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.

California Representatives Advocate for Access to IRF Care

What’s happening: Several California representatives joined fellow members of Congress in urging the Centers for Medicare & Medicaid Services (CMS) to take steps that will ensure Medicare Advantage (MA) plan beneficiaries have access to medically necessary inpatient rehabilitation facility (IRF) care.    

What else to know: In the letter, the authors observe that, by statute, MA must cover all services included under traditional Medicare, including inpatient rehabilitation — an essential service for many beneficiaries when recovering from a major medical event.  

Correction Notices Issued for Medicare Payment Final Rules

What’s happening: The Centers for Medicare & Medicaid Services issued correction notices to the federal fiscal year (FFY) 2025 Medicare payment final rules.  

What else to know: The changes are minor, and the inpatient prospective payment system (IPPS) final rule changes are not reflective of the low-wage index interim final rule.  

CMS Issues Updated Medicare Advantage Complaint Form

What’s happening: As previously reported, the Centers for Medicare & Medicaid Services (CMS) has developed a process that allows providers to submit questions and complaints related to Medicare Advantage (MA) plan appeals or claims payment issues. 

What else to know: The form serves as a mechanism for Medicare providers seeking CMS assistance to resolve specific MA claims issues; CMS will enter complete complaint forms into the complaints tracking module and direct the MA to investigate the case.   

CMS Issues Annual Data Submission Requirements for MA Plans

What’s happening: The Centers for Medicare & Medicaid Services (CMS) has issued detailed information about data collection and audit procedures for Medicare Advantage (MA) (Part C) plans. 

What else to know: The information will allow CMS to conduct a comprehensive review of plan compliance with utilization management requirements, including new requirements on development, appropriateness, and public accessibility of internal coverage criteria.   

CMS Discontinues Low-Wage Index Policy for FFY 2025

What’s happening: The Centers for Medicare & Medicaid Services (CMS) has eliminated its low-wage index hospital policy for federal fiscal year (FFY) 2025. 

What else to know: CHA has supported a legal challenge to this policy on behalf of member hospitals since FFY 2020. 

Ask Reps. to Sign Letter Opposing 340B Program Changes

What’s happening: A bipartisan group of U.S. representatives is leading a letter to U.S. Health and Human Services (HHS) Secretary Xavier Becerra about efforts by Johnson & Johnson (J&J) to undermine the 340B Drug Discount Program.   

What else to know: Hospital leaders should call or email their U.S. representative and urge them to sign on to the letter by Sept. 27.  

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.