Finance & Reimbursement

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.

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. 

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.  

Update on 2022 Outpatient PPS and Physician Fee Schedule Proposed Rules Participant Information

The Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2022 outpatient prospective payment system (OPPS) proposed rule on July 19. CMS estimates that Medicare expenditures under OPPS will increase by $1.35 billion based on changes in the proposed rule. CMS also issued its calendar year (CY) 2022 physician fee schedule (PFS) proposed rule on July 13. CHA is hosting a members-only webinar to discuss updates to these proposed rules […]

TEAM Bundled Payment Final Rule Webinar – Participant Information

Over 100 California hospitals were selected to participate in the finalized Transforming Episode Accountability Model (TEAM). Additionally, current participants in other Medicare bundled payment models can opt into TEAM which begins in January of 2026.  The 30-day bundled payment model will hold selected hospitals accountable for the cost and quality of certain high-volume surgical procedures […]