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 Will Host Vitality Payer Scorecard Webinar
What’s happening: CHA is hosting a complimentary, members-only webinar on Feb. 27 at 10 a.m. (PT) to highlight the American Hospital Association Vitality Payer Scorecard, which was recently endorsed by the CHA board.
What else to know: The scorecard captures necessary and normalized data points without sharing protected health information. The automated process is based on de-identified claims and remittance files and eliminates the need for CHA surveys on this issue.
CHA Continues to Urge Congress to Reject Harmful Site-Neutral Payment Cuts
What’s happening: Congress has until March 8 to negotiate a potential health care package that could include Medicare site-neutral payment cuts, which are also being considered in several other bills.
What else to know: CHA opposes the cuts and continues to inform the California congressional delegation of the proposals’ harmful impacts.
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.
CMS Issues Advance Notice of Proposed Medicare Advantage Payment Changes
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued advance notice of proposed changes to Medicare Advantage (MA) Part C and Part D payments for calendar year 2025.
What else to know: Comments are due to CMS by 2 p.m. (PT) on March 1.
Vitality Payer Scorecard: Holding Insurers Accountable
Summary: Finalized Interoperability and Prior Authorization Policies
What’s happening: A members-only summary of finalized interoperability and prior authorization processes is available.
What else to know: The final rule is scheduled for publication in the Feb. 8 issue of the Federal Register.