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 Finalizes Medicaid DSH Third-Party Payment Calculation
What’s happening: The Centers for Medicare & Medicaid Services finalized changes to how states calculate the hospital-specific cap for Medicaid disproportionate share hospitals (DSH).
What else to know: The rule is effective April 23.
CHA Provides Updated Federal Quality Measures Matrix
What’s happening: CHA has updated its federal quality measures matrix to reflect the 2024 federal fiscal year and calendar year Medicare prospective payment system final rules.
What else to know: The matrix includes quality measures required for public reporting and performance-based programs for hospitals and post-acute care providers.
CHA Will Host Vitality Payer Scorecard Webinar
This post has been archived and contains information that may be out of date.
What’s happening: CHA is hosting a complimentary, members-only webinar on Feb. 27 at 10 a.m. (PT) to highlight the American Hospital Association Vitality Payer Scorecard, which was recently endorsed by the CHA board.
What else to know: The scorecard captures necessary and normalized data points without sharing protected health information. The automated process is based on de-identified claims and remittance files and eliminates the need for CHA surveys on this issue.
CHA DataSuite Released Medicare Hospital FFY 2025 Wage Index and Occupational Mix Revised Data Analysis
What’s happening: CHA DataSuite has issued a hospital-specific analysis of the Medicare hospital federal fiscal year (FFY) 2025 wage index and occupational mix data.
What else to know: The data has been 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 2025.
CHA Will Host 2024 Hospital Finance and Reimbursement Seminar
What’s happening: CHA will host a one-day seminar on March 11 (Sacramento) and 13 (Burbank) at 8 a.m. to discuss how Medicare, Medi-Cal, and other hospital reimbursements will be impacted by the state and federal regulatory environment, recently enacted and anticipated policies, and the new Office of Health Care Affordability (OHCA).
What else to know: The program will discuss key policies, challenges, and opportunities. Registration is open.
CMS Issues Advance Notice of Proposed Medicare Advantage Payment Changes
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued advance notice of proposed changes to Medicare Advantage (MA) Part C and Part D payments for calendar year 2025.
What else to know: Comments are due to CMS by 2 p.m. (PT) on March 1.
CHA DataSuite Releases Analysis of the Quality Program Measure Trends for Third Quarter 2023
What’s happening: CHA DataSuite issued a hospital-specific analysis for the quality program measure trends with an updated third quarter 2023 Care Compare data release.
What else to know: The measures updated in this release are hospital consumer assessments of health care providers and systems, safety, outcomes, readmissions, and star ratings. The Centers for Medicare & Medicaid Services adopted a sepsis measure to be evaluated under the federal fiscal year 2026 Value-Based Purchasing (VBP) Program, which is included in this analysis.
CHA Continues Support for Medicaid DSH
What’s happening: Current funding legislation supported by CHA extends the delay in the implementation of pending Medicaid disproportionate share hospital cuts until March 8.
What else to know: 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.
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.