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 Comments on Medicare Advantage Proposals for 2026
What’s happening: CHA submitted comments in response to the Centers for Medicare & Medicaid Services’ (CMS) proposed policy and technical changes to Medicare Advantage (MA) and Part D programs for contract year 2026.
What else to know: Finalization of the proposed rule is expected in April — in time for MA plans to bid to CMS and offer MA products for plan year 2026. The rule, once finalized, will take effect Jan. 1, 2026.
CMS Provides Additional Guidance on Beneficiary Observation Status Appeals
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has issued additional information, including billing instructions, for the Medicare Change of Status Notifications (MCSN).
What else to know: Beginning Feb. 14, CMS will require giving MCSNs to patients who are reclassified from inpatient to observation (outpatient) status.
CHA Webinar Covers New Medicare Conditions of Participation Updates
What’s happening: CHA will host a members-only webinar on Jan. 29 from 11 a.m. to noon (PT) to discuss the new Medicare Conditions of Participation (CoP) updates for obstetrical and other services. Registration is open.
What else to know: The requirements will be phased in over two years, with the first of the requirements in effect July 1.
CMS Proposes Payment Updates for Medicare Advantage, Part D Plans for CY 2026
What’s happening: On Jan. 10, the Centers for Medicare & Medicaid Services (CMS) issued advance notice of proposed capitation rate and payment updates for Medicare Advantage (MA) and Part D plans for calendar year (CY) 2026.
What else to know: The final 2026 rate announcement is expected by April 7.
CMS Makes Additional Updates to Medicare Advantage Provider Complaint Submission Form
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has provided additional updates to the Medicare Advantage Provider Complaint Submission form as it continues to refine the process,.
What else to know: As previously reported, CMS has developed a process that allows providers to submit questions and complaints related to Medicare Advantage (MA) plan appeals or claims payment issues.
Update on 2022 Outpatient PPS and Physician Fee Schedule Proposed Rules Participant Information
The Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2022 outpatient prospective payment system (OPPS) proposed rule on July 19. CMS estimates that Medicare expenditures under OPPS will increase by $1.35 billion based on changes in the proposed rule. CMS also issued its calendar year (CY) 2022 physician fee schedule (PFS) proposed rule on July 13. CHA is hosting a members-only webinar to discuss updates to these proposed rules […]
CHA Encourages Members to Participate in the Vitality Index Payer Scorecard
What’s happening: CHA is endorsing member participation in the Vitality Index Payer Scorecard, which will provide critical information to support CHA’s advocacy to hold insurers accountable for timely and accurate reimbursement.
What else to know: The CHA Board of Trustees has endorsed this tool, which will automatically draw de-identified claims and remittance information from hospitals without requiring additional reporting or surveys.
Area Wage Index Litigation
This page contains important, members-only information related to the Centers for Medicare & Medicaid Services’ recently finalized area wage index policy. To continue, please log in to your member account.
Overview of Changes to the Medicare BPCI-A Payment Model — Participant Information
CMS recently announced the extension of the Bundled Payments for Care Improvement Advanced (BPCI-A) model. Join us for this informative webinar as experts provide an overview of the model, including updates for 2024 participation, application considerations, and program details. Organizations that have never applied for BPCI-A, as well as current BPCI-A participants, will benefit from […]