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.
CMS Proposes Inadequate Inpatient Payment Update
What’s happening: The Centers for Medicare & Medicaid Services’ (CMS) proposed fiscal year (FY) 2025 inpatient prospective payment system (IPPS) rule falls short of what hospitals need to keep up with rising costs and health care needs.
What else to know: The rule includes a net market basket update of 2.6%. As a result of all proposed changes, CMS estimates that hospital inpatient payments will increase by $3.2 billion in FY 2025. Comments are due June 10.
Loan Forgiveness Maximum Increased for Physicians in Shortage Areas
What’s happening: The Health Resources and Services Administration (HRSA) has increased the maximum loan amount that can be forgiven for doctors who commit to practicing in a health professional shortage area.
What else to know: HRSA is accepting applications to participate in this year’s program through May 9 at 4:30 p.m. (PT).
Summaries: FFY 2025 Hospice, Inpatient Rehabilitation Facility, Skilled-Nursing Facility Medicare Payment Rules
What’s happening: Summaries of the hospice wage index, inpatient rehabilitation facility (IRF) prospective payment system (PPS), and skilled-nursing facility (SNF) PPS proposed rules are now available.
What else to know: Comments on the proposed rules are due by May 28.
Summary: Finalized Policy Changes for MA Plans in Contract Year 2025
What’s happening: A summary of the finalized changes to Medicare Advantage (MA) and Part D programs for contract year 2025 is now available.
What else to know: The regulation is effective June 3.
CMS Proposes 2.6% Inpatient Prospective Payment System Rate Increase for FY 2025
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has proposed a net increase to base Medicare inpatient payment rates (market basket update) of 2.6% for fiscal year (FY) 2025.
What else to know: The increase is included in the FY 2025 Medicare hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system proposed rule. Comments on the proposed rule are due to CMS by June 10.
DMHC Provides Overview of Complaint and Appeals Process
What’s happening: A recording of the March 26 Department of Managed Health Care (DMHC) Complaint and Appeals Process Webinar is now available.
What else to know: This complimentary, members-only webinar includes information about DMHC’s role in the independent medical review and complaint process. DMHC staff provided an overview of their jurisdiction and the consumer and provider complaint processes.
CMS Approves 2024 Private Hospital Directed Payment Preprint
What’s happening: On April 4, the Centers for Medicare & Medicaid Services (CMS) approved the calendar year 2024 Private Hospital Directed Payment (PHDP) preprint for the Jan. 1 through Dec. 31 rating period.
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 Issues Post-Acute Care Payment Proposed Rules
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued its proposed payment policies for inpatient rehabilitation facilities (IRFs), skilled-nursing facilities (SNFs), and hospices for federal fiscal year (FFY) 2025.
What else to know: Comments on the proposed rules are due to CMS by 2 p.m. (PT) on May 28.
CMS Issues FFY 2025 Inpatient Psychiatric Facility PPS Proposed Rule
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued its federal fiscal year (FFY) 2025 inpatient psychiatric facility (IPF) prospective payment system (PPS) proposed rule.
What else to know: Comments are due to CMS by 2 p.m. (PT) on May 28.
Medicare Reduces Coinsurance Amount for 41 Different Part B Drugs
What’s happening: Medicare temporarily reduced the coinsurance amount for 41 different Part B prescription drugs under the Inflation Reduction Act.
What else to know: Through June 30, the coinsurance amount is decreased from 20% to between 3.8% and 19.9%, depending on the drug.