CHA News

CMS Approves SFY 2017-18 Rates; Hospital Fee Program 7 Approval Still Pending

This post has been archived and contains information that may be out of date.

On June 17, the Centers for Medicare & Medicaid Services (CMS) approved the Medi-Cal managed care rates for state fiscal year (SFY) 2017-18. Even though CMS has never denied a California managed care rate package, its approvals can take on average between one and two years. Unfortunately, with the SFY 2017-18 managed care rates there was a contractual issue that significantly delayed CMS approval and required more than four years to resolve. Copies of the federal approval letters are available on CHA’s Hospital Fee Program web page under Program 5.  

As previously shared in CHA News, the Department of Health Care Services (DHCS) submitted the Hospital Fee Program 7 (CY 2022) fee and payment model to CMS on Dec. 31. Historically, CMS review and approval of the Hospital Fee Program can take anywhere between six and nine months. Because Program 7 is a one-year program, DHCS was targeting an accelerated CMS approval by June 30. However, based on recent discussions with DHCS, the target date of June 30 for CMS approval is unlikely.  

Discussions between DHCS and CMS are still ongoing, and while there are no significant risks to receiving approval, the timing appears to be more delayed than previously estimated. Stay tuned over the next few weeks for additional updates.