The Hospital Quality Assurance Fee (HQAF) Program and all of its statutory provisions were made permanent through the passage of CHA’s ballot initiative, the Medi-Cal Funding and Accountability Act (Proposition 52), in the November 2016 general election. While this provides the framework for all future hospital fee programs, future iterations must adhere to federal regulations related to health-care provider taxes. Further, the Department of Health Care Services (DHCS) must obtain all necessary federal approvals. 

For each hospital fee program, the Centers for Medicare & Medicaid Services (CMS) must approve: 

• The provider tax waiver, which covers the fee structure used to support the non-federal share of Medi-Cal supplemental payments
• Medi-Cal fee-for-service (FFS) state plan amendments, which cover the FFS supplemental payments
• Medi-Cal managed care rates and contracts, which cover the managed care supplemental payments

While some federal approvals (e.g., provider tax waiver, FFS state plan amendments) cover the entire hospital fee program, others require review/approval on an annual basis (e.g. managed care rates/contracts). Included below are the hospital fee program federal approvals received to date, for the programs beginning on or after January 2014.

Questions? Contact Adam Dorsey, group vice president, financial policy, at adorsey@calhospital.org, or Jesse Delis, vice president, financial policy, at jdelis@calhospital.org

What’s happening: The Department of Health Care Services (DHCS) is holding the first meeting of the Proposition (Prop) 35 “Protect Access to Health Care Act” Stakeholder Advisory Committee on April 14 from 11:30 a.m. to 3:30 p.m. (PT). This meeting is open to the public, and registration for virtual attendance is open. 

What else to know: In November 2024, voters approved the Protect Access to Health Care Act of 2024 (Prop 35), which will deliver significant resources to providers who care for Californians covered by Medi-Cal (as much as $1.4 billion is expected to support hospitals in 2025 and 2026). The committee will advise and make recommendations to the department on implementing these Prop 35 payments. More details can be found on the DHCS website.   

What’s happening: CHA and the California Society of Health-System Pharmacists (CSHP) are calling on pharmacy professionals to join the movement for substantive change in pharmacy practice through their partnership with the American Society of Health-System Pharmacists’ (ASHP) Practice Advancement Initiative (PAI) — and joining the movement begins with taking the California Hospital Survey.  

What else to know: Originally launched in 2010, PAI has helped pharmacists across diverse practice settings implement local changes to improve patient care — and ASHP is bolstering these efforts by launching PAI 2030. In PAI 2030, ASHP has introduced 59 updated recommendations aimed at enhancing medication use, expanding the roles of pharmacists and technicians, and embracing emerging technologies.  

What’s happening: On March 28, the Department of Health Care Services (DHCS) submitted a final draft of the Hospital Quality Assurance Fee (HQAF) program 9 fee and payment model to the Centers for Medicare & Medicaid Services (CMS). An internal, members-only version   is available for members to review. 

What else to know: The model should be considered a draft until the state receives official CMS approval, which is expected to take six to nine months. Learn more about the 2025 HQAF program 9 — including a brief history, a summary of changes, and the future landscape of the program — in our members-only webinar on April 7 at 9 a.m. (PT).  

What’s happening: Payments for the Hospital Quality Assurance Fee program 8 directed payment are due to the Department of Health Care Services (DHCS) by April 8.    

What else to know: Invoices were mailed to hospitals from DHCS on March 24. It is critical that all hospitals pay their invoices in full and on time. CHA encourages those at risk of not paying their invoices in full by April 8 to notify DHCS in advance of the due date about any financial hardship.        

What’s happening: The Hospital Association of Southern California’s (HASC’s) In-Person LEAD Academy — geared toward health care managers who are either new to their position or looking to enhance their skills — was previously slated for six Tuesdays from April 8 to June 24, but its new dates are six Tuesdays from May 6 to July 29. 

What else to know: During this year’s academy —  at Sonoma Valley Hospital from 9 a.m. to 5 p.m. (PT) — attendees will gain  skills in understanding themselves and others, navigating staff dynamics, and driving performance. Registration is open, and attendees can sign up for individual modules or the full academy of six sessions and 12 modules. 

What’s happening: The California Department of Public Health (CDPH) released All Facilities Letter (AFL) 25-13 on March 24 that offers guidance to hospitals on supporting the Medi-Cal doula benefit — available since January 1, 2023 — and outlines recommendations for patient visitation policies and procedures. 

What else to know: As noted in the AFL, called Benefits of Doula Support and Recommendations to Accommodate Doula Services and Foster a Doula-Friendly Environment, doulas offer emotional, physical, and informational support during pregnancy, labor, delivery, and up to one year postpartum. Hospital policies play a key role in creating a welcoming environment for doulas and the families they serve.  

What’s happening: On April 1, the Emergency Medical Services Authority (EMSA) released emergency regulations to implement Assembly Bill (AB) 40 (2023).  

What else to know: Because these are emergency regulations, there will only be a five-day comment period. Comments are due to the Office of Administrative Law (OAL) by Saturday, April 5.  

What’s happening: Hospitals’ deadline for commenting on the Office of Health Care Affordability’s (OHCA’s) proposed methodology to identify “high-cost” hospitals is rapidly approaching; letters are due April 11.  

What else to know: On April 2, CHA issued an Alert with resources to assist in hospitals’ outreach, including template letters, a data worksheet, and template for hospital patients who wish to submit their stories.  

What’s happening:  The California Department of Managed Health Care (DMHC) has issued All Plan Letter (APL) 25-007, which provides guidance to health care service plans on requirements for reimbursing claims for health care services with a date of receipt on or after Jan. 1, 2026.  

What else to know: The updated guidance reflects the provisions of Assembly Bill 3275 (2024). This CHA-supported legislation amends Health & Safety Code provisions regarding timeliness and other requirements for the processing and reimbursement of claims, and implements enhanced consumer protection relating to grievances.    

What’s happening: In a final judgment filed March 31, the U.S. District Court for Eastern Texas ruled that the Food & Drug Administration (FDA) does not have the authority to regulate laboratory-developed tests, rendering a final rule issued May 6, 2024, null and void.  

What else to know: This final rule phased out the FDA’s general enforcement discretion approach for most laboratory-developed tests to instead provide greater oversight.