SB 853 (Statutes of 2010, Chapter 717) mandates that the California Department of Health Care Services (DHCS) develop a Diagnosis Related Group (DRG) Payment System by July 1, 2012. DHCS has hired ACS, a Xerox company, to lead the transition to the new payment system. In an effort to make the process transparent, DHCS asked CHA to create a consultation group of health care providers to give input on the development of the payment system. The group meets monthly to discuss DRG payment system policy and implications. This website area contains pertinent documents related to those discussions, and much of the information is available to members only. All member hospitals are advised to contact CHA with any additional questions, thoughts or concerns.
The California Department of Health Care Services (DHCS) has released guidance on how hospitals should bill under the Diagnosis Related Payment (DRG) methodology for beneficiaries hospitalized with a California Children’s Services (CCS)-eligible condition, as well as a condition covered by a Medi-Cal managed care plan (MCP). Effective retroactively to July 1, a specific billing policy will apply for services provided to Medi-Cal beneficiaries with CCS-eligible conditions who are enrolled in an MCP that does not cover CCS-eligible conditions.
A recording of the July 13 web seminar on the Medi-Cal diagnosis-related group data set and simulation is now available at http://tinyurl.com/86drjz6. The web seminar, hosted by the Department of Health Care Services, guides hospitals through the instructions for modifying their hospital-specific data file to reflect the final simulation results. For more information on the DRG transition, visit www.calhospital.org/medi-cal-drg-conversion.