San Joaquin County: intermittent-clinic strategy preserved parent Medi-Cal PPS rates, staff to reassess in 2026 plan

San Joaquin County health clinics staff told the clinics board on Oct. 27 that the county's intermittent-clinic strategy preserved parent-site Medi-Cal Prospective Payment System (PPS) reimbursement and reduced the risk of rate dilution during expansion. The presentation traced the strategy from planning in November 2021 to implementation on 09/09/2024 and outlined next steps for a financial and operational reassessment.

The presenter defined an intermittent clinic as a site operated by a licensed primary-care clinic that is open fewer than 40 hours per week, is exempt from a separate licensure process and inherits the parent clinic's Medi-Cal PPS rate. "Intermittent clinics expand services, not reimbursement rates," the presenter said, adding that the model is intended to expand access without creating standalone sites.

Using two examples, staff said the intermittent approach was applied to co-located sites in Stockton and French Camp. Staff reported that in fiscal 2024 the two intermittent sites averaged about $265 per visit while the parent site averaged about $312; after implementation staff said the shared PPS rate rose to about $326 in fiscal 2025 and approached $340 in fiscal 2026. Staff summarized those changes as an approximate 8.3% increase in the parent-site rate after alignment.

Board members asked why different physical sites showed different final rates. Presenters and guest John Dielio, identified as chief operating officer at San Bernardino Health Centers, said PPS rates depend on the address/site, visit volume, case mix, service lines and negotiation with the Department of Health Care Services (DHCS). "The service lines in Stockton and French Camp are slightly different," Dielio said, noting that introducing services such as dental can change negotiation dynamics and the net financial picture.

County staff said the intermittent designation preserves higher parent-site rates by aggregating services under one PPS calculation, rather than creating separate PPS calculations that can dilute higher rates. They emphasized that PPS revenue remains contingent on visit volume, acuity and operational efficiency and that legal or regulatory limits mean the county cannot simply transfer a higher PPS rate from one distinct physical site to another without renegotiation.

Looking ahead, staff recommended completing a focused financial and operational reassessment and evaluating alignment with current visit volumes and service mixes as part of the county's 2026'2028 strategic planning process. If changes are warranted, staff said they will return to the board with options and recommendations.

The board took no formal policy vote on changing the strategy during the meeting. The presentation closed with staff saying they would return with options after the reassessment.