About Medi-Cal
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, including care for more than 50% of all births, 51% of behavioral health-related emergency department visits, and 49% of rural hospital patient care But for low-income Californians who rely on Medi-Cal for coverage — two-thirds of whom are people of color — their care is at serious risk. Communities with high Medi-Cal enrollment already suffer from a severe lack of health care providers and with hospital services at risk of being reduced and outright closures looming, California’s most vulnerable, including people living in rural and underserved areas, are in jeopardy.
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.
DHCS Delays First Wave of Medi-Cal Rx Prior Authorization Reinstatement to Sept. 16
On July 26, the California Department of Health Care Services (DHCS) and its Medi-Cal Rx contractor Magellan announced a delay in the first wave of reinstatement of prior authorizations for new start medications in 11 therapeutic drug classes from late August to Sept. 16.
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.