About Medi-Cal
More than 15 million Californians rely on Medi-Cal, the state’s health care coverage safety net, for health insurance. Two-thirds of those on Medi-Cal are people of color and often live in communities with a lack of adequate health care providers. Without significant investments to support providers that deliver health care to California’s most vulnerable, millions living in rural and underserved areas are in jeopardy.
DHCS Releases Private Hospital-Directed Payment Encounter Files
What’s happening: On Dec. 13, 2024, the Department of Health Care Services (DHCS) uploaded three new hospital-directed payment encounter files, available via the Secure File Transfer Protocol site, that hospitals must download as soon as possible — they will be deleted within 45 days of the upload date.
What else to know: DHCS has also published new calendar year 2023 encounter detail file toolkits for each Directed Payments program.
Budget Work Begins to Determine Prop 35 Payments
Following last week’s release of Gov. Gavin Newsom’s proposed $322 billion budget for 2025-26, work will now focus on ensuring allocations from a recently approved managed care organization tax are delivered in accordance with the intent of the ballot measure passed in November.
DHCS Shifts Deadline for Hospital Fee Program Payments to April 8
What’s happening: As previously shared with member hospitals via email, the Department of Health Care Services (DHCS) has shifted the timing of fees and payments for the Hospital Quality Assurance Fee (HQAF) program attributable to the managed care pass-through cycle for the Jan. 1, 2024, through Dec. 31, 2024, period.
What else to know: The fees associated with this cycle are now due April 8, 2025.
Federal Funding Will Bolster Medi-Cal Reimbursement for Inpatient Psychiatric Care
What’s happening: On Dec. 16, California was approved for the large BH-CONNECT behavioral health demonstration project, which is estimated to bring $5 billion of new federal Medicaid dollars for California over the next five years.
What else to know: During this time, BH-CONNECT will use the funds to test new approaches to behavioral health treatment, housing, and workforce development.
CMS Responds to Congressional Letter Urging Adequate IRF Access
What’s happening: The Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-Lasure has responded to a Congressional letter, signed by several members of the California delegation, that urged CMS to take steps that will ensure Medicare Advantage (MA) plan beneficiaries have access to medically necessary inpatient rehabilitation facility (IRF) care.
What else to know: In the letter, Ms. Brooks-Lasure notes several recent rules issued by CMS that seek to ensure that MA plans adhere to CMS requirements, including network adequacy, prior authorization, and data collection. Ms. Brooks-Lasure also agrees to take the writers’ comments into consideration for future policy development.
AHA Survey on 340B Rebate Model Closes Jan. 10
What’s happening: The American Hospital Association (AHA) is asking hospitals to complete a survey by Jan. 10 to help it understand how a 340B rebate model would impact 340B member hospitals.
What else to know: Completing this 10-question survey will help AHA understand the financial, operational, and patient impacts that a rebate model — such as the one Johnson & Johnson sought to implement this year — would have on your hospital or health system.
DHCS Releases Updated List of Medi-Cal Managed Care Plan Liaisons for Long-Term Care Providers
What’s happening: The Department of Health Care Services (DHCS) requires Medi-Cal managed care plans (MCPs) to identify a liaison to serve as a single point of contact for long-term care providers. These liaisons are listed in an updated DHCS document.
What else to know: The long-term services and supports (LTSS) liaison provides support to LTC providers, including skilled-nursing facilities (SNFs) with addressing claims and payment inquiries and care transitions to support Medi-Cal members’ needs.
182 Members of Congress Sign Letter to Prevent Medicaid DSH Cuts
What’s happening: A bipartisan letter asking House leadership to prevent upcoming Medicaid disproportionate share hospital (DSH) payment cuts gathered 182 signatures — including 36 from the California delegation. CHA thanks hospital leaders for their outreach on this critical issue.
What else to know: Reductions in Medicaid DSH payments to states are scheduled to take effect on Jan. 1, 2025. If these cuts go into effect, California’s hospitals would lose $1.2 billion in 2025.
Urge Congress to Support Patient Care in Year-End Legislation
What’s happening: CHA issued an alert asking members to urge their congressional representatives to support hospital priority issues in year-end legislation.
What else to know: Outreach is needed by Dec. 20 when Congress will wrap up the session.
CHA Member Alert: Urge Congress to Eliminate Medicaid DSH Payment Reductions
What’s happening: Reductions in Medicaid disproportionate share hospital (DSH) payments to states are scheduled to take effect on Jan. 1. If these cuts go into effect, California hospitals would lose $1.2 billion in 2025.
What else to know: CHA is urging members to contact their Congressional representatives before Dec. 6 and ask them to sign a bipartisan letter requesting that House leadership prevent the cuts.