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.
CHA to Host DMHC Complaint and Appeals Process Webinar
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).
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.
CMS Announces Flexibilities for Providers Impacted by Change Healthcare Hack
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued a statement outlining the flexibilities it is offering to providers impacted by the Change Healthcare data breach.
What else to know: CHA is closely following this issue and will provide updates on additional steps CMS is taking as they become available.