California State Auditor releases report outlining flaws with Medi-Cal program The California State Auditor’s office released a report on Tuesday expressing a need for better monitoring of the health plans participating in California’s Medicaid program, Medi-Cal, in order to improve beneficiaries’ access to care. Among the key findings of the audit was that the California Department of Health Care Services (DHCS), which administers Medi-Cal, “has not consistently monitored health plans to ensure that they meet beneficiaries’ medical needs—it did not perform any annual medical audits before 2012 and performed medical audits on less than half of the health plans in ... June 26, 2015 Medi-Cal DHCS, Medi-Cal, Network Adequacy, Provider Networks, Department of Health Care Services 0 0 Comment Read More »
DHCS releases concept paper on Medicaid Waiver The California Department of Health Care Services (DHCS) has released a proposal to modify provider payments to save money in the Medicaid system. The state is seeking to waive existing laws and regulations in order to implement new projects for the state’s next 1115 Section Medicaid Waiver. California is currently in the final year of its current Section 1115 Waiver, which was approved by the federal government so California could expand Medi-Cal coverage in accordance with the Affordable Care Act in 2010 and implement a variety of delivery reform projects ... April 1, 2015 Medi-Cal DHCS, Medi-Cal, Department of Health Care Services 0 0 Comment Read More »
DHCS identifies another glitch in issuing primary care rate increase for CHDP claims The California Department of Health Care Services (DHCS) has experienced various difficulties issuing the Affordable Care Act primary care rate increase funds on Child Health and Disability Prevention (CHDP) Program claims. Before the rate increases were implemented, some practices had been instructed by DHCS to bill CHDP claims at their Medi-Cal rates. This caused concern – based on DHCS’s pricing logic of paying the lesser of Medicare’s rate or the billed charges – that some practices would not qualify for the retroactive increases once the systems were updated to ... March 17, 2015 Medi-Cal, Medicare CHDP, Child Health and Disabilityh Prevention Program, Affordable Care Act, DHCS 0 0 Comment Read More »
Medi-Cal UCR web app for CHDP primary care rate increases now available; deadline to submit is Nov. 28 The California Department of Health Care Services (DHCS) has taken steps to correct a problem with the Affordable Care Act primary care rate increase unique to Child Health and Disability Prevention Program Services (CHDP) providers. Before the rate increases were implemented, some practices were previously instructed by DHCS to bill at their Medi-Cal rates. This caused concern—based on DHCS's pricing logic of paying the lesser of Medicare’s rate or the billed charges—that some practices would not qualify for the retroactive increases once the systems were updated to process claims at ... November 14, 2014 General, Medi-Cal Child Health and Disability Prevention Program, DHCS, Medi-Cal, Affordable Care Act 0 0 Comment Read More »
Don't miss out on increased Medi-Cal payments - deadline to attest is December 31 The Department of Health Care Services (DHCS) reports that eligible physicians who have already attested have received over $283 million for services provided to fee-for-service Medi-Cal enrollees under the Affordable Care Act (ACA) primary care rate increase. Don't miss out! Remember, to qualify for enhanced payments for fee-for-service Medi-Cal and Medi-Cal managed care plans, you must first self-attest to your eligibility. The deadline to attest, if you haven't already done so, is December 31, 2014. Practices that have attested but have not yet received any additional funds are encouraged to ... November 6, 2014 Managed Care, Medi-Cal Attestation, DHCS, Medi-Cal, Department of Health Care Services 0 0 Comment Read More »
DHCS announces additional delays for some ACA Medi-Cal primary care rate increases The California Department of Health Care Services (DHCS) has released additional information about the timing of the outstanding Affordable Care Act (ACA) Medi-Cal primary care rate increase for certain claim types. Specifically, DHCS had previously announced delays in payment of three types of claims, including certain NICU/PICU services, Child Health and Disability Prevention Program (CHDP) services and crossover claims (also referred to as Medi/Medi claims). Retroactive NICU/PICU claims – At the request of CMA and other stakeholders DHCS will allow claims data to be submitted via ... September 19, 2014 Medi-Cal Child Health and Disability Prevention Program, DHCS, Medi-Cal, CHDP 0 0 Comment Read More »
DHCS announces new continuity of care rules for duals demonstration project The California Department of Health Care Services (DHCS) recently announced new continuity of care rules for the Cal MediConnect duals demonstration project. The project – an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities – transitions a large portion of the state's dual eligible beneficiaries to managed care plans. Although the program already had continuity of care provisions, the new rules make it easier for a patient to continue receiving needed care from out-of-network physicians without interruption. The new continuity of care ... September 19, 2014 Medi-Cal, Medicare DHCS, Medi-Cal, Medicare, Cal MedConnect, Dual Eligible 0 0 Comment Read More »
Medi-Cal audits began in September The California Department of Health Care Services (DHCS) has begun post-payment claims review of Medi-Cal claims in California. The purpose of this audit is to identify and correct improper Medicaid payments through the collection of overpayments and reimbursement of underpayments made on claims for health care services provided to Medicaid beneficiaries. The program will enable the Centers for Medicare and Medicaid Services (CMS) to implement actions that will prevent future improper payments in all 50 states. DHCS has contracted with Health Management Systems, Inc. (HMS) to act as the Recovery ... September 18, 2014 Medi-Cal Department of Health Care Services, DHCS, Medi-Cal, Audits 0 0 Comment Read More »
DHCS revises Cal MediConnect 'Choice Forms' After advocacy from the California Medical Association (CMA) in conjunction with patient advocacy groups, the California Department of Health Care Services (DHCS) has revised its “Choice Forms” that allow dual eligibles to opt-out of the Cal MediConnect duals demonstration project and remain in traditional Medicare fee for service. The project was authorized by the state in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. The program begins with a three-year demonstration project that transitions a large portion ... September 11, 2014 Medicare Department of Health Care Services, DHCS, Dual Eligible, Medicare, Cal MediConnect 0 0 Comment Read More »
DHCS releases Medi-Cal concept paper that proposes risk-based health home models and malpractice subsidies The California Department of Health Care Services (DHCS) has released a proposal in the form of a concept paper for the state’s next 1115 Section Medicaid Waiver for public for comment. California is currently in the fourth year of its current Section 1115 waiver that was approved by the federal government so California could expand Medi-Cal coverage in accordance with the Affordable Care Act in 2010 and implement a variety of delivery reform projects like the duals demonstration project. The concept paper outlines new ideas to modify provider payments and save ... September 4, 2014 Medi-Cal DHCS, Medi-Cal, Affordable Care Act 0 0 Comment Read More »
