CHA News Article

DHCS Provides Grace Period for Medi-Cal Provider-Preventable Conditions Mandated Reporting

Section 2702 of the Affordable Care Act (ACA) directs states to develop and implement a plan that withholds Medicaid payments to hospitals for provider-preventable conditions defined in the regulation. The regulation was effective June 11, 2011; however, the Centers for Medicare & Medicaid Services (CMS) elected not to enforce compliance with the rule until July 1, 2012, so states could develop compliance plans and processes. 

Based on a Department of Health Care Services (DHCS) analysis, reporting will be done using a paper form. CHA, with the support of several member organizations, provided input to DHCS on its proposed reporting form, process, data requirements and implementation, and was successful in obtaining several changes that achieved some improvements. DHCS is now waiting for approval of the State Plan Amendment (SPA) to implement the provider-preventable condition reporting, and expects CMS approval within days. CHA understands the reporting process and form are burdensome for California hospitals, and plans to keep working with DHCS to address hospital concerns.

When the SPA is approved, DHCS will notify all organizations and post instructions, a reporting form, FAQs and responses to stakeholder questions on its website. CHA also will notify hospitals. Until full implementation can occur, DHCS is providing a reporting grace period. Questions and comments may be submitted to PPCHCAC@dhcs.ca.gov.The final federal ACA regulation is available at https://federalregister.gov/a/2011-13819.

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