What’s happening: Hospital Quality Assurance Fee (HQAF) program 8 fees for the Jan. 1-June 30, 2023, managed care directed payment cycle are due March 7 — and the invoice will be 15% higher than the modeled fee amount.
What else to know: The fee is increased because the Department of Health Care Services (DHCS) is repaying the Centers for Medicare & Medicaid Services (CMS) for inpatient upper payment limit (UPL) overages incurred in HQAF program 6 — and CMS directed DHCS to repay immediately without any flexibility.
An invoice reduction in August 2025 (for the July 1-Dec. 31, 2023, managed care direct payment cycle) will completely offset the increased March 7 fees — and DHCS will instruct managed care plans (MCPs) to plan for prompt payment to hospitals as soon as payment is received, which is expected to occur across multiple pay dates in mid-March.
It’s critical that hospitals submit their payments by March 7, so the hospital fee program fund balance does not enter a deficit. If that happens, DHCS has suggested it may need to withhold payments to MCPs. Withholding those funds would affect subsequent payments from plans to hospitals.
For questions, contact Adam Dorsey, group vice president, financial policy, at adorsey@calhospital.org or Jesse Delis, vice president, financial policy, at jdelis@calhospital.org.
