The CMS has granted California permission to change the hospital admission process for some Medicaid beneficiaries in the state.
Under a newly approved waiver, California will launch a two-year process for hospitals to voluntarily transition to a more streamlined process for admitting Medicaid patients. Currently, all hospitals except for public safety net hospitals have to get pre-authorization from the program before admitting fee-for-service Medicaid patients.
Under the program, all hospitals will be able to forgo the pre-authorization process and instead follow established national clinical guidelines for determining whether a fee-for-service Medicaid patient should be hospitalized.
To start, 11 yet-to-be-identified hospitals will receive in-depth education and training starting in early 2016, according to Jan Emerson-Shea, a spokeswoman for the California Hospital Association. 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 of California,” Emerson-Shea said.
Dr. Jay Kaplan, president-elect of the American College of Emergency Physicians, said faster admissions can save lives.
“Once we make a decision to admit a patient, we know the quicker we get them into a bed, the better the outcome,” said Kaplan, who is an emergency medicine physician at Marin General Hospital in Greenbrae, Calif.
In recent years, California has moved the vast majority of its Medicaid population into managed care. However, as many as 3 million people remain in fee-for-service, according to state data. They include people who are dually eligible for Medicare and Medicaid, people who are enrolled in a home- and community-based programs and residents of long-term care facilities.
Fee-for-service beneficiaries are somewhat more likely than those enrolled in managed care to be without a primary-care provider and much more likely to be hospitalized for conditions that generally can be managed on an outpatient basis, such as asthma and diabetes, according to the California HealthCare Foundation, a nonpartisan think tank.
Patient advocates said the new waiver is a positive development for those patients. “Anything that streamlines access to needed healthcare is a good step forward,” said Anthony Wright, executive director of Health Access California.