CHA News

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).  

DMHC Provides Additional Guidance Regarding Post-Stabilization Care Requests

What’s happening: The Department of Managed Health Care (DMHC) has issued All Plan Letter (APL) 24-012, which reminds plans that they may not require a hospital to make more than one telephone call to request authorization to provide post-stabilization care to plan members.   

What else to know: The APL reiterates the requirements of Health & Safety Code 1371.4, which states that plans must provide hospitals with one telephone number to serve as the point of contact for 24-hour access for post-stabilization authorization requests. Plans may not require a hospital to contact the plan in any way other than the plan’s designated phone number.   

Creators of the Vitality Index Payer Scorecard Announce Partnership with HFMA

What’s happening: Hyve Health, the creator of the CHA-endorsed Vitality Index Payer Scorecard, has entered into a national partnership on payer accountability with the Healthcare Financial Management Association.   

What else to know: CHA continues to encourage members to enroll in the scorecard tool, which will provide critical information to support CHA’s advocacy to hold insurers accountable for timely and accurate reimbursement.   

Congress Reintroduces Legislation to Streamline Prior Authorization

What’s happening: Congressional leaders have reintroduced bipartisan legislation to address concerns regarding prior authorization (PA) and timely access to care for beneficiaries enrolled in Medicare Advantage (MA) plans.   

What else to know: The Improving Seniors’ Timely Access to Care Act would establish an electronic PA standard, reduce the amount of time a health plan is allowed to consider a PA request, and require MA plans to report on their use of PA, including rates of approvals and denials.  

CMS Issues Guidance on New Staffing Requirements

What’s happening: The Centers for Medicare & Medicaid Services (CMS) has issued updated guidance to state survey agencies and providers regarding facility assessment requirements for long-term care facilities.     

What else to know: The revised guidance updates the survey and assessment process as implemented under the Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting final rule.  

HQI Releases CHPSO Annual Report

What’s happening: The Hospital Quality Institute (HQI) has released its CHPSO Annual Report, an overview of the most significant work done on behalf of hospitals in 2023.  

What else to know: HQI is dedicated to improving the quality and safety of patient care in hospitals and health care systems and oversees the Collaborative Health Care Patient Safety Organization (CHPSO). The focus of CHPSO is on improving patient safety and quality of care by collecting, analyzing, and sharing data on adverse events and near misses in health care.  

Reminder: Supplier Diversity Reports Due July 1

What’s happening: The deadline to submit annual supplier diversity reports to the Department of Health Care Access and Information is July 1.    

What else to know: If you are unable to submit on time, you can request a 30-day extension. A penalty of $100 per day is charged for each day the report is late. 

Letters to OHCA Board Highlight New Data, Caution Against Overly Broad Review Process

What’s happening: Last week, CHA submitted two letters to the Office of Health Care Affordability (OHCA) — one responding to the May OHCA board meeting, and another addressing the office’s proposed changes to the cost and market impact review (CMIR) regulations.  

What else to know: The board met June 26 to approve the alternative payment model (APM) standards and discuss the proposed CMIR regulations, the draft workforce stability standards, and the draft primary care investment benchmark.   

ONC Finalizes Financial Penalties for Information Blocking

What’s happening: The Office of the National Coordinator for Health Information Technology (ONC) issued a final rule on provider disincentives for information blocking.    

What else to know: CHA is disappointed in the finalized policies and remains concerned about the selective application of penalties to certain health care providers, as previously outlined in comments