CDPH’s Centralized Application Evolution
The Center for Health Care Quality (CHCQ) licenses and certifies over 14,000 health care facilities and agencies in California in 30 different licensure and certification categories. Keeping licensing and certification practices consistent throughout California can be challenging. The Centralized Program Flex Unit (CPFU), a division of CHCQ, has a mission to ensure standardization and consistency […]
CHA Summary: Proposed Changes for Oversight of Accrediting Organizations
What’s happening: CHA is sharing its summary of the Centers for Medicare & Medicaid Services’ (CMS) proposed rule intended to strengthen oversight of accrediting organizations (AOs) such as The Joint Commission and Det Norske Veritas.
What else to know: While the proposed policies are applicable to AOs, several proposed changes will affect hospitals and health systems that rely on AO accreditation.
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.
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 Summary: Final Federal Independent Dispute Resolution Fees
What’s happening: CHA has issued a final rule summary of the finalized federal independent dispute resolution (IDR) administrative fee and entity fee ranges.
What else to know: The fees are effective Jan. 22.