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Section 1: About HPSM
Section 2: Customer Support
Section 3: Member Complaints
Section 4: Claims
Section 5: Provider Disputes
Section 6: Ancillary Services
Section 7: Utilization Management
Section 8: Provider Services
Section 9: Quality Improvement
Section 10: Health Education
Section 11: Fraud Waste and Abuse
Section 12: Privacy
Clinical Guidelines
Language Interpreter Services
Translated & Alternative Format Member Materials
Language Documentation Requirements
Language Training and Resources
Provider Forms
Directory Search
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Diabetes Prevention Program
End of Life Care
Grievance & Appeals Process
Healthcare Effectiveness Data and Information Set
Home Health Care
Initial Health Appointment
Maternal Care
Medical Record and Facility Site Reviews
Member Handbooks
HEALTHmatters MD
Pediatric Care
Potential Quality Issues
Urgent Care
Tobacco Cessation Information and Resources
Identifying Tobacco Users
Treating Patients Who Use Tobacco
Vulnerable Populations
Provider Education and Trainings
Older Adults and People with Disabilities
Provider Videos
Remote Patient Monitoring
Incentives for Primary Care Providers
Incentives for Nursing Facilities
Incentives for Specialty Providers
Learning Lab
SB855 Training Request
HPSM Dental Providers
Join HPSM Dental
Dental Provider Payments
Covered Dental Services
Benefits of Dental Integration
HPSM Dental Mission
An Innovative Pilot Program
Patient Experience
Incentive Payments for Nursing Facilities
HPSM offers bonus payments for quality performance to in-network nursing facilities providing skilled and/or long-term care services to our Medi-Cal and CareAdvantage members. In-network facilities are automatically opted-in to the following upside-only bonuses:
- Nursing Facility P4P offers bonus payments based on performance in quality metrics designed to improve HPSM member bed access, reduce inpatient and emergency department utilization, and improve care transitions.
- Community Discharge P4P offers long-term care facilities bonus payments for successfully discharging HPSM members with extended institutional stays to a community setting where they remain continuously for six months or more.
Resources
- PY5 2024 Nursing Facility P4P Guidelines – These program guidelines contain comprehensive information on structure and quality performance metrics.
- PY4 2022-2023 Nursing Facility P4P Guidelines
- PY5 2024 Community Discharge P4P Guidelines – This incentive overview provides information on the eligibility requirements for a credited discharge and community retention.
- PY4 2022-2023 Community Discharge P4P Guidelines