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 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 As part of the survey, participants are asked include information on the number of claims withdrawn from appeal to rebill for Part B payment.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.
The Department of Health Care Services (DHCS) has issued a draft physician toolkit for Cal MediConnect and the Coordinated Care Initiative. Developed to provide important information to physicians and assist them in answering questions from patients, the toolkit includes a sample patient letter, FAQs, information on crossover claims and fact sheets on various aspects of the program. DHCS is requesting comments on the draft toolkit by July 25 at noon (PT). Comments may be submitted to firstname.lastname@example.org.
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.
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.
The Centers for Medicare & Medicaid Services (CMS) has issued the attached guidance regarding Medicaid disproportionate share (DSH) audit reports in advance of the State Plan Rate Year (SPRY) 2011 audits and reports that are due by Dec. 31, 2014.
The Medicaid and CHIP Payment and Access Commission (MACPAC) has released its annual report to Congress providing policy and data analysis on a wide range of issues affecting Medicaid and the Children’s Health Insurance Program (CHIP). Of particular interest to hospitals, MACPAC examined the policy implications of non-disproportionate share hospital (DSH) supplemental payments (e.g. provider tax or fee program) through an analysis of five state Medicaid programs’ payment and financing approaches. The data confirmed that non-DSH supplemental payments can be a significant source of Medicaid payments, particularly to hospitals, but more data on both health care related taxes and supplemental payment are needed to meaningfully analyze the adequacy of Medicaid payments at either the state or provider level.
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.