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Proposition 56 & GEMT

Proposition 56

Prop 56 Directed Payment for Physician Services sunset December 31, 2023. IEHP continued to make these payments through Calendar Year 2024 dates of services while implementing the DHCS Provider Targeted Rate Increase (TRI). For more information about TRI, please click here.

Proposition 56 Payment Dispute Process

For Prop 56 paid claims or encounter disputes, providers can submit either dispute by using the documents below and emailing the completed forms to Prop56Inquiry@iehp.org or fax to (909) 296-3550.
 
Providers can also check the status of a Prop 56 dispute by emailing Prop56Inquiry@iehp.org to request a status update. 
 

Proposition 56 and GEMT Payment Schedule

Electronic Payments

To minimize any disruption or delay in payment, we recommend that you sign up for electronic payments as soon as possible if you have not done so already. Our team is available to assist you with the necessary paperwork required to make this change or to answer any questions you may have. The team can be reached by e-mailing

vendormaintenance@iehp.org or by calling (909) 294-3928 and selecting Option 1.

Adverse Childhood Experiences Screening (ACES) Services

PSA Videos:

Developmental Screening Services

Family Planning Services

Ground Emergency Medical Transport (GEMT) Payment

The Department of Health Care Services (DHCS) has established a Ground Emergency Medical Transport (GEMT) Quality Assurance Fee (QAF) program. In accordance with 42 USC Section 1396u-2(b)(2)(D), Title 42 of the Code of Federal Regulations part 438.114(c), and WIC Sections 14129-14129.7, Medi-Cal Managed Care Health Plans must provide increased reimbursement rates for specified GEMT services to non-contracted GEMT providers. SPA 18-004 implements a one-year QAF program and reimbursement add-on for GEMT provided by emergency medical transportation providers effective for State Fiscal Year (SFY) 2018-19 from July 1, 2018, to June 30, 2019.

 

For a GEMT paid claims dispute, providers can submit using the GEMT Dispute Request Form below and emailing the completed form to Prop56Inquiry@iehp.org or fax to (909) 296-3550.

 

For additional GEMT related information:

Private Services - HYDE

 

You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.