CMS OKs stream­lined Med­i­caid ad­mis­sions in Calif.

Modern Healthcare - - REGIONAL NEWS - —Vir­gil Dick­son

The CMS has given Cal­i­for­nia per­mis­sion to ease the hospi­tal ad­mis­sion process for pa­tients in the Med­i­caid fee-for-ser­vice pro­gram.

Un­der a new waiver, the state will launch a two-year process for hos­pi­tals to vol­un­tar­ily tran­si­tion to a more stream­lined way of ad­mit­ting pa­tients. Cur­rently, all hos­pi­tals, ex­cept for pub­lic safety net hos­pi­tals, have to get preau­tho­riza­tion be­fore ad­mit­ting fee-for-ser­vice Med­i­caid pa­tients. Now, hos­pi­tals will be able to skip pre-au­tho­riza­tion and in­stead fol­low na­tional clin­i­cal guide­lines for de­ter­min­ing whether a pa­tient should be hos­pi­tal­ized.

To start, 11 hos­pi­tals will re­ceive ed­u­ca­tion and train­ing start­ing in early 2016, ac­cord­ing to Jan Emer­son-Shea, a Cal­i­for­nia Hospi­tal As­so­ci­a­tion spokes­woman. The state in­tends to have all hos­pi­tals us­ing the new process by 2018. “This should save time and money for both hos­pi­tals and the state,” Emer­son-Shea said.

Dr. Jay Kaplan, a Cal­i­for­nia emer­gency physi­cian who is pres­i­dent-elect of the Amer­i­can Col­lege of Emer­gency Physi­cians, said faster ad­mis­sions can save lives. “We know the quicker we get them into a bed, the bet­ter the out­come,” he said.

As many as 3 mil­lion Cal­i­for­nia Med­i­caid ben­e­fi­cia­ries are still in the fee-for-ser­vice pro­gram, ac­cord­ing to the state. They in­clude peo­ple who are du­ally el­i­gi­ble for Med­i­caid and Medi­care, and res­i­dents of long-term-care fa­cil­i­ties.

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