About Finance & Reimbursement
California’s hospitals are under duress, facing crippling inflation and systemic underfunding by government payers — Medi-Cal and Medicare. Every day, over half of California’s hospitals lose money caring for patients. The 2023-24 state budget reauthorizes California’s managed care organization tax, dedicating much of the revenue to support for Medi-Cal enrollees. But without meaningful change to Medicare and Medi-Cal, the most vulnerable Californians will continue to be left behind. Health insurance companies must also do their part to protect essential services, including timely reimbursement and processing of claims. reimbursement and processing of claims.
Summary: FFY 2025 Inpatient Psychiatric Facility Medicare Payment Proposed Rule
What’s happening: A summary of the inpatient psychiatric facility (IPF) prospective payment system (PPS) proposed rule is available.
What else to know: Comments on the proposed rule are due by May 28.
CHA Will Host Webinar on Mandatory Bundled Payment Model
What’s happening: CHA will host a complimentary, members-only webinar on May 1 at noon (PT) to discuss the mandatory bundled payment model proposed by Medicare. Registration is open.
What else to know: The Centers for Medicare & Medicaid Services proposed the Transforming Episode Accountability Model (TEAM), which will hold selected hospitals accountable for the cost and quality of certain surgical procedures.
CHA DataSuite Releases FFY 2025 Medicare Inpatient Rehabilitation Facility Proposed Rule Analysis
What’s happening: CHA DataSuite issued a hospital-specific analysis of the federal fiscal year (FFY) 2025 Medicare inpatient rehabilitation facility proposed rule analysis.
What else to know: The analysis is intended to show hospitals how Medicare fee-for-service payments would change from FFY 2024 to FFY 2025 based on the policies set forth in the proposed rule.
FFY 2025 IPPS Proposed Rule Webinar
Join CHA’s Megan Howard and Chad Mulvany as they provide a summary of the proposed rule implications on your organization and how you can share your concerns on the impending changes.
340B Dispute Resolution Process Finalized
What’s happening: The Health Resources and Services Administration (HRSA) finalized requirements and procedures for the 340B Drug Discount Program’s administrative dispute resolution (ADR) process.
What else to know: The regulation is effective June 18.
Hospital Leaders Discuss Financial Challenges with Legislators on Capitol Hill
What’s happening: Last week, California hospital and health system leaders convened in Washington, D.C. for the American Hospital Association (AHA) Annual Membership Meeting.
What else to know: Hospital and health system leaders participated in meetings on Capitol Hill with the California congressional delegation to advance CHA’s position on key advocacy priorities.
Medicare Inpatient Rule: Mandatory Bundled Payment Model
The Centers for Medicare and Medicaid Services (CMS) proposed the Transforming Episode Accountability Model (TEAM), which will hold selected hospitals accountable for the cost and quality of certain surgical procedures. TEAM aims to improve outcomes for Medicare patients undergoing certain high-volume surgical procedures while reducing Medicare spending.
CMS Proposes Inadequate Inpatient Payment Update
What’s happening: The Centers for Medicare & Medicaid Services’ (CMS) proposed fiscal year (FY) 2025 inpatient prospective payment system (IPPS) rule falls short of what hospitals need to keep up with rising costs and health care needs.
What else to know: The rule includes a net market basket update of 2.6%. As a result of all proposed changes, CMS estimates that hospital inpatient payments will increase by $3.2 billion in FY 2025. Comments are due June 10.
Loan Forgiveness Maximum Increased for Physicians in Shortage Areas
What’s happening: The Health Resources and Services Administration (HRSA) has increased the maximum loan amount that can be forgiven for doctors who commit to practicing in a health professional shortage area.
What else to know: HRSA is accepting applications to participate in this year’s program through May 9 at 4:30 p.m. (PT).
Summaries: FFY 2025 Hospice, Inpatient Rehabilitation Facility, Skilled-Nursing Facility Medicare Payment Rules
What’s happening: Summaries of the hospice wage index, inpatient rehabilitation facility (IRF) prospective payment system (PPS), and skilled-nursing facility (SNF) PPS proposed rules are now available.
What else to know: Comments on the proposed rules are due by May 28.