Finance & Reimbursement

About Finance & Reimbursement

The COVID-19 pandemic has decimated California’s hospitals, leaving more than half losing money every day to care for patients. While hospitals strive to contain costs as they deliver essential care to their communities, the simple fact is that the cost to provide care is outpacing reimbursement for those services. Without meaningful change within the Medicare and Medi-Cal systems, the most vulnerable Californians will continue to be relegated to a second-class health care system. Health insurance companies must also do their part to protect essential services, including timely reimbursement and processing of patient claims.

CMS Issues Guidance, FAQs, Survey Procedures for Rural Emergency Hospitals 

The Centers for Medicare & Medicaid Services has issued new guidance on the enrollment and conversion process for rural emergency hospitals (REHs), FAQs, and a newly developed State Operations Manual Appendix (Appendix O) with survey procedures.   Interpretive guidelines for REHs are still pending and will be released at a future date.  The state of California […]

CHA to Host Webinar on Medi-Cal Long-Term Care

CHA will host a Feb. 3 webinar on changes to Medi-Cal long-term care (LTC), which is being standardized across the state under California Advancing and Innovating Medi-Cal.  Effective Jan. 1, all managed care plans must authorize and cover medically necessary LTC services at skilled-nursing facilities (SNFs). During the webinar, the Department of Health Care Services […]

CalAIM Long-Term Care Carve-In

To increase access to comprehensive care coordination, care management, and a broad array of services for Medi-Cal beneficiaries, CalAIM is standardizing Medi-Cal Long-Term Care (LTC) across the state. Effective January 1, all managed care plans must authorize and cover medically necessary LTC services at Skilled Nursing Facilities.