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.
Summary: CY 2025 ESRD PPS Proposed Rule
What’s happening: A members-only summary, prepared by Health Policy Alternatives, Inc., of the calendar year (CY) 2025 end-stage renal disease (ESRD) prospective payment system (PPS) proposed rule is available.
What else to know: Comments on the proposals are due to the Centers for Medicare & Medicaid Services by Aug. 26.
CHA Comments on Proposed Payment Model to Expand Kidney Transplant Access
What’s happening: CHA submitted comments in response to the proposed Increasing Organ Transplant Access (IOTA) Model, which aims to improve access to kidney transplants.
What else to know: CHA raised significant concerns about the model and requested it be made voluntary.
CHA Member Alert: Invite Congressional Representatives to Your Hospital This Summer
What’s happening: CHA is urging hospitals to build relationships with members of Congress by inviting them for a visit or tour during summer recess. Invitations should go out soon because schedules fill up quickly.
What else to know: These visits will help educate and inform lawmakers ahead of critical health care policy votes in December.
CMS Proposal Seeks to Mitigate Abnormal DME Billing in Medicare Shared Services Program
What’s happening: The Centers for Medicare & Medicaid Services (CMS) released a proposed rule on abnormal billing activity within the Medicare Shared Savings Program.
What else to know: The proposed rule seeks to mitigate the impact of the billing activity on reconciliation of accountable care organization (ACO) payments in calendar year (CY) 2023.
CMS Proposes Inadequate Outpatient Payment Update
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2025 outpatient prospective payment system proposed rule.
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 outpatient payments will increase by $1.8 billion in CY 2025, excluding changes in enrollment, case mix, and utilization.
CMS Issues CY 2025 Physician Fee Schedule Proposed Rule
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2025 proposed rule for the physician fee schedule (PFS).
What else to know: Comments on the proposed rule are due Sept. 9.
Office of Inspector General to Examine Medicare Advantage Use of Prior Authorization for Post-Acute Care
What’s happening: The U.S. Health and Human Services Agency has announced that the Office of Inspector General (OIG) will investigate the use of prior authorization for post-acute care services by Medicare Advantage (MA) plans.
What else to know: CHA members have reported that they encounter significant challenges in obtaining authorizations from MA plans for access to the most appropriate level of post-acute care (PAC).
Congress Reintroduces Legislation to Streamline Prior Authorization
What’s happening: Congressional leaders have reintroduced bipartisan legislation to address concerns regarding prior authorization (PA) and timely access to care for beneficiaries enrolled in Medicare Advantage (MA) plans.
What else to know: The Improving Seniors’ Timely Access to Care Act would establish an electronic PA standard, reduce the amount of time a health plan is allowed to consider a PA request, and require MA plans to report on their use of PA, including rates of approvals and denials.
CMS to End Medicare Advanced Payments from Change Healthcare Cyberattack Disruptions
What’s happening: The Centers for Medicare & Medicaid Services (CMS) will close the program that provided Medicare accelerated and advance payments to providers affected by the Change Healthcare cyberattack.
What else to know: CMS will no longer accept new applications for these payments after July 12.
CHA Supports Federal Bill to Preserve Access to Care in Rural Communities
What’s happening: CHA sent a letter to the California congressional delegation in support of the Preserving Emergency Access in Key Sites (PEAKS) Act (H.R. 7931).
What else to know: The legislation would protect critical access hospitals (CAHs) in rural and mountainous areas by correcting a misalignment in Medicare’s CAH ambulance reimbursement requirements.