Medi-Cal is California’s Medicaid program — a public health insurance program that provides needed health care services for low-income families with children, seniors, people with disabilities, foster caregivers, pregnant women and low-income people with specific diseases, such as tuberculosis, breast cancer or HIV/AIDS. Medi-Cal is financed equally by the state and federal governments.
The Department of Health Care Services (DHCS) has begun publishing a weekly newsletter featuring updates on the ongoing implementation of the Coordinated Care Initiative and Cal MediConnect. The email newsletter includes the latest information on provider outreach, as well as events and activities in each of the counties where the program is being implemented. In addition, DHCS has revamped the Cal MediConnect website to include designated sections for providers and beneficiaries, with related informational materials. To access the website and subscribe to the weekly newsletter, visit www.calduals.org.
The Centers for Medicare & Medicaid Services (CMS) has posted the attached notice announcing preliminary federal disproportionate share hospital (DSH) allotments for fiscal year (FY) 2014. The notice also announces the preliminary federal share FY 2014 limits on aggregate DSH payments that states may make to institutions for mental diseases (IMDs) and other mental health facilities. CMS estimates California’s DSH allotment at $1.169 billion and the state’s IMD DSH limit at $777,960. The DSH allotment notice was delayed by legislation that repealed Medicaid DSH cuts under the Affordable Care Act for FYs 2014 and 2015. Since the final rule implementing the cuts applied only to 2014 and 2015 and the legislation pushes both the 2014 and 2015 cuts into 2016, the final rule is effectively moot. CHA believes CMS must go through a new round of rulemaking, as it had planned for implementing the 2016 cuts, and that may not occur until 2015. CHA continues to monitor the situation closely and will keep the members informed.
Providers interested in participating in a California Department of Health Care Services (DHCS) beta test for ICD-10 coding must sign up by Feb. 28. As beta testers, participants will submit practice claims with ICD-10-CM and ICD-10-PCS codes to Medi-Cal during the second quarter of this year. To express interest in volunteering, send an email request to ICD-10Medi-Cal@xerox.com by midnight on Feb. 28. Details of information to include in the email, as well as more information about the beta test program, are available on the DHCS website.
The Centers for Medicare & Medicaid Services (CMS) Medicare-Medicaid Coordination Office is facilitating a series of webinars for interested providers, health care professionals and others regarding the Disability-Competent Care (DCC) model. The DCC model is designed to enhance capacity to integrate care for adults with disabilities. Webinars will be tailored by audience and topic, for a total of eight webinars presented live on a weekly basis.
Initial topics will include the dignity of risk and strategies to stimulate and support participant engagement. The first webinar will take place Feb.4 from 11 a.m. – noon (PT). To register for the webinars, visit www.event.on24.com. Additional information and recordings of previous webinars are available at www.ResourcesForIntegratedCare.com.
The California Department of Health Care Services (DHCS) has issued updated county-by-county information on the timeline for implementation of the Coordinated Care Initiative (CCI) , including Cal MediConnect. As previously announced, Cal MediConnect/CCI — including the passive enrollment of eligible dual beneficiaries — will begin in April in Riverside, San Bernadino, San Diego and San Mateo counties. In Los Angeles County, voluntary enrollment into Cal MediConnect will start in April. Passive enrollment will begin in July 2014 for one plan only (Health Net). It is anticipated that passive enrollment into LA CARE will begin Dec. 1.
Implementation in Orange County has been delayed as the result of a recent program audit of CalOptima by the Centers for Medicare & Medicaid Services (CMS), which resulted in the suspension of enrollment of Medicare beneficiaries into Cal Optima. DHCS has indicated that Cal MediConnect will not move forward in Orange County until CalOptima has taken required corrective action.
Cal MediConnect/CCI will begin July 1 in Alameda County. In Santa Clara County, Cal MediConnect will begin Jan. 1, 2015, while other components of CCI will begin July 1, 2014.
A summary of the information provided by DHCS is attached. Additional information is available at www.calduals.org.
The Health Resources and Services Administration (HRSA) has announced the results of 51 audits it conducted of 340B drug pricing program participants. Begun in 2012, the audits included 410 covered entity sites. According to HRSA, results range from no adverse findings to minor and more significant infractions. All of the current audit findings are available on HRSA’s website.
