MHA Today | December 8, 2016

December 8, 2016
MHA Today: News for Healthcare Leaders

twitter linkedin MHA Today is provided as a service to members of the Missouri Hospital Association. Additional information is available online at MHAnet.

In This Issue
Gov. Nixon Withholds And Releases State Funding
Congress Completes Enactment Of 21st Century Cures Legislation
Court Requires HHS To Clear Medicare Claim Appeal Backlog By End Of 2020
U.S. House Passes Stopgap Spending Bill
MedPAC Recommends Full Marketbasket Update For FY 2018
MLN Connects Provider eNews Available

Advocate
state and federal health policy developments


Gov. Nixon Withholds And Releases State Funding

Staff Contact: Daniel Landon

Gov. Jay Nixon announced $51 million in spending restrictions for the current state fiscal year, which ends June 30, 2017. Of the withholding, $42.8 million is for Medicaid pharmacy spending. The amount of appropriated funding exceeds projected spending, which Nixon attributed to savings achieved by his administration. Nixon had been urged by state legislators to trim spending before his successor, Eric Greitens, takes office Jan. 9, 2017. The chair of the House Budget Committee asserted that another $150 million in spending reductions will be needed beyond Nixon’s most recent withholdings. Nixon also authorized the release of $4 million in previous budget withholdings, including $400,000 to expand a hospital emergency department diversion program.

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Congress Completes Enactment Of 21st Century Cures Legislation

Staff Contact: Daniel Landon

The U.S. Senate has ratified the 21st Century Cures legislation. The legislation now goes to the President, who supports it. The underlying bill addresses medical research, but Congress amended it to include a variety of other health-related topics, including adjusting Medicare hospital readmissions data to reflect patients’ sociodemographic status, mental health treatment and coverage, clarifications to site-neutral payments to hospital outpatient departments, antibiotic stewardship, Medicare pricing transparency, and extensions of current programs and enforcement waivers for rural hospitals and long-term care hospitals. A congressional staff summary provides more detail, and MHA has created a separate list of its sections with descriptions. MHA has published an issue brief on the legislation.

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Court Requires HHS To Clear Medicare Claim Appeal Backlog By End Of 2020

Staff Contacts: Andrew Wheeler or Jane Drummond

The U.S. District Court for the District of Columbia imposed a request by the American Hospital Association to resolve the backlog of nearly 658,000 pending Medicare provider appeals by the end of 2020. The imposed timeline means that the U.S. Department of Health & Human Services will reduce the backlog of cases by 30 percent by Dec. 31, 2017; 60 percent by Dec. 31, 2018; 90 percent by Dec. 31, 2019; and 100 percent by Dec. 31, 2020. HHS also is to file status updates and report progress with the court every 90 days. AHA’s general counsel, Melinda Hatton, stated that the decision “is a victory for hospitals that continue to have billions of dollars in Medicare reimbursement tied up in a heavily backlogged appeals system. We trust that HHS will implement real reforms critical to resolving the backlog, including fundamental reforms of the RAC program.”

Recently, the Centers for Medicare & Medicaid made available another settlement opportunity for claims that were denied because of inpatient status denials. This serves as a way for HHS to meet the imposed request backlog reduction time schedule. Hospitals have until Jan. 31, 2017, to submit an expression of interest. CMS also is hosting another national provider call about the settlement opportunity, scheduled at 12:30 p.m. Monday, Dec. 12.

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U.S. House Passes Stopgap Spending Bill

Staff Contact: Daniel Landon

The U.S. House of Representatives has passed a stopgap spending bill that funds the federal government through April 28, 2017. The Senate is expected to ratify the House action tomorrow, which is the deadline for passing a bill to avert a government shutdown.

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Regulatory News
the latest actions of agencies monitoring health care


MedPAC Recommends Full Marketbasket Update For FY 2018

Staff Contact: Andrew Wheeler

The Medicare Payment Advisory Commission convened today and recommended that hospitals would receive a full marketbasket update, which would be applied to Medicare payments for fiscal year 2018. The full update for Medicare inpatient and outpatient services currently are projected at 1.85 percent, which includes a 3 percent update less adjustments for productivity and other Affordable Care Act reductions. MedPAC staff stated that hospital Medicare margins continue to decline and is projected to be minus 10 percent in 2017. The commission also monitors the use of services in stand-alone emergency departments to determine if hospitals are exploiting a payment differential.

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MLN Connects Provider eNews Available

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services issues updates to MLN Connects Provider eNews. eNews includes information about national provider calls, meetings, events, announcements and other MLN educational product updates. The latest issue provides updates and summaries of the following.

  • 2016 hospital appeals settlement update call – Monday, Dec. 12
  • skilled nursing facility quality reporting program video presentation
  • vaccine and vaccine administration payments under Medicare Part D fact sheet
  • submit quality payment program comments by Saturday, Dec. 19

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Consider This ...

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Source: Centers for Disease Control and Prevention