Health Commission tables patient-rate ordinance after questions on billing, bundled payments

The San Francisco Health Commission on May 5 postponed a vote on the Department of Public Health's proposed patient-rate ordinance after multiple commissioners pressed staff for clearer explanations of how the rates were constructed and how commercial insurers and patients would be billed.

The commission voted to table the ordinance until May 19, 2025, after discussion about recent amendments and several unanswered operational questions.

At the meeting, Matthew Sir, Reimbursement and Revenue Cycle Director for the San Francisco Health Network, described three technical amendments: a change to the billing frequency and amount for injectable buprenorphine (SUBLOCADE) to match a CMS change from weekly to monthly administration; a price update for injectable naltrexone (Vivitrol); and a shift at Laguna Honda Hospital from historic 'all-inclusive' rates to line-item billing. Sir said the department also proposed 2.67% and 2.82% rate increases in the two fiscal years to align with CPI guidance and Medi-Cal adjustments, and that DPH was adding rates for new BH Connect…