Based on requests from stakeholders, including CHA, the Department of Health Care Services has released guidance on the reimbursement requirements associated with the California Advancing and Innovating Medi-Cal (CalAIM) major organ transplant changes.
The CalAIM changes, which took effect on Jan. 1, have increased the responsibility of health plans providing services to their members. Hospital leaders should note that the state, through this memo, is directing plans that the statutory reimbursement requirement:
“ …will apply ONLY to newly transitioning transplant events. It will not apply to COHS counties where all organ and bone marrow transplants are already managed are covered services, nor to single-organ kidney and corneal transplants that are already covered in managed care statewide, nor to California Children’s Services (CCS) pediatric transplants in non-Whole Child Model (WCM) counties.”