CHA News Article

DHCS Releases Final Guidance on Network Provider Status
CHA to host webinar on impact for Hospital Fee Program

Last week, the Department of Health Care Services (DHCS) issued its final All Plan Letter (APL) 19-001, specifying contractual requirements that must exist between Medi-Cal managed care plans (MCPs) and hospitals for a hospital to be considered a network provider.

This definition of a network provider will take effect in state fiscal year 2019-20 (July 1, 2019-June 30, 2020). As previously noted in CHA News and discussed on a previous CHA Hospital Fee Program webinar, hospitals and MCPs must comply with the requirements to be eligible to receive Hospital Fee Program managed care payments under the Private Hospital Directed Payment Program. To be eligible for directed payments, hospitals and MCPs must:

  • Have an executed written Network Provider Agreement with the MCP, or its subcontractor, that meets all the requirements set forth in Attachment A of APL 19-001.
  • Be enrolled in accordance with the APL 17-019, the Medi-Cal Managed Care Provider Enrollment FAQ document, or any subsequent APL or FAQ.
  • Be reported on the MCP’s 274 file submitted to DHCS in accordance with APL 16-019 or any subsequent APL on the topic and the most recent DHCS 274 Companion Guide.
  • Be included on all network adequacy filings that occur within the effective dates on the written Network Provider Agreement, in accordance with APL 18-005 or any subsequent APL following the agreement’s execution.

Even though the definition of a network provider will change in state fiscal year 2019-20 as result of APL 19-001, DHCS intends to continue the current process of hospitals and MCPs working together to populate the Contract Status (“network provider”) fields for each encounter.

To help members understand how this APL impacts the Hospital Fee Program, CHA will host a webinar on Feb. 21; registration is available online.

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