Targeted Rate Increase definition
Targeted Rate Increase or “TRI” means the set of provider rate increases authorized by Assembly Bill 118 (Chapter 42, Statutes of 2023) as implemented by DHCS. The TRI applies to eligible network providers, as defined by DHCS. The first phase of TRIs are effective for dates of service beginning January 1, 2024. For services on the Medi-Cal TRI fee schedule from eligible network providers, CalOptima and its delegates must pay the greater of the DHCS published TRI fee schedule or the then current contractual rates inclusive of any Proposition 56 supplemental payment previously due to County. The TRI applies to both fee-for-service and other provider payment arrangements such as capitation payments. In the case of capitation and other prospective payment arrangements, the expected fee-for-service equivalency of those rates must be the same or greater than the TRI fee schedule rate.”
2. In Article 3, FUNCTIONS AND DUTIES OF COUNTY, Section 3.13 CalOptima QMI Program shall be deleted in its entirety and replaced by the following: