Medi-Cal Managed Care

Doula Access in Hospitals: What the Law Requires

Join this webinar and learn more about creating a partnership between your hospital and the doulas that serve your geographic area. Learn about the legal requirements associated with doulas as well as best practices from a hospital with a successful doula program.

DHCS Issues Memo to Medi-Cal Managed Care Health Plans on Change Healthcare Cyberattack

What’s happening: On March 13, the Department of Health Care Services issued a memo to its contracted Medi-Cal managed care plans (MCPs) related to flexibilities to ensure delivery system stability following the Change Healthcare cyberattack.  

What else to know: The memo reminds MCPs of their claims payment contractual responsibilities, including oversight of their delegated entities, and strongly encourages MCPs to take steps to support the provider community.  

Medi-Cal Managed Care Plans Receive Private Hospital Directed Payment Funding 

What’s happening: During the week of Feb. 26, Medi-Cal managed care plans received the funds related to Hospital Fee Program 7, Private Hospital Directed Payment (PHDP) Cycle 1. In January, hospitals and Medi-Cal managed care plans also received their payment schedules, which detail the amount each health plan is directed to pay and to which hospitals. 

What else to know: Health plans are required to make these payments to hospitals within 30 days of receipt of the funds. Hospitals that have not yet received their PHDP funds should reach out to their health plans for a status update. Hospitals that still have not received the PHDP funding by the end of March should contact Robert Ducay, vice president, policy, at rducay@calhospital.org

DHCS Scheduled to Release Medi-Cal Managed Care Utilization Data to Health Plans and Hospitals

What’s happening: On March 8, the California Department of Health Care Services (DHCS) released the latest round of Medi-Cal managed care utilization data to hospitals and health plans. These data are used to determine the amount of funding each hospital will receive in the Private Hospital Directed Payment Program.   

What else to know: Hospitals should download their data from the DHCS secure site as soon as possible because uploaded files will be deleted within 45 days. Hospitals should compare these data to their own utilization records and work with their contracted Medi-Cal managed care plans to reconcile any differences in order to get full credit and payment for contracted services provided during the program period. Medi-Cal managed care plans have approximately five weeks to return the data to DHCS. The uploaded files cover the following service periods: 

CHA Participates in DHCS Population Health Management Summit

What’s happening: CHA recently participated in the Population Health Management Transitional Care Services Summit hosted by the Department of Health Care Services. 

What else to know: The summit provided an opportunity for Medi-Cal Managed Care leaders to provide updates on the implementation of transitional care services and share best practices. Several panels included representatives from CHA member hospitals, including Watsonville Community Hospital, Dignity Health, and the University of California, San Francisco.