Medicare

About Medicare

The federal Medicare program is an essential pillar of the state’s health care system, supporting more than 6 million Californians over the age of 65 and younger Californians with disabilities. One in five hospitals is at risk of closing, in part because Medicare reimbursement rates are far lower than the cost of providing care. It’s essential that future federal Medicare policy protects patient care.

Medicare Patient Reclassification Notices Now in Effect

What’s happening: Effective Feb. 14, providers are required to issue a Medicare Change of Status Notice (MCSN) to eligible patients who were admitted as hospital inpatients, but the hospital subsequently reclassified them as outpatients who are receiving observation services.

What else to know: This requirement only applies to patients with traditional Medicare as the primary payer. The form and its instructions are available to download.   

CMS Announces Quality Reporting Exceptions for Hospitals Impacted by Los Angeles Fires

What’s happening: The Centers for Medicare & Medicaid Services (CMS) is granting exceptions for certain measures in Medicare quality reporting and value-based programs to hospitals, psychiatric hospitals, and post-acute providers in designated areas affected by the California Wildfires and Straight-line Winds public health emergency in Los Angeles.  

What else to know: If providers voluntarily report data where exceptions are allowed, CMS notes that the data will be used for public reporting and applying scoring methodologies under value-based programs.  

CHA Comments on Medicare Advantage Proposals for 2026

What’s happening: CHA submitted comments in response to the Centers for Medicare & Medicaid Services’ (CMS) proposed policy and technical changes to Medicare Advantage (MA) and Part D programs for contract year 2026.   

What else to know: Finalization of the proposed rule is expected in April — in time for MA plans to bid to CMS and offer MA products for plan year 2026. The rule, once finalized, will take effect Jan. 1, 2026.  

CMS Provides Additional Guidance on Beneficiary Observation Status Appeals

What’s happening: The Centers for Medicare & Medicaid Services (CMS) has issued additional information, including billing instructions, for the Medicare Change of Status Notifications (MCSN).   

What else to know: Beginning Feb. 14, CMS will require giving MCSNs to patients who are reclassified from inpatient to observation (outpatient) status.   

CHA Webinar Covers New Medicare Conditions of Participation Updates

What’s happening: CHA will host a members-only webinar on Jan. 29 from 11 a.m. to noon (PT) to discuss the new Medicare Conditions of Participation (CoP) updates for obstetrical and other services. Registration is open. 

What else to know: The requirements will be phased in over two years, with the first of the requirements in effect July 1.  

CMS Makes Additional Updates to Medicare Advantage Provider Complaint Submission Form

What’s happening: The Centers for Medicare & Medicaid Services (CMS) has provided additional updates to the Medicare Advantage Provider Complaint Submission form as it continues to refine the process,.   

What else to know: As previously reported,  CMS has developed a process that allows providers to submit questions and complaints related to Medicare Advantage (MA) plan appeals or claims payment issues.