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 to Hold Webinar on Hospital Fee Program Updates
A CHA members-only webinar on Feb. 21 from 9:30-11 a.m. will provide information on recent changes to how Medi-Cal managed care plans can make supplemental payments through the Hospital Fee Program.
Hospitals Should Review New Requirements for Hospital Presumptive Eligibility Application Portal
Later this year, the Department of Health Care Services (DHCS) will modify access to the Hospital Presumptive Eligibility (HPE) Application Portal. Providers who have not yet updated their HPE user information should do so to ensure they do not lose access to the portal.
CHA Outlines Worksheet S-10 Concerns, Urges CMS to Delay Current Deadline for Cost Report Audits
Last week, CHA sent a letter to the Centers for Medicare & Medicaid Services (CMS) outlining concerns about the use of Worksheet S-10 data in the Medicare uncompensated care (UCC) payment distribution methodology. CHA urged CMS to delay the current deadline for cost report audits.
DHCS Clarifies Guidance on Network Certification for Medi-Cal Managed Care Plans
The Department of Health Care Services (DHCS) has released All Plan Letter 19-002, which details reporting requirements for Medi-Cal managed care health plans (MCPs) during the annual network certification process.
CHA Comments on CMS’ Proposed Managed Care Rule
CHA submitted the attached comment letter responding to the Centers for Medicare & Medicaid Services’ (CMS) proposed rule that would change managed care regulations for Medicaid and the Children’s Health Insurance Program (CHIP). While most of the rule’s proposals are technical adjustments or changes that have little impact on the Medi-Cal managed care program, some could impact the managed care portion of the Hospital Fee Program.
FFY 2019 Uncompensated Care Payments to Come From 2014, 2015 Worksheet S-10 Data
In the federal fiscal year (FFY) 2019 inpatient prospective payment system final rule, the Centers for Medicare & Medicaid Services (CMS) finalized its second year of a three-year transition to use Worksheet S-10 data for distributing Medicare disproportionate share hospital (DSH) uncompensated care payments. CMS will use two years (FFYs 2014 and 2015) of Worksheet S-10 cost report data and one year of proxy data to distribute the uncompensated care payments for FFY 2019.
In response to comments from CHA, CMS noted in the final rule that it planned audits of the data in fall 2018. In late August, CMS began audits of selected hospitals’ FFY 2015 cost reports. A number of hospitals in California have received this data request, and must respond by Sept. 28.
Because CMS has given the Medicare administrative contractors (MACs) only until the end of January to complete the audits, providers have a short timeline to complete this work with their MACs. Though CHA acknowledges that this presents a challenge from both technical and resource perspectives, CHA highly encourages hospitals that have received a request to respond as quickly as possible. Early communication with Noridian (or its subcontractor, Figliozzi & Company) is critical under this short timeline. A copy of the letter Noridian sent to select providers requesting documentation is attached; these letters are consistent across all MACs.
Budget and SGR Reforms Advance
Last night the House of Representatives passed the Bipartisan Budget Act of 2013. The Senate is expected to do so today, and the President has indicated he will sign the measure. The vote in the House was 332-62; nine Californians voted against passage. The legislation contains both good news and bad news for California’s hospitals.
Also this week, the House Ways and Means and Senate Finance Committees reported bipartisan legislation to repeal the sustainable growth rate (SGR) for physician Medicare payments. They will continue to work toward a permanent solution during the first quarter of 2014. The financing mechanisms for offsetting the cost of repeal have not been released. Payments to hospitals continue to be vulnerable as the committees look for as much at $150 billion over the next 10 years to pay for the SGR repeal.
CHA has provided the attached summary of the Bipartisan Budget Act of 2013 with additional information about the hospital-related provisions.
CHA Members Take Hospital Message to Capitol Hill
CHA President/CEO C. Duane Dauner was joined by 10 representatives of CHA member hospitals in Washington, D.C., Dec. 3 for the CHA and American Hospital Association hospital advocacy day. The group met with about half of the California Congressional delegation, including House Minority Leader Nancy Pelosi, House Majority Whip Kevin McCarthy, and Sens. Boxer and Feinstein.
Duals Demo Timeline Changes Included in Proposed State Budget
Gov. Jerry Brown’s 2013-14 state budget proposal, released Jan. 10, includes a delay in implementing the Coordinated Care Initiative (CCI), which will transition individuals eligible for both Medicare and Medi-Cal —dual-eligibles — into managed care. It will also integrate long-term care services and supports into managed Medi-Cal. CCI implementation is now scheduled for September 2013, rather than June 2013 as originally planned. Under the revised timeline, beneficiaries will receive notice of changes no sooner than June 2013. Beneficiary enrollment schedules have also been modified and will vary among the designated counties: in Los Angeles County, enrollment will be phased in over 18 months; in the County of San Mateo, beneficiaries will be enrolled at once; and in Orange County, County of San Diego, County of San Bernardino, County of Riverside, Alameda County, and the County of Santa Clara, enrollment will be phased in over 12 months.
DSH Task Force Urges Congress to Protect Medicaid
CHA has joined with California’s safety-net hospitals on the Disproportionate-Share Hospital (DSH) Task Force to send a letter to members of the California congressional delegation urging them to protect the Medicaid program from any additional cuts to hospital payments. As the House searches for spending reductions to offset the elimination of cuts to defense spending, proposals have emerged to reduce states’ ability to use Medicaid provider taxes and DSH payments. These programs provide critical means for hospitals to bolster their ability to preserve health care services for the state’s most needy patients. CHA will continue to advocate against further cuts to hospitals as the House continues its budget reconciliation process. The DSH Task Force letter is attached.