CSAC Bulletin Article

Three Things You Need to Know From the Centers For Medicare and Medicaid Services

June 9, 2016

CMS Overhauls Medicaid and CHIP Managed Care Regulations 

In May, CMS issues a final rule on Medicaid managed care and the Children’s Health Insurance Program (CHIP). This final rule has broad implications on the Department of Healthcare Services (DHCS), particularly their contracts and oversight of Medi-Cal managed care plans, county mental health plans, dental managed care plans, and county Drug Medi-Cal Organized Delivery Systems. DHCS is currently analyzing the final rule to determine compliance with the requirements and will be developing a communication plan to engage stakeholders. The final rule has four key goals:

  • Support state delivery system reform efforts
  • Strengthen program integrity by improving accountability and transparency
  • Strengthen the beneficiary experience and key consumer protections
  • Align key rules with those of other overall health coverage programs

CMS Approves Managed Care Organization Tax

On May 16, CMS approved a slightly revised version of the MCO provider tax enacted in SBX2 2, which CSAC supported. The revised MCO tax now covers all managed care plans in California and helps provide more than $1 billion in funding for the Medi-Cal program.

Upcoming Webinar on the First Uncompensated Care Report

The California Department of Health Care Services (DHCS) will host a webinar on key findings from the first Uncompensated Care Report submitted to CMS on Friday, June 10, 2016, from 1:00 – 2:00 p.m. Registration information will be available here prior to the webinar.

This report was required in the Special Terms and Conditions of California’s 1115 Waiver Renewal (Medi-Cal 2020), and DHCS, on behalf of Blue Shield California Foundation, contracted with Navigant to produce this report, the first of two which review the uncompensated care in California.

This first report focuses on the level of uncompensated care at California’s 21 Designated Public Hospitals and aims to support the determination of the appropriate level of Uncompensated Care Pool funding in years two through five of the demonstration for the Global Payment Program (GPP).

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