Medi-Cal is California's Medicaid program — a public health insurance program that provides needed health care services for low-income families with children, seniors, people with disabilities, foster caregivers, pregnant women and low-income people with specific diseases, such as tuberculosis, breast cancer or HIV/AIDS. Medi-Cal is financed equally by the state and federal governments.
Medi-Cal is California’s Medicaid program — a public health insurance program that provides needed health care services for low-income families with children, seniors, people with disabilities, foster caregivers, pregnant women and low-income people with specific diseases, such as tuberculosis, breast cancer or HIV/AIDS. Medi-Cal is financed equally by the state and federal governments.
Registration is now open for CHA’s annual Hospital Finance and Reimbursement Seminar, to be held June 13 in Sacramento, June 20 in Costa Mesa and June 21 in Glendale. This year’s seminar will provide a clear understanding of state and federal legislative and regulatory changes impacting hospitals’ financial futures.
Important court cases with implications for Medi-Cal reimbursement
What lies ahead with Medicare Payment Advisory Commission recommendations
Tax reform impact on bonds, corporate debt and more
Navigating reporting for the Internal Revenue Service Form 990 Schedule H and S-10 Worksheet
State budget proposal for 340B Drug Discount Program
Providers can now use their secure Medi-Cal login to view and download PDF versions of remittance advice details (RADs) and Medi-Cal financial summaries on www.medi-cal.ca.gov. RADs, along with their embedded financial summary information, are available online sooner than in paper versions. The site offers up to six calendar weeks of current RADs for immediate download. Currently, historical RADs in PDF, dating back to April 2017, are available on the Medi-Cal website; a larger database will be built over time. When complete, three years of historical RADs will be available within one business day of a request.
Providers may submit printed versions of the online RADs as supporting documentation with claims inquiry and appeal forms. More information is available in the attached flyer.
June 13, Sacramento
June 20, Costa Mesa
June 21, Glendale
Trying to gain a clear understanding of state and federal legislative and regulatory changes impacting your hospital’s financial future, is like trying to hit a moving target. Right when you think you understand, it changes.
The Centers for Medicare & Medicaid Services (CMS) has released the attached informational bulletin describing its plans for enforcement of the Medicaid Home Health final rule. The rule expands coverage for medical supplies, equipment and appliances under the Medicaid (Medi-Cal) home health benefit. The rule was effective on July 1, 2016, but CMS delayed the compliance date for up to two years — based on state legislative cycles — recognizing that states are experiencing operational and budgetary issues as they implement the rule.
The bulletin states CMS’ intent to work with states on a case-by-case basis to provide flexibility for certain provisions of the rule. It also clarifies which provisions of the rule are not subject to enforcement flexibility. CMS asks states to contact it by May 31, 2018, to request flexibility.
The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule that would provide states with greater flexibility in how they meet access to care requirements within the Medicaid program.
The proposed rule addresses concerns associated with the 2015 final rule — which CHA commented on — that requires states proposing to reduce or restructure Medicaid fee-for-service payment rates to collect data through an Access Monitoring Review Plan and solicit input on the potential impact on beneficiaries’ access to care.
CMS proposes to exempt states with an overall Medicaid managed care penetration rate of 85 percent or greater from most fee-for-service access monitoring requirements; California’s current Medi-Cal managed care penetration rate is 80 percent.
CHA has developed interactive maps displaying hospital data from across the state. Featuring 2016 annual data from the Office of Statewide Health Planning and Development, the maps allow users to find information for specific geographic areas, including Senate districts, Assembly districts, congressional districts and counties. The maps include data on:
The Emergency Medical Services Authority (EMSA) has issued a proposed rule that would establish guidelines for local Emergency Medical Services Systems for Children (EMSC) programs. Currently, 21 of 33 local emergency medical services agencies have adopted such programs, which are intended to ensure that children receive appropriate emergency medical services. The proposed rule would clarify the requirements for local emergency medical services agencies to develop and implement EMSC programs into their plans.
In addition, the rule would create quality improvement assurance models and outline specific requirements for pediatric facility designation. The proposal also outlines the necessary resources pre-hospital providers and hospital emergency departments should obtain to adequately provide medical services to pediatric patients, from neonates to adolescents. EMSA states that the goals of this rule are to “provide standards for establishing statewide consistency in policy and program elements, support coordination of limited resource of pediatric specialty centers, and improve pediatric patient care within the California EMSC programs.” More information is available in the attached Notice of Proposed Rulemaking.
