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.
Register for Upcoming DataGen Webinar on CY 2025 OPPS Final Rule
What’s happening: On Dec. 5 at noon (PT), a DataGen webinar will share an overview of and the calendar year 2025 outpatient prospective payment system (OPPS) final rule and analysis. What else to know: CHA encourages members to register for this webinar.
Letter Highlights Challenges CA Hospitals Face Receiving COVID-19 Relief Funds
What’s happening: On Nov. 18, CHA sent a letter to the California congressional delegation about outstanding COVID-19 relief funds owed to California hospitals and the challenges they have had getting funds obligated from the Federal Emergency Management Agency (FEMA).
What else to know: Also on Nov. 18, President Joe Biden sent Congress a $100 billion emergency supplemental funding request, which includes money for FEMA’s Disaster Relief Fund and called on members to approve the package for recent and past disasters.
CHA Outlines Year-End Federal Legislative Health Care Priorities
What’s happening: In a Nov. 18 letter to the California congressional delegation, CHA outlined legislative priorities for the remainder of the 118th Congress — which must act by Dec. 20 to fund the federal government.
What else to know: It is likely that some health care extensions and policies could be a part of Congress’ funding package.
2025 ESRD PPS Final Rule Members-Only Summary Available Now
What’s happening: A members-only summary of the Centers for Medicare & Medicaid Services’ calendar year (CY) 2025 end-stage renal disease (ESRD) prospective payment system (PPS) final rule, prepared by Health Policy Alternatives, Inc., is available.
What else to know: The regulation is effective Jan. 1, 2025.
Members-Only Summary on CMS 2025 Home Health PPS Final Rule Now Available
What’s happening: A summary of the Centers for Medicare & Medicaid Services’ calendar year (CY) 2025 home health (HH) prospective payment system (PPS) final rule, prepared by Health Policy Alternatives, Inc., is available solely to CHA members.
What else to know: The regulation is effective Jan. 1, 2025.
CHA Presses for Elimination of Medicaid DSH Payment Reductions
What’s happening: On Nov. 13, CHA issued an alert urging hospital leaders to ask their U.S. representative to sign on to a bipartisan letter requesting House leadership to stop the pending Medicaid disproportionate share hospital (DSH) payment cuts. Hospital leaders should contact their representatives to sign the bipartisan letter before the Dec. 6 deadline.
What else to know: CHA — along with our partners representing California’s public, private, children’s, and community safety-net hospitals — sent a letter asking the California congressional delegation to both join the letter and, once again, eliminate the reduction in Medicaid DSH allotments.
Prop 35 Passage Kickstarts Work to Develop, Implement Methodologies to Distribute Funding
What’s happening: On Nov. 5, California voters overwhelmingly approved Proposition (Prop) 35, making an existing tax on managed care organizations (MCO) permanent under state law — and directing most of the revenues toward expanding access to care for Medi-Cal patients through improved provider reimbursement. Now, work by the state, hospitals, and others to determine how these funds should be distributed begins.
What else to know: While Prop 35 specifies how much funding shall go to several different service categories, it does not set the methodologies for distributing the funds. The ball is now in the Department of Health Care Services’ court to develop these payment methodologies — in consultation with hospitals and other providers, including through a dedicated stakeholder advisory committee.
CMS Reduces Medicare Payments to Physicians in Final Rule
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2025 Medicare physician fee schedule (PFS) final rule, in which the final CY 2025 PFS conversion factor is $32.35 — a decrease of 2.8% from CY 2024.
What else to know: CMS published a fact sheet on the CY 2025 Medicare PFS that shares the rate setting and conversion factor, and much more.
CMS Finalizes Medicare Payments for Home Health, Dialysis Services
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued final rules for the calendar year 2025 home health prospective payment system (PPS) and end-stage renal disease PPS.
What else to know: CMS estimates a 0.5% increase in payments for home health agencies and dialysis providers treating end-stage renal disease (ESRD) patients will see an increase of 2.7%.
CMS Finalizes Inadequate Outpatient Payment Update, Establishes New Conditions of Participation
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2025 outpatient prospective payment system (OPPS) final rule, including a net market basket update of 2.9%.
What else to know: CMS also establishes new health and safety standards for obstetrical services to be phased in over two years.