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.
Hospitals Have 90 Days to Comply with Off-Site Clinic Requirements
What’s happening: Guidance from the Health Resources and Services Administration (HRSA) affirms it rescinded a COVID-19 public health emergency era waiver related to the 340B Drug Discount Program and off-site clinics.
Penalties Proposed for Health Information Blocking
What’s happening: A long-awaited proposed rule from the Office of the National Coordinator for Health Information Technology establishes provider disincentives for information blocking.
What else to know: Hospitals found to engage in this activity would not meet meaningful use requirements. Comments on the proposed rule are due Jan. 2.
Explaining CMS’ 2024 OPPS and PFS Proposed Rules Webinar
On July 13, the Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2024 outpatient prospective payment system (OPPS) proposed rule and physician fee schedule (PFS) proposed rule. CHA is hosting a members-only webinar to discuss key proposals in these proposed rules on August 21 from 9-10:30 a.m. (PT) ahead of the comment deadline.
Federal Medicaid Proposed Regulations Webinar
CHA is hosting a webinar featuring Chad Mulvany, Vice President of Federal Policy, and Robert Ducay, Vice President of Policy. Both experts will discuss their insights and potential impacts related to these proposals. They will answer any questions you have about these proposed rules.
FEMA Region 9/CalOES Reimbursement Update
Comments on the proposed rule are due to CMS by June 9. 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.
Inpatient Prospective Payment System
Comments on the proposed rule are due to CMS by June 9. 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.
Dual Eligible Medi-Cal Managed Care Enrollment — Participant Information
CalAIM is standardizing Medi-Cal coverage for people enrolled in both Medi-Cal and Medicare with changes for many Californians starting next year. On January 1, 2023, those enrolled in Medicare and Medi-Cal, who currently receive their Medi-Cal benefits through traditional fee-for-service, will have their Medi-Cal benefits transitioned to Medi-Cal managed care statewide, which could mean changes […]
Hospital Fee Program Status
The Hospital Quality Assurance Fee (HQAF) Program and all of its statutory provisions were made permanent through the passage of CHA’s ballot initiative, the Medi-Cal Funding and Accountability Act (Proposition 52), in the November 2016 general election. While this provides the framework for all future hospital fee programs, future iterations must adhere to federal regulations related to health-care provider taxes. Further, the Department of Health Care Services (DHCS) must obtain all necessary federal approvals.
Treating Opioid Use Disorder in Acute Care Hospitals
Overview
Opioid abuse is a long-standing problem in California.
The substance use disorder (SUD) crisis might seem insurmountable, but the CA Bridge Program has developed a model of care that saves lives and helps patients with SUDs get back on track. The 24/7 program is built upon three pillars: rapid access to medication-assisted treatment (MAT), welcoming and destigmatized care and specially trained substance use navigators (SUNs) that connect patients to ongoing care and support.