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.

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.  

House Passes First Package to Fund Federal Government, Includes Health Provisions

What’s happening: The U.S. House passed the Consolidated Appropriations Act of 2024, which will fund a portion of the federal government through the end of the fiscal year. The package includes a group of CHA-supported health care provisions important to hospitals.  

What else to know: Congress has until March 22 to pass a second package to fund the rest of the federal government, including the Department of Health and Human Services.  

CHA Encourages Members to Participate in the Vitality Index Payer Scorecard

What’s happening: CHA is endorsing member participation in the Vitality Index Payer Scorecard, which will provide critical information to support CHA’s advocacy to hold insurers accountable for timely and accurate reimbursement.  

What else to know: The CHA Board of Trustees has endorsed this tool, which will automatically draw de-identified claims and remittance information from hospitals without requiring additional reporting or surveys.