Finance & Reimbursement

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.

State Policymakers Reach a Budget Agreement with Major Implications for Hospitals

What’s happening: This week, the 2024-25 budget and supporting legislation will be signed by the governor, ensuring the spending plan is in place by July 1, the start of the fiscal year. 

What else to know: The budget includes important changes to the managed care organization (MCO) tax and the health care worker minimum wage, while also having implications for the hospital fee program. 

CHA DataSuite Releases Analysis of FFY 2025 Medicare IPF Proposed Rule

What’s happening: CHA DataSuite issued a hospital-specific analysis of the federal fiscal year (FFY) 2025 Medicare inpatient psychiatric facility (IPF) prospective payment system.   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 […]

CMS Proposes Inadequate Home Health Payment Update

What’s happening: The Centers for Medicare & Medicaid Services issued a proposed calendar year (CY) 2025 home health prospective payment system.  

What else to know: CMS estimates payments to home health agencies, as a result of the changes in the proposed rule, will decrease by $280 million (1.7%). Other key provisions of the proposed rule include: 

Hospital Tours are Key to Rallying Support for Seismic Legislation

What’s happening: CHA-sponsored legislation that would offer important modifications to 2030 hospital seismic standards is making its way through the Legislature.  

What else to know: CHA is urging hospitals to help build support for Senate Bill (SB) 1432 by offering tours to their lawmakers and elected officials now through July. Marshall Medical Center in Placerville successfully held tours to showcase the challenges of seismic construction.    

Extension Announced for IDR Disputes Impacted by Change Healthcare Cyberattack

What’s happening: The departments of Health & Human Services, Labor, and Treasury (departments) announced a 120-day extension for parties impacted by the Change Healthcare cyberattack to open disputes under the No Surprises Act independent dispute resolution (IDR) process.  

What else to know: Disputes must be filed by Oct. 12, and parties must attest that their ability to open a dispute was affected by the incident in February.  

CHA Supports Federal Bill to Preserve Access to Care in Rural Communities

What’s happening: CHA sent a letter to the California congressional delegation in support of the Preserving Emergency Access in Key Sites (PEAKS) Act (H.R. 7931). 

What else to know: The legislation would protect critical access hospitals (CAHs) in rural and mountainous areas by correcting a misalignment in Medicare’s CAH ambulance reimbursement requirements.