Health Commission reviews patient-rate ordinance extending 2023–25 rates and aligning behavioral health with CalAIM

At the Sept. 5 meeting, Finance staff presented the patient rates ordinance for FY23–24 and FY24–25. The Board of Supervisors had already approved the ordinance effective July 25; the commission received the report for review.

Jenny Louie, DPH chief financial officer, and Matt Sir, director of reimbursement, explained the updates: inpatient, emergency and trauma-related rate authorizations were extended; physical-health services rates increase by 5.6% in FY23–24 and 2.9% in FY24–25 consistent with the Controller’s CPI guidance; and evaluation-and-management (E&M) rates were consolidated at the Health Network level to simplify ordinance language. The ordinance also incorporates behavioral-health payment reform under CalAIM, transitioning some Medi-Cal behavioral services from a cost-based system to fee-for-service CPT code payments as of July 1.

Officials emphasized that the rate adjustments are intended to maintain adequate reimbursement from Medicare, Medi-Cal and private insurers and should not increase patient liability because of existing patient-cap protections, sliding scales and compliance with the No Surprises Act and recent state law. Commissioners asked for follow-up on how patients with high-deductible exchange plans or bronze plans will be affected; staff said most DPH patients are Medi-Cal and agreed to follow up about exchange-plan impacts and the timing of a market-peer rate review.