Medi-Cal Waiver Will Change Hospital Admissions Process
Medi-Cal is California's Medicaid program.
According to Modern Healthcare, all hospitals -- except for public safety-net facilities -- are required under federal law to obtain pre-authorization from Medi-Cal before admitting fee-for-service beneficiaries.
The majority of Medi-Cal beneficiaries have been moved to managed care in recent years, but up to three million individuals still are in fee-for-service coverage, including beneficiaries who are:
- Dually eligible for Medicare and Medi-Cal;
- Enrolled in home- and community-based programs; and
- Residents in long-term care facilities.
Fee-for-service beneficiaries are more likely to be hospitalized for conditions that can be treated on an outpatient basis, Modern Healthcare reports (Dickson, Modern Healthcare, 10/19).
Details of Waiver
Under a prior waiver, California's 21 designated public hospitals have been piloting a new method allowing them to skip the pre-authorization process for admitting fee-for-service Medi-Cal beneficiaries. Instead, the hospitals follow national clinical guidelines to determine whether a fee-for-service beneficiary should be hospitalized.
The renewal waiver issued this month adds private and non-designated public hospitals to the list of entities allowed to use that method (DHCS website, 10/20).
California Hospital Association spokesperson Jan Emerson-Shea said 11 such hospitals initially will receive education and training for the new method starting in early 2016. The hospitals have not yet been selected.
California plans to have all hospitals using the new process by 2018, according to Modern Healthcare.
Emerson-Shea said the waiver "should save time and money for both hospitals and the state of California."
Meanwhile, Anthony Wright, executive director of Health Access California, said, "Anything that streamlines access to needed health care is a good step forward" (Modern Healthcare, 10/19).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.