Laws & Regulations

About Laws & Regulations

Navigating the vast network of health care laws and regulations is difficult. To help hospitals, CHA produces manuals and guidebooks and guidebooks, including the Consent Manual, a one-stop resource for all legal requirements related to patient consent for medical treatment, release of medical information, reporting requirements and more; the Model Medical Staff Bylaws and Rules, which outline the framework for working relationships among medical staff, hospital administrators and governing bodies; and the California Hospital Compliance Manual, which covers high-risk compliance issues. CHA also represents California hospitals’ interests in court on issues, including reimbursement, labor and employment, and more.

CHA Will Host Vitality Payer Scorecard Webinar

What’s happening: CHA is hosting a complimentary, members-only webinar on Feb. 27 at 10 a.m. (PT) to highlight the American Hospital Association Vitality Payer Scorecard, which was recently endorsed by the CHA board.   What else to know: The scorecard captures necessary and normalized data points without sharing protected health information. The automated process is based […]

Changes Proposed for Accrediting Organizations Requirements

What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued proposed changes to accrediting organization (AO) requirements.  

What else to know: The proposed changes are intended to strengthen the agency’s oversight of AOs and prevent conflicts of interest. Comments are due to CMS by 2 p.m. (PT) on April 15.  

CMS Provides “Two-Midnight Rule” Guidance for Medicare Advantage Plans

What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued a frequently asked questions (FAQ) document on finalized contract year 2024 Medicare Advantage (MA) policies.   

What else to know: The document provides guidance on how the “two-midnight” hospital admissions policies apply to MA patients when MA organizations are permitted to deny payment through post-claim audits. 

CHA Advocacy Materials on Key Issues Available  

What’s happening: CHA has released advocacy materials — infographics, key messages, and issue briefs — for a suite of priority issues for 2024.  

What else to know: Infographics offer a quick view for people in a hurry (e.g., lawmakers) while issue briefs provide a deeper dive for those who want more information (e.g., staffers). Both are ideal leave-behinds. Key messages are for use in developing talking points or presentations, or for general information.   

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.  

HCAI Opens Hospital Charity Care Portal

What’s happening: Hospitals must register as soon as possible for the Department of Health Care Access and Information’s (HCAI) online policy submission portal, which opened on Jan. 1. 

What else to know: Hospitals must also submit their policies and applications that comply with the new regulations to HCAI, effective Jan. 1. HCAI is authorized to levy penalties of $500 per day for late submissions.