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: Details of Final Outpatient Payment Rule
What’s Happening: A comprehensive summary of the finalized payment updates and policy changes to the Medicare outpatient prospective payment system for calendar year 2024 is available.
What Else to Know: The provisions are generally effective Jan. 1, 2024.
Updated Guide on Final Rule Implementation Now Available
What’s happening: A members-only guide from the American Hospital Association to support hospitals in the implementation of the Medicare Advantage (MA) final rule is now available for calendar year 2024.
What else to know: The document provides a summary of key provisions of the final rule, which seeks to align MA coverage with traditional Medicare more clearly and to increase oversight of MA plans.
Return Hospital Engagement Letters for Area Wage Index Litigation by Dec. 8
What’s happening: Dec. 8 is the deadline for hospitals to sign up for a CHA-supported legal challenge to Medicare’s low-wage index policy.
What else to know: An updated analysis increases the estimated impact of these policies on California hospitals from $26 million to $33 million in federal fiscal year (FFY) 2024.
Summary: Finalized Policies Address Physician Payment and Quality Updates
What’s happening: A members-only summary from Health Policy Alternatives, Inc. discusses the final physician payment policies for calendar year (CY) 2024.
What else to know: Policies are effective Jan. 1.
Hear From DataGen About the Outpatient Payment Final Rule
What’s Happening: A DataGen webinar on Dec. 5 at noon (PT) will provide an overview of the calendar year 2024 outpatient prospective payment system final rule. What Else to Know: Registration is required.
Summary: Providers Would Face Financial Penalties for Information Blocking
What’s happening: A members-only summary from Health Policy Alternatives, Inc., of the proposed rule on information blocking details provider disincentives related to programs from the Centers for Medicare & Medicaid Services.
What else to know: Comments on the proposed rule are due Jan. 2.
Physicians Will See Medicare Payment Cuts Next Year
What’s happening: The Centers for Medicare & Medicaid Services’ (CMS) 2024 physician fee schedule final rule reduces Medicare payments to physicians by 1.23% compared to the prior year.
What else to know: The final 2024 physician fee schedule conversion factor is $32.74, a decrease of $1.15, or 3.4%, from 2023.
Access to Mental Health Services Could Increase for Medicare Advantage Enrollees
What’s happening: The Centers for Medicare & Medicaid Services (CMS) proposes policy changes for Medicare Advantage (MA) plans in contract year (CY) 2025.
What else to know: Comments on the proposed rule, which addresses MA policies such as prior authorization, outpatient behavioral health and supplemental benefits, are due Jan. 5.
CMS Finalizes Inadequate Outpatient Payment Update
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has finalized the calendar year (CY) 2024 outpatient prospective payment system rule.
What else to know: It includes a net market basket update of 3.1%, which is a slight increase over the proposed 2.8%.
Final Home Health Rule Reduces Impact of Behavioral Adjustments on Providers
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has issued the final rule for the home health prospective payment system for calendar year 2024.
What else to know: Medicare payments to home health agencies will increase in the aggregate by 0.8% instead of the 2.2% decrease that was originally proposed.