About Laws & Regulations
Navigating the vast network of health care laws and regulations is difficult. To help hospitals, CHA produces manuals and guidebooks, including the Consent Manual, a one-stop resource for all legal requirements related to patient consent for medical treatment, release of medical information, reporting requirements and more; the Model Medical Staff Bylaws and Rules, which outline the framework for working relationships among medical staff, hospital administrators and governing bodies; and the California Hospital Compliance Manual, which covers high-risk compliance issues. CHA also represents California hospitals’ interests in court on issues, including reimbursement, labor and employment, and more.
CMS Proposal Seeks to Mitigate Abnormal DME Billing in Medicare Shared Services Program
What’s happening: The Centers for Medicare & Medicaid Services (CMS) released a proposed rule on abnormal billing activity within the Medicare Shared Savings Program.
What else to know: The proposed rule seeks to mitigate the impact of the billing activity on reconciliation of accountable care organization (ACO) payments in calendar year (CY) 2023.
CMS Proposes Reducing Medicare Payments to Physicians
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2025 physician fee schedule (PFS) proposed rule.
What else to know: The proposed CY 2025 PFS conversion factor is $32.36, a decrease of $0.93, or 2.8%, from CY 2024.
CMS Update on 2025 OPPS and PFS Proposed Rules
On July 10, the Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2025 outpatient prospective payment system (OPPS) proposed rule and physician fee schedule (PFS) proposed rule.
CHA is hosting this members-only webinar to discuss key proposals in these proposed rules ahead of the comment deadline.
CMS Proposes Inadequate Outpatient Payment Update
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2025 outpatient prospective payment system proposed rule.
What else to know: The rule includes a net market basket update of 2.6%. As a result of all proposed changes, CMS estimates that hospital outpatient payments will increase by $1.8 billion in CY 2025, excluding changes in enrollment, case mix, and utilization.
CMS Issues CY 2025 Physician Fee Schedule Proposed Rule
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2025 proposed rule for the physician fee schedule (PFS).
What else to know: Comments on the proposed rule are due Sept. 9.
ONC Issues Additional Rule on Health Data, Technology, and Interoperability
What’s happening: The Office of the National Coordinator for Health Information Technology (ONC) issued a proposed rule to advance interoperability and improve information sharing among patients, providers, payers, and public health authorities.
What else to know: The proposed rule builds upon a final rule published in January.
Updates for the Week of July 8
Reminder: Hospital Price Transparency Resources Available to Help Hospitals Comply with July 1, 2024 Requirements Updated eCQM Data Element Repository (DERep) for CY2025 Reporting and Performance Periods Care Compare June Refresh of IRF QRP and LTCH QRP Data Available IRF Quality Reporting Reconsideration and Exception & Extension LTCH Quality Reporting Reconsideration and Exception & Extension […]
DHCS Announces Upcoming Supplemental Payment Dates
What’s happening: The Department of Health Care Services (DHCS) has announced it will make disproportionate share hospital (DSH) payments on July 15.
What else to know: The payments will have a warrant date of July 11.
Letters to OHCA Board Highlight New Data, Caution Against Overly Broad Review Process
What’s happening: Last week, CHA submitted two letters to the Office of Health Care Affordability (OHCA) — one responding to the May OHCA board meeting, and another addressing the office’s proposed changes to the cost and market impact review (CMIR) regulations.
What else to know: The board met June 26 to approve the alternative payment model (APM) standards and discuss the proposed CMIR regulations, the draft workforce stability standards, and the draft primary care investment benchmark.
ONC Finalizes Financial Penalties for Information Blocking
What’s happening: The Office of the National Coordinator for Health Information Technology (ONC) issued a final rule on provider disincentives for information blocking.
What else to know: CHA is disappointed in the finalized policies and remains concerned about the selective application of penalties to certain health care providers, as previously outlined in comments.