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.
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.
Hospitals have until Sept. 10 to complete the annual recertification process for 340B program eligibility. All hospitals with an active 340B ID as of July 1 and without a future termination date are required to recertify and will be removed from the 340B program if they do not complete the process. The Health Resources and Services Administration (HRSA) has notified hospitals’ authorizing officials of their user names and passwords, allowing for login to the 340B database to complete the recertification process. Hospitals will also need to decertify sites that have closed or that are not eligible to participate in the program. HRSA’s June webinar on recertification is available for replay, and questions about registration and recertification can be directed to (888) 340-2787 or ApexusAnswers@340bpvp.com.
The Department of Health Care Services has issued revised enrollment materials for the Coordinated Care Initiative (CCI), which provides for the enrollment of dually eligible beneficiaries in eight designated counties into managed care. The materials and associated Choice Form were revised in response to stakeholder concerns that the current notices did not adequately communicate choices and required action for CCI-eligible individuals — in particular, the ability and process to opt out and maintain traditional Medicare coverage. Use of the revised Choice Form will begin in September with the 60-day notices sent to those subject to passive enrollment in November. Attached are samples of the revised Choice Form and enrollment materials.
The California Department of Health Care Services (DHCS) has announced that Medi-Cal has fixed an issue with an erroneous denial of All Patient Refined Diagnosis Related Group (APR-DRG) type of bill code 121.
The annual recertification of hospital 340B eligibility began Aug. 6 and continues through Sept. 10. All hospitals with an active 340B ID as of July 1 and without a future termination date are required to recertify and will be removed from the 340B program if they do not complete the process.
At a meeting yesterday of the Health and Human Service (HHS) Agency’s Olmstead Advisory Committee, HHS Secretary Diana Dooley and Department of Health Care Services (DHCS) Chief Margaret Tatar provided implementation updates on the Coordinated Care Initiative/Cal MediConnect, including that enrollment materials and the “choice” form will be made available in August. The materials have been revised in response to stakeholder concerns and developed and tested with consumer focus groups. CHA has requested that copies of the final form and materials be shared with providers, including hospitals, as soon as possible. In addition, DHCS reported that implementation of Cal MediConnect in Alameda and Orange counties, most recently anticipated for January 2015, will be delayed until July 1, 2015. Implementation must occur no later than July in order for the counties to be included in the demonstration program.
The American Hospital Association’s (AHA) RACTrac survey data is used specifically to analyze the impact of the Medicare Recovery Audit Contractor (RAC) program on hospitals and helps to guide CHA’s advocacy for important and necessary changes in the RAC program. AHA membership is not required to participate in RACTrac; CHA encourages all hospitals to participate regardless of AHA membership status. As part of the survey, participants are asked include information on the number of claims withdrawn from appeal to rebill for Part B payment. For registration information, contact AHA’s RACTrac support at (888) 722-8712 or email@example.com. For more on the survey, including the latest results, visit www.aha.org/ractrac.
The Department of Health and Human Services (HHS) and its Health Resources and Services Administration (HRSA) have issued the attached interpretive rule on the 340B Drug Pricing Program. The rule continues to allow hospitals subject to the “orphan drug” exclusion to purchase those drugs through the 340B program when the drugs are not used to treat the rare conditions for which the orphan drug designation was given. In May, a federal court vacated HHS’ adoption of a regulation to implement the orphan drug exclusion policy. The interpretive rule is effective July 23.
Hospitals can play an important role in reducing the number of uninsured through the Hospital Presumptive Eligibility (HPE) program. The HPE program will allow all hospital Medi-Cal providers — including any clinic on a hospital’s license — to provide potentially-eligible individuals with temporary, full-scope Medi-Cal benefits.
CHA and the American Hospital Association are gathering input from hospitals to help convey the true benefit of the 340B program. CHA encourages all members that participate in the 340B program to develop case examples showing how the program helps their patients and communities. Specifically, CHA is interested in learning more about grateful patient stories and services that hospitals would not be able to provide without the 340B program. Please share those examples with CHA by emailing firstname.lastname@example.org.
New findings from the Health Resources and Services Administration (HRSA) for the 340B Drug Pricing Program show adverse audit findings for only four of 19 covered entities. HRSA’s Office of Pharmacy Affairs conducted the audits in fiscal year 2013 and will update corrective action plans and sanctions once approved by HRSA. Until the corrective action plans are posted on the HRSA website, manufacturers are advised not to contact audited entities about sanctions. To help hospitals with 340B recertification, the Office of Pharmacy Affairs will host a webinar tomorrow, June 26 at 11 a.m. (PT). Hospital leaders can join the meeting here and access the call-in line at (888) 950-6750 (participant code 8501607). Providers who cannot participate in the webinar will be able to access a replay at http://opanet.hrsa.gov/opa/default.aspx.
The Department of Health Care Services has issued the attached dual plan letter (DPL) clarifying the responsibilities of Medicare-Medicaid plans (MMPs) to provide coverage of nursing facility services as required under the Coordinated Care Initiative (CCI). The DPL includes information on required plan policies and procedures, payment, continuity of care and other provisions for MMP beneficiaries in CCI counties.
On May 20, the Department of Health Care Services (DHCS) mailed to hospitals the Diagnosis Related Group (DRG) reimbursement year two base rates, effective July 1. This week, on June 26, DHCS and Xerox will host an additional webinar training session specific to changes in year two of implementation. The webinar will be held from 9 a.m. – 10:30 a.m. (PT), and attendees must register prior to the start of the webinar in order to receive meeting details. The webinar will also be recorded for future reference. For more information about the DRG methodology, visit www.dhcs.ca.gov/provgovpart/Pages/DRG.aspx.
The Health Resources and Services Administration (HRSA) announced yesterday that it will continue to allow covered entities to purchase orphan drugs through the 340B Drug Pricing Program as long as the drugs are not used to treat the conditions for which the orphan drug designation was given.
The Medicaid and CHIP Payment and Access Commission (MACPAC) released its June report to Congress last week, recommending an extension of federal funding for the Children’s Health Insurance Program (CHIP) for an additional two years, to give Congress, the Department of Health and Human Services, and the states time to ensure that children continue to have a relatively high level of good health coverage.
Late last week a federal court ruled against the Department of Health and Human Services (HHS) in a lawsuit brought by the Pharmaceutical Research and Manufacturers of America, seeking to exclude all drugs with an “orphan” designation from the 340B drug pricing program.
The Department of Health Care Services (DHCS) has updated the statewide administrative day rates, including the rates for distinct-part nursing facilities level B (DP/NF-B), effective for the following dates of service:
The Department of Health Care Service (DHCS) has announced that it will update the All Patient Refined Diagnosis Related Group (APR-DRG) core grouping software from version 29 to version 31, effective July 1.