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.

Real-Time Exchange of Electronic Health Records is Underway

What’s happening: Health care and social services organizations in California are required to share electronic health records as of Jan. 31 under the new Data Exchange Framework (DxF).   

What else to know: Assembly Bill 133 (Statutes of 2021) outlined the requirement for health care providers, plans, and other entities to exchange health information for treatment, payment, or health care operations.   

CHA Webinar to Explore OHCA’s Spending Target in Depth

This post has been archived and contains information that may be out of date.

What’s happening: CHA will host a complimentary, members-only webinar on Feb. 12 at 10 a.m. (PT) to discuss the Office of Health Care Affordability’s (OHCA) proposed 3% spending growth target for 2025-29. 

What else to know: CHA staff will focus on what this proposal means, the detrimental impacts it would have on health care, and how hospitals can lend their voices to protect care. A 45-day public comment period on the proposed target ends March 11.  

House Ways and Means Committee Advances Bipartisan Tax Package

What’s happening: The House Ways and Means Committee voted 40-3 last week to advance the Tax Relief for American Families and Workers Act (TRAFWA) of 2024, which includes provisions that have bipartisan support.  

What else to know: To pay for the package cost, the legislation accelerates the employee retention credit (ERC) claims submission deadline to Jan. 31. The ERC is a refundable tax credit for employers, including hospitals, who kept workers on their payrolls during the COVID-19 pandemic. 

Congress Passes Legislation to Fund Government Through March

What’s happening: On Jan. 18, the House and Senate passed legislation, known as a continuing resolution, to fund the federal government though March 1 for certain departments and March 8 for others. President Joe Biden signed the bill on Jan. 19.  

What else to know: The resolution included a CHA-supported provision to delay scheduled Medicaid disproportionate share hospital cuts until March 8. 

CMS Announces New Payment Model Targeting Behavioral Health

What’s happening: The Centers for Medicare & Medicaid Services announced a new Innovation in Behavioral Health (IBH) Model on Jan. 18.  

What else to know: The Notice of Funding Opportunity will open in spring 2024, and up to eight states will be selected to participate. 

CHA DataSuite Releases Value-Based Purchasing Program Analysis

What’s happening: CHA DataSuite has issued a hospital-specific analysis of the third quarter federal fiscal year (FFY) 2024 value-based purchasing program. 

What else to know: The analysis is intended to provide a preview to hospitals of the program’s potential impact for FFY 2025, based on the most recent publicly available data and program rules established by the Centers for Medicare & Medicaid Services. 

Governor’s 2024-25 Budget Proposal Largely Maintains Health Care Commitments

What’s happening: On Jan. 10, the governor released his $209 billion state general fund budget for 2024-25. The spending plan includes a nearly $38 billion (18%) deficit before accounting for solutions.

What else to know: The governor proposes to close the deficit without major cuts to health care programs. The budget still needs to make its way through the Legislature, and the May revision will deliver new and more up-to-date revenue tallies.