SCA provides clients with oversight and strategic planning related to various hospital supplemental payment programs. Clients are advised of impacts on program changes and given guidance and support regarding program requirements. SCA works with clients to ensure that the required data can be captured and reported which is critical for the supplemental payments to be made at their appropriate levels. Supplemental payment levels are also analyzed to address cost limit issues and to assist with the client’s budgeting process.

 QIP/Prime Transition Strategic Guidance

  • Provide District hospital QIP/PRIME teams with an understanding of the “directed payment” approach for claiming funding
  • Work with the Hospital QIP team in reviewing all relevant metrics that may lend themselves for inclusion within the hospital’s QIP program by analyzing each metric over the most recent year
  • Work with hospital QIP project team (s) that will monitor the relevant data for each metric and develop interventions or planned substitute metrics as necessary.

AB 915 Outpatient Supplemental Payment Program Analysis

  • Review the calculations and data sources pertaining to the DHCS calculation of “overpayment” for the 2002-03 through the 2016-17 fiscal year. Provide assessment of the validity of the calculations and source documents
  • Review the hospital district “filed” AB 915 reports from 2002-03 through 2016-17 to validate their accuracy and consistency with the source data supporting the filings. Compare and contrast with the DHCS estimates calculated for the same 2002-03 through 2016-17 fiscal periods. Provide a detailed report of findings

Medi-Cal Managed Care Rate Range Program

  • Examine hospital service data to prepare for negotiations with health plans to seek increased rate range funding
  • Monitor and work within specified timelines to ensure that all requirements for receiving funding are being met
  • Review and monitor rate range contracts with health plans to ensure compliance