Beginning with the State Fiscal Year (SFY) 2017-18 rating period, the Department will direct Managed Care Plans (MCPs) to reimburse private hospitals as defined in WIC 14169.51, based on actual utilization of contracted services. The enhanced payment is contingent upon hospitals providing adequate access to service, including primary, specialty, and inpatient (both tertiary and quaternary) care. The state will evaluate the extent to which enhanced payments are achieving the goals identified. These may only apply to certain managed care categories of aid. The payments will be enhanced by either a uniform percentage or dollar increment. The total funding available for the enhanced contracted payments will be limited to a predetermined amount (pool).
MCPs, for all managed care questions regarding this program, please reach out to the Hospital Directed Payment team PlanDP@dhcs.ca.gov.
Providers, for all managed care questions regarding this program, please reach out to the Hospital Directed Payment team PrivateDP@dhcs.ca.gov.
