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.
California Rural Hospitals Invited to AHA Town Hall
What’s happening: The American Hospital Association (AHA) Region 9 will hold a virtual Rural Advocacy Town Hall on Oct. 9, 10-11 a.m. (PT) through Microsoft Teams. Region 9 includes California, Nevada, Oregon, Washington State, Alaska, Hawaii, and the Pacific territories.
What else to know: The call will be led by AHA’s rural advocacy experts in Washington, D.C.: Travis Robey, vice president, political affairs, and Shannon Wu, PhD, director, payment policy. Susan Doherty, vice president for field engagement and rural health segment lead, will also join. All CHA member hospitals with membership in the AHA are welcome to register.
Mental Health Parity Rules Finalized
What’s happening: The departments of the Treasury, Labor, and Health and Human Services have finalized rules to improve access to mental health services by requiring health plans to make changes when inadequate access is provided.
What else to know: The final rule reinforces the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which requires health plans to ensure that access to mental health or substance use disorder care is not more restrictive than access to medical and surgical benefits.
CHA Issues Comments on CY 2025 OPPS Proposed Rule
What’s happening: CHA has submitted comments on the calendar year 2025 outpatient prospective payment system proposed rule.
What else to know: Comments were due to the Centers for Medicare & Medicaid Services (CMS) on Sept. 9.
CMS Offers Updated Training on PAC QRP
What’s happening: The Centers for Medicare & Medicaid Services (CMS) is offering a series of updated web-based training courses on coding cross-setting data elements for Section GG of the post-acute care (PAC) patient assessment tools.
What else to know: Section GG collects admission and discharge information about functional status for patients in long-term care hospitals (LTCHs), inpatient rehabilitation facilities (IRFs), skilled-nursing facilities (SNFs), and home health agencies (HHAs).
CHA Comments on CY 2025 Home Health Payment Rule
What’s happening: CHA submitted comments to the Centers for Medicare & Medicaid Services (CMS) in response to the calendar year 2025 home health prospective payment system proposed rule.
What else to know: CHA thanks members for their feedback, which helped to inform comments.
New Provider Complaint Process Aims to Increase Federal Oversight of Medicare Advantage Plans
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has implemented a new process allowing providers to submit questions and complaints related to Medicare Advantage (MA) plan appeals or claims payment issues.
What else to know: CHA welcomes these first steps in establishing greater CMS oversight for MA plans. The MA final rule, which took effect on Jan. 1, codified important new policies and expectations for MA plans, directed toward greater alignment between traditional Medicare and MA.
CMS Develops Resources to Help Hospitals Comply with Machine-Readable File Requirements
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has published resources to help hospitals implement hospital price transparency machine-readable file (MRF) requirements.
What else to know: As of July 1 of this year, hospitals are required to publish a comprehensive MRF containing the standard charges for all items and services provided by the hospital.
CHA Issues Summary of FFY 2025 LTCH PPS Final Rule
What’s happening: CHA has issued a summary of the finalized payment updates and policies for long-term care hospitals (LTCHs) for federal fiscal year (FFY) 2025.
What else to know: The policy and payment provisions are generally effective for FFY 2025 discharges, beginning Oct. 1.
Summary: FFY 2025 Inpatient Psychiatric Facility PPS Final Rule
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued its federal fiscal year (FFY) 2025 inpatient psychiatric facility (IPF) prospective payment system (PPS) final rule.
What else to know: Finalized payment rates are slightly higher than proposed, but still insufficient relative to input cost inflation.
Summaries Available: FFY 2025 Post-Acute Care Payment Final Rules
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued its final payment rules for inpatient rehabilitation facilities (IRFs), skilled-nursing facilities (SNFs), and hospices for federal fiscal year (FFY) 2025. CHA has issued members-only summaries of each rule.
What else to know: In general, the payment updates were slightly higher than proposed, but still inadequate relative to input price inflation.