On Nov. 5, California voters overwhelmingly approved Proposition (Prop) 35, making an existing tax on managed care organizations (MCO) permanent under state law — and directing most of the revenues toward expanding access to care for Medi-Cal patients through improved provider reimbursement. Now, work by the state, hospitals, and others to determine how these funds should be distributed begins. 

What’s happening: The Office of Health Care Affordability (OHCA) board met earlier this week to discuss options for defining hospitals as a sector for spending target purposes, as well as receive an update on progress toward adopting a behavioral health investment benchmark. 

What else to know: CHA wrote to the board and provided public comment, pressing that the adoption of a hospital sector definition is premature and misguided, while stating the importance of including the full continuum of clinically appropriate services in OHCA’s behavioral health investment benchmark. 

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When Leandro and Sara’s infant daughter Mia started exhibiting a yellow pigment in her eyes, tests and scans at a local hospital led to a diagnosis of biliary atresia. After being referred to Children’s Hospital Los Angeles, Mia received a liver transplant and is now back to achieving infant milestones like playing with toys and using her big voice.

Read more about Mia’s liver transplant

What’s happening: CHA has incorporated its disaster preparedness website, www.calhospitalprepare.org, into the general CHA website, giving members one-stop access to all association info. 

What else to know: The new web page retains the critical disaster recovery and response information formerly housed on the previous site, combining that essential content with CHA’s broader resources.  

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What’s happening: CHA has issued a members-only summary of the proposed changes to Medicare Advantage (MA) and Part D programs for contract year 2026.  

What else to know: The summary, prepared by Health Policy Alternatives, Inc., also includes proposals to codify existing sub-regulatory guidance in the MA Part C and Part D programs.  

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What’s happening: A summary of the finalized Increasing Organ Transplant Access Model is available for CHA members.  

What else to know: The model will test whether performance-based incentive payments paid to or owed by participating kidney transplant hospitals increase access to kidney transplants for patients with end-stage renal disease.  

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What’s happening: CHA DataSuite has issued a hospital-specific analysis on quality program measure trends for the third quarter of 2024.  

What else to know: The analysis provides hospitals a comparative review of the quality data collected over time by the Centers for Medicare & Medicaid Services (CMS) and published on Care Compare.   

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As 2024 comes to a close, it’s a good time to pause to reflect on the work we’ve done together to help improve the lives of all Californians.  

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What’s happening: The Department of Health Care Services (DHCS) requires Medi-Cal managed care plans (MCPs) to identify a liaison to serve as a single point of contact for long-term care providers. These liaisons are listed in an updated DHCS document. 

What else to know: The long-term services and supports (LTSS) liaison provides support to LTC providers, including skilled-nursing facilities (SNFs) with addressing claims and payment inquiries and care transitions to support Medi-Cal members’ needs. 

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What’s happening: On. Dec. 16, the California Department of Managed Health Care (DMHC) announced that it fined Blue Cross of California (Anthem Blue Cross) $3.5 million for mishandling member grievances and not responding on time.  

What else to know: Anthem Blue Cross has paid the $3.5 million fine and acknowledged its failure to follow law, which states that “health plans must resolve a standard grievance within 30 days and send a written resolution to the member.”  

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