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.
The Department of Health Care Services has issued two duals plan letters (DPLs) providing guidance to Medicare-Medicaid plans participating in Cal MediConnect.
DPL 14-004 provides clarification and guidance on continuity of care requirements — including who may make such requests — and limitations. DPL 14-005 establishes standards and provides updated due dates for facility site reviews and physical-accessibility reviews conducted by managed care plans that participate in Cal MediConnect. Both DPLs are attached.
The U.S. Department of Health and Human Services Office of the Inspector General (OIG) has issued a report evaluating the adequacy of access to care for enrollees in Medicaid managed care. OIG found that standards for access to care vary widely by state. The report also found that the Centers for Medicare & Medicaid Services (CMS) currently provides limited oversight of state access standards. OIG recommends that CMS strengthen its oversight of state standards and of its methods to ensure compliance with state standards. OIG also recommends that CMS provide technical assistance and share effective practices while ensuring states develop standards to measure access to Medicaid managed care. The full report is available at http://oig.hhs.gov/oei/reports/oei-02-11-00320.asp.
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 firstname.lastname@example.org. 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 email@example.com.
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.
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.
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.