Proposition 56 supplemental payments

 

In November 2016, voters approved the California Healthcare, Research and Prevention Tobacco Tax Act (known as Proposition 56) which increased the excise tax rate on cigarettes and tobacco products. As a result, Assembly Bill No.120 was passed in 2017 to appropriate Proposition 56 funds for specified Department of Health Care Services (DHCS) healthcare expenditures.

Since 2017, DHCS has issued several All Plan Letters (APLs) to govern the distribution of Proposition 56 funds, mainly as supplemental payments to providers and facilities. Each APL contains specific information regarding covered services, program effective dates, funding amounts, qualification requirements, and guidelines for these payments.

APL 19-013 (PDF, 73 KB)
Proposition 56 Hyde reimbursement requirements for specified services
APL 19-015 (PDF, 98 KB)
Proposition 56 directed payments for physician services (supersedes APL 19-006)
APL 19-016 (PDF, 93 KB)
Proposition 56 directed Payments for developmental screening services
APL 19-018 (PDF, 91 KB)
Proposition 56 directed payments for adverse childhood experiences screening services
APL 20-014 (PDF, 151 KB)
Proposition 56 value-based payment program directed payments
APL 22-011 (PDF, 244 KB)
Proposition 56 directed payments for family planning services (supersedes APL 20-013)

Frequently asked questions

 

What provider types are eligible for Proposition 56 supplemental payments?

Any professional provider who is eligible to bill for the applicable services included in any of the APLs governing Proposition 56 funds is eligible for supplemental payments.


 
Which service settings are excluded from Proposition 56 supplemental payments?

In general, services rendered in the following settings are excluded from Proposition 56 supplemental payments: Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs), Cost Based Reimbursement Clinics (CBRCs), and Indian Heath Setting (IHS). 


 
What is the effective date or period for Proposition 56 supplemental payments?

The effective dates and periods for Proposition 56 payments vary, depending on the APL governing their distribution.


 
What are the eligible (qualified) procedure codes and corresponding supplemental payment amounts?

The eligible (qualified) procedure codes and corresponding supplemental payment amounts vary based on the specific guidelines for each APL.


 

Additional information

 Proposition 56 provider notification (PDF, 1224 KB)
 

Contact us

  Email: Prop56Inquiries@blueshieldca.com

Provider dispute resolution policy and procedures

Communicate your questions and concerns to Blue Shield Promise and learn how to appeal or dispute a claim payment.

Review our provider dispute resolution process

All Plan Letter summaries

See what guidelines and requirements have been posted in the latest Department of Health Care Services All Plan Letters (APLs).

Learn about APLs

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