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 California ICD-10 Collaborative will host a conference call tomorrow, Dec. 4, from 10 a.m. – 11:30 a.m. (PT). The meeting will include a panel discussion with Anthem Blue Cross, Blue Shield of California, United/Optum and SCAN, focusing on their preparation for ICD-10. Participants may email questions to be addressed by the panel to email@example.com before or during the conference call.
Because of anticipated wide interest in the call and a limitation of 200 participants, attendees are encouraged to share call-in lines. For more information, including conference call number and access code, see the attached flyer.
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 County Medical Services Program (CMSP) will host two webinars in November featuring information on the Path2Health program transition to Medi-Cal, which begins Jan. 1, 2014. Recommended for hospitals, clinics and other providers, the webinars will be held Nov. 19 from 10 a.m. – noon and Nov. 20 from 1:30 p.m. – 3:30 p.m., offering the same information and training materials. To register for one of the sessions visit http://cmspcounties.webex.com.
In addition to the Path2Health member transition, topics to be covered in the training include CMSP in 2014 and beyond; continuity of care; member notifications; and key contact information. After the training, CMSP will post presentation slides on the Path2Health website. For more information about the webinar and CMSP, see the attached flyer or contact firstname.lastname@example.org or (916) 649-2631, ext. 19.
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) continues to host its monthly stakeholder webinars on the Coordinated Care Initiative (CCI), which is currently scheduled to begin no sooner than April 2014. The webinars are open to all interested parties. The next monthly webinar will be held Tuesday, Nov. 18 from 1 p.m. to 2 p.m. (PT). For more information and to register, visit http://www.calduals.org/2013/09/05/upcoming-webinars-covering-the-coordinated-care-initiative/.
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 Care Services (DHCS) has announced that implementation of the coordinated care initiative (CCI) will begin no sooner than April 2014. The demonstration program was previously scheduled to begin in January 2014 in eight designated counties.
A major component of the CCI is the Cal MediConnect program, which will enroll beneficiaries with both Medicare and Medi-Cal (“dual eligibles”) into managed care. The CCI also includes the integration of long-term care services and supports, including long-term care provided in a skilled-nursing facility, in-home support services and multipurpose senior services programs.
The California Department of Health Care Services (DHCS) has announced that hospital outreach labs now have until Aug. 30 to submit data related to clinical laboratory services. DHCS originally requested the data by May 31, but many labs were not able to meet the deadline due to the complexities associated with complying. Last month, CHA met with DHCS to explain hospitals’ concerns and request an extension of the reporting requirement, and DHCS agreed to extend the deadline until it can better understand the complexities of hospital billing and reimbursement. In addition, DHCS confirmed that it is only requesting data from hospital outreach labs that receive global payments (hospital and physician payments combined). Any hospital that believes it should be exempt from the requirement or is unable to submit the requested data in the specified format by the deadline should contact DHCS by email at email@example.com and include hospital name, NPI and explanation. Attached is the initial request from DHCS.
In a move aimed at ensuring that hospital funds intended to pay for care provided to low-income Californians are not diverted by lawmakers for other, non-hospital patient care purposes, CHA has filed ballot initiative language with the state Attorney General’s (AG) office.
In a move aimed at ensuring that hospital funds intended to pay for care provided to low-income Californians are not diverted by lawmakers for other, non-hospital patient care purposes, CHA today filed ballot initiative language with the state Attorney General’s (AG) office. The initiative, called the Medi-Cal Funding and Accountability Act of 2014, will prohibit the Legislature and the Administration from imposing a tax on hospitals unless the monies and matching federal funds are used to pay for hospital care provided to Medi-Cal patients, including the elderly, the disabled and children.
The California Department of Health Care Services (DHCS) has issued for public comment a draft enrollment strategy and schedule for Cal MediConnect in Los Angeles County. The plan is directed at transitioning 213,000 dually eligible beneficiaries into the new program of integrated care beginning in January 2014. CHA encourages member hospitals in Los Angeles County to review the plan and communicate questions and concerns to CHA staff. A copy of the draft plan is attached. Comments are due Aug. 2, 2013.
The California Department of Health Care Services (DHCS) has submitted to the Centers for Medicare & Medicaid Services (CMS) an amendment to the Section 1115 “Bridge to Reform” demonstration waiver. The amendment would allow DHCS to implement provisions of the Coordinated Care Initiative (CCI) in eight counties, integrating Medicare and Medi-Cal benefits for dual eligibles, enrolling dual eligibles as mandated, and integrating long-term services and supports as managed care benefits. DHCS has requested an effective date of January 1, 2014, for the waiver amendment, to coincide with the projected date for implementation of the CCI and Cal MediConnect. A copy of the amendment and the state’s cover letter are attached.
Upcoming payments to providers who render services through Medi-Cal and state-funded programs have been deferred until the assumed July 1 enactment of the state’s 2013-14 budget. Payments scheduled to be paid June 20 will be delayed two weeks, until July 5, including the following programs:
Medi-Cal (including Family Planning, Access, Care and Treatment)
Medi-Cal funded Child Health and Disability Prevention (CHDP)
Payments scheduled for June 27 will also be delayed until July 5, including:
Medi-Cal (including Family Planning, Access, Care and Treatment)
CHDP, both state-funded (aid code 8Y) and Medi-Cal funded
California Children’s Services (CCS-state only, CCS-Healthy Families and CCS-Medi-Cal)
Genetically Handicapped Persons Program (GHPP-state only and GHPP-Medi-Cal)
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.
The Department of Health Care Services (DHCS) has revised and published a document outlining the state’s concept for a Medi-Cal waiver that would go into effect Sept. 1, replacing the state’s current waiver for hospital financing and uninsured care that expires Aug. 31.