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.
Summary: Providers Would Face Financial Penalties for Information Blocking
What’s happening: A members-only summary from Health Policy Alternatives, Inc., of the proposed rule on information blocking details provider disincentives related to programs from the Centers for Medicare & Medicaid Services.
What else to know: Comments on the proposed rule are due Jan. 2.
Continuing Resolution Averts Government Shutdown and Delays DSH Cuts
What’s happening: The House voted 336-95 on a two-tiered stopgap measure that funds the federal government past the Nov. 17 deadline and delays Medicaid disproportionate share hospital cuts until Jan. 19. The Senate passed the measure on Nov. 15 and President Biden has indicated he will sign it.
What else to know: Funding expires for certain federal agencies on Jan. 19 and other agencies on Feb. 2.
Physicians Will See Medicare Payment Cuts Next Year
What’s happening: The Centers for Medicare & Medicaid Services’ (CMS) 2024 physician fee schedule final rule reduces Medicare payments to physicians by 1.23% compared to the prior year.
What else to know: The final 2024 physician fee schedule conversion factor is $32.74, a decrease of $1.15, or 3.4%, from 2023.
Independent Dispute Resolution Portal Reopening for Certain Disputes
What’s happening: The departments of Health and Human Services, Labor, and Treasury are reopening the independent dispute resolution (IDR) portal for all batched disputes and single air ambulance disputes.
What else to know: The portal has been closed since federal agencies suspended all IDR process operations in August to align with the district court’s opinions and orders in TMA III and TMA IV.
Access to Mental Health Services Could Increase for Medicare Advantage Enrollees
What’s happening: The Centers for Medicare & Medicaid Services (CMS) proposes policy changes for Medicare Advantage (MA) plans in contract year (CY) 2025.
What else to know: Comments on the proposed rule, which addresses MA policies such as prior authorization, outpatient behavioral health and supplemental benefits, are due Jan. 5.
CMS Finalizes Inadequate Outpatient Payment Update
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has finalized the calendar year (CY) 2024 outpatient prospective payment system rule.
What else to know: It includes a net market basket update of 3.1%, which is a slight increase over the proposed 2.8%.
Final Home Health Rule Reduces Impact of Behavioral Adjustments on Providers
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has issued the final rule for the home health prospective payment system for calendar year 2024.
What else to know: Medicare payments to home health agencies will increase in the aggregate by 0.8% instead of the 2.2% decrease that was originally proposed.
Certain 340B Hospitals to Receive Lump-Sum Settlement
What’s happening: A final rule from the Centers for Medicare & Medicaid Services (CMS) contains a remedy for the agency’s 340B-acquired drug payment policy that was in effect from 2018 to 2022.
What else to know: Eligible hospitals will receive a lump-sum settlement for claims, including beneficiary cost sharing, as a result of CMS’ invalidated policy that reduced payments for separately payable outpatient drugs acquired under the 340B program.