General Information

Medi-Cal Electronic Health Record Incentive Program
Hospital Workbook Amendment

Notice to Hospital Representatives,

It has come to our attention that some hospitals in California do not use the CMS 2552-96 form according to CMS instructions when reporting on Medi-Cal services. Many comply with supplemental instructions issued by DHCS that require reporting of contract services in column 3 (designated for Medicare Title V by CMS). Also, these supplemental instructions state that Medi-Cal managed care bed days should not be reported on the form. CMS provides line 2 (HMO) for this purpose.

The data sources identified on the Hospital Workbook assume compliance with CMS instructions. To deal with these disparities we are issuing the following instructions:

In calculating Total Medicaid Inpatient Bed Days, if managed care bed days have not been reported on the CMS 2552-96 form in Line 2, Column 5, the Medi-Cal managed care bed days reported on the OSHPD Annual Hospital Financial Report should be used instead. Specifically, the amount in Section 4.1, line 5, column 3, of the Patient Census Days table of the OSHPD report may be used. Please upload a copy of the appropriate OSHPD report page with your application if your hospital will be using this data source.

If column 3 of the CMS 2552-96 form has been used to report contractual services, the amounts in this column may be added to the relevant column 5 (Title XIX) amounts to establish Total Medicaid Inpatient Bed Days. If Medicare Title V funding has been used for any bed days reported in column 3, these must be excluded before adding to column 5.

The hospital workbook has been updated to reflect these new instructions and can be accessed HERE.