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

With each Hospital Fee Program renewal, DHCS retrieves the requisite hospital data and updates the fee and payment model as directed under the authorizing legislation found under state law (specifically, the Medi-Cal Hospital Reimbursement Improvement Act of 2013 codified at Welfare and Institutions Code sections 14169.50 through 14169.76).

What’s happening: Reductions in Medicaid disproportionate share hospital (DSH) payments to states are scheduled to take effect on Jan. 1. If these cuts go into effect, California hospitals would lose $1.2 billion in 2025. 

What else to know: CHA is urging members to contact their Congressional representatives before Dec. 6 and ask them to sign a bipartisan letter requesting that House leadership prevent the cuts.  

What’s happening: As ballots from more than 16 million Californians continue to be counted, state and congressional races are coming into focus.  

What else to know: Though the election was more than two weeks ago, the winners of some key races have yet to be decided.  

What’s happening: On Dec. 5 at noon (PT), a DataGen webinar will share an overview of and the calendar year 2025 outpatient prospective payment system (OPPS) final rule and analysis.   

What else to know: CHA encourages members to register for this webinar.  

What’s happening: On Nov. 18, CHA sent a letter to the California congressional delegation about outstanding COVID-19 relief funds owed to California hospitals and the challenges they have had getting funds obligated from the Federal Emergency Management Agency (FEMA). 

What else to know: Also on Nov. 18, President Joe Biden sent Congress a $100 billion emergency supplemental funding request, which includes money for FEMA’s Disaster Relief Fund and called on members to approve the package for recent and past disasters.  

What’s happening: In a Nov. 18 letter to the California congressional delegation, CHA outlined legislative priorities for the remainder of the 118^th Congress — which must act by Dec. 20 to fund the federal government.  

What else to know: It is likely that some health care extensions and policies could be a part of Congress’ funding package. 

“We can only be said to be alive in those moments when our hearts are conscious of our treasures.” — Thornton Wilder, playwright 

What’s happening: The Department of Health Care Access and Information (HCAI) has released policy intent notices (PIN) on steel quality and quality control, and code application notices (CAN) for nurse stations and self-contained medication dispensing units (MDUs). 

What else to know: Issued by HCAI’s Office of Statewide Hospital Planning and Development, these new policies and code changes aim to streamline, outline, and clarify various aspects of hospital operations.  

What’s happening: At its most recent meeting, the Office of Health Care Affordability (OHCA) board elected Kim Johnson, secretary of the California Health and Human Services Agency, as its new chair — and considered potential adoption of hospital sector targets, a provisional approach to measuring hospital spending, and a proposal for tracking quality and equity.  

What else to know: Ahead of the meeting, CHA wrote to the board on these topics, urging further learning and progress toward implementation before adopting sector targets; supporting a comprehensive yet streamlined approach to measuring quality, equity, and access; and asking that the behavioral health investment goal consider the full continuum of behavioral health services. 

What’s happening: A members-only summary of the Centers for Medicare & Medicaid Services’ calendar year (CY) 2025 end-stage renal disease (ESRD) prospective payment system (PPS) final rule, prepared by Health Policy Alternatives, Inc., is available.   

What else to know: The regulation is effective Jan. 1, 2025.