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.
Key Messages: Headwinds for Hospitals Mean Uncertainty for Patients
California hospitals face growing challenges with government underfunding having the biggest impact.
CHA Comments on Proposed Financial Penalties for Information Blocking
What’s happening: CHA submitted comments in response to the Office of the National Coordinator for Health Information Technology’s (ONC) proposed provider disincentives for information blocking.
What else to know: Comments were due Jan. 2.
Major OHCA Developments to Track in 2024
What’s happening: OHCA ended 2023 with a proposed preliminary spending target of 3% annually for five years and it finalized cost and market impact review regulations.
What else to know: OHCA’s policy development and implementation is expected to accelerate in 2024, specifically related to the adoption of an initial health care spending target.
DHCS Receives Federal Approval of the 2023-24 Hospital Fee Program
What’s happening: On Dec. 15, the Department of Health Care Services (DHCS) received federal approval of the 2023-24 Hospital Fee Program, originally submitted in March 2023.
What else to know: The program runs from Jan. 1, 2023, to Dec. 31, 2024, and will provide California’s hospitals with an annual net benefit of approximately $5.3 billion per year on an accrual basis over the 24-month period.
CMS Launches New Model to Improve Maternal Health
What’s happening: The Centers for Medicare & Medicaid Services (CMS) announced a new model aimed at improving maternal health.
What else to know: State Medicaid agencies can apply in spring 2024 for funding and technical assistance to participate in the model.
Federal Independent Dispute Resolution Fees Finalized
What’s happening: The departments of Health and Human Services, Labor, and Treasury issued a final rule setting the No Surprises Act independent dispute resolution (IDR) fees.
What else to know: This was in response to an earlier court ruling that found the departments’ approach to setting the administrative fee was impermissible.
Independent Dispute Resolution Portal Reopened for All Disputes
What’s happening: On Dec. 15, the departments of Health and Human Services, Labor and Treasury reopened the federal independent dispute resolution (IDR) portal for all dispute types.
What else to know: Dispute types include previously initiated batched disputes, new batched disputes, and new single disputes involving air ambulance services.
Office of Health Care Affordability Cost & Market Impact Review Process
Hear directly from CHA and the Department of Health Care Access and Information, Office of Health Care Affordability experts on how this review process will impact your hospital.
CHA Will Host Dec. 18 Webinar on Office of Health Care Affordability
What’s happening: CHA will host a complimentary, members-only webinar on Dec. 18 at 10 a.m. (PT) to discuss the Office of Health Care Affordability (OHCA).
Office of Health Care Affordability (OHCA) 101: What You Need to Know and What is to Come
CHA is hosting a webinar to review the Office of Health Care Affordability’s various responsibilities and objectives under state law, provide a high-level update of implementation progress to date, and preview what is coming next from this important new regulatory agency.