Medi-Cal Managed Care

Parent Issue

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. 

DHCS Releases Access Assessment Draft, Comments Due June 28

The Department of Health Care Services (DHCS) has released a draft assessment of California health plans’ compliance with time/distance access standards for managed care patients. According to the assessment, only a small number of plans failed to meet these standards for at least 99% of enrollees.  

DHCS Invites Hospitals to Participate in Medical Interpretation Services Survey

Tthe California Department of Health Care Services (DHCS) is conducting a study — as required by Assembly Bill 635 (Chapter 600, Statutes of 2016) — to identify current requirements for medical interpretation services. The findings will inform the department’s recommendations for future strategies related to medical interpretation services for Medi-Cal members with limited English proficiency.

May 20 Marks Comment Deadline for DMHC Draft Implementation Guidance on Licensure Regulation

The Department of Managed Health Care (DMHC) has released draft guidance and accompanying forms — a confidentiality request form and an expedited exemption request form — related to its Knox-Keene licensure regulation. 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. 

DHCS Provides Health Homes Program Update

The Department of Health Care Services (DHCS) has released an update on the Health Homes Program, including current and future implementation counties, and counties where the program will not be implemented.