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.
Summaries Available for CY 2026 Home Health, End-Stage Renal Disease Payment Final Rules
What’s happening: Summaries of the calendar year (CY) 2026 home health prospective payment system (PPS) and end-stage renal disease (ESRD) PPS final rules are available for CHA members.
Summary of CY 2026 PFS Final Rule Includes Impact Analysis for 100+ Medicare Specialties
What’s happening: A summary of the calendar year (CY) 2026 physician fee schedule (PFS) final rule is available for CHA members.
CMS Proposes Changes to MA and Part D Star Ratings for Contract Year 2027
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued the contract year 2027 proposed rule for Medicare Advantage (MA) and Part D plans.
CHA Issues Summary of CY 2026 OPPS Final Rule
What’s happening: A detailed summary of the finalized provisions of the calendar year (CY) 2026 outpatient prospective payment system (OPPS) final rule is available for members.
Eyes on CMS as Fee Program Negotiations Continue
As California hospitals continue to face strong financial headwinds — soaring inflation, the pending effects of nearly $1 trillion in nationwide federal health care cuts, increased regulatory pressures, and more — all eyes are on the Centers for Medicare & Medicaid Services (CMS), where California’s submission for the next Hospital Fee Program is currently under review.
House Passes Five-Year Extension of Hospital-at-Home Program
What’s happening: On Dec. 1, the U.S. House of Representatives passed the CHA-supported Hospital Inpatient Services Modernization Act (H.R. 4313) which would extend the Hospital-at-Home program for five years, through Sept. 30, 2030.
DHCS Releases Private Hospital-Directed Payment Encounter Files — Download by Jan. 5
What’s happening: On Nov. 21, the Department of Health Care Services (DHCS) uploaded three new hospital-directed payment encounter files, available via the Secure File Transfer Protocol (SFTP) site. The SFTP site is not intended for long-term storage, so files will be deleted Jan. 5, 2026.
CMS to Decrease Home Health Payments 1.3% in 2026
What’s happening: On Nov. 28, the Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2026 home health prospective payment system final rule.
Hospitals Should Review and Update DHCS Contact Info by Dec. 12
What’s happening: The Department of Health Care Services (DHCS) Capitated Rates Development Division is asking providers to confirm their contact info as part of its ongoing efforts to maintain accurate and up-to-date contact information.