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Health Commission reviews patient-rate ordinance extending 2023–25 rates and aligning behavioral health with CalAIM
Summary
The commission reviewed an ordinance (approved by the Board of Supervisors) extending patient rates for FY23–24 and FY24–25, implementing modest increases and consolidating evaluation-and-management rates; behavioral health changes align with CalAIM payment reform.
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.
