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.
Medicaid Managed Care Final Rule Overview Webinar
Summary: Medicaid Managed Care Final Rule
What’s happening: A summary of the finalized changes and clarifications regarding Medicaid managed care delivery and finance is available.
What else to know: The regulation is effective July 9.
House Approves Bills Focused on Rural Health Care
What’s happening: The House Ways and Means Committee approved six bills that address a wide range of pressing health care issues facing rural communities.
What else to know: CHA will continue to work with members of the California delegation to support these measures and urge their passage into law.
CHA Continues Work to Hold Insurers Accountable
What’s happening: CHA continues to await a response to the lawsuit filed against Anthem Blue Cross on April 23.
What else to know: In the interim, CHA continues to collect information to support its position that many managed care plans, including Anthem Blue Cross, are violating certain provisions of the Knox-Keene Act.
CHA DataSuite Releases FFY 2025 Medicare Long-Term Care Hospital Prospective Payment System Proposed Rule Analysis
What’s happening: CHA DataSuite issued a hospital-specific analysis of the federal fiscal year (FFY) 2025 Medicare long-term care hospital (LTCH) prospective payment system proposed rule.
What else to know: The analysis is intended to show hospitals how Medicare LTCH fee-for-service payments would change from FFY 2024 to FFY 2025 based on the policies set forth in the proposed rule.
CHA DataSuite Releases FFY 2025 Medicare Inpatient Prospective Payment System Proposed Rule Analysis
What’s happening: CHA DataSuite issued a hospital-specific analysis of the federal fiscal year (FFY) 2025 Medicare inpatient prospective payment system (IPPS) proposed rule.
What else to know: The analysis is intended to show hospitals how Medicare fee-for-service payments would change from FFY 2024 to FFY 2025 based on the policies set forth in the proposed rule.
HHS Issues FAQs Extending Enforcement Discretion for Certain IDR Disputes
What’s happening: The Departments of Labor, Health and Human Services, and Treasury (the departments) issued new frequently asked questions (FAQs) related to enforcement discretion for certain disputes under the No Surprises Act.
What else to know: The FAQs are in response to the Aug. 24, 2023, decision in Texas Medical Association et al. v. United States Department of Health and Human Services et al. (TMA III) case.
CHA Responds to Request for Information on Consolidation in Health Care Markets
What’s happening: CHA submitted comments in response to the joint Department of Health and Human Services, Department of Justice, and Federal Trade Commission request for information on consolidation in health care markets.
What else to know: CHA’s letter highlights the value health system integration activities provide for communities served by the hospitals involved, including expanded access to care.
CHA Issues Summaries of IPPS, LTCH PPS Proposed Rules
What’s happening: CHA has issued summaries of the federal fiscal year 2025 inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) PPS proposed rules.
What else to know: CHA will host a complimentary, members-only webinar on the IPPS provisions on May 15. Comments on the proposed rules are due by 2 p.m. (PT) on June 10.
New Process Released for Resubmitting Certain IDR Disputes
What’s happening: The Departments of Health and Human Services, Labor, and the Treasury announced the release of a new process for resubmitting independent dispute resolution (IDR) disputes that were originally improperly batched or bundled.
What else to know: The new resubmission process is automated in the federal IDR portal.