About Finance & Reimbursement
Vulnerable Californians who rely on the care provided by California hospitals are at risk. Driven by skyrocketing costs for labor, pharmaceuticals, regulatory mandates, and more, 53% of all hospitals statewide lose money every day to deliver patient care.
That isn’t sustainable. And California is already seeing the frightening result: rural health care services being cut to the bone, severe behavioral health care needs not being met, and more.
CalAIM Section 1115 Renewal Open for Public Comment Until March 12
What’s happening: The Department of Health Care Services (DHCS) has opened a 30-day public comment period — ending on March 12 — to solicit feedback on a five-year renewal request of the California Advancing and Innovating Medi-Cal (CalAIM) Section 1115 demonstration.
DHCS Issuing DSH Payments Starting This Week
What’s happening: The Department of Health Care Services (DHCS) will issue full disproportionate share hospital (DSH) payments beginning on Feb. 20.
Action Needed for Prescribers: Ensure Enrollment as Medi-Cal FFS Provider
What’s happening: Beginning on June 26, claims and prior authorizations will not be processed by Medi-Cal Rx if the prescribing health care provider is not enrolled in Medi-Cal fee-for-service (FFS) with a Type 1 National Provider Identifier (NPI).
CHA DataSuite Releases Analysis of FFY 2027 Wage Index and Occupational Mix Date
What’s happening: CHA DataSuite has issued a hospital-specific impact analysis of Medicare’s revised public use files (PUFs) data for the development of the federal fiscal year (FFY) 2027 hospital wage index and occupational mix data.
HHS Takes Initial Step Toward Restarting Review Process for 340B Rebate Model
What's happening: The Department of Health and Human Services (HHS) has taken a step toward restarting the administrative process for establishing a 340B rebate model, filing a notice with the Office of Management and Budget that it will look to publish an advance notice of proposed rulemaking. The timing of a proposed rule is unclear at this time, but CHA will keep members apprised of any new administrative process that is put forward.
Hospital Fee Program Invoices Due Feb. 25
What’s happening: Payments for the Hospital Fee Program 8 directed payment for cycle MC2 DPa are due to the Department of Health Care Services (DHCS) on Feb. 25. It is critical that all hospitals pay their invoices in full and on time.
CMS Issues Updated Guidance on Medicaid State-Directed Payments
What’s happening: On Feb. 2, the Centers for Medicare & Medicaid Services (CMS) issued a letter providing guidance on Section 71116 of the One Big Beautiful Bill Act, which eventually limits the total managed care payment rate received by hospitals to Medicare levels after a temporary grandfathering period. This letter supersedes the guidance CMS released on Sept. 9, 2025.
Federal Spending Deal Includes Key Wins for Hospital Care
Hospitals and health systems are getting some financial relief and operational predictability, thanks to a bipartisan health care spending bill signed by President Trump earlier this week.
CHA Urges State to Leverage MCO Funds to Support Directed Payments, Ensure Compliance with Prop. 35 Provisions
What’s happening: Following this month’s release of the 2025-26 spending plan for managed care organization (MCO) tax proceeds generated under Proposition 35 (2024), CHA has submitted recommendations to Department of Health Care Services (DHCS) Director Michelle Baass.
DHCS to Host Webinar on Implementation of One Big Beautiful Bill Act
What’s happening: On Feb. 5 at 11 a.m. (PT), the Department of Health Care Services will host an “all-comer” webinar to walk through its implementation plan for House Resolution (H.R.) 1, the One Big Beautiful Bill Act, which will make sweeping changes to Medicaid.