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.

CHA DataSuite Releases FFY 2025 Medicare Inpatient Prospective Payment System Proposed Rule Analysis

What’s happening: CHA DataSuite issued a hospital-specific analysis of the federal fiscal year (FFY) 2025 Medicare inpatient prospective payment system (IPPS) proposed rule.  

What else to know: The analysis is intended to show hospitals how Medicare fee-for-service payments would change from FFY 2024 to FFY 2025 based on the policies set forth in the proposed rule.  

CHA Issues Summaries of IPPS, LTCH PPS Proposed Rules

What’s happening: CHA has issued summaries of the federal fiscal year 2025 inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) PPS proposed rules. 

What else to know: CHA will host a complimentary, members-only webinar on the IPPS provisions on May 15. Comments on the proposed rules are due by 2 p.m. (PT) on June 10.  

CHA Will Host Webinar on Mandatory Bundled Payment Model

What’s happening: CHA will host a complimentary, members-only webinar on May 1 at noon (PT) to discuss the mandatory bundled payment model proposed by the Centers for Medicare & Medicaid Services (CMS). Registration is open. 

What else to know: CMS proposed the Transforming Episode Accountability Model (TEAM), which will hold selected hospitals accountable for the cost and quality of certain surgical procedures.  

Hospital Leaders Discuss Financial Challenges with Legislators on Capitol Hill

What’s happening: Last week, California hospital and health system leaders convened in Washington, D.C. for the American Hospital Association (AHA) Annual Membership Meeting.   

What else to know: Hospital and health system leaders participated in meetings on Capitol Hill with the California congressional delegation to advance CHA’s position on key advocacy priorities.  

HRSA Implements Long-Awaited Dispute Resolution Process

What’s happening: The Health Resources and Services Administration (HRSA) finalized requirements and procedures for the 340B Drug Discount Program’s administrative dispute resolution (ADR) process.  

What else to know: The regulation is effective June 18.  

Medicare Inpatient Rule: Mandatory Bundled Payment Model

The Centers for Medicare and Medicaid Services (CMS) proposed the Transforming Episode Accountability Model (TEAM), which will hold selected hospitals accountable for the cost and quality of certain surgical procedures. TEAM aims to improve outcomes for Medicare patients undergoing certain high-volume surgical procedures while reducing Medicare spending.

CMS Proposes Inadequate Inpatient Payment Update

What’s happening: The Centers for Medicare & Medicaid Services’ (CMS) proposed fiscal year (FY) 2025 inpatient prospective payment system (IPPS) rule falls short of what hospitals need to keep up with rising costs and health care needs.  

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 inpatient payments will increase by $3.2 billion in FY 2025. Comments are due June 10.  

Submit Medicare Physician Attestation Statements by May 3

What’s happening: As a condition of participation, Medicare-certified hospitals must complete attestation and acknowledgment of physicians with newly granted admitting privileges in the previous calendar year. 

What else to know: Attestation statements for 2023 should be submitted by May 3.