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 Updates Hospital Guidance for Texting Patient Info

What’s happening: The Centers for Medicare & Medicaid Services (CMS) updated guidance for hospitals and critical access hospitals related to texting patient information.  

What else to know: Hospitals should use a Health Insurance Portability and Accountability Act-compliant secure texting platform that complies with Medicare and Medicaid conditions of participation.  

Changes Proposed for Accrediting Organizations Requirements

What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued proposed changes to accrediting organization (AO) requirements.  

What else to know: The proposed changes are intended to strengthen the agency’s oversight of AOs and prevent conflicts of interest. Comments are due to CMS by 2 p.m. (PT) on April 15.  

Medicare Coverage for Behavioral Health Expanded

What’s happening: The Department of Health Care Services (DHCS) announced that Medicare will cover visits with mental health counselors, addiction counselors, and marriage and family therapists, effective since Jan. 1. 

What else to know: The Centers for Medicare & Medicaid Services (CMS) will conduct both routine and focused program audits of Medicare Advantage (MA) organizations in 2024 to assess compliance with new requirements. 

CMS Provides “Two-Midnight Rule” Guidance for Medicare Advantage Plans

What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued a frequently asked questions (FAQ) document on finalized contract year 2024 Medicare Advantage (MA) policies.   

What else to know: The document provides guidance on how the “two-midnight” hospital admissions policies apply to MA patients when MA organizations are permitted to deny payment through post-claim audits. 

CHA Will Host Inpatient Rehabilitation Facility Webinar

What’s happening: CHA will host a complimentary, members-only webinar on Feb. 13 at 9 a.m. (PT) to discuss an inpatient rehabilitation facility (IRF) review choice demonstration. Registration is open.  

What else to know: The Centers for Medicare & Medicaid Services (CMS) recently introduced the review choice demonstration (RCD) for IRFs in Alabama, with plans to expand the program to California in the near future.  

IRF Review Choice Demonstration

The Centers for Medicare & Medicaid Services (CMS) recently introduced the Review Choice Demonstration (RCD) for Inpatient Rehabilitation Facilities (IRFs) in Alabama, with plans to expand the program to California in the near future.

New Federal Electronic Prior Authorization Requirements Finalized

What’s happening: The Centers for Medicare & Medicaid Services (CMS) has finalized policies to advance interoperability and streamline prior authorization processes by using application programming interfaces (API) technology.  

What else to know: The final rule also requires payers to provide a specific reason for denied prior authorization decisions and publicly report certain prior authorization metrics.