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.
| Requirement | Approval Description | CMS Approval Status |
|---|---|---|
| Waiver Approval | HQAF VIII Waiver | Received 12/19/23. View approval |
| FFS State Plan Amendments (SPAs) | Inpatient SPA 23-0007 | Received 12/15/23. View approval |
| Outpatient SPA 23-0008 | Received 12/15/23. View approval | |
| Managed Care Preprints | Jan. 1, 2023 – Dec. 31, 2023 | Received 3/18/23 View approval |
| Jan 1, 2024 – Dec. 31, 2024 | Received 4/4/24 View approval |
| Requirement | Approval Description | CMS Approval Status |
|---|---|---|
| Waiver Approval | HQAF VII Waiver | Received 9/30/22. View approval |
| FFS State Plan Amendments (SPAs) | Inpatient SPA 21-0036 | Received 9/30/22. View approval |
| Outpatient SPA 21-0037 | Received 9/30/22. View approval | |
| Managed Care Rates/Contracts | Jan. 2022 – Dec. 31, 2022 | Received 2/22/24 View approval |
| Managed Care Preprints | Jan. 1, 2022 – Dec. 31, 2022 | Received 5/10/22 View approval |
| Requirement | Approval Description | CMS Approval Status |
|---|---|---|
| Waiver Approval | HQAF VI Waiver | Received 2/14/20 View approval |
| FFS State Plan Amendments (SPAs) | Inpatient SPA 19-0018 | Received 2/25/20 View approval |
| Outpatient SPA 19-0019 | Received 2/25/20 View approval | |
| Managed Care Rates/Contracts | July 1, 2019 – Dec. 31, 2020 (18-month bridge) | Received 2/28/23 View approval |
| Jan. 1 – Dec. 31, 2021 | Received 9/14/2023 View approval | |
| Managed Care Preprints | July 1, 2019 – Dec. 31, 2020 | Received 6/12/20 View approval |
| Jan. 1 – Dec. 31, 2021 | Received 10/8/21 View approval |
| Requirement | Approval Description | CMS Approval Status |
|---|---|---|
| Waiver Approval | HQAF V Waiver | Received 12/14/17 View approval |
| FFS State Plan Amendments | Inpatient SPA 17-004 | Received 12/18/17 View approval |
| Outpatient SPA 17-005 | Received 12/15/17 View approval | |
| Subacute 18-012 | Received 9/24/18 View approval | |
| Managed Care Rates/Contracts | 1/1/17-6/30/17 | Received 5/18/20 View approval |
| 7/1/17-6/30/18 | Received 6/15/22 View approval | |
| 7/1/18-6/30/19 | Received 6/23/22 View approval | |
| Managed Care Preprints | 7/1/17-6/30/18 | Received 3/6/18 View approval |
| 7/1/18-6/30/19 | Received 12/17/18 View approval |
| Requirement | Approval Description | CMS Approval Status |
|---|---|---|
| Waiver Approval | HQAF IV Waiver | Received 12/10/14 View approval |
| FFS State Plan Amendments | Inpatient SPA 14-001 | Received 12/5/14 View approval |
| Outpatient SPA 14-002 | Received 12/23/14 View approval | |
| Managed Care Rates | 1/1/14-6/30/14 (expansion) | Received 3/29/16 View approval |
| 1/1/14-6/30/14 (non-expansion) | Received 6/30/15 View approval | |
| 7/1/14-12/31/14 (expansion) | Received 12/30/16 View approval | |
| 7/1/14-6/30/15 (non-expansion) | Received 12/30/16 View approval | |
| 1/1/15-6/30/15 (expansion) | Received 12/12/18 View approval | |
| 7/1/15-6/30/16 (all) | Received 3/18/19 View approval | |
| 7/1/16-12/31/16 (all | Received 4/10/19 View approval | |
| Managed Care Preprints | N/A | Not Applicable prior to 7/1/17 |
Questions? Contact Robert Ducay, Vice President, Policy, at rducay@calhospital.org.
