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 Initiates Collection of SNF Ownership Information
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has begun notifying skilled-nursing facilities (SNFs) of new requirements to report detailed information about ownership and management.
What else to know: SNFs must disclose this information on the updated Medicare Enrollment Application (CMS-855A) form attachment, for which CMS has provided additional guidance. Over the next few months, CMS will give all SNFs, including hospital-based SNFs, direction on submitting a revalidation application with the information.
CMS Reduces Medicare Payments to Physicians in Final Rule
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2025 Medicare physician fee schedule (PFS) final rule, in which the final CY 2025 PFS conversion factor is $32.35 — a decrease of 2.8% from CY 2024.
What else to know: CMS published a fact sheet on the CY 2025 Medicare PFS that shares the rate setting and conversion factor, and much more.
CMS Finalizes Medicare Payments for Home Health, Dialysis Services
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued final rules for the calendar year 2025 home health prospective payment system (PPS) and end-stage renal disease PPS.
What else to know: CMS estimates a 0.5% increase in payments for home health agencies and dialysis providers treating end-stage renal disease (ESRD) patients will see an increase of 2.7%.
CMS Finalizes Inadequate Outpatient Payment Update, Establishes New Conditions of Participation
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2025 outpatient prospective payment system (OPPS) final rule, including a net market basket update of 2.9%.
What else to know: CMS also establishes new health and safety standards for obstetrical services to be phased in over two years.
CMS Guidance Clarifies Hospital Respiratory Illness Data Reporting Requirements Effective Nov. 1
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued guidance to hospitals and state surveyors that underscores the importance of following reporting requirements for new hospital respiratory illness data reporting conditions of participation (CoP).
What else to know: CMS also clarifies in the guidance that psychiatric hospitals and rehabilitation hospitals will report their daily COVID-19, influenza, and respiratory syncytial virus data annually rather than weekly.
California’s Hospitals, Doctors Seek Congressional Delegation Support in Preserving Access to Care
What’s happening: In a joint letter to the California congressional delegation, CHA and the California Medical Association (CMA) asked members to support access to health care for all Californians in year-end legislation.
What else to know: Critical federal health care legislation on Medicaid, Medicare, and telehealth will be up for votes in December.
Senate Subcommittee Issues Scathing Report on Medicare Advantage Plans
What’s happening: The U.S. Senate Permanent Subcommittee on Investigations (PSI) released a report revealing that the three largest Medicare Advantage (MA) plans intentionally target costly stays in post-acute care facilities to increase profits.
What else to know: These MA plans denied prior authorization (PA) requests for post-acute care requests at far higher rates than they did for other types of care, resulting in diminished access to post-acute care for MA beneficiaries and an increase in the number of post-acute care services subject to PA. The PSI’s investigation also provided insight into automation and predictive technologies in the PA process.
Noridian Shares Resource for Outpatient Therapy Providers
What’s happening: Noridian, the Medicare administrative contractor (MAC) for California, has provided a one-page resource for outpatient therapy service providers, including physical therapy, occupational therapy, and speech/language pathology services.
What else to know: The resource includes information on coding and claim processing, therapy accruals, certification for therapy plan of care, advance beneficiary notice of noncoverage and more.
CMS Issues Final Rule on Appeals of Observation Status
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has issued a final rule that establishes an appeals process for Medicare enrollees who are initially admitted as hospital inpatients but are subsequently reclassified as outpatient observation patients.
What else to know: The new regulations create processes for both retrospective appeals and prospective appeals. CMS expects the retrospective appeals to become operational in January 2025 and the prospective appeals to become operational in mid-February 2025.
CMS Finalizes Medicare Observation Appeals Processes
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has established appeals processes for Medicare beneficiaries who were admitted as inpatient but whose status changed to outpatient observation during their hospital stay.
What else to know: The appeals processes only apply to patients enrolled in traditional Medicare, not patients enrolled in Medicare Advantage.