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.
CMS Proposes Inadequate Inpatient Payment Update
What’s happening: The Centers for Medicare & Medicaid Services’ (CMS) proposed fiscal year (FY) 2025 inpatient prospective payment system (IPPS) rule falls short of what hospitals need to keep up with rising costs and health care needs.
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 inpatient payments will increase by $3.2 billion in FY 2025. Comments are due June 10.
Summaries: FFY 2025 Hospice, Inpatient Rehabilitation Facility, Skilled-Nursing Facility Medicare Payment Rules
What’s happening: Summaries of the hospice wage index, inpatient rehabilitation facility (IRF) prospective payment system (PPS), and skilled-nursing facility (SNF) PPS proposed rules are now available.
What else to know: Comments on the proposed rules are due by May 28.
Submit Medicare Physician Attestation Statements by May 3
What’s happening: As a condition of participation, Medicare-certified hospitals must complete attestation and acknowledgment of physicians with newly granted admitting privileges in the previous calendar year.
What else to know: Attestation statements for 2023 should be submitted by May 3.
Summary: Finalized Policy Changes for MA Plans in Contract Year 2025
What’s happening: A summary of the finalized changes to Medicare Advantage (MA) and Part D programs for contract year 2025 is now available.
What else to know: The regulation is effective June 3.
CMS Proposes 2.6% Inpatient Prospective Payment System Rate Increase for FY 2025
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has proposed a net increase to base Medicare inpatient payment rates (market basket update) of 2.6% for fiscal year (FY) 2025.
What else to know: The increase is included in the FY 2025 Medicare hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system proposed rule. Comments on the proposed rule are due to CMS by June 10.
CMS Issues Post-Acute Care Payment Proposed Rules
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued its proposed payment policies for inpatient rehabilitation facilities (IRFs), skilled-nursing facilities (SNFs), and hospices for federal fiscal year (FFY) 2025.
What else to know: Comments on the proposed rules are due to CMS by 2 p.m. (PT) on May 28.
CMS Issues FFY 2025 Inpatient Psychiatric Facility PPS Proposed Rule
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued its federal fiscal year (FFY) 2025 inpatient psychiatric facility (IPF) prospective payment system (PPS) proposed rule.
What else to know: Comments are due to CMS by 2 p.m. (PT) on May 28.
Medicare Reduces Coinsurance Amount for 41 Different Part B Drugs
What’s happening: Medicare temporarily reduced the coinsurance amount for 41 different Part B prescription drugs under the Inflation Reduction Act.
What else to know: Through June 30, the coinsurance amount is decreased from 20% to between 3.8% and 19.9%, depending on the drug.
CY 2025 Medicare Advantage, Part D Payment Changes Finalized
What’s happening: The Centers for Medicare & Medicaid Services (CMS) finalized changes to Medicare Advantage (MA) Part C and Part D payments for calendar year (CY) 2025.
What else to know: Comments on the MA data request for information are due by May 29. The policies are effective Jan. 1, 2025.
MedPAC to Develop Rural Hospital and Clinician Payment Workplan
What’s happening: The Medicare Payment Advisory Commission (MedPAC) is developing a rural hospital and clinician payment policy workplan for 2024–25.
What else to know: The March MedPAC meeting included discussion to inform a future recommendation to Congress related to rural hospitals.