-2968.
• Mailing to:
  Anthem Blue Cross
  Grievance and Appeals Department
  P.O. Box 60007
  Los Angeles, CA 90060-0007

Through our efforts, we are committed to reducing administrative burden and ensuring timely payments because we value you, our care provider partner. 

Contact us

Availity* Chat with Payer is available during normal business hours. Get answers to your questions about eligibility, benefits, authorizations, claims status, and more. To access Availity Essentials, go to Availity.com and select the appropriate payer space tile from the drop-down. Then, select Chat with Payer and complete the pre-chat form to start your chat.

For additional support, visit the Contact Us section at the bottom of our provider website for the appropriate contact.