Finance & Reimbursement

About Finance & Reimbursement

Even before the COVID-19 pandemic, many California hospitals’ financial situations were challenging — nearly 40% operated in the red. Hospitals strive to contain costs while delivering essential care to their communities in the most cost-effective manner. CHA provides direction to hospitals on the diverse issues that affect their financial performance, and advocates for them to ensure that much-needed programs retain their funding. In addition, CHA offers tools such as DataSuite to help hospitals analyze government reimbursement changes, and the potential impact of regulatory and legislative actions on hospitals.  

May 20 Marks Comment Deadline for DMHC Draft Implementation Guidance on Licensure Regulation

The Department of Managed Health Care (DMHC) has released draft guidance and accompanying forms — a confidentiality request form and an expedited exemption request form — related to its Knox-Keene licensure regulation. The regulation, among other things, defines various types of risk and requires entities that assume any amount of global risk to either obtain a license under the Knox-Keene Health Care Service Plan Act of 1975 or receive an exemption from DMHC. 

CMS Issues FFY 2020 Long-Term Care Hospital PPS Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) has issued the proposed rule for the long-term care hospital (LTCH) prospective payment system (LTCH PPS), as part of the inpatient prospective payment system (IPPS) for federal fiscal year (FFY) 2020.  The provisions in the proposed rule, if finalized, would be effective Oct. 1.

CMS Issues FFY 2020 IPPS Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) this week released its federal fiscal year (FFY) 2020 inpatient prospective payment system (IPPS) proposed rule. In addition to annual payment updates, including changes to Medicare disproportionate share hospital (DSH) payments, CMS proposes significant changes to the hospital area wage index. CHA believes this proposal inappropriately and unnecessarily punishes states like California with a high cost of living and is analyzing the impact of the proposal to determine an appropriate political and policy response.

CMS Approves Hospital Fee Program Managed Care Rates

This week, the Department of Health Care Services shared four approval letters, dated April 10, from the Centers for Medicare & Medicaid Services (CMS). While these letters mention approval is for state fiscal year 2016-17, the rates approved only include the Hospital Fee Program for June 1 to Dec. 31, 2016.

CHA DataSuite Releases Fourth Quarter 2018 Impact Analyses

CHA DataSuite has issued hospital-specific analyses showing the estimated impact of the federal fiscal year (FFY) 2020 Medicare inpatient Hospital-Acquired Condition (HAC) Reduction Program as well as the hospital Value-Based Purchasing (VBP) Program, based on publicly available data and program rules established by the Centers for Medicare & Medicaid Services (CMS).