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.

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

HQAF Program 6: July 2019 – Dec. 2021

Requirement Approval Description CMS Approval Status
Waiver Approval                 HQAF VI Waiver                 Received Feb. 14, 2020
View approval 
FFS State Plan Amendments (SPAs) Inpatient SPA 19-0018       Received Feb. 25, 2020
View approval
  Outpatient SPA 19-0019    Received Feb. 25, 2020
View approval
Managed Care Rates/Contracts  July 1, 2019 – Dec. 31, 2020 (18-month bridge) Received June 12, 2020
View approval
  Jan. 1 – Dec. 31, 2021        DHCS has not yet submitted to CMS
Managed Care Preprints     July 1, 2019 – Dec. 31, 2020 Pending CMS approval
Submitted June 30, 2019
  Jan. 1 – Dec. 31, 2021 DHCS has not yet submitted to CMS

January 2017 – June 2019

Waiver Approval HQAF V Waiver  
FFS State Plan Amendments Inpatient SPA 17-004 California State Plan Amendment 17’004
  Outpatient SPA 17-005 California State Plan Amendment (SPA) 17-005
Managed Care Preprints 1/1/17-6/30/17 N/A
  7/1/17-6/30/18 uniform_dollar_increase_per_adjudicated_claim_for_private_hospitals.
  7/1/18-6/30/19 uniform_dollar_increase_per_adjudicated_claim_for_private_hospitals_as_defined_in_ca_welfare__institutions

January 2014 – December 2016

Waiver Approval HQAF IV Waiver  
FFS State Plan Amendments Inpatient SPA 14-001 California State Plan Amendment 14-001 
  Outpatient SPA 14-002 Supplement 22 to Attachment 4.19-B
Managed Care Rates 1/1/14-6/30/14 (expansion) CMS Approved 03/26/2016
  7/1/13-6/30/14 (non-expansion) CMS Approved 06/30/2015
  7/1/14-12/31/14 (expansion) CMS Approved 12/30/2016
  7/1/14-6/30/15 (non-expansion) CMS Approved 12/30/2016
  1/1/15-6/30/15 (expansion) CMS Approved 12/12/2018
  7/1/15-6/30/16 (all) CMS Approved 3/18/2019
  7/1/16-12/31/16 (all CMS Approved 4/10/2019
Managed Care Preprints N/A Not Applicable prior to July 1, 2017