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 |
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| 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 |