As reported in CHA News last week, the Department of Health Care Services (DHCS) recently sent hospitals invoices covering the first six fee-for-service cycles of the 2017-19 Hospital Fee Program. The attached draft model incorporates those invoiced amounts, as well as the supplemental fee-for-service payment amounts approved last month by the Centers for Medicare & Medicaid (CMS) services. Notably, the “Gain.Contribute” tab in the model includes a summary, by state fiscal year, of the estimated fee and payment amounts for the 30-month program period. CHA is in the process of creating hospital-specific fee and payment schedules, which will be distributed within the next week.
It is important to note that the managed care components of the program have not been approved by CMS and, therefore, the payment amounts in the draft model are very preliminary. Furthermore, the supplemental Medi-Cal managed care payments made through the new directed payment mechanism have been estimated using inpatient utilization data publicly reported to the Office of Statewide Planning and Development for fiscal years ending in 2015. However, in actuality, the directed payments will be made for inpatient and outpatient services provided to in-network patients during the current state fiscal year.
As previously reported in CHA News, DHCS will rely on the encounter data file to calculate the 2017-18 and 2018-19 utilization. CHA and a small group of hospital and health plan representatives are working with DHCS to refine the definition of a network provider and tackle other areas of concern related to the accuracy of the encounter data file. CHA will continue to update members through CHA News.