As California begins to implement the Affordable Care Act (ACA), Medi-Cal is experiencing a re-design of its programs and delivery system.
The Department of Health Care Services (DHCS), in partnership with the Centers for Medicare and Medicaid Services (CMS), has initiated special waiver and demonstration programs designed to bring the state in line with the goals of federal healthcare reform.
The state is proactively moving toward healthcare reform using the Medi-Cal managed care network as a key element, and re-configuring many programs with the Medi-Cal managed care delivery system at the core.
Re-designed Medi-Cal programs in 2013 include:
Palmetto GBA in Georgia has been the MAC for Region J1 (now named Jurisdiction E), which includes California, for the past five years. Apparently the new contract has been awarded to Noridian Administrative Services out of Fargo, North Dakota. They have been the Medicare Part A & B MAC for Jurisdiction F, which includes upper mid-West and Pacific Northwest states, for the past five years. The CMS award is currently under appeal and may take more time to finalize.
The American Recovery and Reinvestment Act of 2009 provides for Medicaid incentive payments to eligible acute care and children’s hospitals that are meaningful users of certified Electronic Health Record (EHR) technology. An eligible acute care inpatient hospital is defined as a health care facility with an average length of stay (ALOS) of 25 days or fewer, and a Claim Control Number (CCN) ending with 0001-0879 or 1300-1399. In addition, to be eligible to receive a Medicaid EHR incentive payment, acute care hospitals must also meet a 10 percent Medicaid patient volume threshold. 
Submit DSRIP Plan to Avoid Funding Loss
Now, Palmetto is requiring providers to reduce their bad debts by the actual SOC. If any SOC was actually collected on a claim, then the corresponding Medicare bad debt would be reduced by that amount. If any amount of SOC was uncollectible, then to claim the bad debt for that portion, the provider would have to prove that they made reasonable collection efforts, a difficult process in many cases, and doubly so when trying to collect from Medi-Cal beneficiaries.