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What’s happening: The Department of Health Care Services (DHCS) has issued a new technical assistance resource to support Medi-Cal managed care plans (MCPs) and others in implementing transitional care services (TCS) for Medi-Cal members who need long-term services and supports (LTSS) needs. What else to know: Under the CalAIM population health management program, MCPs are responsible for...
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What’s happening: As previously reported, the Centers for Medicare & Medicaid Services (CMS) has developed a process that allows providers to submit questions and complaints related to Medicare Advantage (MA) plan appeals or claims payment issues. What else to know: The form serves as a mechanism for Medicare providers seeking CMS assistance to resolve specific...
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What’s happening: The Centers for Medicare & Medicaid Services (CMS) has issued detailed information about data collection and audit procedures for Medicare Advantage (MA) (Part C) plans. What else to know: The information will allow CMS to conduct a comprehensive review of plan compliance with utilization management requirements, including new requirements on development, appropriateness, and...
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What’s happening: CHA has issued a members-only summary of the Mental Health Parity Final Rule that aims to improve access to mental health services by requiring health plans to make changes when inadequate access is provided.
What else to know: The regulations are effective Nov. 22.
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What’s happening: The California Department of Managed Health Care (DMHC) has taken enforcement actions, including a total of $8.5 million in fines, against Blue Cross of California Partnership Plan and Anthem Blue Cross for their failure to address payment disputes with health care providers in a timely manner. What else to know: In addition to...
This post has been archived and contains information that may be out of date.
This post has been archived and contains information that may be out of date.
What’s happening: A Los Angeles Superior Court Judge has designated a lawsuit brought by CHA against Anthem Blue Cross a “complex case,” requiring exceptional judicial management. What else to know: CHA’s suit challenges Anthem’s failure to authorize and arrange for access to timely and appropriate post-hospital health care services for its members. The next activity...
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 implemented a new process allowing providers to submit questions and complaints related to Medicare Advantage (MA) plan appeals or claims payment issues. What else to know: CHA welcomes these first steps in establishing greater CMS oversight for MA plans. The MA final rule, which...
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What’s happening: CHA continues its work to hold insurance companies accountable for providing timely, comprehensive patient care. Last week, CHA submitted a letter to the Department of Managed Health Care urging it to expand network adequacy standards to reflect patients' current health care needs and hold plans accountable for making those life-changing, lifesaving services available. ...
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What’s happening: The U.S. Health and Human Services Agency has announced that the Office of Inspector General (OIG) will investigate the use of prior authorization for post-acute care services by Medicare Advantage (MA) plans. What else to know: CHA members have reported that they encounter significant challenges in obtaining authorizations from MA plans for access to...