The Medicaid and CHIP Payment and Access Commission (MACPAC) issued its March 2018 Report to Congress on Medicaid and the Children’s Health Insurance Program. The report focuses on two topics of high interest to Congress – managed care and telehealth — and covers the mandated analysis of Medicaid disproportionate share hospital allotments.
MACPAC recommends amending and revising three separate legal authorities under the Social Security Act to reduce administrative burdens for states implementing Medicaid managed care programs. It suggests extending the approval and renewal periods for all Section 1915(b) waivers from two to five years; permitting Section 1915(c) waivers for beneficiaries’ freedom of choice and selective contracting; and amending Section 1932(a)(2) to allow states to require beneficiaries to enroll in Medicaid managed care programs under state plan authority.
The Integrated Healthcare Association has released the second edition of its California Regional Health Care Cost & Quality Atlas, reflecting multi-payer data by geographic region — including commercial insurance, Medicare and Medi-Cal — on more than 30 standardized measures of health care quality, cost, patient cost sharing and utilization. Developed with support from the California Health Care Foundation and the California Health and Human Services Agency, the atlas includes information about care provided in 2013 and 2015, just before and after the Affordable Care Act (ACA) coverage expansions took effect. The updated atlas incorporates new characteristics to allow comparison among market segments, subpopulations and the overall insured population. The new characteristics include large group, small group and individual coverage; self-insured employers; Covered California; risk-sharing arrangements; accountable care organizations; and clinical condition cohorts.
According to the data, clinical quality in 2015 varied across the state’s 19 geographic regions by an average of 25 percentage points, and costs ranged from 22 percent below the statewide average to 29 percent above.
On Feb. 9, the House of Representatives passed a bill delaying the Medicaid disproportionate share hospital (DSH) payment reduction until Oct. 1, 2020. Previously, the Department of Health Care Services (DHCS) had implemented the DSH reductions on Oct. 1, 2017, to comply with current law.
As a result of the delay, DHCS will now reverse the reductions that have taken place since Oct. 1, 2017, and has updated the program payments to add the previous reductions into the next payment, according to hospital group, as follows:
Private hospitals will see the increase in their December-January DSH replacement payment, scheduled for March 1.
Non-designated public hospitals will see the increase during the February-March 2018 DSH payment, scheduled for April 26.
University of California hospitals will see the increase in the round 3 DSH payments, scheduled for April 5 for certified public expenditures, and April 19 for intergovernmental transfers.
Global Payment Program hospitals will see the increase in their prior year 3, quarter 3 payments, scheduled for April 15.
A new issue paper from the California Health Care Foundation shows policy avenues the state could take to expand coverage, including establishing a single-payer system, improving affordability of Covered California plans, expanding Medi-Cal to undocumented adults and creating a public coverage option in Covered California. The paper addresses how these approaches intersect with various federal programs and law, as well as legal issues the state and stakeholders would need to consider under each approach. For each approach, the paper outlines respective policy goals, federal authorities invoked and potential pathways to federal approval.
The California Department of Health Care Services has provided an update on the Drug Medi-Cal Organized Delivery System (DMC-ODS) waiver, a voluntary pilot program that offers California counties the opportunity to expand access to care for Medi-Cal enrollees with substance use disorders. The program’s goal is to demonstrate that organized care for substance use disorders improves beneficiary health outcomes while decreasing system-wide health care costs. Counties that choose to participate in the DMC-ODS are required to provide access to a full continuum of benefits modeled after the American Society of Addiction Medicine criteria, in addition to other requirements.
According to the department, all 40 counties from the first four stages of implementation that submitted implementation plans have been approved. Intergovernmental agreements have been approved for San Francisco, Marin, Riverside, San Mateo, Santa Clara, Los Angeles, Contra Costa, Santa Cruz, Napa, and San Luis Obispo counties through the Centers for Medicare & Medicaid Services, and all have begun delivering DMC-ODS services. The department is providing technical assistance via contracted services, regional meetings, county-specific sessions, tribal consultation, and webinars. More information about the DMC-ODS is available online.
On Dec. 5, the California Department of Health Care Services (DHCS) received Centers for Medicare & Medicaid Services (CMS) approval of State Plan Amendment (SPA) 17-030, the time-limited supplemental payment program for certain physician services rendered from July 1, 2017, to June 30, 2018. The effective date of the SPA is July 1, 2017. As previously reported, the payments are for new and established patient office/outpatient visits, psychiatric diagnostic evaluations, psychiatric diagnostic evaluation with medical services and psychiatric pharmacological management services.
