PRIME Update–January 21, 2016

On January 21, 2016, DHLF staff met with DHCS regarding the PRIME program. Below are a few updates.  The protocols are still awaiting approval by CMS so this could change, but this is based on where we are today.

The protocols are expected by be completed by CMS March 1 which then drives the deadline for the submission of hospital plans.  After the protocols are approved (hopefully around March 1), DHCS/CMS will provide a template for hospitals’ use (within 7 days of the approval of protocols).  Hospitals will have 30 days from the date of approval to submit their plans to DHCS.  So the latest estimate is that plans will be due by April 1.  While the template is forthcoming, the funding metrics (the draft provided to you about 3 weeks ago) indicates the following components that will need to be included in the submitted plan.

  1. Participating Entity Information
  2. Executive Summary of 5-Year Plan that includes a summary of the overall Five-year PRIME Pool Plan, a description of the participating PRIME entity and local needs, and goals and objectives for being a high- performing safety net system
  3. Narrative on how the Five-year PRIME Pool Plan will result in improved care for the patients they serve and a path for sustained delivery system improvement
  4. Project Selection
  5. Statement of Understanding of Project Metrics
  6. Program Incentive Payment Amounts
  7. Signed Certification statement documenting that the information provided is accurate at the time of submission

While the submission date is slipping, the first “year” of the program is January 1, 2016 through June 30, 2016, so we encourage you all to continue moving forward on finalizing projects for your plans.

DHCS will reconvene weekly conference calls with district/municipal hospital staff (the same group that has met with them a couple of times over the last few months) and they will attend the DHLF Board meeting on February 3 for further discussion.

A few questions that have been asked recently:

District/municipal hospitals CAN work with other entities (clinics not on the hospital license; medical groups) to implement projects as required by the project.

Not all core components in the draft protocols have to be completed for a project, but all metrics do have to be used.  If you have identified either components or metrics that DO NOT WORK, let me know so we can pass that along to DHCS  DHLF staff is working with DHCS on milestones/metrics that will be used for infrastructure building.  If your projects require infrastructure building, please let me know, so we can ensure the appropriate standardized milestones are included.

DHLF staff is working with DHCS and CAPH on some of the reporting requirements which will come along quickly after implementation, especially due to this short first demonstration period.

Many thanks for providing input over the last couple of weeks regarding the projects that your hospital is planning.  31 of the 39 district/municipal hospitals are planning to participate in this important incentive program.  DHCS was pleased to hear of the interest across all types of district/municipal hospitals.  If you were still finalizing project last week and now have that information, please pass that along to me for discussions with DHCS.

Also, if you are on the workgroup that is working through recommendations for the distribution of funds, we will reconvene later this week.  If you have any suggestions/concerns for this group to consider, please let me know.

And, if you have additional questions, feel free to contact me.  We will continue to keep you apprised as information becomes available.