HRSA also plans to formalize existing program guidance in a proposed rule by June of this year, addressing the definition of an eligible patient, compliance requirements for contract pharmacy arrangements, hospital eligibility criteria and eligibility of off-site facilities. For more information about the 340B program, visit www.hrsa.gov/opa/update.html.
The California Department of Health Care Services (DHCS) has distributed updated information about the upcoming implementation of Cal MediConnect, including information on enrollment timelines and the Ombuds Program.
The Centers for Medicare & Medicaid Services has released the attached proposed rule establishing emergency preparedness requirements for hospitals, critical access hospitals and 15 other suppliers and providers participating in the Medicare and Medicaid programs. The proposed rule would require participating providers and suppliers to meet four standards, including developing an emergency plan based on a risk assessment; developing and implementing policies and procedures based on the plan; developing and maintaining a communication plan; and a testing and training program based on the plans. The proposed rule would also require hospitals, critical access hospitals and long-term care facilities to implement emergency and standby power systems based on their emergency plan. CHA is currently reviewing the proposed rule and welcomes member input for comments being developed. Comments on the proposed rule are due Feb 25.
The Centers for Medicare & Medicaid Services (CMS) has approved State Plan Amendment (SPA) #13-034, exempting distinct-part skilled-nursing facilities (DP/SNFs) from the Medi-Cal payment reduction and rate freeze required by AB 97, passed in 2011. The restoration of the rates going forward is the result of provisions included in CHA-sponsored SB 239, passed by the state Legislature in 2013.
Approval of the SPA paves the way for implementation of full and unreduced 2013-14 rates, retroactive to Sept. 1, 2013, for DP/SNFs in designated rural or frontier areas, and retroactive to Oct. 1, 2013, for remaining DP/SNFs. CHA will provide additional information about the timelines for rate implementation as soon as it is available.
CHA has submitted the attached comments to the Centers for Medicare & Medicaid Services (CMS) and the California Department of Health Care Services (DHCS) regarding the revised enrollment strategy for Los Angeles County dual eligible beneficiaries into Cal MediConnect beginning in April 2014. CHA continues to raise concerns regarding access and network adequacy that, if not addressed, may undermine the success of the demonstration. Among CHA’s concerns under the revised enrollment strategy is that it relies exclusively on the Health Net network for passive enrollment for a five-month period.
The California Department of Health Care Services (DHCS) has announced that its Medi-Cal fiscal intermediary, Xerox State Healthcare, will hold provider training webinars throughout January 2014. Topics will include common denials, recipient eligibility, share of cost, claim form specifics, presumptive eligibility and much more. For a complete list of sessions to be offered, visit the Medi-Cal training calendar. Details about the registration process and accessing webinars are available on the Medi-Cal Outreach & Education page.
The California Department of Health Care Services (DHCS) has announced that Medi-Cal will select stakeholders in the first quarter of 2014 for ICD-10 coding beta tests, with testing to take place in the second quarter of 2014. DHCS will publish the results in August 2014. Hospitals interested in being considered for selection as a beta tester should send an email request to ICD-10Medi-Cal@xerox.com and include their national provider identifier; name and ID; submitter type (clearing house, billing service, hospital group, individual provider, etc.); primary claim type (pharmacy, professional, institutional, etc.); average number of providers represented; and average number of claims submitted per month.
The Department of Health Care Services (DHCS) has announced that its fiscal intermediary, Xerox State Healthcare, will reprocess claims in the first quarter of next year for those crossover claims that were erroneously denied with remittance advice details (RAD) codes 0002 (recipient not eligible for benefits under Medi-Cal or other special programs) and 0314 (recipient not eligible for the month of service billed). DHCS also reports that the system problem that caused the erroneously denied claims has been corrected, and that providers do not need to take any action. Reprocessed claims will appear on providers’ RAD reports.
