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. reimbursement and processing of claims.

CHA Comments on the Office of Health Care Affordability’s Draft Market Oversight Regulations

On Aug. 31, the California Hospital Association shared comments with the Office of Health Care Affordability on its draft cost and market impact review regulations. The letter conveys a significant number of concerns and requests amendments that are largely focused on properly scoping the breadth of the office’s oversight and bringing regulations in line with the authorizing statute.   

CMS Announces Voluntary State Total Cost of Care Model

The Centers for Medicare & Medicaid Services (CMS) Innovation Center announced a new voluntary, state total cost of care model: the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. CMS will select up to eight states to participate in the model, which is intended to curb health care cost growth, improve population health, and advance health equity, and is built on best practices from the Maryland Total Cost of Care model, the Pennsylvania Rural Health Model, and the Vermont All-Payer ACO Model.  

2024 Statewide Ballot Measure Could Bring Significant Annual Funding to Health Care 

The Coalition to Protect Access to Care — a broad and diverse group of doctors, dentists, community health centers, hospitals, including CHA, Planned Parenthood, emergency responders, health plans, and health care workers — this week filed a statewide ballot measure with the California Attorney General’s office with the goal of qualifying the measure for the November 2024 ballot.  

AHA to Host Virtual Advocacy Day on Sept. 13

The American Hospital Association (AHA) will host a Virtual Advocacy Day for its members on Sept. 13 to discuss proposed site-neutral legislation, transparency, and other issues that will affect the financial stability of hospitals and health systems.   

District Court Disallows Certain Provisions Related to No Surprises Act

For the third time, the U.S. District Court for the Eastern District of Texas ruled to set aside certain regulations implementing the No Surprises Act. The Texas Medical Association, joined by several air ambulance providers and supported by an amicus brief filed by the American Hospital Association, successfully argued that the methodology used to calculate the qualifying payment amount (QPA) favors insurers during the arbitration process.  

CHA Comments on CY 2024 Home Health PPS Proposed Rule

CHA submitted comments on the calendar year (CY) 2024 home health (HH) prospective payment system proposed rule. In the letter, CHA raised concerns about the impact of CMS’ proposed payment adjustments. CHA requested that CMS take steps to eliminate punitive and unwarranted decreases in reimbursement that have negatively impacted access to HH care. CHA specifically […]