CHA News Article

CMS Approves Medi-Cal APR-DRG State Plan Amendment
Implementation of new methodology set for July 1

On Friday, May 31, the Centers for Medicare & Medicaid Services (CMS) approved the State Plan Amendment (SPA) submitted by the California Department of Health Care Services (DHCS) to implement the All Patient Refined Diagnosis Related Group (APR-DRG) payment methodology on July 1. CHA met with CMS on March 7 and again on May 28 to reiterate concerns about the July 1 implementation of APR-DRG.  As a result of CHA’s advocacy efforts, CMS required several changes to the SPA initially submitted by DHCS. Of most significance, CMS will require DHCS to obtain an approved SPA prior to making any changes to payment parameters, including policy adjusters and base rates. Attached are the SPA approval as well as the CHA follow-up letter to CMS.