About Finance & Reimbursement
Vulnerable Californians who rely on the care provided by California hospitals are at risk. Driven by skyrocketing costs for labor, pharmaceuticals, regulatory mandates, and more, 53% of all hospitals statewide lose money every day to deliver patient care.
That isn’t sustainable. And California is already seeing the frightening result: rural health care services being cut to the bone, severe behavioral health care needs not being met, and more.
Fee Program Proposal Submitted to CMS, Approval Typically Takes Up to Nine Months
Last week, and on schedule, the state Department of Health Care Services submitted the proposed model for the next iteration of the hospital fee program to the Centers for Medicare & Medicaid Services.
Hospital Fee Program IX Webinar
The Department of Health Care Services (DHCS) recently submitted a final draft of the Hospital Fee Program (IX) fee and payment model to the Centers for Medicare & Medicaid Services (CMS). The model should be considered a draft until the state receives official CMS approval, which is expected to take four to six months. CHA will release […]
Summary on Affordable Care Act Marketplace Integrity Proposed Rule Now Available
What’s happening: A summary of the Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability proposed rule for health insurance marketplaces — including issuers, agents, and brokers who assist marketplace enrollees — is available for CHA members.
What else to know: Comments on the proposed rule, which alters several policies, are due to the Centers for Medicare & Medicaid Services (CMS) by April 11.
Analysis Released on OPPS Observation and Emergency Department Utilization for CYs 2019-23
What’s happening: CHA DataSuite has issued a hospital-specific analysis of the outpatient prospective payment system (OPPS) observation and emergency department (ED) utilization.
What else to know: The analysis provides a comparative review of Medicare fee-for-service (FFS) outpatient observation and ED visits during calendar years (CYs) 2019-23.
Post-Acute Care Transfer Policy Analysis for FFYs 2020-25 Shows Estimated Impact on Medicare Inpatient FFS Payments and More
What’s happening: CHA DataSuite has issued a hospital-specific analysis of the inpatient post-acute care transfer (PACT) adjustment policy that shows the estimated impact on Medicare inpatient fee-for-service (FFS) payments.
What else to know: The analysis also shows corresponding Medicare severity diagnosis-related group (MS-DRG) volumes from the inpatient prospective payment system (IPPS) during federal fiscal years (FFYs) 2020-25.
CHA Board Member Testifies Before Assembly Health Committee
What’s happening: Earlier this week, Lori Morgan, MD, MBA, President & CEO of Huntington Health in Pasadena — who is also a member of the boards of both CHA and the American Hospital Association — shared an important perspective before the state Assembly Health Committee on how the Los Angeles fires impacted surrounding communities and the role of hospitals in California’s response to this and other disasters.
What else to know: Dr. Morgan’s testimony was an important opportunity to share perspective on hospitals’ unique role in disaster response and the ways that state government can be helpful before, during, and after crises to ensure an efficient, rapid response that delivers care for Californians.
MedPAC Issues Report to Congress with Payment Recommendations
What’s happening: On March 13, the Medicare Payment Advisory Commission (MedPAC) released its report to Congress that includes fiscal year 2026 payment recommendations for hospitals and other Medicare fee-for-service payment systems.
What else to know: In the report, MedPAC urges Congress to update the base payment rate for hospitals by current law plus 1%.
DHCS to Submit Hospital Fee Program 9 This Month
What’s happening: The Department of Health Care Services (DHCS) will submit the Hospital Quality Assurance Fee (HQAF) program 9 to the Centers for Medicare & Medicaid no later than March 31. Once submitted, CHA will share a draft model for member hospitals to review that will include internal calculations to assist in their review.
What else to know: Shortly after the approved model is released, CHA will host a webinar to provide historical HQAF program context and share the changes specific to program 9. CHA News will share updates and information on program 9’s status, as well as related educational opportunities, as they become available.
CHA Gathering Focuses on Financial Sustainability of Critical Access Hospitals
What’s happening: CHA convened leadership from California’s critical access hospitals (CAHs) for a strategic discussion on achieving financial sustainability. The meeting took place Feb. 20-21 in Sacramento.
What else to know: CEOs and chief financial officers from private, system, and district hospitals participated in small group discussions — led by Todd Linden of Linden Consulting, a retired CEO with 40 years of experience in CAH leadership — to identify the most pressing operational challenges and explore potential solutions. Key issues include aging infrastructure and persistent workforce shortages.
Hospital Fee Program Fees Due March 7
What’s happening: Hospital Quality Assurance Fee (HQAF) program 8 fees for the Jan. 1-June 30, 2023, managed care directed payment cycle are due March 7 — and the invoice will be 15% higher than the modeled fee amount.
What else to know: The fee is increased because the Department of Health Care Services (DHCS) is repaying the Centers for Medicare & Medicaid Services (CMS) for inpatient upper payment limit (UPL) overages incurred in HQAF program 6 — and CMS directed DHCS to repay immediately without any flexibility.