Tri-State Community Healthcare Center v. Baass CA3

BACKGROUND FACTS AND PROCEDURE

Tri-State is a nonprofit, public benefit corporation that operates as a federally qualified health center (FQHC). FQHCs are clinics that receive federal grants to provide primary health care services to medically underserved populations. (42 U.S.C. § 254b(a)(1).) FQHCs are entitled to compensation under state Medicaid programs, which compensate them at a fixed per-visit rate calculated to cover the allowable costs related to providing covered services. (42 U.S.C. § 1396a(bb).) Medicaid is a program under which the federal government and participating state governments share the costs of medical treatment for eligible low-income individuals. (County of Colusa v. Douglas (2014) 227 Cal.App.4th 1123, 1126.) California’s Medicaid program is known as Medi-Cal. (Ibid.) DHCS is the state agency designated to administer the Medi-Cal program. (§§ 10740, 14000 et seq.)

2 To obtain reimbursement for Medi-Cal services, providers generally must be enrolled in the Medi-Cal program for each location at which covered services are provided. (Marvin Lieblein, Inc. et al. v. Shewry (2006) 137 Cal.App.4th 700, 707; §§ 14043, 14043.1, subd. (o), 14043.15, 14043.26.)…