General Information

CHA Continues Efforts to Challenge State Plan Amendments

CHA, the California Medical Association and the California Pharmacists Association together filed a writ action in state court Oct. 1 to compel the Department of Health Care Services (DHCS) to produce public records used to support State Plan Amendments (SPAs) filed with the federal government. The State Budget Act of 2011, signed by Gov. Brown on March 24, includes significant cuts to Medi-Cal providers, including decreasing reimbursement rates for skilled-nursing facilities and subacute-care units that are distinct parts of hospitals. CHA has made multiple requests for the public information provided to the Centers for Medicare & Medicaid Services (CMS), including access studies and information used to show the impact of the proposed reductions. However, DHCS has provided little information. CHA believes that transparency is essential when formulating public policy. Providers must be able to actively participate in creating state policy that directly impacts hospitals’ ability to operate and provide quality care. On a similar front, CHA petitioned for party status on DHCS’ appeal of a disapproved SPA regarding previous rate cuts. The appeal is postponed until further notice; however, CMS has now provided CHA with many of the documents, which the state refused to provide, that were used by the state to support the rate cuts. CHA is now evaluating those documents. Finally, CHA was present at a DHCS public meeting on soft-cap limits on provider clinic visits. DHCS submitted an SPA in late July to obtain federal approval of the seven-visit limit on provider clinic visits. CHA immediately requested all public records related to this SPA. DHCS confirmed the seven-visit cap does not apply to hospital emergency department visits. The soft cap applies to other hospital outpatient clinic visits for hands-on care; however, there are exemptions on the cap that include visits to assess a chief complaint and visits for ongoing care of a chronic condition.