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.   

Summary: Proposed Policy Changes for Medicare Advantage Plans

What’s Happening: A members-only summary from Health Policy Alternatives, Inc. of the proposed policy changes for Medicare Advantage (MA) plans is available.  

What Else to Know: The proposed policies affect MA (Part C), Medicare Prescription Drug Benefit (Part D), Medicare cost plans, and Programs of All-Inclusive Care for the Elderly.