Finance & Reimbursement

About Finance & Reimbursement

Even before the COVID-19 pandemic, many California hospitals’ financial situations were challenging — nearly 40% operated in the red. Hospitals strive to contain costs while delivering essential care to their communities in the most cost-effective manner. CHA provides direction to hospitals on the diverse issues that affect their financial performance, and advocates for them to ensure that much-needed programs retain their funding. In addition, CHA offers tools such as DataSuite to help hospitals analyze government reimbursement changes, and the potential impact of regulatory and legislative actions on hospitals.  

Hospital Fee Program Status

The Hospital Quality Assurance Fee (HQAF) Program and all of its statutory provisions were made permanent through the passage of CHA’s ballot initiative, the Medi-Cal Funding and Accountability Act (Proposition 52), in the November 2016 general election. While this provides the framework for all future hospital fee programs, future iterations must adhere to federal regulations related to health-care provider taxes. Further, the Department of Health Care Services (DHCS) must obtain all necessary federal approvals.

CMS to Reweight 2020 MIPS Cost Performance Category

The Centers for Medicare & Medicaid Services (CMS) will reweight the cost performance category for the Merit-Based Incentive Payment System (MIPS) from 15% to 0% for the 2020 performance period, due to the impact of the COVID-19 public health emergency.  

CHA DataSuite Releases IPPS Proposed Rule FFY 2022 Impact Analysis

CHA DataSuite has issued hospital-specific analyses of the federal fiscal year (FFY) 2022 Medicare inpatient prospective payment system (IPPS) proposed rule, intended to show how Medicare inpatient fee-for-service (FFS) payments would change from FFY 2021 to FFY 2022 based on the policies set forth in the proposed rule. 

HHS Announces Additional Block Grants to Address Substance Use Disorder and Mental Health Crisis

The U.S. Department of Health and Human Services has announced the Substance Abuse and Mental Health Services Administration is distributing $3 billion in American Rescue Plan funding. The Community Mental Health Services Block Grant (MHBG) program and Substance Abuse Prevention and Treatment Block Grant (SABG) program will disperse $1.5 billion each to states and territories.  

HRSA Orders Drug Companies to Resume Discounts to 340B Contract Pharmacies

The Health Resources & Services Administration (HRSA) ordered six pharmaceutical companies to resume payments to contract pharmacies participating in the 340B discount program, stating that their current policies have resulted in overcharges and are in direct violation of the 340B statute. The letters were sent to Eli Lilly, Sanofi, AstraZeneca, Novartis, United Therapeutics, and Novo Nordisk. 

Governor Releases Revised State Budget

On May 14, Gov. Newsom presented the Legislature with revisions to the budget he proposed in January, the process referred to as the May Revise. Throughout the week leading up to the release of the revision, the governor had been presenting various proposals as part of his “California Roars Back” plan, touted as a recovery package tackling the […]