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What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for contract year 2026 that would increase oversight of Medicare Advantage (MA) plans.
What else to know: The rule includes additional proposed changes to the prior authorization process and guardrails for artificial intelligence use.
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What’s happening: CHA issued an alert asking members to urge their congressional representatives to support hospital priority issues in year-end legislation.
What else to know: Outreach is needed by Dec. 20 when Congress will wrap up the session.
This post has been archived and contains information that may be out of date.
This post has been archived and contains information that may be out of date.
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...
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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...
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What’s happening: The U.S. Senate Permanent Subcommittee on Investigations (PSI) released a report revealing that the three largest Medicare Advantage (MA) plans intentionally target costly stays in post-acute care facilities to increase profits. What else to know: These MA plans denied prior authorization (PA) requests for post-acute care requests at far higher rates than they...
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What’s happening: Several California representatives joined fellow members of Congress in urging the Centers for Medicare & Medicaid Services (CMS) to take steps that will ensure Medicare Advantage (MA) plan beneficiaries have access to medically necessary inpatient rehabilitation facility (IRF) care. What else to know: In the letter, the authors observe that, by statute,...
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What’s happening: On Oct. 8, California Department of Managed Health Care (DMHC) and Department of Health Care Services (DHCS) officials announced they have reached settlement agreements with the largest Medi-Cal plan in the state. What else to know: The two agreements with the Local Initiative Health Authority for Los Angeles County (L.A. Care Health Plan) — a $35...
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What’s happening: The Department of Health Care Services (DHCS) has issued a new technical assistance resource to support Medi-Cal managed care plans (MCPs) and others in implementing transitional care services (TCS) for Medi-Cal members who need long-term services and supports (LTSS) needs. What else to know: Under the CalAIM population health management program, MCPs are responsible for...
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What’s happening: As previously reported, the Centers for Medicare & Medicaid Services (CMS) has developed a process that allows providers to submit questions and complaints related to Medicare Advantage (MA) plan appeals or claims payment issues. What else to know: The form serves as a mechanism for Medicare providers seeking CMS assistance to resolve specific...
