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.
2025 ESRD PPS Final Rule Members-Only Summary Available Now
What’s happening: A members-only summary of the Centers for Medicare & Medicaid Services’ calendar year (CY) 2025 end-stage renal disease (ESRD) prospective payment system (PPS) final rule, prepared by Health Policy Alternatives, Inc., is available.
What else to know: The regulation is effective Jan. 1, 2025.
Members-Only Summary on CMS 2025 Home Health PPS Final Rule Now Available
What’s happening: A summary of the Centers for Medicare & Medicaid Services’ calendar year (CY) 2025 home health (HH) prospective payment system (PPS) final rule, prepared by Health Policy Alternatives, Inc., is available solely to CHA members.
What else to know: The regulation is effective Jan. 1, 2025.
Register for Upcoming DataGen Webinar on CY 2025 OPPS Final Rule
What’s happening: On Dec. 5 at noon (PT), a DataGen webinar will share an overview of and the calendar year 2025 outpatient prospective payment system (OPPS) final rule and analysis. What else to know: CHA encourages members to register for this webinar.
CHA Outlines Year-End Federal Legislative Health Care Priorities
What’s happening: In a Nov. 18 letter to the California congressional delegation, CHA outlined legislative priorities for the remainder of the 118th Congress — which must act by Dec. 20 to fund the federal government.
What else to know: It is likely that some health care extensions and policies could be a part of Congress’ funding package.
CHA Letter Shares Support, Feedback on Annual Data Submission Requirements for MA Plans
What’s happening: In a Nov. 12 letter to the Centers for Medicare & Medicaid Services (CMS), CHA conveyed its strong support for proposed implementation of additional data collection and audit procedures for Medicare Advantage (MA) plans’ utilization management policies and tools — and shared additional comments.
What else to know: CHA has consistently advocated for greater oversight of MA plans by CMS to ensure beneficiary access to medically necessary services.
CMS Initiates Collection of SNF Ownership Information
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has begun notifying skilled-nursing facilities (SNFs) of new requirements to report detailed information about ownership and management.
What else to know: SNFs must disclose this information on the updated Medicare Enrollment Application (CMS-855A) form attachment, for which CMS has provided additional guidance. Over the next few months, CMS will give all SNFs, including hospital-based SNFs, direction on submitting a revalidation application with the information.
CMS Reduces Medicare Payments to Physicians in Final Rule
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2025 Medicare physician fee schedule (PFS) final rule, in which the final CY 2025 PFS conversion factor is $32.35 — a decrease of 2.8% from CY 2024.
What else to know: CMS published a fact sheet on the CY 2025 Medicare PFS that shares the rate setting and conversion factor, and much more.
CMS Finalizes Medicare Payments for Home Health, Dialysis Services
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued final rules for the calendar year 2025 home health prospective payment system (PPS) and end-stage renal disease PPS.
What else to know: CMS estimates a 0.5% increase in payments for home health agencies and dialysis providers treating end-stage renal disease (ESRD) patients will see an increase of 2.7%.
CMS Finalizes Inadequate Outpatient Payment Update, Establishes New Conditions of Participation
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2025 outpatient prospective payment system (OPPS) final rule, including a net market basket update of 2.9%.
What else to know: CMS also establishes new health and safety standards for obstetrical services to be phased in over two years.
CMS Guidance Clarifies Hospital Respiratory Illness Data Reporting Requirements Effective Nov. 1
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued guidance to hospitals and state surveyors that underscores the importance of following reporting requirements for new hospital respiratory illness data reporting conditions of participation (CoP).
What else to know: CMS also clarifies in the guidance that psychiatric hospitals and rehabilitation hospitals will report their daily COVID-19, influenza, and respiratory syncytial virus data annually rather than weekly.