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.
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.
President Biden Releases FY 2025 Budget Request
What’s happening: President Biden submitted his fiscal year (FY) 2025 budget request to Congress.
What else to know: The budget is a blueprint of the administration’s priorities and is not legislation.
House Passes First Package to Fund Federal Government, Includes Health Provisions
What’s happening: The U.S. House passed the Consolidated Appropriations Act of 2024, which will fund a portion of the federal government through the end of the fiscal year. The package includes a group of CHA-supported health care provisions important to hospitals.
What else to know: Congress has until March 22 to pass a second package to fund the rest of the federal government, including the Department of Health and Human Services.
DHCS Releases Distinct-Part Nursing and Subacute Rates
What’s happening: Last week, the California Department of Health Care Services (DHCS) posted updated payment rates for distinct-part nursing facilities (DP-NF) and distinct-part subacute facilities (DP-SA) for adults and pediatrics.
What else to know: Now that DP-NF and DP-SA services have been fully carved into Medi-Cal managed care plans’ (MCPs) scope of benefits, DHCS has implemented a policy that transitions the DP-NF and DP-SA rate year to a calendar year to align with the Medi-Cal managed care rate year.
DHCS Issues Private Hospital Supplemental Funds Round B Payments
What’s happening: Over the past two weeks, the Department of Health Care Services (DHCS) issued Private Hospital Supplemental Fund Round B payments to hospitals eligible for the program in fiscal year 2023-24.
What else to know: This round of payments to the approximately 90 eligible hospitals totaled roughly $60 million.
CMS Approves Calendar Year 2022 Medi-Cal Managed Care Rates
What’s happening: On Feb. 22, the Centers for Medicare & Medicaid Services approved the Medi-Cal managed care rates for the rating period from Jan. 1, 2022, to Dec. 31, 2022.
What else to know: Copies of the federal approval letters are available on CHA’s Hospital Fee Program web page under Program 7.
CHA Encourages Members to Participate in the Vitality Index Payer Scorecard
What’s happening: CHA is endorsing member participation in the Vitality Index Payer Scorecard, which will provide critical information to support CHA’s advocacy to hold insurers accountable for timely and accurate reimbursement.
What else to know: The CHA Board of Trustees has endorsed this tool, which will automatically draw de-identified claims and remittance information from hospitals without requiring additional reporting or surveys.
CMS Announces Flexibilities for Providers Impacted by Change Healthcare Hack
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued a statement outlining the flexibilities it is offering to providers impacted by the Change Healthcare data breach.
What else to know: CHA is closely following this issue and will provide updates on additional steps CMS is taking as they become available.