Every year, California’s hospitals treat millions of patients, many of them covered by Medi-Cal, the state’s health care safety net. This includes numerous essential health care services for Californians, including care for more than 50% of all births, 46% of behavioral health-related emergency department visits, 58% of rural hospital patient care days, 1 million inpatient stays, and nearly 16 million outpatient visits in 2018. CHA is committed to protecting Medi-Cal rates and assuring that the state’s neediest maintain access to the high quality of care that all Californians deserve.
About Medi-Cal
DHCS Updating Payment System for Diagnosis-Related Group Reimbursement
On Sept. 23, the Department of Health Care Services (DHCS) announced it is updating the Medi-Cal payment system for diagnosis-related group (DRG) reimbursement with the newest ICD-10 diagnosis and surgical procedure codes released by the Centers for Medicare & Medicaid Services, effective for dates of service on or after Oct. 1. However, system updates will […]
DHCS Delaying Implementation of Provider 274 File to Determine Contracting Status for Directed Payments
On Sept. 21, the Department of Health Care Services (DHCS) announced that it is delaying the implementation of the Provider 274 file for determining contracting status relevant to Medi-Cal managed care directed payment programs.
No Surprises Act Webinar Will Discuss Final Rule and Implementation Update
To assist members in navigating the No Surprises Act final rule, CHA will host a complimentary webinar from 11 a.m. to noon (PT) on Sept. 30.
DHCS Releases Private Hospital-Directed Payment Encounter Files
On Sept. 9, the Department of Health Care Services (DHCS) uploaded three new hospital-directed payment encounter files, available via the Secure File Transfer Protocol site. It is important for hospitals to download these files as soon as possible, as the site is only intended for file transfers, not ongoing storage, and uploaded files will be […]
State Budget Takes a Wide Variety of Health Care-Related Actions
In June 2022, the Legislature and governor approved a $308 billion budget for the state fiscal year spanning from July 2022 through June 2023. In late August, the Legislature passed and the governor is expected to approve revisions to the 2022-23 Budget Act, which generally redirect, build upon, or provide statutory parameters around actions previously […]
No Surprises Act: Final Rule Overview and Implementation Update
Join CHA’s Chad Mulvany and Amanda Hayes-Kibreab, partner at King & Spalding, as they provide insight and guidance for members navigating the No Surprises Act final rule.
DHCS Adds New COVID-19-Related Codes to the Diagnosis-Related Group Methodology, Retroactively to April 1
The Department of Health Care Services (DHCS) recently announced the incorporation of new Centers for Medicare & Medicaid Services-approved ICD-10-CM and ICD-10-PCS codes related to COVID-19 into the diagnosis-related group inpatient hospital payment methodology, retroactively to April 1. The following diagnosis and procedure codes will now be reflected in the methodology of determining a hospital’s […]
DHCS Announces Intended Awardees of Medi-Cal Managed Care Request for Proposal
On Aug. 25, the Department of Health Care Services (DHCS) has announced its intent to award contracts to commercial managed care plans to deliver Medi-Cal services beginning in 2024.
Disproportionate Share Hospital Eligibility for 2022-23 Data Corrections Due on Sept. 12
On Aug. 1, the Department of Health Care Services notified district hospitals and private hospitals of their tentative eligibility for disproportionate share hospital (DSH) and virtual DSH, also known as DSH replacement, for fiscal year 2022-23. Hospitals have until Sept. 12 to review their DSH eligibility determination and may correct and resubmit their data if […]
CMS Final IPPS Rule Improves After Intense Advocacy Efforts
Earlier this week, the Centers for Medicare & Medicaid Services (CMS) issued its 2023 inpatient prospective payment system final rule — a rule that includes several positive changes compared to CMS’ initial proposal.