14-15 QAF managed care funds
DHCS and California hospitals are still awaiting CMS approval on the first component of rates submitted for the IGT via the managed care plans as part of the hospital quality assurance fee (QAF). This includes the amount that will be IGT’d and matched and the first installment of the expansion (no IGT required). It is expected that approval will be received in October which will then mean the IGT will be done likely in November. DHCS will give us a heads up when they receive the verbal indication from CMS that the rate approval is imminent (probably 2 weeks before it is received).
The second installment for the expansion population (no IGT) will follow but the timing on that component is somewhat unknown at this time. The model for 14-15 was provided to you previously. Please contact the DHLF if you would like another copy.
14-15 “regular” rate range IGTs
These rates are included in the same package as the above rates currently at CMS. So, this approval and timing will be very similar to the above. (This includes the regular rate range for all managed care plans – COHS, two-plan and geographic. This is different from prior iterations when the managed care model types were staggered.)
We recognize having these two IGTs occur so close together will present some cash flow challenges for some, especially since this timing will also be similar to the PRIME IGTs. We likely have a little more timing flexibility in working with PRIME funding, so if you anticipate any challenges with the timing, let me know.
15-16 QAF managed care funds
The good news is the amounts for 15-16 are estimated to be similar to the 14-15 amounts (which are significantly more than we anticipated when we were working with CHA in crafting the provider fee for 2014-16). These rates are estimated to be submitted to CMS in November which could mean a March approval with a May IGT timeframe.
If you receive Medi-Cal DSH funds, managing the various supplemental funds (those identified above and the AB 113 program among others) to ensure your OBRA limit isn’t exceeded will be important.
As always, the above are estimated timeframes.
