Waiver Legislation / CMS Final Rule on Medicaid Managed Care / Hospital outpatient site neutral activities
Many thanks DHLF members who wrote letters to the Senate and Assembly Health Committees in support of the two bills that will implement Medi-Cal 2020, the 1115 waiver. Both SB 815 and AB 1568 passed the respective Health Committees April 27 and 26. Our advocacy team of Meghan Loper and Kathryn Scott used your letters (which were key, especially with Republicans which are needed since the bill requires a two-thirds vote) in addition to their own terrific advocacy efforts. DHLF staff testified at both committees (focusing on PRIME and its impact on district/municipal hospitals); along with Mari Cantwell, chief deputy director, DHCS (who provided an overview of all four components in the waiver); Sarah Muller, VP at CAPH (discussed the PRIME from the county/UC perspective and the global payment for DSH and safety net care pool for those hospitals) and Kelly Brooks, legislative advocate for the County Supervisors Association of California (CSAC) (who discussed the whole person care program in the waiver). Again – many thanks to those of you who took the time to both write letters and to describe your projects. Committee members referenced hearing from DMPHs and being enthusiastic about your projects during the hearings. (And stay tuned … as the bills move through the Legislature, additional letters will be needed.)
Kelly Brooks (who represents ACHD as well as CSAC) will attend our May 17 Board meeting to discuss whole person care program in the waiver (wearing her CSAC hat) as 1) there may be opportunities for district/municipal hospitals in this program and 2) some projects may dovetail with PRIME projects.
Medicaid Managed Care Rule
The long-awaited Medicaid managed care rule was released this week by CMS. This is the rule that, in its proposed format, had some serious consequences for all supplemental payments made via Medi-Cal managed care plans (hospital provider fee and rate range). Congress was able to influence some of the provisions, but the final rule is remains concerning. However, the DHLF is first reviewing the 1600-page rule and also working with other California hospital constituency groups (including CHA) and DHCS. DHCS’ very preliminary thoughts are that we will work together to try to navigate complying with the rule in the way that is the least negative for California’s hospitals (and health plans and beneficiaries). More information will be available at the May Board meeting, however, this will continue to be an ongoing discussion item as it will take significant time to read and understand the provisions and then formulate a plan. Implementation is in 2017 so rate range and provider fee discussions currently underway are not affected.
Hospital Outpatient Site Neutrality
We wanted to make sure you saw the April 27 CHA News. There is an advocacy alert encouraging hospital executives to contact their congressional representatives and urge them to sign on to a letter to CMS Administrator Andy Slavitt, supporting needed flexibility in the interpretation of the recent change in the Bipartisan Budget Act of 2015 that will limit payments for new off-campus outpatient services. Our federal advocate, Charity Bracy, will be working with you on which contacts are most critical.
If you have any questions on any of the above, please contact Sherreta Lane.