About Finance & Reimbursement
Vulnerable Californians who rely on the care provided by California hospitals are at risk. Driven by skyrocketing costs for labor, pharmaceuticals, regulatory mandates, and more, 53% of all hospitals statewide lose money every day to deliver patient care.
That isn’t sustainable. And California is already seeing the frightening result: rural health care services being cut to the bone, severe behavioral health care needs not being met, and more.
Hospital Fee Program Fees Due March 7
What’s happening: Hospital Quality Assurance Fee (HQAF) program 8 fees for the Jan. 1-June 30, 2023, managed care directed payment cycle are due March 7 — and the invoice will be 15% higher than the modeled fee amount.
What else to know: The fee is increased because the Department of Health Care Services (DHCS) is repaying the Centers for Medicare & Medicaid Services (CMS) for inpatient upper payment limit (UPL) overages incurred in HQAF program 6 — and CMS directed DHCS to repay immediately without any flexibility.
New Analysis Shares Potential Impact of FFY 2026 Value-Based Purchasing Program (Third Quarter 2024 Data Update)
What’s happening: CHA DataSuite issued a hospital-specific analysis of the Value-Based Purchasing (VBP) Program, which is based on the most recent publicly available data and program rules established by Centers for Medicare & Medicaid Services (CMS). The analysis is intended to give hospitals a preview of the potential impact of the federal fiscal year (FFY) 2026 VBP program.
What else to know: Comparison to the FFY 2025 program performance is limited as CMS has not yet made final measure and domain level scores available.
Beginning FFY 2026, hospitals will be awarded health equity adjustment (HEA) bonus points for excellent care of underserved populations based on their performance in the four evaluated domains, as well as their percentage of full-dually-eligible patients. An HEA estimate is included in this analysis. There will be winners and losers due to the HEA, as the program slope changes with the additional bonus points.
Correction Requests for Medicare Hospital FFY 2026 Wage Index, Occupational Mix Revised Data Due Feb. 18
What’s happening: CHA DataSuite issued a hospital-specific analysis of the Medicare hospital federal fiscal year (FFY) 2026 wage index and occupational mix revised data — and it is imperative that hospitals review these data, as they have until Feb. 18 to submit requests for either error corrections or revisions.
What else to know: The data analyzed is revised and is the second of three wage and occupational mix data public use files (PUFs) that the Centers for Medicare & Medicaid Services (CMS) issued to develop the hospital wage index for FFY 2026.
As Congress Prepares to Focus on Area Wage Index, CHA Issues Informational Document for Hospitals
2025 Hospital Finance and Reimbursement Conference
Registration opens May 19. November 3 & 4, 2025 | Newport Beach Join CHA and California hospital finance experts for an in-person program examining the fiscal impact of state and federal regulations and policies. This event will delve into critical topics such as public payer financing, financial regulations, managed care payment plans, the Office of […]
CHA Presentation Details Hospitals’ Role in Health Care Ecosystem
What’s happening: As part of CHA’s efforts to educate new and existing lawmakers on hospitals’ role in the health care ecosystem, Kathryn Austin Scott, senior vice president, state relations and advocacy, and vice presidents of advocacy Kalyn Dean, Mark Farouk, and Vanessa Gonzalez hosted a “Hospital 101” legislative staff briefing on Jan. 14. What else […]
CHA Publishes New Advocacy Materials on Priority Issues
What’s happening: In December, CHA’s board approved three advocacy priorities for California hospitals in 2025: Insurer Accountability, Office of Health Care Affordability (OHCA), and Securing Hospitals. New and updated advocacy materials on these priority issues are now available on CHA’s website.
CMS Announces Quality Reporting Exceptions for Hospitals Impacted by Los Angeles Fires
What’s happening: The Centers for Medicare & Medicaid Services (CMS) is granting exceptions for certain measures in Medicare quality reporting and value-based programs to hospitals, psychiatric hospitals, and post-acute providers in designated areas affected by the California Wildfires and Straight-line Winds public health emergency in Los Angeles.
What else to know: If providers voluntarily report data where exceptions are allowed, CMS notes that the data will be used for public reporting and applying scoring methodologies under value-based programs.
CHA Publishes Resources to Support Hospitals’ Congressional Advocacy Efforts
What’s happening: CHA’s new federal resources can assist hospitals in their messaging to lawmakers on health policy options circulating in Washington, D.C. What else to know: The resources cover financial instability, rural hospital care, site-neutral policies, disproportionate share hospital payment cuts, and the 340B drug pricing program.
CHA Comments on Medicare Advantage Proposals for 2026
What’s happening: CHA submitted comments in response to the Centers for Medicare & Medicaid Services’ (CMS) proposed policy and technical changes to Medicare Advantage (MA) and Part D programs for contract year 2026.
What else to know: Finalization of the proposed rule is expected in April — in time for MA plans to bid to CMS and offer MA products for plan year 2026. The rule, once finalized, will take effect Jan. 1, 2026.