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CHA Publishes New Advocacy Materials on Priority Issues

What’s happening: In December, CHA’s board approved three advocacy priorities for California hospitals in 2025: Insurer Accountability, Office of Health Care Affordability (OHCA), and Securing Hospitals. New and updated advocacy materials on these priority issues are now available on CHA’s website.  

What else to know: Each issue has a dedicated web page with relevant news and various resources, including the following advocacy materials: an infographic (intended as a leave-behind for policymakers), key messages (intended for your internal use in framing issues), and an issue brief (intended as a leave-behind for legislative staff).  

CHA Comments on Medicare Advantage Proposals for 2026

What’s happening: CHA submitted comments in response to the Centers for Medicare & Medicaid Services’ (CMS) proposed policy and technical changes to Medicare Advantage (MA) and Part D programs for contract year 2026.   

What else to know: Finalization of the proposed rule is expected in April — in time for MA plans to bid to CMS and offer MA products for plan year 2026. The rule, once finalized, will take effect Jan. 1, 2026.  

Judge Delays Jan. 27 Hearing on Anthem’s Motions in CHA Lawsuit

What’s happening: A Los Angeles Superior Court judge has delayed the Jan. 27 court hearing on two motions by Anthem Blue Cross — to dismiss CHA’s lawsuit and strike requested remedies — to Feb. 14. In the lawsuit, CHA claims Anthem failed to provide timely post-hospital care for its members.  

What else to know: CHA has filed opposition to each of the motions, disputing both Anthem’s legal arguments and its characterization of the facts. The judge’s decision could come as soon as the hearing, but no later than May 14. The judge gave no reason for delaying the hearing. 

Judge to Hear Anthem’s Motions in CHA Lawsuit on Jan. 27

What’s happening: A Los Angeles Superior Court judge will hear two motions by Anthem Blue Cross on Jan. 27 to dismiss CHA’s lawsuit and strike requested remedies. In the lawsuit, CHA claims Anthem failed to provide timely post-hospital care for its members.  

What else to know: CHA has filed opposition to each of the motions, disputing both Anthem’s legal arguments and its characterization of the facts. The judge’s decision could come as soon as the hearing, but no later than April 28.  

Additional Participation Information Now Available on Blue Cross Blue Shield Settlement

What’s happening: With additional information available on the Blue Cross Blue Shield (BCBS) antitrust claims settlement process, hospitals will benefit from reviewing the recent BCBS antitrust settlement agreement’s potential impact with their legal counsel, including whether to remain in or opt out of the settlement.  

What else to know: BCBS plans (referred to as Blue Plans) have agreed to a $2.8 billion settlement to resolve legal allegations from a slew of providers who claim the insurers colluded to prevent competition and lower reimbursements. The settlement will bring a decade-long legal battle to a close, should it secure final approval.  

CMS Responds to Congressional Letter Urging Adequate IRF Access

What’s happening: The Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure has responded to a congressional letter, signed by several members of the California delegation, that urged 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, Ms. Brooks-LaSure notes several recent rules issued by CMS that seek to ensure that MA plans adhere to CMS requirements, including network adequacy, prior authorization, and data collection. Ms. Brooks-LaSure also agrees to take the writers’ comments into consideration for future policy development.   

DMHC Fines Blue Cross of California $3.5 Million, Second Grievance-Related Fine in Recent History

What’s happening: On. Dec. 16, the California Department of Managed Health Care (DMHC) announced that it fined Blue Cross of California (Anthem Blue Cross) $3.5 million for mishandling member grievances and not responding on time.  

What else to know: Anthem Blue Cross has paid the $3.5 million fine and acknowledged its failure to follow law, which states that “health plans must resolve a standard grievance within 30 days and send a written resolution to the member.”  

CMS Requires Patient Reclassification Notices in February 2025

What’s happening: Beginning Feb. 14, 2025, the Centers for Medicare and Medicaid Services (CMS) will require giving “Observation Change of Status Notices” to patients who are reclassified from inpatient to observation (outpatient) status.  

What else to know: CMS has issued updated information on these new requirements for communication to affected patients. Hospitals will be required to provide a Medicare Change of Status Notice (MCSN) to eligible Medicare patients who are reclassified from inpatient to outpatient receiving observation services.

DMHC Fines Blue Cross of California for Failing Cancer Patient, Ignoring Complaints

What’s happening: The California Department of Managed Health Care (DMHC) has fined Blue Cross of California (Anthem Blue Cross) $500,000 after a health plan member was forced to file 17 grievances in order to obtain coverage for cancer care, including chemotherapy.  

What else to know: Anthem Blue Cross has acknowledged its failure to respond to the member’s grievances and agreed to pay the fines, repay providers, and take corrective action involving the grievance process.