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.
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.)
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 Data
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.
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.
Federal Spending Deal Includes Key Wins for Hospital Care
Hospitals and health systems are getting some financial relief and operational predictability, thanks to a bipartisan health care spending bill signed by President Trump earlier this week.
Inpatient Post-Acute Care Transfer Policy Analysis Shows Impact on FFS Payments
What’s happening: DataSuite has issued hospital-specific analyses of the inpatient post-acute care transfer (PACT) adjustment policy. The analysis shows the estimated impact on Medicare inpatient fee-for-service payments, and corresponding Medicare severity diagnosis-related group (MS-DRG) volumes from the inpatient prospective payment system (IPPS) during federal fiscal years 2021-26.
Prop 35 Advisory Committee Presents Revised 2025-26 Spending Plan at January Meeting
What’s happening: At its Jan. 14 meeting, the Proposition 35 Protect Access to Health Care Act Stakeholder Advisory Committee was presented a revised spending plan for calendar years 2025 and 2026. The spending plan reflects investments supported by managed care organization (MCO) tax proceeds generated from taxes imposed on Medi-Cal managed care plans.