Hospital Fee Program Status

Helping you keep track of federal approvals

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.

RequirementApproval DescriptionCMS 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 6/12/20
View approval
 Jan. 1 – Dec. 31, 2021       DHCS has not yet submitted to CMS
Managed Care Preprints    July 1, 2019 – Dec. 31, 2020Pending CMS approval
Submitted 6/30/20
 Jan. 1 – Dec. 31, 2021DHCS has not yet submitted to CMS
RequirementApproval DescriptionCMS Approval Status
Waiver ApprovalHQAF V WaiverReceived 12/4/17
View approval 
FFS State Plan AmendmentsInpatient SPA 17-004Received 12/18/17
View approval
 Outpatient SPA 17-005Received 12/15/17
View approval
Subacute 18-012Received 9/24/18
View approval
Managed Care Preprints1/1/17-6/30/17Received 5/18/20
View approval
 7/1/17-6/30/18Received 4/6/18
View approval
 7/1/18-6/30/19Received 12/17/18
View approval
RequirementApproval DescriptionCMS Approval Status
Waiver ApprovalHQAF IV WaiverReceived 12/10/14
View approval
FFS State Plan AmendmentsInpatient SPA 14-001Received 12/5/14
View approval
 Outpatient SPA 14-002Received 12/23/14
View approval
Managed Care Rates1/1/14-6/30/14 (expansion)Received 3/29/16
View approval
 7/1/13-6/30/14 (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 (allReceived 4/10/19
View approval
Managed Care PreprintsN/ANot Applicable prior to 7/1/17

Questions? Contact Ryan Witz, vice president, health care finance, at [email protected].