Hospital Case Management

Parent Issue

CMS Finalizes Rule on Prior Authorization Process

The Centers for Medicare & Medicaid Services (CMS) – in coordination with the Office of the National Coordinator for Health Information Technology – has issued a final rule intended to streamline and reduce the burden associated with health plan prior authorization processes through Application Programming Interfaces (APIs).   

CDPH Issues Revised AFL on Interdisciplinary Team Decisions in SNFs

The California Department of Public Health (CDPH) has issued All Facilities Letter (AFL) 20-83.1, which clarifies previously issued guidance on the interdisciplinary team (IDT) medical decision-making process for skilled-nursing facility residents who are unable to provide informed consent and do not have a representative to make decisions on their behalf.  

HHS Issues Gov. Newsom’s Master Plan for Aging

In June 2019, Gov. Gavin Newsom issued an Executive Order calling for the creation of a Master Plan for Aging, which affirmed the priority of the health and well-being of older Californians and the need for policies that promote healthy aging.  

DMHC Issues All Plan Letter on Compliance with Mental Health and Substance Use Parity Law

On Jan. 5, the Department of Managed Health Care (DMHC) issued All Plan Letter (APL) 21-002 to all commercial full-service health plans and specialized health plans offering behavioral health services that are regulated by the department. The guidance is designed to ensure health plans comply with amendments made to Senate Bill (SB) 855 (Wiener, D-San Francisco), the mental health and substance use parity law that took effect on Jan. 1.   

CY 2021 OPPS and Physician Fee Schedule Proposed Rules

 

Recording

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Overview

This presentation provides members with a high level summary of significant proposals included in the Centers for Medicare & Medicaid Services (CMS) calendar year 2021 outpatient prospective system and physician fee schedule proposed rules. CHA will also provide members with information on the development of our comments, which are due to the agency by October 5.

Recommended for:

COVID-19 Workers’ Compensation Presumption

Overview

COVID-Specific Workers’ Compensation Presumption Law Goes Into Effect September 17

On September 17, 2020, Governor Newsom signed SB 1159 and it goes into effect immediately. This bill adopts a COVID-19 specific presumption in the workers’ compensation system for employees that test positive for COVID-19. The bill is retroactive to July 6, 2020 and expires on January 1, 2023.

The bill does four things:

DHCS, CDA Solicit Input on Long-Term Care at Home Benefit

The Department of Health Care (DHCS) and the California Department of Aging (CDA) have released the first draft of the Medi-Cal Long Term Care at Home benefit design for public comment, which includes an overview of key goals, target populations, model of care, financing structure, and federal authority.

FFY 2021 IPPS Proposed Rule

 

Recording

Since the publication of this recording, CMS has published the final rule. Review a summary here. This topic will be covered in Hospital Compliance webinars in February 2021.

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