The District Hospital Leadership Forum (DHLF) represents district and municipal hospitals throughout California. DHLF originated from the efforts of a number of public district hospital executive teams in an effort to address financial issues of importance related to public District hospitals. DHLF strives to promote concepts and analyze options that support public District hospital interests, while providing expert leadership and advocacy in California and federal political realms. The Forum’s specific mission is to improve district hospital access to public funding opportunities in both the short term and in the long term.
The past year the District Hospital Leadership Forum continues to work on district hospital interests in areas such as:
CalAIM, is moving Medi-Cal towards a population health approach that prioritizes prevention and whole person care. The goal is to extend supports and services beyond hospitals and health care settings directly into California communities.
There vision is to meet people where they are in life, address social drivers of health, and break down the walls of health care. CalAIM will offer Medi-Cal enrollees coordinated and equitable access to services that address their physical, behavioral, developmental, dental, and long-term care needs, throughout their lives, from birth to a dignified end of life.
CalAIM has three primary goals:
- Identify and manage member risk and need through Whole Person Care approaches and addressing Social Determinants of Health;
- Move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility; and
- Improve quality outcomes and drive delivery system transformation through value-based initiatives, modernization of systems and payment reform.
The CalAIM Section 1115 demonstration and CalAIM Section 1915(b) waiver move the tested pilot initiatives from prior federal demonstrations (including the Medi-Cal 2020 Section 1115 demonstration; the latest annual report available here) to a comprehensive, integrated Medi-Cal system.
The CalAIM demonstration and waiver materials are available on the DHCS website.
A Better Medi-Cal for Californians:
CalAIM’s bold transformation aligns all elements of Medi-Cal into a system that is standardized, simplified, and focused on helping enrollees live healthier lives. Success requires the investment and sustained commitment of a broad network of health partners, including plans, providers, and community-based organizations, with incentives to achieve high quality of service. When CalAIM is fully implemented, Medi-Cal will better serve and benefit enrollees because it will be a seamless and streamlined health care system.
CalAIM seeks to transform health care for Californians through:
- Population Health Management
Managed care plans will be required to implement a whole-system, person-centered strategy that includes assessments of each enrollee’s health risks and health-related social needs, focuses on wellness and prevention, and provides care management and care transitions across delivery systems and settings.
- Enhanced Care Management:
Enhanced Care Management is person-centered care management provided to the highest-need Medi-Cal enrollees, primarily through in-person engagement where enrollees live, seek care, and choose to access services.
- Community Supports (also known as “In Lieu of Services”)
Medi-Cal managed care plan partners will begin offering “Community Supports,” such as housing supports and medically tailored meals, which will play a fundamental role in meeting enrollees’ needs for heath and health-related services that address social drivers of health.
- New Dental Benefits
CalAIM will expand key dental benefits statewide, including a tool to identify risk factors of dental decay, and silver diamine fluoride for children and certain high-risk populations. Statewide pay-for-performance initiatives will reward dental providers for focusing on preventive services and continuity of care.
- Behavioral Health Delivery System Transformation
DHCS will strengthen the state’s behavioral health continuum of care for all Californians and promote better integration with physical health care. CalAIM will streamline policies to improve access to behavioral health services, simplify how these services are funded, and support administrative integration of mental illness and substance use disorders treatment.
- Services and Supports for Justice-Involved Adults and Youth
These initiatives help California address poor health outcomes and disproportionate risk of illness and accidental death among justice-involved Medi-Cal eligible adults and youth as they re-enter their communities.
- Transition to Statewide Dual Eligible Special Needs Plans and Managed Long-Term Services and Supports
CalAIM will expand statewide a special kind of managed care plan that coordinates all Medicare and Medi-Cal benefits in one plan for enrollees who are eligible for both programs. CalAIM will also transition Medi-Cal to statewide managed long-term services and supports for dual eligible enrollees to better coordinate care, simplify administration and provide a more integrated experience.
- Standard Enrollment with Consistent Managed Care Benefits
To improve each enrollee’s experience, CalAIM will expand the use of managed care plans and standardize benefits so that each enrollee will have access to a consistent set of services, no matter where they live.
- Delivery System Transformation
CalAIM will explore other ways to improve care, including developing a long-term plan of action for foster youth; seeking a federal waiver for short-term residential treatment for enrollees with a Serious Mental Illness or Serious Emotional Disturbance; and, piloting full integration of physical health, behavioral health, and dental health in one managed care plan.
The Public Hospital Redesign and Incentives in Medi-Cal (PRIME) program will build upon the foundational delivery system transformation work, expansion of coverage, and increased access to coordinated primary care achieved through the prior California Section 1115 Bridge to Reform demonstration. Activities supported by the PRIME program are designed to accelerate efforts by participating PRIME entities to change care delivery to maximize health care value and strengthen their ability to successfully perform under risk-based alternative payment models (APMs) in the long term, consistent with CMS and Medi-Cal 2020 goals. The PRIME program is intentionally designed to be ambitious in scope and time-limited. Using evidence-based, quality improvement methods, the initial work will require the establishment of performance baselines followed by target setting and the implementation and ongoing evaluation of quality improvement interventions. Participating PRIME entities will consist of two types of entities: Designated Public Hospital (DPH) systems and the District/Municipal Public Hospitals (DMPH). For more details, please see the PRIME fact sheet.
Beginning January 1, 2021, district/municipal public hospitals (DMPHs) transitioned from PRIME to the Quality Incentive Pool (QIP) program. QIP shares the goals of PRIME and will allow DMPHs to continue the work on quality initiatives begun in PRIME. More information on the DMPH QIP can be found in the attachment.
- The Disproportionate Share Hospital (DSH) Program is a Medi-Cal supplemental payment program. It was established to reimburse hospitals for some of the uncompensated care costs associated with furnishing inpatient hospital services to Medi-Cal beneficiaries and uninsured individuals.
- There is no application process to become a DSH hospital. Instead, DSH eligibility is determined annually by the Department of Health Care Services using the established Medicaid Utilization Rate (MUR) and Low-Income Utilization Rate (LIUR) formulas. The MUR calculates the ratio of Medi-Cal days to the total patient days. The LIUR calculates the ratio of Medicaid/Medi-Cal revenue to the total paid patient revenue. To be eligible the hospital must have a LIUR in excess of twenty five percent with a MUR of at least one percent, or a MUR of at least one standard deviation above the statewide mean.
- DSH payments are calculated for eligible hospitals and are disbursed in cycles throughout the state’s fiscal year. An amount totaling to eleven twelfths of the estimated annual total is disbursed during the applicable state fiscal year. The remaining amount is disbursed upon finalization of the annual total.
- The types of hospitals and/or health facilities that are eligible to participate in the DSH Program consist of general acute care hospitals, acute psychiatric hospitals, and psychiatric health facilities.
- Address 950 Glenn Drive, Suite 250, Folsom, CA 95630
- Email email@example.com
- Phone (916) 673-2020