The following attachments are amendments to the California State Plan that were recently approved by the Centers for Medicare and Medicaid Services (CMS). Stakeholders can update their copies by following the links and instructions attached to the documents.
18-001 Removes the prior authorization requirement for more than eight injections for allergy desensitization, hyposensitization, or immunotherapy by injection in any 120-day period.
18-0003-A Adds Marriage and Family Therapists as a billable provider for Federally Qualified Health Centers and Rural Health Clinics.
18-004 Provides increased reimbursement to ground emergency medical transport providers by application of an add-on to the Medi-Cal fee-for-services fee schedule base rates for eligible emergency medical transportation services.
18-005 Requests to authorize a change in the rate development methodology for the Program of All-Inclusive Care for the Elderly (PACE) capitation payments.
18-006 Addresses sick leave for In-Home Support Services (IHSS) care providers as a result of Senate Bill 3 (SB 3).
18-010 Proposes to extend the Supplemental Reimbursement for Qualified Private Hospitals Program to June 30, 2019.
18-011 Technical correction which proposes to provide behavioral health treatment (BHT) for all individuals under 21 when determined to be medically necessary by a physician or psychologist.
18-012 Revises subacute pool of the supplemental payments, funded by a quality assurance fee, for private hospital inpatient services.
18-013 Updates Year 6 (State Fiscal Year 2018-19) Diagnosis Related Group (DRG) payment parameters for general acute inpatient services provided by private hospitals and non-designated public hospitals in California, out-of-state (border and non-border) hospitals, and hospitals designated by Medicare as critical access hospitals.
18-016 Updates estate hearing procedures for the DHCS Estate Recovery (ER) program.
18-017 Proposes to extend for another 12 months the supplemental reimbursement to qualified Non-Designated Public Hospitals (NDPHs).
18-0018 Proposes to amend the phased implementation schedule of multiple counties and clarifies that affected Medi-Cal Managed Care Plans (MCPs) will receive Health Home Programs (HHP) supplemental payments upon receipt of HHP covered services by eligible enrollees and based on information reported by the MCPs to DHCS.
18-0019 Proposes to add additional counties for Group 2 with the population criterion of Chronic Physical Conditions/Substance Use Disorders (SUD).
18-0020 Proposes to seek the necessary approvals to add the population criterion of serious mental illness (SMI) or serious emotional disturbance (SED) in the County of San Francisco to the Health Homes Program (HHP).
18-0021 Seeks to amend the total payment amount for State Fiscal Year 2018-19 for the Martin Luther King Jr. – Los Angeles Healthcare Corporation (MLK-LA) program.
18-0023 Proposes to amend the HCBS 1915(i) State Plan for the Developmentally Disabled.
18-0024 Proposes to authorize an extension of the time-limited supplemental payment program for certain dental services for an additional year (Proposition 56).
18-0025 Proposes to formalize Periodontal Maintenance Rate Adjustments and Prior Authorization for Dental Benefits.
18-0029 Proposes to extend the time-limited supplemental payment program for Intermediate Care Facilities for the Developmentally Disabled (ICF/DD), ICF/DD-Habilitative (ICF/DD-H), and ICF/DD-Nursing (ICF/DD-N) for an additional year (Proposition 56).
18-0030 Proposes to provide an additional year of augmentation payments to emergency medical air transportation providers for services rendered during the State Fiscal Year 2018-2019.
18-0031 Proposes to allow time-limited supplemental reimbursements under the Family PACT Program for the Evaluation and Management (E&M) portion of office visits rendered for the purpose of comprehensive family planning services (Proposition 56).
18-0032 Proposes to authorize Medi-Cal Reimbursement for Primary Care Services Provided by Medical Residents in a FQHC or RHC Sponsored Graduate Medical Education Program.
18-0033 Proposes to extend the supplemental payment program for certain physician services for another 12 months, effective beginning July 1, 2018 through June 30, 2019 (Proposition 56).
18-0034 Proposes renewal of the Quality and Accountability Supplemental Payment (QASP) Program for Rate Year 2018-19.
18-0036 Proposes to make technical corrections to remove the obsolete Medi-Cal Administrative Claiming System (MAC) Agreement reference among other revisions.
18-0037 Proposes sunset of payment reduction for home health agency services and increase to reimbursement rates for home health agency and certain pediatric day health care services (Proposition 56).
18-0039 Proposes to authorize reimbursement and establish rates for specified pharmacists services.
18-0040 Proposes to add the Diabetes Prevention Program (DPP) as a Medi-Cal preventative service benefit to prevent or delay the onset of type 1 and type 2 diabetes for adults age 18 and older.
18-0042 Proposes to establish a time-limited supplemental payment for Freestanding Pediatric Sub-acute Facilities (FS/PSAs) for services rendered in rate year 2018/19 beginning August 1, 2018 through July 31, 2019.
18-0045 Proposes to update the geographic area offering Targeted Case Management (TCM) services for the “Children Under the Age of 21” TCM group.
18-0046 Proposes to update the geographic area offering TCM services for the “Medically Fragile Individuals” TCM group.
18-0047 Proposes to update the geographic area offering TCM services for the “Individuals at Risk for Institutionalization” TCM group.
18-0048 Proposes to update the geographic area offering TCM services for the “Individuals in Jeopardy of Negative Health or Psycho-Social Outcomes” TCM group.
18-0049 Proposes to update the geographic area offering TCM services for the “Individuals with a Communicable Disease” TCM group.
18-0050 Proposes modifications to capital cost reimbursement methodology for certain Freestanding Skilled Nursing Facilities.
18-0054 Adds Community Crisis Homes as a new provider for Behavioral Intervention Services, subject to utilization controls
18-0056 Proposes to sunset the Public Freestanding Non-Hospital Based Clinics (PFNC) supplemental reimbursement program.
