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.
CY 2025 Medicare Advantage, Part D Payment Changes Finalized
What’s happening: The Centers for Medicare & Medicaid Services (CMS) finalized changes to Medicare Advantage (MA) Part C and Part D payments for calendar year (CY) 2025.
What else to know: Comments on the MA data request for information are due by May 29. The policies are effective Jan. 1, 2025.
CHA Comments on Draft 340B Legislation
What’s happening: CHA submitted feedback on draft legislation related to the 340B Drug Pricing Program, which allows rural and safety-net hospitals to buy outpatient drugs at discounted prices.
What else to know: The bipartisan SUSTAIN 340B Act considers significant changes to the 340B program.
MedPAC to Develop Rural Hospital and Clinician Payment Workplan
What’s happening: The Medicare Payment Advisory Commission (MedPAC) is developing a rural hospital and clinician payment policy workplan for 2024–25.
What else to know: The March MedPAC meeting included discussion to inform a future recommendation to Congress related to rural hospitals.
CHA to Host DMHC Complaint and Appeals Process Webinar
This post has been archived and contains information that may be out of date.
What’s happening: CHA is hosting the Department of Managed Health Care (DMHC) Complaint and Appeals Process Webinar on March 26 at 9 a.m. (PT).
What else to know: This complimentary, members-only webinar will help attendees better understand DMHC’s role in the independent medical review and complaint process. Registration is open.
CMS Approves the Calendar Year 2023 Private Hospital Directed Payment Preprint
What’s happening: On March 18, the Centers for Medicare & Medicaid Services (CMS) approved the calendar year 2023 private hospital directed payment (PHDP) preprint for the rating period from Jan. 1, 2023, to Dec. 31, 2023.
What else to know: A copy of the federal approval letter is available on CHA’s Hospital Fee Program web page under Program 8.
CMS Announces New Primary Care Payment Model
What’s happening: The Centers for Medicare & Medicaid Services (CMS) announced the Accountable Care Organization (ACO) Primary Care (PC) Flex Model, a new voluntary payment model that will test how prospective payments and increased funding for primary care in ACOs impact health outcomes, quality, and costs of care.
What else to know: CMS will launch the model on Jan. 1, 2025.
CHA DataSuite Releases Four Analyses
What’s happening: CHA DataSuite issued hospital-specific analyses on the Value-Based Purchasing (VBP) Program, the Hospital-Acquired Condition (HAC) Reduction Program, quality program measure trends, and a quality programs overview report.
What else to know: Analyses are updated with the latest Care Compare data release for fourth quarter 2023. See below for the members-only analysis descriptions.
AHA to Host Annual Meeting April 14-16 in Washington, D.C.
What’s happening: Hospital leaders from around the country will convene in Washington, D.C. on April 14-16 for the American Hospital Association’s (AHA) Annual Membership Meeting.
What else to know: CHA encourages AHA members to register for this event.
President Biden Releases FY 2025 Budget Request
What’s happening: President Biden submitted his fiscal year (FY) 2025 budget request to Congress.
What else to know: The budget is a blueprint of the administration’s priorities and is not legislation.
Payment Program Announced for Providers Affected by Change Healthcare Cyberattack
What’s happening: The Centers for Medicare & Medicaid Services (CMS) provided details on Medicare advance and accelerated payments for providers affected by the Change Healthcare cyberattack.
What else to know: Impacted hospitals should apply through their Medicare administrative contractor (MAC).