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
CHA Provides Resources to Support Hospitals’ FEMA Applications
The Federal Emergency Management Agency (FEMA) is requiring hospitals to offset reimbursement requests for qualified COVID-19 expenses for any third-party claims payment for health care services. However, the agency has not offered any detailed guidance on how any patient care-related revenue should be offset, and is relying on hospitals to provide a methodology.
Reminder: Reinstatement of Medi-Cal Rx Pharmacy Claim Edits Goes Live July 22
As previously announced in CHA News, the California Department of Health Care Services (DHCS) and its Medi-Cal Rx contractor Magellan will reinstate pharmacy claim edits and Reject Code 88 for diagnosis and drug utilization review requirements on July 22.
DHCS Releases Provider Training Webinar Schedule for August
The Department of Health Care Services has announced its Medi-Cal provider training webinar schedule for August.
Medi-Cal Coverage of Community Health Worker Services Effective July 1
On June 29, the Department of Health Care Services (DHCS) announced that, effective July 1, Medi-Cal will cover community health worker (CHW) services, including violence prevention and asthma prevention.
Deadline for Providers to Return Electronic Claims Agreements for Medi-Cal Rx Is July 31
On June 30, the Department of Health Care Services announced an extension and reminder to all participating Medi-Cal Rx providers and billers to submit their completed Medi-Cal Rx Telecommunications Provider and Biller Application/Agreement Form by July 31. If a provider’s form is not received by July 31, they will NOT be able to continue to […]
Budget Deal Brings Big Changes for Health Care
Earlier this week, California’s Senate and Assembly, along with Gov. Gavin Newsom, finalized several important details of this year’s budget, a $300 billion spending package that includes several far-reaching features that will affect both health care delivery and hospital operations. While legislation is far from complete and it is expected that more issues will arise […]
CMS Approves SFY 2018-19 Medi-Cal Managed Care Rates
On June 23, the Centers for Medicare & Medicaid Services approved the Medi-Cal managed care rates for state fiscal year (SFY) 2018-19.
DHCS Provides Updated Acute Rehab Criteria
The Department of Health Care Services has provided updated information on treatment authorization request (TAR) criteria for acute inpatient rehabilitation.
DHCS and Magellan Announce Upcoming Reinstatement of Medi-Cal Rx Claim Edits
On June 22, the Department of Health Care Services (DHCS) and its Medi-Cal Rx contractor Magellan announced that effective July 22 , pharmacy claim edits for diagnosis and drug utilization review (DUR) requirements will be reinstated.
CMS Approves SFY 2017-18 Rates; Hospital Fee Program 7 Approval Still Pending
On June 17, the Centers for Medicare & Medicaid Services (CMS) approved the Medi-Cal managed care rates for state fiscal year (SFY) 2017-18. Even though CMS has never denied a California managed care rate package, its approvals can take on average between one and two years. Unfortunately, with the SFY 2017-18 managed care rates there […]