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CHA Opinion Piece Shines Light on Insurer Crisis in Orange County

This post has been archived and contains information that may be out of date.

What’s happening: CHA President & CEO Carmela Coyle shares how vulnerable Californians in Orange County are losing access to health care because an insurance company is dropping safety-net hospitals.  

What else to know: CalOptima has dropped from its network four hospitals that serve people experiencing homelessness, substance abuse disorders, chronic health conditions, and more. CHA is calling for regulators to take action to preserve health care access for California’s most vulnerable patients.   

CMS Provides “Two-Midnight Rule” Guidance for Medicare Advantage Plans

This post has been archived and contains information that may be out of date.

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. 

DMHC Responds to CHA, Hospital Council Advocacy on Central Valley Capacity Crisis

This post has been archived and contains information that may be out of date.

What’s happening: The Department of Managed Health Care (DMHC) has issued All Plan Letter 23-027, urging health plans to reduce administrative barriers for hospitals in the Fresno County area during a surge in the demand that strained hospital capacity.   

What else to know: The communication from DMHC was the result of extensive advocacy from CHA and Hospital Council — Northern & Central California leadership and staff to DMHC, seeking its support in working with plans to facilitate patient discharge and transfers.

CHA Advocacy Materials on Key Issues Available  

This post has been archived and contains information that may be out of date.

What’s happening: CHA has released advocacy materials — infographics, key messages, and issue briefs — for a suite of priority issues for 2024.  

What else to know: Infographics offer a quick view for people in a hurry (e.g., lawmakers) while issue briefs provide a deeper dive for those who want more information (e.g., staffers). Both are ideal leave-behinds. Key messages are for use in developing talking points or presentations, or for general information.   

Summary: Finalized Interoperability and Prior Authorization Policies

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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.  

CHA Analysis Reveals How Insurer Practices Impede Patient Care

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What’s happening: CHA developed a detailed analysis of how insurance company practices negatively affect patients, which is a key proof point supporting a comprehensive strategy to hold insurers accountable for patient care in California. 
 
What else to know: One of CHA’s priorities this year is to create greater accountability (network adequacy, prior authorization, medical necessity, payment practices, and parity) for insurers operating in California.  

DHCS Must Take Steps to Ensure Network Adequacy

This post has been archived and contains information that may be out of date.

What’s happening: In a letter to the California Health & Human Services Agency (HHS), CHA President & CEO Carmela Coyle expressed concern that arbitrary decisions by Medi-Cal managed care plans to terminate contracts with safety net hospitals undermines network adequacy and worsens existing critical capacity issues. 

What else to know: The letter also requests that HHS investigate and address recent concerns that have emerged in Orange County. HHS oversees the Department of Health Care Servies. 

New Federal Electronic Prior Authorization Requirements Finalized

This post has been archived and contains information that may be out of date.

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.  

CHA Comments on Proposed Changes to Medicare Advantage Plans

This post has been archived and contains information that may be out of date.

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.