Medi-Cal Managed Care

Parent Issue

CMS Finalizes 2018 Proposed Rule for Medicaid Managed Care and CHIP

Earlier today, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that revises Medicaid Managed Care and Children’s Health Insurance Program regulations intended to reduce state administrative burden and increase program flexibility. CHA provided written comments on CMS’ proposed rule in January 2019.

New Infographic Available on Hospital Fee Program

CHA has developed for members a new infographic on the Hospital Fee Program, highlighting the expected changes between the 2017-19 Hospital Fee Program (V) and the 2019-21 Hospital Fee Program (VI). The infographic illustrates the shift in payment structure toward managed care “directed payments,” which requires a hospital to be a network provider to receive a payment. 

Advisory Group Meeting on Medi-Cal Pharmacy Carve-Out Set for July 24

CHA encourages members to participate in an upcoming meeting on the Governor’s Executive Order that would transition pharmacy services from Medi-Cal managed care plans into the fee-for-service delivery system by January 2021 — which will impact hospitals that participate in the 340B Drug Discount Program. The meeting will be held July 24 from 9:30-11:30 a.m. in Sacramento, and is designed to facilitate community awareness and provide a forum for stakeholder feedback.

DMHC Releases Guidance on General Licensure Regulation

The Department of Managed Health Care (DMHC) has released final guidance on its Knox-Keene licensure regulation, which applies to any contract entered into, amended, or renewed on or after July 1. The regulation, among other things, defines various types of risk and requires entities that assume any amount of global risk to either obtain a license under the Knox-Keene Health Care Service Plan Act of 1975 or receive an exemption from DMHC.