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.
CHA Supports Legislation Improving Rural Access to Care
What’s happening: In a June 30 letter to the California congressional delegation, CHA urges members to cosponsor and support the Preserving Emergency Access in Key Sites (PEAKS) Act (S. 1960/H.R. 3778).
Hospital Fee Program 9 Approval Takes Key Step Forward
What’s happening: On July 1, the Department of Health Care Services submitted an amended and completed directed payment preprint for Hospital Quality Assurance Fee Program 9 to the Centers for Medicare & Medicaid Services (CMS).
New Analyses Show Hospitals’ Performance under Key Quality Programs
What’s happening: DataSuite issued hospital-specific analyses based on the Value-Based Purchasing (VBP) Program, Hospital-Acquired Condition (HAC) Reduction Program, and quality measure trends.
State Budget Redirects Prop 35 Funds, Sets New Medi-Cal Requirements
What’s happening: State lawmakers and Gov. Gavin Newsom this week reached a tentative agreement on the 2025-26 state budget, concluding weeks of negotiations.
Final Rule on ACA Marketplace Integrity Aims to Address ‘Improper’ Enrollment
What’s happening: On June 20, the Centers for Medicare & Medicaid Services (CMS) issued its final rule on Affordable Care Act (ACA) marketplace integrity and affordability.
DHCS Releases Private Hospital-Directed Payment Encounter Files
What’s happening: On June 13, the Department of Health Care Services (DHCS) uploaded three new hospital-directed payment encounter files, available via the Secure File Transfer Protocol site, that hospitals must download as soon as possible — they will be deleted within 45 days of the upload date.
Upcoming Webinar Details BCBS Settlement’s Implications for Members
What’s happening: On June 23 from 9-10 a.m. (PT), revenue recovery consulting firm Managed Care Advisory Group and Hospital Council – Northern & Central California will host a members-only webinar on the $2.8 billion Blue Cross Blue Shield (BCBS) Provider Settlement and its implications for member organizations.
Senate Committee Proposes Drastic Medicaid Cuts
On Monday, the U.S. Senate Finance Committee released legislative language for its version of the “One Big Beautiful Bill Act,” a budget bill that would overhaul the nation’s tax structure, in large part through expansive cuts to Medicaid (Medi-Cal in California).
Reminder: Documents that Create Medical Debt Must Include Specific Language
What’s happening: Beginning July 1, hospitals must include specific language on any document that indicates the patient agrees to pay the hospital’s bill, per Senate Bill (SB) 1061 (2024). Failure to include the required language means the hospital cannot enforce the debt.
MedPAC Releases Report to Congress on Medicare, Health Care Delivery System
What’s happening: The Medicare Payment Advisory Commission’s (MedPAC’s) June 2025 Report to the Congress: Medicare and the Health Care Delivery System, released June 12, covers improvements to Medicare payment systems, issues affecting the Medicare program, and changes to both health care delivery and the market for health care services.