About Laws & Regulations
Navigating the vast network of health care laws and regulations is difficult. To help hospitals, CHA produces manuals 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.
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.
Changes Finalized to Substance Use Disorder Record Sharing Rules
What’s happening: The U.S. Department of Health and Human Services (HHS) issued long-awaited regulations implementing changes to requirements for sharing substance use disorder (SUD) patient data.
What else to know: The CHA-supported regulations are intended to better align SUD record-sharing rules with Health Insurance Portability and Accountability Act (HIPAA) requirements.
CMS Issues Advance Notice of Proposed Medicare Advantage Payment Changes
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued advance notice of proposed changes to Medicare Advantage (MA) Part C and Part D payments for calendar year 2025.
What else to know: Comments are due to CMS by 2 p.m. (PT) on March 1.
Vitality Payer Scorecard: Holding Insurers Accountable
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.
Summary: Finalized Interoperability and Prior Authorization Policies
What’s happening: A members-only summary of finalized interoperability and prior authorization processes is available.
What else to know: The final rule is scheduled for publication in the Feb. 8 issue of the Federal Register.
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.
CHA Files Amicus Brief Challenging HHS Online Tracking Rule
What’s happening: CHA has filed an amicus brief (friend of the court brief) with 16 other hospital associations in a lawsuit challenging a rule issued by the Department of Health and Human Services’ (HHS) Office for Civil Rights.
What else to know: The rule restricts the use of common third-party web technologies that capture internet protocol addresses on portions of hospitals’ public-facing web pages.