Many insurance companies are violating state laws that require them to ensure patients receive timely, medically appropriate care — and to adequately pay providers for that care. 

• Patients should be able to count on their insurance company to pay for medically necessary health care services without delays or denials. 
• Paying covered, medically necessary claims on time and in full means hospitals, doctors, and other providers can focus on their primary mission — healing those who are sick and injured.  
• Those insurers that focus on their bottom lines over the health and well-being of patients are violating the promises made to their enrollees by imposing unnecessary and harmful barriers to care. Practices such as excessive prior authorization mandates, inadequate provider networks, and improperly denied or delayed payments for care hurt patients and the clinicians who care for them. 

Care that is delayed is care that is denied, and insurance company practices are getting worse, not better. 

• Health insurance should make care more accessible, but nearly two-thirds (62%) of patients surveyed say their insurer makes it harder to get services they need (American Hospital Association, 2023). 
• According to a 2023 survey of California hospitals, 9% of all patients (300,000 people every year) face a discharge delay of at least three days — often due to insurance barriers. In some extreme cases, patients (especially those with behavioral health conditions) have languished unnecessarily in hospitals for as long as a year because insurers have inadequate post-hospital provider networks.  
• California hospitals annually provide 1 million days of excess inpatient care — and 7.5 million hours of avoidable emergency department care — frequently due to barriers imposed by insurers. This wasteful use of clinical resources is not being paid for by insurance companies and pushes more hospitals to the financial brink while leading to higher costs for patients. 

State regulators must hold insurance companies accountable by enforcing existing state laws. 

• Too many medical decisions are being made by insurance companies instead of doctors, and patients face worse health outcomes. California has strong laws regulating insurance company practices, but a lack of enforcement has allowed some to avoid their responsibilities. 
• Many insurers are lining their pockets by withholding payments. In one common tactic, insurers request reams of paperwork with the hope hospitals will give up on collecting what should be straightforward authorized claims. As hospitals struggle with razor-thin margins, they cannot continue to cover hundreds of millions of dollars owed to them while insurers play games and make record profits. 
• State regulators must require insurers to specify all reasons for contested or denied payments within statutory deadlines. Insurers also must be required to pay the full cost of care for patients whose discharge is delayed due to inadequate post-acute care networks or prior authorization delays or denials.  

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SACRAMENTO (January 18, 2024) — Kerry L. Heinrich, President & CEO of Adventist Health, has been elected 2024 chair of the California Hospital Association’s (CHA) Board of Trustees. Heinrich, who has served in the top leadership position at Adventist Health since 2022, oversees the integrated health system that serves more than 90 communities on the West Coast and Hawaii with over 400 sites of care, including 26 acute care facilities. The organization, headquartered in Roseville, has a team of 37,000 employees, medical staff physicians, allied health professionals, and volunteers.

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February 2, 2024 | 11:00 a.m. – 12:00 p.m., PST

Please join CHA for a special “Hospital 101” briefing on Friday, Feb. 2 at 11:00 a.m. (PT). Legislative staff are encouraged to attend this virtual, one-hour briefing to learn more about how California hospitals operate, their impact on communities, and the difficulties they currently face. Ample time will be allowed for your questions during this interactive briefing. 

To join, all participants must register to receive a Zoom link.

Please reach out to Vanessa Gonzalez, CHA vice president, state relations, with any questions. 

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What’s happening: Yesterday, the Office of Health Care Affordability (OHCA) released its final recommendation of a 3% spending growth target for 2025-29.

What else to know: CHA submitted comments on this proposal Jan. 18. As CHA continues to advocate for an attainable, sustainable target, members’ support will be crucial in demonstrating the detrimental impact a 3% spending target would have on patient care.

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Thank you for registering. Below are important instructions and materials you will need to participate in the webinar.

Date: February 2, 2024
Time: 11:00 a.m. – 12:00 p.m., PT

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• Jan. 23: CMS Hospital Open Door Forum 
• Skilled-Nursing Facility Provider Preview Reports Available for Review Until Feb. 15
• Feb. 15 Deadline for Inpatient Psychiatric Facility Quality Reporting Program Participants to Submit Q3 COVID-19 Vaccination Coverage Among Health Care Personnel (COVID HCP) Measure Data 
• Marriage and Family Therapist & Mental Health Counselor Services: Overpayments to Critical Access Hospitals Billing under Method II 
• Medicare Part A Cost Report Exhibits: New Electronic Templates 
• Therapy Services: Per-Beneficiary CY 2024 Threshold Amounts 
• COVID-19 Vaccine CY 2024 Geographically-Adjusted Payment Rates 
• Ambulance Fee Schedule: CY 2024 Inflation Factor 
• Medicare Wellness Visits: Healthy Start to 2024 
• Acute Hospital Care at Home Data Release 
• Medicare Cost Report E-Filing System Webinar — Feb. 14 

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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.  

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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. 

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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. 

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In less than two months, Californians will head to the polls — or the post office for those who prefer mail-in ballots — for the 2024 primary election. A ballot question, Proposition 1, will ask voters to weigh in on whether or not to support a sweeping modernization of the state’s mental health system. This proposal will refocus billions of dollars in existing funds to prioritize Californians with the deepest mental health needs, living in encampments, or suffering the worst substance use disorders.