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.

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.  

Office of Inspector General to Examine Medicare Advantage Use of Prior Authorization for Post-Acute Care

What’s happening: The U.S. Health and Human Services Agency has announced that the Office of Inspector General (OIG) will investigate the use of prior authorization for post-acute care services by Medicare Advantage (MA) plans.   

What else to know: CHA members have reported that they encounter significant challenges in obtaining authorizations from MA plans for access to the most appropriate level of post-acute care (PAC).  

Congress Reintroduces Legislation to Streamline Prior Authorization

What’s happening: Congressional leaders have reintroduced bipartisan legislation to address concerns regarding prior authorization (PA) and timely access to care for beneficiaries enrolled in Medicare Advantage (MA) plans.   

What else to know: The Improving Seniors’ Timely Access to Care Act would establish an electronic PA standard, reduce the amount of time a health plan is allowed to consider a PA request, and require MA plans to report on their use of PA, including rates of approvals and denials.  

CMS Proposes Inadequate Home Health Payment Update

What’s happening: The Centers for Medicare & Medicaid Services issued a proposed calendar year (CY) 2025 home health prospective payment system.  

What else to know: CMS estimates payments to home health agencies, as a result of the changes in the proposed rule, will decrease by $280 million (1.7%). Other key provisions of the proposed rule include: 

CHA Supports Federal Bill to Preserve Access to Care in Rural Communities

What’s happening: CHA sent a letter to the California congressional delegation in support of the Preserving Emergency Access in Key Sites (PEAKS) Act (H.R. 7931). 

What else to know: The legislation would protect critical access hospitals (CAHs) in rural and mountainous areas by correcting a misalignment in Medicare’s CAH ambulance reimbursement requirements. 

CHA Comments on IPPS Proposed Rule

What’s happening: CHA asked the Centers for Medicare & Medicaid Services (CMS) to increase the payment update in comments on the federal fiscal year 2025 inpatient prospective payment system (IPPS) proposed rule. 

What else to know: Members are encouraged to use CHA’s letter as a template to submit comments, which are due on June 10. 

CHA Comments on Data Collection for MA Plans

What’s happening: CHA submitted comments to the Centers for Medicare & Medicaid Services (CMS) in response to a request for information related to data collection for Medicare Advantage (MA) plans. 

What else to know: CHA strongly encourages CMS to use the formal rulemaking process to implement additional data collection and reporting requirements.