About Medi-Cal
More than 15 million Californians rely on Medi-Cal, the state’s health care coverage safety net, for health insurance. Two-thirds of those on Medi-Cal are people of color and often live in communities with a lack of adequate health care providers. Without significant investments to support providers that deliver health care to California’s most vulnerable, millions living in rural and underserved areas are in jeopardy.
CMS Updates Hospital Guidance for Texting Patient Info
What’s happening: The Centers for Medicare & Medicaid Services (CMS) updated guidance for hospitals and critical access hospitals related to texting patient information.
What else to know: Hospitals should use a Health Insurance Portability and Accountability Act-compliant secure texting platform that complies with Medicare and Medicaid conditions of participation.
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.
Vitality Payer Scorecard: Holding Insurers Accountable
DHCS Issues Letters to Recover Prior Year Overpayments for PHSF Program
What’s happening: The Department of Health Care Services (DHCS) issued demand letters last week to nearly 125 private hospitals seeking to recover overspent funds distributed through the Private Hospital Supplemental Fund (PHSF) program.
What else to know: DHCS wants to recover overspent funds from 2013-14 and 2020-21. The overpayments are due to DHCS by April 1.
CHA Continues Support for Medicaid DSH
What’s happening: Current funding legislation supported by CHA extends the delay in the implementation of pending Medicaid disproportionate share hospital cuts until March 8.
What else to know: On Jan. 18, the House and Senate passed legislation, known as a continuing resolution, to fund the federal government though March 1 for certain departments, and March 8 for others.
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.
CHA Analysis: Proposed MCO Tax Spending Plan Maintains Key State Commitment
What’s happening: On Jan. 20, the California Department of Health Care Services (DHCS) published its spending plan on how the Newsom administration proposes to spend almost $2.7 billion in annual managed care organization (MCO) tax funds to improve Medi-Cal reimbursements.
What else to know: CHA expects the proposal to be refined and finalized by July 2024 and implemented starting in 2025.
Congress Passes Legislation to Fund Government Through March
What’s happening: On Jan. 18, the House and Senate passed legislation, known as a continuing resolution, to fund the federal government though March 1 for certain departments and March 8 for others. President Joe Biden signed the bill on Jan. 19.
What else to know: The resolution included a CHA-supported provision to delay scheduled Medicaid disproportionate share hospital cuts until March 8.
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.
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.