What’s happening: The Centers for Medicare & Medicaid Services (CMS) has established appeals processes for Medicare beneficiaries who were admitted as inpatient but whose status changed to outpatient observation during their hospital stay.
What else to know: The appeals processes only apply to patients enrolled in traditional Medicare, not patients enrolled in Medicare Advantage.
What’s happening: Legislation recently signed by the governor — Assembly Bill 2297 and Senate Bill 1061 — requires that California hospitals update their financial assistance policies and submit them to the Department of Health Care Access and Information (HCAI) by Jan. 1, 2025, or face fines.
What else to know: CHA is hosting a members-only webinar titled “Financial Assistance Policies: Mandatory Changes by Year-End” to discuss this information on Oct. 29 from 9-10:30 a.m. (PT).
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, MA must cover all services included under traditional Medicare, including inpatient rehabilitation — an essential service for many beneficiaries when recovering from a major medical event.
What’s happening: The latest edition of Quality Quarterly explores the prevalence of behavioral health conditions among California hospital encounters, the dangers of menopause misdiagnosis, new patient safety measures outlined by the Centers for Medicare & Medicaid Services (CMS), and the need for effective reporting of workplace violence incidents by hospital staff.
What else to know: More than half of California hospitals now use HQI’s Hospital Quality Improvement Platform (HQIP), which provides comparative analytics to help hospitals identify opportunities for improvement. Learn about HQIP’s new features and updates in this latest edition.
What’s happening: The new Hospital Respiratory Data (HRD) module, including both the HRD Daily and HRD Weekly Reporting Pathways, is available in the National Healthcare Safety Network (NHSN) application, effective since Oct. 9.
What else to know: Facilities can voluntarily submit HRD prior to the Nov. 1 required reporting date. NHSN recommends that hospitals submit actual data (not “test” data) voluntarily to NHSN before Nov. 1 to ensure familiarity with the module and reporting processes.
What’s happening: The Centers for Medicare & Medicaid Services issued correction notices to the federal fiscal year (FFY) 2025 Medicare payment final rules.
What else to know: The changes are minor, and the inpatient prospective payment system (IPPS) final rule changes are not reflective of the low-wage index interim final rule.
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 million settlement with the DMHC and a $20 million settlement with the DHCS — require that L.A. Care Health Plan improve its operations to ensure timely access to medically necessary health care services for all plan members, among other actions.
Crisis has a way of reminding us of our commonalities.
Take, for instance, Hurricane Helene. Though California is far from the storm’s devastation, its effects have rippled all the way to our coast due to the temporary closure of Baxter International’s North Carolina plant, which supplies 60% of the nation’s IV fluids. Hospitals across the country are working to ensure continued patient care despite a shortage of supplies critical to emergency care, trauma, oncology, surgery, and other lifesaving services.
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 delivering TCS to enrollees before, during, and after their transition from one care setting to another.
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 MA claims issues; CMS will enter complete complaint forms into the complaints tracking module and direct the MA to investigate the case.
