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mATERNAL, cHILD, AND aDOLESCENT hEALTH Division

Function Codes

Each rate of reimbursement is unique in its reimbursement formula. Within the four rates, there are a total of 12 function codes. Each function code has a definable and unique set of activities that are performed by staff. Consequently, all activities and paid time-off are identified under the function codes in the appropriate reimbursement class.

See Fiscal Policy and Procedures (PDF, 1.4 MB) for further instructions.

Function Code 1: Outreach

This function code is to be used by all staff (SPMP and Non-SPMP) at 50/50 match when performing activities that inform Medi-Cal eligible or potentially eligible individuals, as well as other clients, about health services covered by Medi-Cal and how to access the health programs. Activities include a combination of oral and written informing methods that describe the range of services available through the Medi-Cal program and the benefits of preventive or remedial health care offered by the Medi-Cal program.


Function Code 2: SPMP Administrative Medical Case Management

This function code is to be used only by SPMPs for enhanced matching funds when participating in medical reviews; assessing the necessity for and types of medical care associated with medical case management and case coordination activities for Medi-Cal eligible required by individual Medi-Cal beneficiaries.



Function Code 3: SPMP Intra/Interagency Coordination, Collaboration, and Administration

This function code is to be used only by SPMPs when performing collaborative activities that involve planning and resource development with other agencies which will improve the cost effectiveness of the (Medi-Cal) health care delivery system and improve availability of medical services.



Function Code 4: Non-SPMP Intra/Interagency Collaboration and Coordination​

This function code is to be used by non-SPMP staff (or SPMP staff in which their medical expertise is not necessary) when performing activities that are related to program planning functions, including collaborative and intra/interagency coordination activities.


Function Code 5: Program Specific Administration

This function code is to be used by all staff when performing activities that are related to (Medi-Cal) program specific administration.

Function Code 6: SPMP Training

This function code is to be used only when training is provided for or by SPMPs and only when the training activities directly relate to the SPMP’s performance of specifically allowable SPMP administrative activities.


Function Code 7: Non-SPMP Training

This function code is to be used by all staff (SPMP and Non-SPMP) when training relates to Non- SPMP allowable (Medi-Cal) administrative activities and to the medical care of Medi-Cal eligible/member.

Function Code 8: SPMP Program Planning and Policy Development

This function code is to be used only by SPMPs and only when performing (Medi-Cal) program planning and policy development activities. The SPMP’s tasks must officially involve program planning and policy development, and those tasks must be identified in the employee’s position description/duty statement.


Function Code 9: Quality Management by SPMP

This function code is to be used only by SPMPs and only when performing quality management activities (that benefit the Medi-Cal eligible population).

Function Code 10: Non-program Specific General Administration​

This function code is to be used by all staff when performing non-program specific administrative activities that relate to multiple functions or to no specific, identifiable functions due to the general nature of the activities. This is an allocated function code. Time recorded under this function code will be prorated amongst all programs (BIH, MCAH, AFLP, PEI, etc.) included in the time study and matched and unmatched function codes. The portion allocated as matchable may only be matched at the Non-Enhanced rate.​

Function Code 11: Other Activities

This function code is to be used by all staff to record time performing activities which are in the SOW but not specific to the administration of the Medi-Cal program. These activities do not qualify for FFP match.


Function Code 12: Paid Time Off

This function code is to be used by all staff to record usage of paid leave, holiday, vacation, sick leave, or any paid leave other than CTO. This is an allocated function code. Time recorded under this function code will be prorated amongst all programs (BIH, MCAH, AFLP, PEI, etc.) included in the time study and matched and unmatched function codes. CMS permits the matchable amount to be proportionately distributed between the Enhanced rate and the Non-Enhanced rate.​​

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