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.
What else to know: As previously reported, CMS has developed a process that allows providers to submit questions and complaints related to Medicare Advantage (MA) plan appeals or claims payment issues.
HCAI Updates Policy on Alternate Power Requirements for Skilled-Nursing Facilities
What’s happening: The Department of Health Care Access and Information (HCAI) has issued updated information on requirements for alternate sources of power in skilled-nursing facilities (SNFs).
What else to know: The revised Policy Intent Notice provides guidance for the implementation of alternate sources of power to maintain safe temperatures, availability of lifesaving equipment, and oxygen-generating devices for SNF buildings as required by state law.
New Interoperability Final Rule Focuses on Information Sharing
What’s happening: The Assistant Secretary for Technology Policy (ASTP) and Office of the National Coordinator for Health Information Technology issued the second part of a final rule to advance interoperability and improve information sharing among patients, providers, payers, and public health authorities.
What else to know: This final rule focuses on information blocking exceptions, including reproductive health data policies.
CHA Releases Summary of New Hospital Bed Tracking System
What’s happening: The California Department of Public Health (CDPH) received the authority and funding to implement a real-time hospital bed capacity system through Assembly Bill 177. CDPH plans to work with the Hospital Association of Oregon to implement the Healthcare Capacity System (HCS), developed by its affiliate, Apprise
What else to know: CDPH selected HCS after an extensive search. The state’s goal is to use this data to monitor hospital surge and system capacity, understand regional needs, develop policies, and position resources appropriately
What’s happening: The American Hospital Association (AHA) is asking hospitals to complete a survey by Jan. 10 to help it understand how a 340B rebate model would impact 340B member hospitals.
What else to know: Completing this 10-question survey will help AHA understand the financial, operational, and patient impacts that a rebate model — such as the one Johnson & Johnson sought to implement this year — would have on your hospital or health system.
CMS Responds to Congressional Letter Urging Adequate IRF Access
What’s happening: The Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-Lasure has responded to a Congressional letter, signed by several members of the California delegation, that urged CMS to take steps that will ensure Medicare Advantage (MA) plan beneficiaries have access to medically necessary inpatient rehabilitation facility (IRF) care.
What else to know: In the letter, Ms. Brooks-Lasure notes several recent rules issued by CMS that seek to ensure that MA plans adhere to CMS requirements, including network adequacy, prior authorization, and data collection. Ms. Brooks-Lasure also agrees to take the writers’ comments into consideration for future policy development.
HQI to Host Five-Part Webinar Series on Building a Hospital Safety Culture
What’s happening: The Hospital Quality Institute (HQI) is offering a five-part webinar series to address strategies for increasing patient safety and improving response to patient harm.
What else to know: The series will provide a deep dive into the five domains of HQI’s flagship program, HQI Cares: BETA HEART®, and explore their alignment with the Centers for Medicare & Medicaid Services’ new Patient Safety Structural Measure.
As we start the new year, many new faces will be coming to Sacramento and Washington, D.C. Here in California, some three dozen new legislators have been sworn in and will take state office for the first time. In our nation’s capital, President-elect Trump is preparing to bring a different approach to, and new priorities for, health care policy than that of the Biden administration.
On Nov. 5, California voters overwhelmingly approved Proposition (Prop) 35, making an existing tax on managed care organizations (MCO) permanent under state law — and directing most of the revenues toward expanding access to care for Medi-Cal patients through improved provider reimbursement. Now, work by the state, hospitals, and others to determine how these funds should be distributed begins.
OHCA Board Could Approve Creation of Statewide Hospital Sector in Early 2025
What’s happening: The Office of Health Care Affordability (OHCA) board met earlier this week to discuss options for defining hospitals as a sector for spending target purposes, as well as receive an update on progress toward adopting a behavioral health investment benchmark.
What else to know: CHA wrote to the board and provided public comment, pressing that the adoption of a hospital sector definition is premature and misguided, while stating the importance of including the full continuum of clinically appropriate services in OHCA’s behavioral health investment benchmark.
