About Holding Insurers Accountable
Health insurance companies have enormous power in California. In fact, 94% of the commercial health insurance market is controlled by just six companies. They are increasingly denying enrollees access to care, and even refusing to pay for care that’s already been delivered, all while enjoying record profits. According to the federal government, some insurance companies are denying more than a quarter of Medicaid managed care requests. CHA is working to hold insurers accountable for meeting their basic responsibilities to patients and advocating for increased oversight and accountability for insurance companies.
New Federal Electronic Prior Authorization Requirements Finalized
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has finalized policies to advance interoperability and streamline prior authorization processes by using application programming interfaces (API) technology.
What else to know: The final rule also requires payers to provide a specific reason for denied prior authorization decisions and publicly report certain prior authorization metrics.
CHA Comments on Proposed Changes to Medicare Advantage Plans
What’s happening: CHA submitted comments on the proposed technical changes to Medicare Advantage plans for contract year 2025.
What else to know: Comments were due to the Centers for Medicare & Medicaid Services on Jan. 5.
Managed Care Plans to Face Sanctions from DHCS for Poor Performance
What’s happening: Medi-Cal managed care plans (MCPs) will face sanctions from the Department of Health Care Services (DHCS) for failing to meet quality performance standards.
What else to know: DHCS has issued All Plan Letter (APL) 23-012, which updates and clarifies the policy on the imposition of administrative and monetary sanctions to plans that fail to meet minimum performance for required quality performance measures.
New Managed Care Plan Changes in January Help Advance Health Equity, Access, and Accountability
What’s happening: Effective Jan. 1, 2024, Medi-Cal managed care plans (MCPs) will operate under a new and revamped contract intended to better advance quality, access, accountability, health equity, and transparency.
What else to know: Also effective Jan. 1, 2024, MCPs available for enrollment in certain counties will change due to county-elected model changes, the awarding of new commercial MCP contracts, and/or the expansion of direct contracts with Kaiser Permanente.
Children’s Behavioral Health Services Lack Timely Access
What’s happening: The California State Auditor recently investigated children’s access to Medi-Cal-covered behavioral health services.
What else to know: The auditor concluded that many Medi-Cal health plans were out of compliance with state requirements for timely care and that the Department of Health Care Services (DHCS) is not adequately disciplining health plans.
Analysis of Statewide Survey on Insurer-Driven Discharge Crisis
Insurance company red tape, inadequate networks, and authorization denials leave patients stranded in hospitals
Updated Guide on Final Rule Implementation Now Available
What’s happening: A members-only guide from the American Hospital Association to support hospitals in the implementation of the Medicare Advantage (MA) final rule is now available for calendar year 2024.
What else to know: The document provides a summary of key provisions of the final rule, which seeks to align MA coverage with traditional Medicare more clearly and to increase oversight of MA plans.