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.
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 […]
DHCS Announces Two-Week Fee-for-Service Checkwrite Hold for Some Services and Programs
On June 16, the Department of Health Care Services announced through a Medi-Cal provider newsflash that fee-for-service payments for certain services and programs that were scheduled to be paid at the end of June will be held until early July. This delay does not apply to services provided in Medi-Cal managed care.
CHA Comments on FFY 2023 IPPS Proposed Rule
CHA has submitted comments on the federal fiscal year (FFY) 2023 inpatient prospective payment system (IPPS) proposed rule issued by the Centers for Medicare & Medicaid Services (CMS).
DHCS Releases Updated Treatment Authorization Request Criteria for Inpatient Services
On June 9, the Department of Health Care Services (DHCS) announced through a Medi-Cal provider bulletin that the criteria for Treatment Authorization Requests (TAR) for inpatient services will be updated effective for admissions on or after June 15.
CHA Submits Comments to DHCS on Draft Population Health Management Strategy and Roadmap
Earlier this month, CHA shared feedback with the Department of Health Care Services (DHCS) on its Draft Population Health Management (PHM) Strategy and Roadmap 2022.
Latest State Budget Proposal Sharpens Our Focus on Hospitals’ Needs
Last week, Gov. Newsom released the May Revision to his 2022-23 budget proposal — an update to the one he announced in January — which the Legislature will now consider for its June 15 deadline to pass a finalized budget.
DHCS Launches Coverage Ambassador Program, Will Host Two Webinars
Under the COVID-19 federal public health emergency (PHE), Medi-Cal beneficiaries were guaranteed continuous coverage as long as the PHE was in effect.
CHA Issues Detailed Summary of FFY 2023 IPPS Proposed Rule, Will Hold Webinar May 25
CHA has issued a comprehensive summary of the federal fiscal year (FFY) 2023 inpatient prospective payment system proposed rule released by the Centers for Medicare & Medicaid Services (CMS). Comments on the proposed rule are due to CMS by 2 p.m. (PT) on June 17.