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.
Commission Examines System-Level Challenges During First Meeting
What’s happening: The Future of Medi-Cal Commission meeting on Jan. 22 brought commissioners together for the first time, giving the group an opportunity to introduce themselves and start tackling the challenges facing Medi-Cal.
Following State Bill Intro Deadline, Focus Remains on Financial Instability
Last Friday marked the deadline to introduce bills for the 2026 state legislative session. While the focus for this year will be on CHA’s two sponsored bills, there are several concerning pieces of legislation that will demand intensive engagement. (All told, about 1,800 bills have been introduced this year.)
Register for Webinars on IRF Review Choice Demonstration
What’s happening: Noridian will host three webinars for inpatient rehabilitation facilities (IRF) ahead of the May 1 implementation of the IRF Review Choice Demonstration.
DataSuite Analysis Shows Potential Impact of FFY 2027 VBP Program (Third Quarter 2025 Data Update)
What’s happening: CHA DataSuite has issued a hospital-specific analysis, which is intended to give hospitals a preview of the potential impact of the federal fiscal year (FFY) 2027 Value-Based Purchasing (VBP) program.
CalAIM Section 1115 Renewal Open for Public Comment Until March 12
What’s happening: The Department of Health Care Services (DHCS) has opened a 30-day public comment period — ending on March 12 — to solicit feedback on a five-year renewal request of the California Advancing and Innovating Medi-Cal (CalAIM) Section 1115 demonstration.
DHCS Issuing DSH Payments Starting This Week
What’s happening: The Department of Health Care Services (DHCS) will issue full disproportionate share hospital (DSH) payments beginning on Feb. 20.
Action Needed for Prescribers: Ensure Enrollment as Medi-Cal FFS Provider
What’s happening: Beginning on June 26, claims and prior authorizations will not be processed by Medi-Cal Rx if the prescribing health care provider is not enrolled in Medi-Cal fee-for-service (FFS) with a Type 1 National Provider Identifier (NPI).
CHA DataSuite Releases Analysis of FFY 2027 Wage Index and Occupational Mix Date
What’s happening: CHA DataSuite has issued a hospital-specific impact analysis of Medicare’s revised public use files (PUFs) data for the development of the federal fiscal year (FFY) 2027 hospital wage index and occupational mix data.
Hospital Fee Program Invoices Due Feb. 25
What’s happening: Payments for the Hospital Fee Program 8 directed payment for cycle MC2 DPa are due to the Department of Health Care Services (DHCS) on Feb. 25. It is critical that all hospitals pay their invoices in full and on time.
CMS Issues Updated Guidance on Medicaid State-Directed Payments
What’s happening: On Feb. 2, the Centers for Medicare & Medicaid Services (CMS) issued a letter providing guidance on Section 71116 of the One Big Beautiful Bill Act, which eventually limits the total managed care payment rate received by hospitals to Medicare levels after a temporary grandfathering period. This letter supersedes the guidance CMS released on Sept. 9, 2025.