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.
CHA Comments on Proposed Changes to Medicare Advantage Plans
What’s happening: CHA submitted comments on the proposed technical changes to Medicare Advantage plans for contract year 2025.
What else to know: Comments were due to the Centers for Medicare & Medicaid Services on Jan. 5.
CHA Comments on Proposed Financial Penalties for Information Blocking
What’s happening: CHA submitted comments in response to the Office of the National Coordinator for Health Information Technology’s (ONC) proposed provider disincentives for information blocking.
What else to know: Comments were due Jan. 2.
New Patient Medicare Appeals Processes Proposed
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would establish an appeals process for Medicare beneficiaries who were admitted as an inpatient but whose status changed to outpatient during their hospital stay.
What else to know: Policies are being established in response to a court order following a class action case filed in 2011.
Provisions of Prescription Error Legislation to Take Effect
What’s happening: Certain provisions in Assembly Bill (AB) 1286 (Haney, D-San Francisco) become effective Jan. 1, 2024. The California State Board of Pharmacy encourages licensees to immediately take steps for compliance.
What else to know: The new law establishes a requirement for the reporting of medication errors that occur in the outpatient setting to an entity that will be approved by the board. The Enforcement and Compounding Committee (ECC) will begin its evaluation of entities in the coming months.
Federal Independent Dispute Resolution Fees Finalized
What’s happening: The departments of Health and Human Services, Labor, and Treasury issued a final rule setting the No Surprises Act independent dispute resolution (IDR) fees.
What else to know: This was in response to an earlier court ruling that found the departments’ approach to setting the administrative fee was impermissible.
Requirements Expanded for Hospital Supplier Diversity Program
What’s happening: Assembly Bill (AB) 1392 expands the existing requirements for the Hospital Supplier Diversity Program for 2025.
What else to know: Beginning with the July 2025 report, hospitals must include their plans for increasing procurement from diverse suppliers, contact information for interested businesses, and descriptions of the procurement processes.