In The News

Frequently Asked Questions � Simi Valley Hospital Discontinuation of Medi-Cal Contract

The following information has been posted for our patients with Medi-Cal coverage. We hope that the following information will explain what the discontinuation of our Medi-Cal agreement means to these patients and our community.

We want to emphasize that our Emergency Department remains available to all community members, regardless of their insurance, health coverage or ability to pay. Patients with Medi-Cal coverage have the same access to high quality services as those community members with private insurance coverage.

If you are currently seeking Emergency Medical Care, please dial 911 immediately.

Can I still access health care services at SVH if I am a Medicare enrollee?

The discontinuation of our inpatient Medi-Cal agreement in no way impacts a patient’s Medicare status. Nothing changes for our Medicare population.

How does the discontinuation of the Medi-Cal contract affect patients coming to Simi Valley Hospital?

Simi Valley Hospital is committed to providing medical services to every patient coming into our care. Medi-Cal patients—like all of our patients—will continue to have access to our Emergency Department for immediate, lifesaving care regardless of insurance or their ability to pay. Further, Simi Valley Hospital will continue to admit Medi-Cal patients for inpatient care when appropriate—the provision of the highest quality health care services will continue regardless of your insurance coverage (or lack thereof).

In the event that a Medi-Cal patient is admitted to Simi Valley Hospital, our staff will make arrangements to have them transported to a nearby Medi-Cal designated facility once they are stable and deemed appropriate for transport by the attending physician.

Why did Simi Valley Hospital discontinue its Medi-Cal fee-for-service contract?

The low reimbursement rates from Medi-Cal hinder our ability to reinvest in the community with new equipment and technology purchases, building enhancements and community education. Our mission to the community is being severely impacted by the current reimbursement structure that Medi-Cal provides, which is one of the lowest in the country.

Our goal in negotiating a new Medi-Cal agreement was to obtain fair compensation for indirect costs associated with care—such as administrative, financial and facility expenses. The previous agreement only reimbursed Simi Valley Hospital for direct costs, such as nursing, clinical care services and medical supplies.

Simi Valley Hospital has been negotiating with the California Medical Assistance Commission (CMAC)—the organization that negotiates Medi-Cal contracts on behalf of the state of California—to reach an agreement that would adequately provide for the direct and indirect costs associated with health care services provided. At this time, Simi Valley Hospital has elected to provide medical care services to Medi-Cal patients without a long term agreement specifying set reimbursement figures.

Are outpatient or long term care services (sub acute) affected?

Outpatient services are not impacted by the discontinuation of our Medi-Cal agreement. Only inpatient care services are affected. Sub acute care is not impacted either.

Will Simi Valley Hospital have a Medi-Cal contract in the future?

We are hopeful that CMAC and Simi Valley Hospital can come to an agreement that would provide for complete reimbursement of all services provided to Medi-Cal patients. The former Medi-Cal agreement only provided for direct costs, such as nursing, clinical care and supplies.

We have a mission to provide for the medical needs of our entire community and with the reimbursement rates structured as they were in the previous Medi-Cal agreement, our ability to invest vital dollars back into the community was greatly restricted.

I have a specific question about my Medi-Cal coverage. Is there someone at Simi Valley Hospital who can better explain my Medi-Cal coverage?

Simi Valley Hospital has taken the extra step to provide our community with a Medi-Cal information line to answer questions from concerned community members. It will be manned Monday through Friday, 8 a.m. to 4 p.m. Again, we want to emphasize that our Emergency Department will remain open to all members of our community. The number is 805-955-7000.

Posted 12/7/07