What does LPPF mean in FUNDS

Local Provider Participation Funds (LPPF) are financial instruments created by the California Department of Health Care Services (DHCS) to provide a system of reimbursement for providers who deliver health care services to Medi-Cal beneficiaries.

LPPFs are used to reimburse providers for services provided in accordance with relevant statutes, regulations and DHCS policies. For example, participating hospitals may use their LPPF funds to cover any additional costs incurred when providing a service not covered by Medi-Cal or if the provider's costs exceed the approved Medi-Cal rate.

Different types of providers may be eligible for LPPF payments, including physicians, hospitals, ambulatory surgical centers and rural clinics. Additionally, most managed care organizations also receive payments from LPPFs based on the size of their enrollee population and other criteria.

The majority of funds used for the Local Provider Participation Fund program are generated through hospital fees that are assessed annually and then matched with federal dollars from the Centers for Medicare & Medicaid Services (CMS).

Yes, organizations must use their funds for activities related to improving access or quality of care or activities related to preventing fraud and abuse in the Medi-Cal system. Organizations may not use their funds for salaries or administrative expenses unless they have received prior approval from DHCS.