Expanding Access to Dyadic Care: CPCA’s Collaborative Efforts to Implement and Support This New Medi-Cal Benefit

CPCA has been actively collaborating with various partners, including the Department of Health Care Services (DHCS)  and the University of California San Francisco (UCSF) Center for Advancing Dyadic Care in Pediatrics on the implementation of the dyadic care services and uptick of this new benefit in California’s community health centers (CHCs).

Dyadic Services Benefit

On January 6, 2025, the Centers for Medicare and Medicaid Services (CMS) approved State Plan Amendment (SPA) #23-0010. This authorizes DHCS to utilize an Alternative Payment Methodology to pay Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and Tribal Health programs for dyadic services at a Medi-Cal fee-for-service (FFS) rate when those services occur in addition to a Prospective Payment Services (PPS) visit for the patient on the same day. This means FQHCs/RHCs would receive a separate payment for dyadic services at the FFS rate that would be in addition to a separately billed PPS visit on the same day in certain circumstances when the clinic met the daily PPS–eligible visit limitation.  

While the policy reflected in the approved SPA does not authorize same day PPS billing for primary and dyadic services – something CPCA continues to advocate for – it does represent additional revenue for FQHCs and RHCs on top of what would be allowable without this methodology. CPCA’s policy position remains that dyadic and mental health services delivered by a PPS billable provider generally should be paid at PPS, regardless of the other types of services provided to the patient that day.

Further, in response to CPCA’s advocacy, DHCS has developed and released a new provider manual section focused on dyadic services as well as an accompanying provider manual section focused on providing detailed FQHC-specific dyadic billing guidance and claim examples. DHCS will also be presenting a live webinar for FQHC providers, walking them through the policy and how to successfully implement and seek reimbursement for dyadic services. In the meantime, CPCA has released accompanying FAQs to support CHCs in understanding and implementing dyadic services.  

Dyadic Services Grant

In addition to our work on the dyadic services benefit, CPCA has been working in partnership with UCSF on the implementation of our Scaling Evidence-Based and Community-Defined Evidence Practice grant through the Children and Youth Behavioral Health Initiative (CYBHI). This grant is focused on expanding dyadic services in CHCs across the state through training, technical assistance, and resources. Through our grant partnership, CPCA and UCSF have hosted four dyadic care webinars and communities of practice covering topics such as dyadic care 101, financing and sustainability, workflows, and providing education, training, and technical assistance on how to implement this new Medi-Cal benefit in health centers. These webinars, along with four training vignettes that are coming soon, can be found on CPCA’s Learning Management System (LMS) for FREE. This LMS course also includes dyadic services resources including CPCA’s FAQ, provider manual sections, DHCS guidance, and more. We encourage you to visit our website to access this FREE course and helpful resources to support the implementation of dyadic care services.