The payments are being made through the California Healthcare, Research and Prevention Tobacco Tax Act (Proposition 56), which increases the excise tax rate on cigarettes and tobacco products. Under Proposition 56, a specified portion of the tobacco tax revenue is allocated to DHCS for the non-federal share of health care expenditures in accordance with the annual state budget process.
The House and Senate today passed, and the President signed, another short-term spending bill to fund the federal government through March 23. The measure includes a number of CHA priorities, as well as a two-year budget agreement and increase to the debt limit. In addition to delaying cuts to Medicaid disproportionate share hospitals by two years and extending a number of rural programs, the measure authorizes the Children’s Health Insurance Program for a total of 10 years, as well as a wide variety of programs relating to telehealth, chronic care delivery and Medicare Advantage. CHA is preparing a summary of the legislation and its estimated impact for California’s hospitals and post-acute care providers. A section-by-section summary of the bill was released in CHA News yesterday.
Last week, the Department of Finance released the Administration’s budget trailer bill proposals, including the Department of Health Care Services (DHCS) proposal to restrict the federal 340B Drug Pricing Program within Medi-Cal. Specifically, the proposal would require the department to seek federal authorization to prohibit a covered entity from dispensing a drug purchased through the 340B program to a Medi-Cal beneficiary or other individual participating in another program that is eligible for federal drug rebates. CHA opposes the state budget proposal, which would cost safety-net hospitals across the state hundreds of millions of dollars each year. CHA will meet with DHCS and members of the Legislature to share its concerns and mitigate the proposal’s impact on hospitals that participate in the 340B program.
On Thursday, the House of Representatives passed by a vote of 230-197 a continuing resolution to extend funding for the federal government through Feb. 16. The measure includes a six-year reauthorization of the Children’s Health Insurance Program but does not include CHA’s other priorities, such as delays in cuts to the Medicaid Disproportionate Share Hospital and 340B Drug Pricing programs as well as several Medicare payment programs. Of the six Democrats who voted “Yes” with the Republicans, two were from California: Reps. Carbajal and Costa. None of the 11 Republicans who voted “No” with the Democrats were from California.
The Senate must pass the resolution by midnight (ET) tonight to avoid a government shutdown. It is not clear whether the 60 votes required to pass the measure are lined up. Congressional leaders are struggling to negotiate overall spending caps for the military and domestic discretionary programs, which is creating the month-to-month process.
Yesterday, the California Department of Health Care Services announced that the Centers for Medicare & Medicaid Services has approved California’s proposal to amend its Medicaid State Plan and Medi-Cal 2020 waiver to authorize a health homes program beginning in July 2018. The program, which aims to improve care for Medi-Cal members with chronic health conditions, will be implemented by the department through the Medi-Cal managed care delivery system. The Affordable Care Act authorized an option under which states may use home health programs to coordinate the full range of physical health, behavioral health, and community-based long-term services and supports needed by Medicaid members with chronic conditions. Enhanced federal matching funds of 90 percent are available for two years. The program will provide services for comprehensive care management, care coordination, health promotion, comprehensive transitional care, individual and family support, and referral to community-based and social support services; it is expected to be fully implemented across 29 counties in January 2020. More information is available online.
The California Health Care Foundation has released the attached 2017 quick reference guide with updated data that provides a snapshot of some key Medi-Cal data points, including:
Pre and post-ACA Medi-Cal enrollment
Enrollment by race/ethnicity, age and aid category
An overview of Medi-Cal managed care models
Managed care and fee-for-service penetration
Medi-Cal share of state expenditures for fiscal years 2014-16
Medi-Cal expenditures by service category, Medi-Cal spending per enrollee
Medi-Cal participating physicians per 100,000 enrollees
The percentage of Medi-Cal enrollees with no usual source of care
The percentage of Medi-Cal members who delayed or did not obtain medical care
The quick reference guide is a snapshot of the foundation’s Medi-Cal Facts and Figures report, a set of materials that provides an overview of Medi-Cal, covering program eligibility and enrollment, benefits, service delivery, background on policy issues, budget and forces that affect the program’s costs. The foundation will publish a fully updated Medi-Cal Facts and Figures report in late 2018.