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.
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.
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.
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.
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.
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.
Summary: Finalized Policy Changes for MA Plans in Contract Year 2025
What’s happening: A summary of the finalized changes to Medicare Advantage (MA) and Part D programs for contract year 2025 is now available.
What else to know: The regulation is effective June 3.
CMS Proposes 2.6% Inpatient Prospective Payment System Rate Increase for FY 2025
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has proposed a net increase to base Medicare inpatient payment rates (market basket update) of 2.6% for fiscal year (FY) 2025.
What else to know: The increase is included in the FY 2025 Medicare hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system proposed rule. Comments on the proposed rule are due to CMS by June 10.
DMHC Provides Overview of Complaint and Appeals Process
What’s happening: A recording of the March 26 Department of Managed Health Care (DMHC) Complaint and Appeals Process Webinar is now available.
What else to know: This complimentary, members-only webinar includes information about DMHC’s role in the independent medical review and complaint process. DMHC staff provided an overview of their jurisdiction and the consumer and provider complaint processes.