The Department of Health Care Services (DHCS) has released for stakeholder comment revised draft enrollment materials that will be distributed to beneficiaries eligible to enroll in the Cal MediConnect program. The current release reflects comments submitted in response to previous draft materials provided in June. The materials include template notices that will be mailed to beneficiaries at 90 and 60 days prior to their scheduled date of passive enrollment into Cal MediConnect, as well as a Cal MediConnect Health Plan Guidebook. The goal of the guidebook is to explain to beneficiaries their health plan choices, how to choose a health plan, their rights and responsibilities after they join a health plan, and to provide additional resources and information. Comments are due by Friday, Oct. 18.
CHA has released a video statement from President/CEO C. Duane Dauner, thanking Governor Brown and the State Legislature for their leadership in enacting SB 239
(Hernandez, D-West Covina/Steinberg, D-Sacramento). The new law eliminates Medi-Cal cuts for non-rural hospital-based skilled-nursing facilities (rural facilities were exempted in August) and lifts a rate freeze that was harming health care providers struggling to treat some of the most medically complex patients. It also delivers more than $10 billion in new federal Medicaid funds to California hospitals over the next three years and will provide $2.4 billion in additional revenue to the state General Fund.
“SB 239 creates protections for the state, for patients, and for hospitals without any tax increases,” Dauner explains in the video. “In all, patients and Californians are the real winners.”
The Affordable Care Act (ACA) makes a number of changes to simplify the Medicaid enrollment process, including requiring a “no wrong door” approach to enrollment. As part of these changes, beginning in 2014 all states will be required to use a single-streamlined application, meaning that people who are seeking health coverage will only need to complete one application in order to learn which programs they and their family members can enroll in. In California, the California Department of Health Care Services (DHCS) and Covered California have partnered to create a single-streamlined paper application that will allow consumers to apply for a range of health coverage options, including Medi-Cal/CHIP, advanced premium tax credits (subsidies) and cost-sharing reductions, to help purchase coverage under a Covered California Qualified Health Plan. Consumers can apply online, by phone or by paper when open enrollment begins Oct. 1.
The Centers for Medicare & Medicaid Services (CMS) has issued a new individualized quality control plan (IQCP) for laboratories, to begin Jan. 1, 2014, and conclude Jan. 1, 2016. IQCP is voluntary and will provide laboratories with flexibility in customizing quality control policies and procedures based on each laboratory’s test systems and unique aspects. During the education and transition period between Jan. 1, 2014, and Jan. 1, 2016, laboratories will have three acceptable quality control options: 1) follow the CLIA regulatory requirements as written, 2) continue to follow the Equivalent Quality Control (EQC) procedures as described in the current interpretive guidelines in Appendix C, and 3) implement IQCP. More information about the IQCP option is available in the attached CMS memo.
The California Department of Health Care Services (DHCS) has announced a proposed billing change that would discontinue the use of local modifier ZS, which is used to bill for the full professional (26) and technical (TC) components of a procedure. DHCS has also proposed three scenarios with instructions for billing and TAR completion after the modifier ZS is discontinued.
DHCS will accept stakeholder comments through 4 p.m. on Oct. 30. Instructions for submitting comments are available on the DHCS website. The attached document explains the proposed billing change.
The Centers for Medicare & Medicaid Services (CMS) has posted the final rule implementing the provision of the Affordable Care Act that reduces Medicaid state disproportionate share hospital (DSH) allotments. CHA is currently reviewing the final provisions and will share more information and a detailed summary soon. The final rule adopts a proposal to ignore states’ decisions on the now-optional Medicaid expansion over the next two years when calculating DSH reductions, totaling $1.1 billion. According to a CMS fact sheet about the final rule, states’ decisions to expand Medicaid will not affect the reduction in DSH allotments. CMS states that it intends to revisit the DSH allotment reduction methodology in federal fiscal year 2016. The final rule is attached.
The Department of Health and Human Services (HHS) has released its final rule reforming the Medicare and Medicaid Conditions of Participation for hospitals and Critical Access Hospitals (CAHs). Among other changes, the final rule increases flexibility for hospitals by allowing one governing body to oversee multiple hospitals in a single health system. The rule also allows CAHs to partner with other providers so they can be more efficient and ensure the safe and timely delivery of care to their patients. In addition, the rule allows hospitals and their medical staff to include non-physician practitioners on the medical staff. CHA is reviewing the final rule and will release a detailed summary in the coming weeks. The final rule is attached.