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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.  

Hospital Fee Program Invoices Due July 24

What’s happening: Invoices for the 2023-24 Hospital Fee Program, fee-for-service cycle 4, were mailed on June 24.  

What else to know: Payments to the Department of Health Care Services (DHCS) are due on July 24.   

CHA Releases APOT Reduction Protocol Educational Materials

What’s happening: CHA released a members-only educational brief and on-demand presentation on ambulance patient offload time (APOT) reduction protocol requirements. These materials provide key deadlines and guidance and share Sutter Health’s approach to incorporating the new requirements into existing procedures.   What else to know: As mandated by Assembly Bill 40, California hospitals must submit APOT […]

PAGA Overhaul Means Reduced Fines for Employers, Greater Opportunity to Correct Mistakes

What’s happening: Earlier this month, Gov. Newsom and legislative leadership announced sweeping changes to the Private Attorneys General Act (PAGA) intended to disincentivize costly lawsuits while protecting employees’ ability to bring claims against employers that violate the law.  

What else to know: These changes are included in Assembly Bill 2288 (Kalra, D-San Jose) and Senate Bill 92 (Umberg, D-Santa Ana), which were passed by the Legislature in late June and signed by the governor on July 1. They will apply to lawsuits brought on or after June 19. 

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).