The newsroom includes access to CHA News, which provides timely information to members every Monday and Thursday and is at the core of CHA benefits. In addition, it is also home to resources such as toolkits and talking points designed to help member hospitals and health systems communicate with internal and external audiences on a range of current health care-related issues. Links to CHA media statements and press releases can also be found here.  

DHCS Reminds Providers That New Fee-for-Service Pharmacy Reimbursement Begins Feb. 23

Beginning Feb. 23, the Department of Health Care Services (DHCS) will implement a new fee-for-service reimbursement methodology for covered outpatient drugs. The methodology will reimburse the lower of the actual acquisition cost (as determined by the Centers for Medicare & Medicaid Services), the federal upper limit, the maximum allowable ingredient cost, and the pharmacy’s usual and customary charge. For more details about the changes, visit the DHCS website.

Feb. 5 Webinar to Address Implementation of Children’s Hospital Bond Act of 2018

As shared previously in CHA News, the California Health Facilities Financing Authority (CHFFA) will host a webinar to address implementation of the Children’s Hospital Bond Act of 2018 on Feb. 5.

The webinar will provide an overview of the program and includes a question and answer session. CHFFA has proposed draft regulations to implement the program and will use feedback received during the webinar to inform the finalized regulations. Comments on the proposed regulatory package are due Feb. 8 and should be submitted to [email protected].

CalMedForce Awards $38 Million in Proposition 56 Graduate Medical Education Funding

This week, Physicians for a Healthy California announced 73 awards totaling $38 million in the inaugural cycle of its CalMedForce Program, which provides funding for graduate medical education programs in California.

The program is committed to growing a diverse physician workforce by supporting, incentivizing, and expanding graduate medical education in California. Its goal is to grow and strengthen the physician pipeline to meet the demands of California’s growing patient population, with a focus on medically underserved areas and populations.

In the program’s first application cycle, 131 applications were submitted, totaling approximately $147.3 million in requests to support 594 residents. The 73 programs that received awards in this cycle represent 156 residency slots in programs from all across California, in both urban and rural areas. Programs that focus on medically underserved areas and populations were given priority.

Department of Veterans Affairs Proposes Access Standards for Veteran Community Care Program

The Department of Veterans Affairs (VA) has proposed access standards under the new Veterans Community Care Program, as required by the MISSION Act of 2018. The VA also issued a proposed rule that establishes a new benefit for veterans to access urgent care services.

The access standards will be used to determine whether a veteran can access care outside a VA medical facility at an eligible community provider. Specifically, the agency proposes access standards of:

  • A 30-minute average drive time standard for primary care, mental health and non-institutional extended care services
  • A 60-minute average drive time standard for specialty care
  • Appointment wait-time standards of 20 days for primary care, mental health care and non-institutional extended care services, and 28 days for specialty care, with certain exceptions

For urgent care, the VA proposes a veteran could receive care at any provider in the community care network, with the possibility of a co-pay charge. Additional details on the establishment of an eligible community provider network are not included in the proposed rule and are expected to be issued in a separate interim final rule in late spring. The MISSON Act requires the program to be implemented by June 6. Comments are due March 4.

CMS Proposes Rate Updates for 2020 Medicare Advantage Plans

The Centers for Medicare & Medicaid Services (CMS) has issued Part II of its 2020 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part D Payment Policies and Draft Call letter. CMS proposes a 1.59 percent increase to baseline Medicare Advantage payment rates for 2020.

Part II of the advance notice also includes a number of proposals to address the opioid epidemic, including:

  • Offering new flexibilities for plans to offer targeted benefits and cost-sharing reductions for patients with chronic pain or who are undergoing addiction treatment
  • Encouraging Part D sponsors to provide lower cost-sharing for opioid-reversal agents, such as naloxone
  • Updating the star rating methodology to include new opioid-related measures

CMS also proposes additional flexibility — as required by the Bipartisan Budget Act of 2018 — for MA plans to offer supplemental health benefits for certain enrollee populations, such as reductions from fee-for-service Medicare-equivalent cost sharing, and primarily non-health related supplemental benefits, such as transportation for non-medical needs, home-delivered meals, food and produce.

