October/November Recap of DHLF Activities

Following is a summary of the issues the DHLF has been focusing on since our last monthly recap.  As we near the end of 2013, most of the Forum activities have been related to planning for 2014.  This newsletter, as well as additional information and resources related to Forum activities, is available on our website – www. cadhlf.org. 

November DHLF Board Meeting 

The DHLF Board and members met November 13 in Sacramento.  A brief description of actions taken during this meeting is outlined below (a full set of minutes will be provided and documents outlining the issues were provided with the meeting materials).  

  • 2014 DHLF Executive Committee – the Board approved the Executive Committee recommendation to add Donna Hefner, CEO, Sierra View District Hospital to the Executive Committee.
  • Board Structure – the Board approved a change to the bylaws making the DHLF a member-governed organization, which eliminates the need for the 17-member Board and provides all dues-paying members a vote and the opportunity to participate in the Executive Committee.
  • 2014 DHLF Budget and Dues – the proposed budget and dues structure were approved.  Both include a replenishment of the reserves and a Strategic Projects Fund.
  • 2014 DHLF Work Plan – The Board approved the plan (more information about some of the activities in progress below).
  • Department of Health Care Services (DHCS) staff attended the meeting and engaged in a dialogue about the impending transition for district/municipal hospitals to APR-DRGs. 

2014 Workplan

As part of the Forum’s approved 2014 work plan, efforts continue on the multi-prong approach to improve reimbursement for California’s district/municipal hospitals.  This includes federal advocacy (Congressional and Centers for Medicare and Medicaid Services), state advocacy (Legislature and Administration) and the operational efforts (with the California Hospital Association and Department of Health Care Services) to ensure approved programs (such as the many components of the 2014-2016 hospital provider fee) are implemented appropriately. 

Federal Advocacy 

An email was prepared by Forum federal advocate, Charity Bracy and sent outlining the details of the DHLF Federal Advocacy program on December 3.  The short-term efforts include letters from Congressional representatives to California Health & Human Services (CHHS) Secretary Diana Dooley and getting representatives to visit district hospitals when they have district work periods in December, January and February.  Early 2014, the Forum will begin advocacy efforts with the Centers for Medicare and Medicaid Services (CMS) (letters and webinars to outline some of the technical aspects of the waiver and district hospital issues).  An advocacy trip to Washington, D.C. will be scheduled for early March and will include visits with both CMS and Congressional offices.  

State Advocacy 

State Legislative Advocates, Kathryn Scott and Meghan Loper, are working with the state Legislature delivering a message similar to that occurring with Congressional offices.  As with Congressional representatives, we urge you to invite your state Assembly Member/state Senator to visit/tour your hospital so they can see first-hand the importance of district hospitals in their communities. 

Similarly, DHLF staff continues to meet with DHCS and CHHS to advance our message. 

DHLF talking points on the Medi-Cal waiver are attached and can be used with state, federal and local officials.  More information will be provided on local efforts needed in the coming weeks. 

For other state legislative priorities discussed at the November meeting (the threshold for bond measures for health care districts, for example), a more complete memorandum outlining the issues, the political landscape and surveying members’ needs/timing is being prepared by Kathryn and Meghan for distribution within a couple of weeks. 

Operational Issues 

Staff has begun discussions with DHCS regarding the various components of the 2014-16 hospital provider fee.  Programs not previously included in the fee will be critical to ensuring district hospitals’ expected benefit is realized (the same is true of all hospital constituencies).  These include using intergovernmental transfers (IGTs) for Medi-Cal managed care (accessing available funding generated both by the hospital provider fee and by the AB 113 program so two IGTs are likely for each program period), and both accessing Medi-Cal managed care rate range room by districts and making some of that funding available (after the districts’ “maintenance of effort” is achieved) for private hospitals. 

More information will be made available to members as details become known.  Additionally, a workgroup of DHLF members will be convened to discuss and provide recommendations on distribution, to the extent possible, of all supplemental funding (AB 113, hospital provider fee and uncompensated care which was included in AB 498 if approved by CMS). 

Medi-Cal APR-DRGs 

As a reminder, district/municipal hospitals are transitioning to Medi-Cal APR-DRGs for inpatient fee-for-service beginning January 1, 2014.  Information/resources (including available training, etc.) are available on the DHCS website at http://www.dhcs.ca.gov/provgovpart/Pages/DRG.aspx 

Medi-Cal Managed Care Expansion to Rural Areas 

On November 1, Medi-Cal managed care expanded to 20 rural counties (Alpine, Amador, Butte, Calaveras, Colusa, El Dorado, Glenn, Imperial, Inyo, Mariposa, Mono, Nevada, Placer, Plumas, San Benito, Sierra, Sutter, Tehama, Tuolumne and Yuba).  District/municipal hospitals in these areas are challenged with a number of issues and have met with DHLF staff who is turn prepared the attached letter to DHCS.  DHCS has responded and is prepared to meet with both the health plans and representatives of affected hospitals to mitigate at least the concerns related to the loss of supplemental Medi-Cal outpatient funds (AB 915 funds). 

DHLF Calendar 

Upcoming DHLF Board Events (outlook invitations forthcoming):

  • February 25, 2014 – DHLF Legislative Day, Sacramento
  • Early March 2014 – D.C. Advocacy Trip
  • March 18, 2014 – DHLF Board Meeting, Sacramento