§ 14167.37
359 words·~2 min read·
/ca/welfare-and-institutions-code/14167-37A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(1)The department shall make available all public documentation it uses to administer and audit the program authorized under Article 5.230 (commencing with Section 14169.50) pursuant to the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(2)In addition, upon request from a hospital, the department shall require Medi-Cal managed care plans to furnish hospitals with the amounts the plan intends to pay to the hospital pursuant to Article 5.230 (commencing with Section 14169.50). Nothing in this paragraph shall require the department to reconcile payments made to individual hospitals from Medi-Cal managed care plans.
(b)Notwithstanding subdivision (a), the department shall post all of the following on the department’s internet website:
(1)Within 10 business days after receipt of approval of the hospital quality assurance fee program under Article 5.230 (commencing with Section 14169.50) from the federal Centers for Medicare and Medicaid Services (CMS), the hospital quality assurance fee final model and upper payment limit calculations.
(2)Quarterly updates on payments, fee schedules, and model updates when applicable.
(3)Within 10 business days after receipt, information on managed care rate approvals.
(c)For purposes of this section, the following definitions shall apply:
(1)“Fee schedules” mean the dates on which the hospital quality assurance fee will be due from the hospitals and the dates on which the department will submit fee-for-service payments to the hospitals. “Fee schedules” also include the dates on which the department is expected to submit payments to managed care plans.
(2)“Hospital quality assurance fee final model” means the spreadsheet calculating the supplemental amounts based on the upper payment limit calculation from claims and hospital data sources of days and hospital services once CMS approves the program under Article 5.230 (commencing with Section 14169.50).
(3)“Upper payment limit calculation” means the determination of the federal upper payment limit on the amount of the Medicaid payment for which federal financial participation is available for a class of service and a class of health care providers, as specified in Part 447 of Title 42 of the Code of Federal Regulations, and that has been approved by CMS.