CMS previously issued Part I of the Advance Notice, which includes updates to the risk adjustment model for capitated payments for MA plans. Comments on both Part I and Part II are due March 1. Additional information is available in a CMS fact sheet

DHCS Webinar Tomorrow Will Address Network Provider Status Under Hospital Fee Program

On Jan. 30 from 3-4 p.m. (PT), The Department of Health Care Services (DHCS) will host a webinar to provide guidance for health plans and hospitals on the changes to network provider requirements.

Earlier this month, DHCS implemented new requirements  for network provider status, impacting eligibility for directed payment under the Hospital Fee Program. While the department has granted certain flexibilities for state fiscal years 2017-18 and 2018-19, these new changes are significant and will become effective on July 1, 2019.

Upcoming Webinar Will Provide Update on Children’s Hospital Bond Act of 2018

On Feb. 5 from 10:30 a.m. to noon (PT), the California Health Facilities Financing Authority (CHFFA) will host a webinar to address implementation of Proposition 4, the Children’s Hospital Bond Act of 2018.

The webinar will provide an overview of the program as well as a question and answer session. CHFFA is currently developing proposed regulations to implement the program and will use feedback received during the webinar in this process.

As shared previously in CHA News, California voters passed Proposition 4 in 2018, authorizing the state to issue $1.5 billion in general obligation bonds for capital improvement projects. Of the $1.5 billion in awards, $1.08 billion will be available for eligible children’s hospitals, $270 million will be available for University of California children’s hospitals, and the remaining $150 million will be available for public or private nonprofit hospitals that provide pediatric services for children in the California Children’s Services Program.

Covered California Invites Comment on Quality, Network Management, Delivery System Standards and Improvement Strategy

Covered California is seeking stakeholder feedback on its efforts to promote accountability and support delivery system improvements. In a recently released request for information, Covered California solicits questions and suggestions in four key areas.

Those areas include:

  • Guiding Principles for Promoting Better Care and Delivery Reform
  • Current Qualified Health Plan Issuer Contract Terms: Quality, Network Management, Delivery System Standards and Improvement Strategy
  • Contractual Expectations Domains and Strategies: Right Care/Accountability and Delivery System Improvement 
  • Enabling Factors that Promote Delivery Reform

Instructions for submitting feedback — due Feb. 15 — are also included in the notice. CHA will engage its Managed Care Committee to inform development of CHA’s comments. Members are invited to provide feedback to Amber Kemp, vice president, health care coverage by Feb. 8. Additional background information about Covered California’s process for refreshing its contractual expectations is available online.

Experts Urge Legislators to Adopt New Solutions for California’s Homeless

As hospitals actively engage with community partners to comply with a new homeless patient discharge planning law, members of the Legislature heard from advocates last week about the need for a broad transformation in the way California addresses homelessness.

A panel of state and federal experts addressed a joint informational hearing of two Assembly committees — the Housing and Community Development Committee and the Human Services Committee. Among the findings and solution presented, the panelists urged lawmakers to change California’s decentralized homeless shelters from temporary housing stops to a more integrated system that connects people to the services and resources they need, and more quickly places them into housing.

To help hospitals comply with the new homeless patient discharge law, CHA has developed a guidebook titled Discharge Planning for Homeless Patients.

CMS Announces New Part D Payment Modernization Model

The Centers for Medicare & Medicaid Services (CMS) has announced a new Part D Payment Modernization model, available through the Center for Medicare and Medicaid Innovation, for Part D and Medicare Advantage (MA) drug plans beginning in January 2020.

The voluntary five-year model will test the impact of a Part D payment structure that creates new incentives for plans, patients and providers to choose drugs with a lower list price. The model is open to eligible, standalone prescription drug plans and Medicare Advantage prescription drug plans; CMS will release a request for applications to join the model for calendar year 2020 in the near future. 

CMS also announced updates to the MA Value-Based Insurance Design (VBID) model for calendar year 2020. The model will test different service delivery innovations by allowing plans to provide reduced cost sharing and additional benefits to enrollees in a more targeted fashion, bolster the rewards and incentive programs that plans can offer beneficiaries to take steps to improve their health, and increase access to telehealth services. Eligible MA health plans in all 50 states and territories may apply for the health plan innovations being tested under the VBID model, as required by the Bipartisan Budget Act of 2018.

Press Contact

Jan Emerson-Shea
Vice President, External Affairs
(916) 552-7516

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